How much do you know about gastroscopy biopsy?

Author: Hu Bo, deputy chief physician of Fushun Central Hospital

Reviewer: Xu Bin, Chief Physician of Fushun Central Hospital

With the development of the times, the incidence of malignant tumors has been rising year by year. Gastric cancer is one of the most common cancers in the world. In 2018, there were more than 1 million new cases of gastric cancer in the world, including nearly 783,000 deaths. East Asia is a high-incidence area of ​​gastric cancer. In 2020, the incidence of gastric cancer in my country was 24.30/100,000, with approximately 346,000 new cases. The 5-year survival rate of these people is less than 50%.

Many gastric cancers are already in the middle or late stages when they are discovered. The cost of five years of treatment is about hundreds of thousands of yuan, while an early gastroscopy screening only costs a few hundred yuan. If this were you, which one would you choose?

Figure 1 Copyright image, no permission to reprint

In order to find stomach problems at an early stage, it is very important to popularize gastroscopy. The full name of gastroscopy is upper gastrointestinal endoscopy. It uses a slender tube with a diameter of about 1 cm wrapped in black plastic and a light-guiding fiber. The front end is equipped with an endoscope. It is inserted into the esophagus, stomach, and duodenum of the examinee through the mouth. The strong light emitted by the light source can bend through the light-guiding fiber, allowing the doctor to clearly observe the conditions of various parts of the upper gastrointestinal tract from the other end. If necessary, a clip can be inserted through the small hole on the gastroscope for pathological biopsy to determine whether the stomach has cancer.

Regarding the gastroscopy biopsy pathology report, some patients do not take it seriously and think it is not important; while some patients are overly nervous and seem to be at a loss. So, how to correctly interpret the gastroscopy biopsy pathology diagnosis report? Let's first learn some knowledge related to the gastroscopy biopsy pathology diagnosis report.

1. Typical hyperplasia

Typical hyperplasia refers to the arrangement of cells in a way that is close to normal tissue cells and is a benign manifestation.

1. Superficial gastritis

Superficial gastritis refers to the infiltration of inflammatory cells, mainly lymphocytes or plasma cells, in the superficial layer of gastric mucosa, but the glandular tissue in the deeper layer is normal. According to the degree of infiltration of inflammatory cells, superficial gastritis can be divided into mild, moderate and severe. If accompanied by neutrophil infiltration, it indicates acute inflammation.

2. Atrophic gastritis

Atrophic gastritis refers to the infiltration of inflammatory cells in the gastric mucosa, as well as the partial or complete disappearance of glands. Depending on the degree of glandular reduction, atrophic gastritis can be divided into mild, moderate and severe. If atrophic gastritis is diagnosed, it must be actively treated because it is prone to intestinal metaplasia and has the risk of further canceration.

3. Intestinal metaplasia

Intestinal metaplasia, referred to as "intestinal metaplasia", refers to a pathological change in which the gastric mucosal epithelium is transformed into the intestinal mucosal epithelium under the continuous stimulation of chronic inflammation and various harmful factors. In other words, intestinal metaplasia is a compensatory response of the body to various harmful stimuli. Chronic atrophic gastritis is often accompanied by intestinal metaplasia. Studies have shown that there is a certain correlation between intestinal metaplasia and the occurrence of gastric cancer. Therefore, patients with intestinal metaplasia in gastroscopy biopsy pathology should be taken seriously and treated as soon as possible.

4. Lymph follicles

Lymphoid follicles refer to a type of reactive proliferation of lymphoid tissue that occurs in the gastric mucosa after chronic inflammation. Repeated proliferation of lymphoid tissue can progress to lymphoma. Therefore, if lymphoid follicles are found in gastric mucosal biopsy, especially in middle-aged and elderly people, it should attract the attention of clinicians.

5. Polyps

Polyps are protrusions of mucosal hyperplasia into the lumen, and can be divided into inflammatory polyps, hyperplastic polyps, adenomatous polyps, etc. Hyperplastic and inflammatory polyps are usually benign, while adenomatous polyps, especially those with dysplasia, may become cancerous and need to be removed in time and reviewed regularly.

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6.Hp

Hp, also known as Helicobacter pylori in Chinese, is a Gram-negative bacillus. Studies have shown that Hp is closely related to the occurrence of most gastritis, gastric ulcers and even gastric cancer. If Hp is positive under the microscope, standardized eradication treatment should be carried out.

2. Atypical hyperplasia

Atypical hyperplasia of gastric mucosa, also known as dysplasia, is a more serious pathological change than intestinal metaplasia. It can develop directly from chronic atrophic gastritis or through intestinal metaplasia.

Atypical hyperplasia refers to the difference between the intracellular structure, the arrangement of cells and the degree of proliferation and normal tissue cells. It is the midpoint from benign changes to malignant changes. Atypical hyperplasia is divided into mild, moderate and severe according to the degree. Mild atypical hyperplasia can return to normal after timely treatment. Moderate and severe atypical hyperplasia are precancerous lesions. If not treated in time, they may become cancerous. It is recommended that patients with mild atypical hyperplasia should have a gastroscopy review every 3 to 4 months, moderate patients should have a review every 2 to 3 months, and severe patients should undergo surgery as soon as possible.

3. Cancer

If cancer is directly reported in the pathology report, it is a positive diagnosis. When some patients or their families receive the pathology report, they will ask whether the cancer is in the early, middle or late stages. However, they do not know that gastroscopy biopsy can only determine the nature of the lesion, while tumor staging requires surgical removal of gross specimens, and then the pathologist will fully collect samples, prepare slides and observe under a microscope to determine the depth of cancer tissue infiltration, degree of differentiation and lymph node metastasis for comprehensive assessment.

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4. Recommendations in the Diagnostic Report

If the diagnostic report recommends immunohistochemistry, it may generally be for the following reasons: ① It is currently impossible to confirm whether it is cancer and further clarification is needed; ② It has been determined to be cancer, but in order to further clarify the source, type, degree of differentiation and tumor stage of the cancer cells; ③ It is convenient to discover micrometastases and find the cause of the disease; ④ To guide medication and judge prognosis, etc.

In short, a standardized gastroscopy examination combined with necessary pathological tissue biopsy is particularly important for the screening and diagnosis of gastric diseases. I hope everyone has a healthy body and a strong stomach!