The role of endoscopic examination accompanied by histological examination on biopsy samples in the diagnosis of gastric carcinoma.

Introduction: Endoscopic evaluation is one of the most important explorations in the diagnosis of gastric cancer, increasing its value by adding biopsy sampling and histopathologic examination, especially in early forms of gastric malignant proliferations. The aim of this study was to evaluate some descriptive parameters of macroscopic and microscopic aspects of gastric carcinomas defined with the help of endoscopic investigation and gastric biopsies sampled during endoscopic examination, and their correlation with patient survival.

Materials And Methods: The study was performed on a group of 119 patients diagnosed with gastric carcinoma. The study material was represented by: tissue fragments obtained by endoscopic biopsy, clinical observation charts, histopathologic diagnosis records, ledgers for records of endoscopic investigation, and endoscopic images recorded for each patient. Biopsies were taken preferentially from areas with the highest risk of malignancy. Tumor fragments were subjected to conventional histological processing techniques (fixation and inclusion in paraffin) and then were stained with HIM. The study included two chapters: the imagistic study and the pathologic study. The parameters assessed were: the site of the lesion within the stomach, the endoscope macroscopic appearance, the microscopic appearance of the endoscope biopsy sample, and the survival, followed up until 48 months.

Results: The most frequently observed macroscopic aspect was the fungating one, in more than two thirds of all cases, followed by the infiltrating one, but all with a poor survival - about 25-30% at 24 months. The most frequent location was the antro-pyloric region, with the highest survival rate of 25% at 24 months, followed by the gastric corpus and the lesser curvature. Most of the tumors were restricted to a single segment of the stomach. The most frequent microscopic aspect was the tubular one (75% of all cases) with its poorly differentiated variant (39 of the 91 cases). The 24 months survival was under 50% for all morphological types of carcinoma, with the lowest ones in the tubular and mucinous types (around 25%). The secretory pattern was identified on biopsy samples stained with HE in only 15% of the cases, and did not influence the survival of the patients.

Conclusions: The combined histologic and endoscopic morphologic investigation allowed the shaping of an accurate morphologic and prognostic preoperative profile in gastric carcinomas.