VALUE OF ROUTINE, NON-TARGETED BIOPSIES IN THE DIAGNOSIS OF GASTRIC NEOPLASIA

Aim-To explore how often a diagnosis of gastric neoplasia is made on r outine, nontargeted biopsies taken for determination of Helicobacter p ylori status, compared with directed biopsies from endoscopically abno rmal mucosa. Methods-Records of all patients with a biopsy diagnosis o f gastric cancer or dysplasia during a two year period were reviewed t o determine whether the biopsy had been targeted at an area of mucosal abnormality, and whether there was any evidence of dysplasia or malig nancy before endoscopy. Results-Of the 8907 endoscopic examinations th at included biopsy, histology showed malignancy in 115 cases and dyspl asia in 20. Of these, in 128 cases the biopsies were targeted from foc al abnormal areas of mucosa, and six were from areas of diffuse mucosa l thickening. In one case, adenocarcinoma was diagnosed in a patient w ith a ''normal'' endoscopic appearance; this patient was undergoing re peat endoscopy for previous dysplasia. Conclusions-Gastric malignancy or dysplasia was detected histologically in 1.5% of endoscopies that i ncluded biopsy. The performance of routine biopsies not targeted at a visible lesion from patients without previous diagnosis of neoplasia d id not increase the detection of gastric malignancy Such biopsies are indicated, however, if histological aspects of a patient's gastritis ( such as atrophy or intestinal metaplasia) influence the clinical manag ement, as in the treatment of helicobacter gastritis.