Risk factors suggesting malignant transformation of gastric adenoma: Univariate and multivariate analysis

Background and Study Aims: Since gastric adenomas are precancerous lesions, polypectomy is necessary. However, there have been no reports suggesting f actors capable of predicting malignant transformation of gastric adenomas r emoved by endoscopic snare polypectomy (ESP) or endoscopic mucosal resectio n (EMR) in Korea, a country in which gastric cancer is a major problem. The aim of this paper was to elucidate the risk factors suggesting malignant t ransformation of gastric adenomas removed by ESP or EMR at our center. Patients and Methods: Between November 1994 and June 1999, 118 gastric aden omas diagnosed on the basis of endoscopy and histological examinations of t he forceps biopsy specimens obtained were treated by ESP or EMR at our depa rtment, Factors capable of predicting malignancy were searched for in the e ndoscopy reports, still photographs, and histopathological findings. Results: Eight of the 118 adenomas ultimately proved to have malignant foci , In the univariate analysis, four of the variables studied - location, his tological type, surface redness, and degree of dysplasia - had a statistica lly significant relationship with malignant transformation. In the multivar iate analysis, only the degree of dysplasia had a statistically significant relationship with malignant transformation. Conclusions: These results suggest that a diagnosis of high-grade dysplasia in forceps biopsy material should be considered an absolute indication for ESP or EMR.