First of all, a negative biopsy does not completely exclude the possibility of gastric cancer.
A biopsy, known as a biopsy, is part of a pathologic diagnosis. The first thing you need to do is to take a look at the results of the biopsy. The results of the biopsy were negative and did not completely exclude the possibility of gastric cancer.
The possibility of false-negative gastric cancer biopsies
Regrettably, any of the available tests have the potential to be falsely negative, meaning that the disease is actually present but the test results show no disease. Gastric cancer biopsies are no exception.
False-negative endoscopic biopsy results, which means that cancer cells were not detected in the biopsy specimens of patients with gastric cancer. There are many reports describing the phenomenon of false-negative gastric cancer biopsies. In some patients with suspected gastric cancer, both imaging and blood tests for tumor markers are consistent with gastric cancer, but multiple biopsies are negative and the mass is eventually removed after multidisciplinary care and the patient agrees to surgery and is willing to assume the risks of surgery.
Why would a false negative occur?
- There are some lesions in early gastric cancer that have a more similar morphology under gastroscopy than gastritis, benign ulcers, or adenomas, and are highly likely to be missed or misdiagnosed during gastroscopy.
- There is a certain blind spot in gastroscopy.
- It is more difficult to clip the cancerous tissue when the cancer is growing infiltratively under the mucosa.
- The surface of the lesion and the surrounding tissues are edematous, and the inappropriate site, insufficient depth, or insufficient amount of the clamped tissue may also affect the pathological diagnosis.
How to try to avoid false negatives?
The expert consensus on the standardization of gastrointestinal endoscopic biopsy and pathology in China states that the correct sampling of mucosal biopsy specimens from the esophagus and gastrointestinal tract directly affects the pathologic diagnosis; the accuracy of the biopsy site is key to avoiding false negatives, and the first specimen from the same biopsy site is particularly important, as subsequent biopsies can affect accuracy due to mucosal bleeding; mucosal biopsy requires that the specimen be large enough and as deep as possible to The mucosal biopsy requires the specimen to be large enough and as deep as possible to reach the mucosal muscle layer. This is also the principle that the physician follows when taking biopsies. The physician will obtain and handle the specimen in a standardized manner to minimize the possibility of false negatives.
In patients with negative biopsies, if there is a strong suspicion of gastric cancer based on clinical presentation, imaging, and tumor markers, the physician will usually send the specimen multiple times to reduce the likelihood of false negatives.
In conclusion, the pathological diagnosis is the gold standard for confirming gastric cancer, but a negative biopsy result cannot completely exclude the possibility of gastric cancer, and the clinician will analyze the patient’s performance and other examination results to make a judgment, and if necessary, repeat the biopsy or even remove it surgically after discussion with the patient to clarify the diagnosis. (Contributed by Jianhua Wu, Gastrointestinal Oncology Center, The First Affiliated Hospital of China Medical University)