Number/quality of endoscopic biopsy samples in gastrointestinal cancers for biomarker testing: All that glitters is not gold

作者：Federica Grillo, Alessandro Gambella, Silvia Bozzano, Michele Paudice, Nataniele Piol, Manuele Furnari, Stefania Sciallero, Alessandro Pastorino, Anna Pessino, Paola Parente, Alessandro Vanoli, Matteo Fassan, Luca Mastracci · 发表于：Digestive and Liver Disease · 年份：2025 · DOI：10.1016/j.dld.2025.12.005 · 被引用次数：2 · 研究领域：Cancer Genomics and Diagnostics、Esophageal Cancer Research and Treatment、Gastric Cancer Management and Outcomes

BACKGROUND: Management of gastrointestinal (GI) cancers has shifted from conventional chemotherapy to biomarker-based precision oncology. Biomarker assessment requires adequate endoscopic biopsy tissue both in gastro-esophageal/gastric and colorectal carcinomas. AIMS: This study evaluated real-world endoscopic biopsy adequacy, focusing on tissue quality and suitability for biomarker analysis. METHODS: We retrospectively reviewed 819 endoscopic procedures (274 upper-GI and 545 lower-GI; time-window: January 2021-2024). Gastrointestinal pathologists reviewed 4,908 biopsies to assess diagnostic yield, number of invasive carcinoma-containing biopsies, and tumor cellularity. Biopsy adequacy was evaluated against European Society of Gastrointestinal Endoscopy (ESGE) recommendations and biomarker-specific cellularity thresholds. RESULTS: A histologic diagnosis of invasive carcinoma was established in 96 % of upper-GI and 84 % of lower-GI procedures (p<0.001). However, 41-43 % of procedures yielded fewer than six biopsies, which is below ESGE guidance. Importantly, only 66.7 % of upper-GI and 49.7 % of lower-GI biopsies contained invasive carcinoma, while the rest were composed of samples inadequate for biomarker testing (such as non-invasive lesions, mucin, necrosis, granulation tissue, and normal mucosa). Low neoplastic cellularity (<1000 tumor cells) was observed in 27 % of upper-GI and 5 % of lower-GI cases, while <20 % tumor cellularity was present in 41.7 % of colorectal biopsi...