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Upper GI biopsies for adenocarcinoma: how many biopsies should endoscopists take?

Kaye, Philip; Lindsay, Daniel; Madhusudan, Srinivasan; Vohra, Ravinder; Catton, James; Platt, Craig; Ragunath, Krish

Upper GI biopsies for adenocarcinoma: how many biopsies should endoscopists take? Thumbnail


Philip Kaye

Daniel Lindsay

Ravinder Vohra

James Catton

Craig Platt

Krish Ragunath


Aims: There is evidence that 4 or 5 gastric cancer biopsies are required for accurate HER2 interpretation. However, the number of biopsies that need to be taken to reach this number of viable cancer biopsies is without evidence. This study aimed to address this gap by assessing the number of biopsies required to get at least 4 viable biopsies containing cancer
Methods and results: 105 consecutive biopsy cases of gastric and oesophageal adenocarcinoma were retrieved from file. Only definite cancer diagnoses were included; missed cancers or unproven cases were not considered. The cases were reviewed and the number of biopsies taken, and the number containing viable tumour was recorded. In total, 667 biopsies were taken of which 471 had viable tumour (70.6%) 70/105 cases (67%) had 4 viable tumour biopsies but only 47/105 (45%) had 5 viable tumour biopsies. In order to have a >90% chance of having 4 viable tumour biopsies, 7 biopsies needed to be taken, while 10 or more biopsies were required for a >90% chance of 5 viable tumour biopsies. Mathematically, using a 0.7 probability for a single biopsy, 8 biopsies would be required for a 94% chance of at least 4 viable tumour biopsies.
Conclusion: In our large upper GI cancer centre, many biopsy cases do not contain sufficient material for adequate HER2 assessment. In order to meet the 4 biopsy requirement for adequate HER2 assessment in >90% of cases, at least 8 biopsies need to be taken, while 10 biopsies would be required for the 5 cancer biopsy threshold.

Journal Article Type Article
Acceptance Date Dec 28, 2018
Online Publication Date Dec 28, 2018
Publication Date May 1, 2019
Deposit Date Jan 11, 2019
Publicly Available Date Dec 29, 2019
Journal Histopathology
Print ISSN 0309-0167
Electronic ISSN 1365-2559
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 74
Issue 6
Pages 959-963
Keywords Gastric biopsy, Oesophageal biopsy, HER2, Viable tumour, Molecular testing
Public URL
Publisher URL
Additional Information This is the peer reviewed version of the article, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.


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