Correlation between Endoscopic and Histopathological Findings of Upper Gastrointestinal Tract Lesions: A Cohort Study at a Tertiary Care Center in Northern India

Abstract

Objectives: 1. To study the endoscopic and morphological spectrum of upper gastrointestinal tract lesions. 2. To evaluate the histopathological findings in patients undergoing endoscopic biopsies presenting with signs and symptoms pertaining to upper gastrointestinal tract. 3. To study the distribution of clinicopathological parameters in the above patients Materials and Methods: This is a hospital based cross sectional observational study from March 2023 to August 2024 (18 months). This study includes a total of 158 cases. All the endoscopic biopsy specimens from upper GI tract lesions including esophagus, gastric and duodenum (1 st part and 2 nd part). Tissue received in formalin was measured and a drop of eosin was added and folded in filter paper and then placed in cassettes for further processing. The entire tissue is processed through automated processing system. Results:  A total of 158 cases included in our study .The diagnostic concordance rate of 93.7% was observed, reaffirming endoscopy as an effective screening tool. However, 6.3% of cases exhibited discrepancies, highlighting the challenges in accurately diagnosing inflammatory and neoplastic conditions in this region and the need for histopathological confirmation. Malignancies were most prevalent in the esophagus (85.5%), GEJ (85.7%), and stomach (60.6%), while duodenal biopsies were predominantly non-malignant (89.3%), with celiac disease and chronic duodenitis as major diagnoses. While esophageal malignancies show strong endoscopic-histopathological correlation (93.1%), gastric malignancies present higher misinterpretation rates (75%), necessitating careful histopathological evaluation. These findings highlight the crucial role of biopsy in ensuring diagnostic accuracy, especially in distinguishing inflammatory conditions from neoplastic lesions. Endoscopy demonstrated high sensitivity (97.64%), making it effective for detecting malignancies, while its specificity (89.04%) indicates a strong ability to identify benign lesions. Despite a 93.67% accuracy, the presence of false positives and false negatives highlights the need for histopathological confirmation to ensure definitive diagnosis, particularly in cases of reactive or inflammatory changes mimicking neoplasia. Conclusion: Thus, we conclude that endoscopy alone is insufficient without histopathological biopsy, and their combined application serves as a powerful diagnostic tool for enhancing patient management and improving clinical outcomes.

Keywords:  Endoscopic biopsy, stomach, upper GI tract lesions, duodenum, Histopathology