Upper GI endoscopy in a 55-year-old man identifies a gastric ulcer on the lesser curvature. To reliably distinguish a benign from a malignant ulcer at the index procedure, how should biopsies be taken?

• A Single biopsy from the ulcer base
• B Biopsy only from the surrounding normal mucosa
• C Brush cytology alone from the ulcer centre
• D Biopsies from four quadrants of the margin plus the ulcer base ✓

Explanation

Because even experienced endoscopists misclassify gastric ulcers visually, all gastric ulcers require biopsy. The accepted technique is multiple biopsies from each of the four quadrants of the ulcer margin plus one from the base, giving a sensitivity above 90 percent for detecting malignancy. Malignant change is at the margin, so sampling only the base or only adjacent normal mucosa misses it, and brush cytology alone is less sensitive than biopsy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.