Background and Aims
Gastric cancer is classified into differentiated and undifferentiated types according
to the degree of glandular differentiation. Undifferentiated-type early gastric cancer
(EGC) carries a higher risk of lymph-node metastasis than differentiated type, and
therefore the indication criteria for endoscopic resection differ. This study aimed
to clarify the ability of clinical predictors to distinguish between differentiated-type
and undifferentiated-type EGCs.
Methods
This was a post hoc study of a multicenter prospective trial carried out in 5 Japanese
hospitals, including 343 patients with cT1 EGC of ≥10 mm. According to the protocol,
age, sex, and endoscopic findings of cancer (diameter, location, macroscopic type,
and invasion depth) were evaluated, and the final diagnosis was confirmed from resected
specimens. We evaluated the associations between these clinical factors and the histologic
type of cancer and calculated the ability of the factors to diagnose differentiated-type
EGC. The diagnostic ability of forceps biopsy was also calculated as a reference.
Results
Multivariate analysis identified older age (≥72 years), male sex, larger tumor size
(>30 mm), elevated type, and shallower invasion depth (cT1a) as independent significant
predictors for differentiated-type EGC, with elevated type showing the highest positive
likelihood ratio. The sensitivity, specificity, accuracy, and positive and negative
likelihood ratios of elevated type for differentiated-type EGC were 24%, 99%, 38%,
15.7, and 0.77, respectively, compared with 96%, 86%, 95%, 7.0, and 0.04 for forceps
biopsy.
Conclusions
Endoscopic elevated type is a significant predictor for differentiated-type EGC and
may exclude undifferentiated-type EGC without the need for forceps biopsy.
Abbreviations:
CI (confidence interval), EGC (early gastric cancer), M (mucosa), M-NBI (magnifying narrow-band imaging), ROC (receiver operating characteristic), SM (submucosa)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 06, 2017
Accepted:
October 13,
2017
Received:
July 19,
2017
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Kanesaka at [email protected]
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
