Advertisement

Clinical predictors of histologic type of gastric cancer

Published:November 06, 2017DOI:https://doi.org/10.1016/j.gie.2017.10.037

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Japanese Gastric Cancer Association
        Japanese gastric cancer treatment guidelines 2014 (ver. 4).
        Gastric Cancer. 2017; 20: 1-19
        • Lauren P.
        The two histological main types of gastric carcinoma.
        Acta Pathol Microbiol Scand. 1965; 64: 31-49
        • Gotoda T.
        • Yanagisawa A.
        • Sasako M.
        • et al.
        Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.
        Gastric Cancer. 2000; 3: 219-225
        • Hirasawa T.
        • Gotoda T.
        • Miyata S.
        • et al.
        Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer.
        Gastric Cancer. 2009; 12: 148-152
        • Sekiguchi M.
        • Oda I.
        • Taniguchi H.
        • et al.
        Risk stratification and predictive risk-scoring model for lymph node metastasis in early gastric cancer.
        J Gastroenterol. 2016; 51: 961-970
        • Bossuyt P.M.
        • Reitsma J.B.
        • Bruns D.E.
        • et al.
        Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.
        BMJ. 2003; 326: 41-44
        • Japanese Gastric Cancer Association
        Japanese classification of gastric carcinoma: 3rd English edition.
        Gastric Cancer. 2011; 14: 101-112
        • Nagahama T.
        • Yao K.
        • Imamura K.
        • et al.
        Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: the “non-extension sign” as a simple diagnostic marker.
        Gastric Cancer. 2017; 20: 304-313
        • Choi J.
        • Kim S.G.
        • Im J.P.
        • et al.
        Endoscopic prediction of tumor invasion depth in early gastric cancer.
        Gastrointest Endosc. 2011; 73: 917-927
        • Schlemper R.J.
        • Riddell R.H.
        • Kato Y.
        • et al.
        The Vienna classification of gastrointestinal epithelial neoplasia.
        Gut. 2000; 47: 251-255
        • Lee C.K.
        • Chung I.K.
        • Lee S.H.
        • et al.
        Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia?.
        J Gastroenterol Hepatol. 2010; 25: 1507-1513
        • Takao M.
        • Kakushima N.
        • Takizawa K.
        • et al.
        Discrepancies in histologic diagnoses of early gastric cancer between biopsy and endoscopic mucosal resection specimens.
        Gastric Cancer. 2012; 15: 91-96
        • Lim H.
        • Jung H.Y.
        • Park Y.S.
        • et al.
        Discrepancy between endoscopic forceps biopsy and endoscopic resection in gastric epithelial neoplasia.
        Surg Endosc. 2014; 28: 1256-1262
        • Richardson W.S.
        • Wilson M.C.
        • Keitz S.A.
        • et al.
        Tips for teachers of evidence-based medicine: making sense of diagnostic test results using likelihood ratios.
        J Gen Intern Med. 2008; 23: 87-92
        • Jaeschke R.
        • Guyatt G.
        • Lijmer J.
        Diagnostic tests.
        in: Guyatt G. Rennie D. Users’ guides to the medical literature. AMA Press, Chicago2002: 121-140
        • Deeks J.J.
        • Altman D.G.
        Diagnostic tests 4: likelihood ratios.
        BMJ. 2004; 329: 168-169
        • Yao K.
        • Anagnostopoulos G.K.
        • Ragunath K.
        Magnifying endoscopy for diagnosing and delineating early gastric cancer.
        Endoscopy. 2009; 41: 462-467
        • Ezoe Y.
        • Muto M.
        • Uedo N.
        • et al.
        Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer.
        Gastroenterology. 2011; 141: 2017-2025
        • Yao K.
        • Doyama H.
        • Gotoda T.
        • et al.
        Diagnostic performance and limitations of magnifying narrow-band imaging in screening endoscopy of early gastric cancer: a prospective multicenter feasibility study.
        Gastric Cancer. 2014; 17: 669-679
        • Choi J.M.
        • Kim S.G.
        • Yang H.J.
        • et al.
        Endoscopic predictors for undifferentiated histology in differentiated gastric neoplasms prior to endoscopic resection.
        Surg Endosc. 2016; 30: 89-98
        • Jung D.H.
        • Park Y.M.
        • Kim J.H.
        • et al.
        Clinical implication of endoscopic gross appearance in early gastric cancer: revisited.
        Surg Endosc. 2013; 27: 3690-3695
        • Shim C.N.
        • Song M.K.
        • Kang D.R.
        • et al.
        Size discrepancy between endoscopic size and pathologic size is not negligible in endoscopic resection for early gastric cancer.
        Surg Endosc. 2014; 28: 2199-2207
        • Feng H.
        • Wang Y.
        • Cao L.
        • et al.
        Lymph node metastasis in differentiated-type early gastric cancer: a single-center retrospective analysis of surgically resected cases.
        Scand J Gastroenterol. 2016; 51: 48-54
        • Ohara Y.
        • Toshikuni N.
        • Matsueda K.
        • et al.
        The superficial elevated and depressed lesion type is an independent factor associated with non-curative endoscopic submucosal dissection for early gastric cancer.
        Surg Endosc. 2016; 30: 4880-4888
      1. Shi C, Berlin J, Branton PA, et al. Protocol for the examination of specimens from patients with carcinoma of the stomach. College of American Pathologists. Available at: http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-stomach-17protocol-4000.pdf pdf. Accessed September 5, 2017.

        • Nakayoshi T.
        • Tajiri H.
        • Matsuda K.
        • et al.
        Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video).
        Endoscopy. 2004; 36: 1080-1094
        • Kanesaka T.
        • Sekikawa A.
        • Tsumura T.
        • et al.
        Absent microsurface pattern is characteristic of early gastric cancer of undifferentiated type: magnifying endoscopy with narrow-band imaging.
        Gastrointest Endosc. 2014; 80: 1194-1198