scholarly journals Single-bite versus double-bite technique for mapping biopsies during endoscopic surveillance for hereditary diffuse gastric cancer: a single-center, randomized trial

Endoscopy ◽  
2020 ◽  
Author(s):  
Apostolos Pappas ◽  
Wei Keith Tan ◽  
William Waldock ◽  
Susan Richardson ◽  
Monika Tripathi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Diagnostic Yield ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Hereditary Diffuse Gastric Cancer ◽  
Endoscopic Surveillance ◽  
Diffuse Gastric Cancer ◽  
Muscularis Mucosa ◽  
Procedural Time ◽  
Surveillance Endoscopy

Abstract Background Endoscopic surveillance is recommended in patients with hereditary diffuse gastric cancer (HDGC) who refuse or want to delay surgery. Because early signet-ring cell carcinoma (SRCC) can be inconspicuous, the current surveillance endoscopy protocol entails 30 random biopsies, which are time-consuming. This study aimed to compare single-bite and double-bite techniques in HDGC surveillance. Methods Between October 2017 and December 2018, consecutive patients referred for HDGC surveillance were prospectively randomized to the single- or double-bite arm. The primary outcome was the diagnostic yield for SRCC foci. Secondary outcomes were: procedural time for random biopsies; comfort score; biopsy size; and quality of specimens, the latter assessed by the presence of muscularis mucosa, crush artifact, and proportion usable for diagnostic assessment. Results 25 patients were randomized to the single-bite arm and 23 to the double-bite arm. SRCC foci were detected in three and four patients in the single- and double-bite arms, respectively (P = 0.70). The procedural time for the double-bite arm (12 minutes, interquartile range [IQR] 4) was significantly shorter than for the single-bite arm (15 minute, IQR 6; P = 0.01), but comfort scores were similar. The size of the biopsies in the double-bite arm was significantly smaller than in single-bite arm (2.5 mm vs. 3.0 mm; P < 0.001) but this did not affect the presence of muscularis mucosa (P = 0.73), artifact level (P = 0.11), and diagnostic utility (P = 0.051). Conclusion For patients undergoing HDGC surveillance, the double-bite technique is significantly faster than the single-bite technique. The diagnostic yield for SRCC and the biopsy quality were similar across both groups.

scholarly journals CDH1 Gene Mutation Hereditary Diffuse Gastric Cancer Outcomes: Analysis of a Large Cohort, Systematic Review of Endoscopic Surveillance and Secondary Cancer Risk Postulation

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2622
Author(s):  
Matthew G. K. Benesch ◽  
Stuart R. Bursey ◽  
Andrew C. O’Connell ◽  
Morag G. Ryan ◽  
Carrie L. Howard ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Cancer Risk ◽  
Signet Ring Cell ◽  
Endoscopic Biopsy ◽  
Hereditary Diffuse Gastric Cancer ◽  
Endoscopic Surveillance ◽  
Diffuse Gastric Cancer ◽  
Secondary Cancer ◽  
Secondary Cancer Risk

Hereditary diffuse gastric cancer (HDGC) is a rare signet-ring cell adenocarcinoma (SRCC) linked to CDH1 (E-cadherin) inactivating germline mutations, and increasingly other gene mutations. Female CDH1 mutation carriers have additional risk of lobular breast cancer. Risk management includes prophylactic total gastrectomy (PTG). The utility of endoscopic surveillance is unclear, as early disease lacks macroscopic lesions. The current systematic biopsy protocols have unknown efficacy, and other secondary cancer risks are postulated. We conducted a retrospective study of consecutive asymptomatic HDGC patients undergoing PTG, detailing endoscopic, pathologic, and outcome results. A systematic review compared endoscopic biopsy foci detection via random sampling versus Cambridge Protocol against PTG findings. A population-level secondary-cancer-risk postulation among sporadic gastric SRCC patients was completed using the Surveillance, Epidemiology, and End Results database. Of 97 patients, 67 underwent PTG, with 25% having foci detection on random endoscopic biopsy despite 75% having foci on final pathology. There was no improvement in the endoscopic detection rate by Cambridge Protocol. The postulated hazard ratio among sporadic gastric SRCC patients for a secondary colorectal SRCC was three-fold higher, relative to conventional adenocarcinoma patients. Overall, HDGC patients should not rely on endoscopic surveillance to delay PTG, and may have secondary SRCC risks. A definitive determination of actual risk requires collaborative patient outcome data banking.

Outcomes of Surveillance Endoscopy in the Hereditary Diffuse Gastric Cancer Syndrome

2017 ◽  
Vol 152 (5) ◽  
pp. S553-S554
Author(s):  
Tomer Adar ◽  
Devanshi Patel ◽  
John T. Mullen ◽  
Gregory Y. Lauwers ◽  
Daniel C. Chung
Keyword(s):  
Gastric Cancer ◽  
Hereditary Diffuse Gastric Cancer ◽  
Diffuse Gastric Cancer ◽  
Cancer Syndrome ◽  
Surveillance Endoscopy

scholarly journals Confocal Endomicroscopy Diagnostic Criteria for Early Signet-Ring Cell Carcinoma in Hereditary Diffuse Gastric Cancer

2021 ◽  
Author(s):  
Nastazja D. Pilonis ◽  
Maria O’Donovan ◽  
Susan Richardson ◽  
Rebecca C. Fitzgerald ◽  
Massimiliano Pietro
Keyword(s):  
Gastric Cancer ◽  
Phase I ◽  
Diagnostic Criteria ◽  
Interobserver Agreement ◽  
Signet Ring Cell Carcinoma ◽  
Signet Ring Cell ◽  
Video Sequences ◽  
Diffuse Gastric Cancer ◽  
Signet Ring ◽  
Ring Cell

Abstract Background Recognition of early signet-ring cell carcinoma (SRCC) in patients with hereditary diffuse gastric cancer (HDGC) undergoing endoscopic surveillance is challenging. We hypothesized that probe-based confocal laser endomicroscopy (pCLE) might help diagnose early cancerous lesions in the context of HDGC. The aim of this study was to identify pCLE diagnostic criteria for early SRCC. Methods Patients with HDGC were prospectively recruited and pCLE assessment was performed on areas suspicious for early SRCC and control regions. Targeted biopsies were taken for gold standard histologic assessment. In Phase I two investigators assessed video sequences off-line to identify pCLE features related to SRCC. In Phase II pCLE diagnostic criteria were evaluated in an independent video set by the investigators blinded to the histologic diagnosis. Sensitivity, specificity, accuracy, and interobserver agreement were calculated. Results 42 video sequences from 16 HDGC patients were included in Phase I. Four pCLE patterns associated to SRCC histologic features were identified: (A) glands with attenuated margins, (B) glands with spiculated or irregular shape, (C) heterogenous granular stroma with sparse glands, (D) enlarged vessels with tortuous shape. In Phase II, 38 video sequences from 15 patients were assessed. Criteria A and B and C had the highest diagnostic accuracy, with a κ for interobserver agreement ranging from 0.153 to 0.565. A panel comprising these 3 criteria with a cut-off of at least one positive criterion had a sensitivity of 80.9% (95%CI:58.1 - 94.5%) and a specificity of 70.6% (95%CI:44.0 - 89.7%) for a diagnosis of SRCC. Conclusions We have generated and validated off-line pCLE criteria for early SRCC. Future real-time validation of these criteria is required.

Surveillance Endoscopy in the Management of Hereditary Diffuse Gastric Cancer Syndrome

2021 ◽  
Vol 19 (1) ◽  
pp. 189-191 ◽  
Author(s):  
Madeline Friedman ◽  
Tomer Adar ◽  
Devanshi Patel ◽  
Gregory Y. Lauwers ◽  
Sam S. Yoon ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Hereditary Diffuse Gastric Cancer ◽  
Diffuse Gastric Cancer ◽  
Cancer Syndrome ◽  
Surveillance Endoscopy

Outcomes of Endoscopic Surveillance in Individuals With Genetic Predisposition to Hereditary Diffuse Gastric Cancer

2019 ◽  
Vol 157 (1) ◽  
pp. 87-96 ◽  
Author(s):  
Michelle F. Jacobs ◽  
Henry Dust ◽  
Erika Koeppe ◽  
Sandra Wong ◽  
Michael Mulholland ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Genetic Predisposition ◽  
Hereditary Diffuse Gastric Cancer ◽  
Endoscopic Surveillance ◽  
Diffuse Gastric Cancer
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