Endoscopic Surveillance of Patients With Hereditary Diffuse Gastric Cancer: Biopsy Recommendations After Topographic Distribution of Cancer Foci in a Series of 10 CDH1-mutated Gastrectomies

DSpace/Manakin Repository

Endoscopic Surveillance of Patients With Hereditary Diffuse Gastric Cancer: Biopsy Recommendations After Topographic Distribution of Cancer Foci in a Series of 10 CDH1-mutated Gastrectomies

Citable link to this page

 

 
Title: Endoscopic Surveillance of Patients With Hereditary Diffuse Gastric Cancer: Biopsy Recommendations After Topographic Distribution of Cancer Foci in a Series of 10 CDH1-mutated Gastrectomies
Author: Fujita, Hiroshi; Lennerz, Jochen K.M.; Chung, Daniel Chulyong; Patel, Devanshi; Deshpande, Vikram; Yoon, Sam; Lauwers, Gregory Y.

Note: Order does not necessarily reflect citation order of authors.

Citation: Fujita, Hiroshi, Jochen K.M. Lennerz, Daniel C. Chung, Devanshi Patel, Vikram Deshpande, Sam S. Yoon, and Gregory Y. Lauwers. 2012. “Endoscopic Surveillance of Patients With Hereditary Diffuse Gastric Cancer.” The American Journal of Surgical Pathology 36 (11) (November): 1709–1717. doi:10.1097/pas.0b013e31826ca204.
Access Status: Full text of the requested work is not available in DASH at this time (“dark deposit”). For more information on dark deposits, see our FAQ.
Full Text & Related Files:
Abstract: The management of hereditary diffuse-type gastric cancer revolves around surveillance biopsies and the timing of prophylactic gastrectomy. In the absence of a validated surveillance biopsy protocol, we modeled bioptic diagnostic yield on the basis of the topographic distribution of cancer foci in a series of 10 gastrectomies in CDH1-mutation carriers. Complete histologic examination was performed in all cases, and 1817 slides were evaluated for the presence of in situ, intramucosal, or submucosal diffuse-type carcinoma. Detailed maps determined the density of cancer foci. On the basis of the number of sampled glands per biopsy in routine surveillance preoperative endoscopy, we estimated the theoretical number of biopsies necessary for a 90% rate of detection of neoplastic foci, and we evaluated this number, taking into account the regional distribution of these foci. A total of 96 m of gastric mucosa with ∼1,193,453 gastric glands yielded 302 cancer foci [in situ (n=89), intramucosal (n=209), and submucosal (n=4)] spanning the width of a total of 1820 glands (8 to 1205 per case; average 182±115). On the basis of the number of glands per stomach and the average number of glands sampled during surveillance biopsy (28.7±1.7; range, 0 to 79; n=112), the theoretical number of biopsies necessary to capture at least 1 cancer focus was estimated to be 1768 (range, 50 to 5832) to assure a 90% detection rate. Mapping of cancer foci showed the highest density in the anterior proximal fundus (37%) and cardia/proximal fundus (27%). Our results argue for the incorporation of cancer focus distribution into any biopsy protocol, although detection is likely to remain extremely low, and they call into question the validity of endoscopic surveillance.
Published Version: doi:10.1097/PAS.0b013e31826ca204
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:34268582
Downloads of this work:

Show full Dublin Core record

This item appears in the following Collection(s)

 
 

Search DASH


Advanced Search
 
 

Submitters