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dc.contributor.authorFujita, Hiroshi
dc.contributor.authorLennerz, Jochen K.M.
dc.contributor.authorChung, Daniel Chulyong
dc.contributor.authorPatel, Devanshi
dc.contributor.authorDeshpande, Vikram
dc.contributor.authorYoon, Sam
dc.contributor.authorLauwers, Gregory Y.
dc.date.accessioned2017-10-20T21:43:36Z
dc.date.issued2012
dc.identifier.citationFujita, 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.en_US
dc.identifier.issn0147-5185en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:34268582
dc.description.abstractThe 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.en_US
dc.language.isoen_USen_US
dc.publisherOvid Technologies (Wolters Kluwer Health)en_US
dc.relation.isversionofdoi:10.1097/PAS.0b013e31826ca204en_US
dash.licenseMETA_ONLY
dc.subjectgastric canceren_US
dc.subjecthereditaryen_US
dc.subjectCDH1en_US
dc.subjectfamilialen_US
dc.subjectsurveillanceen_US
dc.titleEndoscopic Surveillance of Patients With Hereditary Diffuse Gastric Cancer: Biopsy Recommendations After Topographic Distribution of Cancer Foci in a Series of 10 CDH1-mutated Gastrectomiesen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalThe American Journal of Surgical Pathologyen_US
dash.depositing.authorLauwers, Gregory Y.
dash.embargo.until10000-01-01
dc.identifier.doi10.1097/PAS.0b013e31826ca204*
dash.contributor.affiliatedYoon, Sam
dash.contributor.affiliatedLauwers, Gregory Y.
dash.contributor.affiliatedChung, Daniel
dash.contributor.affiliatedDeshpande, Vikram
dc.identifier.orcid0000-0003-4230-9308


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