Confocal endomicroscopy diagnostic criteria for early signet-ring cell carcinoma in hereditary diffuse gastric cancer

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 cont...

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Veröffentlicht in:BMC gastroenterology Jg. 23; H. 1; S. 176 - 8
Hauptverfasser: Pilonis, Nastazja D., O’Donovan, Maria, Richardson, Susan, Fitzgerald, Rebecca C., di Pietro, Massimiliano
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 23.05.2023
BioMed Central Ltd
Springer Nature B.V
BMC
Schlagworte:
Adenocarcinoma
Adenocarcinoma - pathology
Adult
Aged
Biopsy
Carcinoma
Carcinoma, Signet Ring Cell - pathology
CDH1
Colposcopes
Confocal laser endomicroscopy
Diagnosis
Endoscopes
Endoscopic surveillance
Endoscopy
Female
Gastric cancer
Gastroenterology
Gastrointestinal surgery
Gastroscopes
Genetic aspects
Glands
Hepatology
Hereditary diffuse gastric cancer
Humans
Internal Medicine
Investigations
Male
Medicine
Medicine & Public Health
Methods
Microscopy, Confocal
Middle Aged
Prospective Studies
Signet ring cell carcinoma
Stomach cancer
Stomach Neoplasms - pathology
Stroma
Surveillance
United Kingdom
Endoscopic surveillance
Hereditary diffuse gastric cancer
Signet ring cell carcinoma
Confocal laser endomicroscopy
CDH1
ISSN:1471-230X, 1471-230X
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Zusammenfassung: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 syndrome were prospectively recruited and pCLE assessment was performed on areas suspicious for early SRCC and control regions during an endoscopic surveillance procedure. 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 Forty-two 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.
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ISSN:1471-230X
1471-230X
DOI:10.1186/s12876-023-02822-3