A prospective longitudinal study shows that taking random biopsies is an essential part of surveillance endoscopies in persons meeting the criteria for hereditary diffuse gastric cancer.
The primary objective of this study was to compare the diagnostic yield for signet ring cell carcinoma of random and targeted biopsies in subjects undergoing endoscopic surveillance for hereditary diffuse gastric cancer. This prospective longitudinal cohort study enrolled individuals ≥ 18 years of age who met the test criteria for hereditary diffuse gastric cancer between June 2005 and July 2021. The primary outcome measure was the detection of intramucosal signet ring cell carcinoma foci. The researchers assessed the detection rate and anatomical location in systematically taken random biopsies versus targeted biopsies based on the endoscopic findings.
145 subjects were included, of whom 47% were male and 63% carriers of the pathogenic CDH1-variant. Invasive signet ring cell carcinoma was diagnosed in 58 patients (40%) during a median follow-up period of 51 months (IQR 18-80). The initial diagnosis of signet ring cell carcinoma was usually made on the basis of random biopsies (29 of 58 patients, 50%), rather than targeted biopsies (15 patients, 26%). The anatomical distribution of signet ring cell carcinoma foci detected with random biopsies more accurately reflected the distribution found after prophylactic total gastrectomy than targeted biopsies. The omission of random biopsies would have led to an underdiagnosis rate of 42 in this cohort. Using a new panel of endoscopic criteria, gastric lesions with signet ring cell carcinoma were predicted with a sensitivity of 67.3% and a specificity of 90.2%.
Bron:
Lee CY, Olivier A, Honing J, et al. Endoscopic surveillance with systematic random biopsy for the early diagnosis of hereditary diffuse gastric cancer: a prospective 16-year longitudinal cohort study. Lancet Oncol. 2023;24:107-16.