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CC BY-NC-ND 4.0 · Endoscopy 2024; 12(06): E723-E731
DOI: 10.1055/a-2301-6248
Original article

The white ring sign is useful for differentiating between fundic gland polyps and gastric adenocarcinoma of the fundic gland type

Keitaro Takahashi 
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Takahiro Sasaki
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Nobuhiro Ueno
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Haruka Maguchi
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Shion Tachibana
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Ryunosuke Hayashi
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Yu Kobayashi
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Yuya Sugiyama
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Aki Sakatani
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Katsuyoshi Ando 
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Shin Kashima
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Kentaro Moriichi
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Hiroki Tanabe 
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Kazumichi Harada
2   Gastroenterology, Harada Hospital, Asahikawa, Japan
,
Sayaka Yuzawa
3   Department of Diagnostic Pathology, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Shin Ichihara
4   Department of Surgical Pathology, Sapporo Kosei General Hospital, Sapporo, Japan
,
Toshikatsu Okumura
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
,
Mikihiro Fujiya
1   Division of Gastroenterology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan (Ringgold ID: RIN38051)
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Abstract

Background and study aims Gastric adenocarcinoma of the fundic gland type (GA-FG) is characterized by an elevated lesion with vessel dilation exhibiting branching architecture (DVBA). However, this feature is also found in fundic gland polyps (FGPs), posing a challenge in their differentiation. In this study, we aimed to investigate the clinicopathological features of gastric elevated lesions with DVBA and assess the efficacy of the white ring sign (WRS) as a novel marker for distinguishing between FGPs and GA-FGs.

Methods We analyzed 159 gastric elevated lesions without DVBA and 51 gastric elevated lesions with DVBA, further dividing the latter into 39 in the WRS-positive group and 12 in the WRS-negative group. The clinicopathological features, diagnostic accuracy, and inter-rater reliability were analyzed.

Results Univariate and multivariate analyses for gastric elevated lesions with DVBA identified the histological type consistent with FGPs and GA-FGs, along with the presence of round pits in the background gastric mucosa, as independent predictors. FGPs were present in 92.3% (36/39) of the WRS-positive group and GA-FGs were observed in 50.0% (6/12) of the WRS-negative group. WRS positivity and negativity exhibited high diagnostic accuracy, with 100% sensitivity, 80.0% specificity, and 94.1% accuracy for FGPs, and 100% sensitivity, 86.7% specificity, and 88.2% accuracy for GA-FGs. Kappa values for WRS between experts and nonexperts were 0.891 and 0.841, respectively, indicating excellent agreement.

Conclusions WRS positivity and negativity demonstrate high diagnostic accuracy and inter-rater reliability for FGPs and GA-FGs, respectively, suggesting that WRS is a useful novel marker for distinguishing between FGPs and GA-FGs.

Keywords

Endoscopy Upper GI Tract - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Endoscopic resection (ESD, EMRc, ...) - Precancerous conditions & cancerous lesions (displasia and cancer) stomach


Publication History

Received: 06 August 2023

Accepted after revision: 03 April 2024

Accepted Manuscript online:
08 April 2024

Article published online:
06 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2024; 56(08): 638-638
DOI: 10.1055/a-2302-5593

 

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