Chromoendoscopy
                    in combination with random biopsies does not improve detection of gastric cancer
                    foci in CDH1 mutation positive patients

Robert Hüneburg; Tim Marwitz; Peer van Heteren; Tobias J. Weismüller; Jonel Trebicka; Ronja Adam; Stefan Aretz; Alberto Perez Bouza; Dimitrios Pantelis; Jörg C. Kalff; Jacob Nattermann; Cristian P. Strassburg

doi:10.1055/s-0042-112582

Endoscopy International Open, Table of Contents

Endosc Int Open 2016; 04(12): E1305-E1310
DOI: 10.1055/s-0042-112582

Original article

Chromoendoscopy in combination with random biopsies does not improve detection of gastric cancer foci in CDH1 mutation positive patients

Robert Hüneburg^*

¹Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Tim Marwitz^*

¹Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

,

Peer van Heteren

¹Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Tobias J. Weismüller

¹Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Jonel Trebicka

¹Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

,

Ronja Adam

²Institute of Human Genetics, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Stefan Aretz

²Institute of Human Genetics, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Alberto Perez Bouza

³Institute of Pathology, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Dimitrios Pantelis

⁴Department of Surgery, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Jörg C. Kalff

⁴Department of Surgery, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Jacob Nattermann^*

¹Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

,

Cristian P. Strassburg^*

¹Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

⁵Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany

› Author Affiliations

Abstract

Background and study aims: Hereditary diffuse gastric cancer (HGGC), an autosomal dominant tumor-syndrome, accounts for 1 % to 3 % of gastric cancers worldwide. Presumably 30 % to 40 % of all patients fulfilling the clinical guidelines for HDGC are carriers of a pathogenic mutation in the CDH1 gene. Patients often show multiple foci of signet ring cell carcinoma at early age and are advised to undergo prophylactic total gastrectomy (PTG). Our aim was to improve the endoscopic detection of HDGC by using an enhanced endoscopic protocol.

Patient and methods: Patients with a proven CDH1 germline mutation identified in our institute were prospectively included. Patients were advised to undergo PTG and offered a baseline endoscopic examination prior surgery. Examination was performed by using high-resolution white-light endoscopy and pan-gastric chromoendoscopy with indigo carmine as dye combined with targeted and multiple random biopsies assessed by an expert histopathologist. Postoperative histopathology was compared with results from endoscopic biopsies.

Results: Between September 2012 and November 2014 8 patients with a proven CDH1 germline mutation were included. We conducted 44 targeted (6.3/patient) and 225 random (32.1/patient) biopsies in 7 patients. We detected 1 gastric cancer by random biopsy (14 %). All other examinations showed no signs of cancer.

Histopathology of gastrectomy specimen revealed multiple foci of gastric carcinoma in 6 patients (86 %) with a total number of 27 cancer foci.

Conclusions: Examination with targeted and random biopsies combined with chromoendoscopy is not able to detect small foci of gastric cancer in CDH1 mutation carriers. Therefore PTG is advocated in these patients.

Full Text

References

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