Abstract
Simple SummaryStomach cancer may be missed during upper endoscopy. We have examined how often this occurs and identified factors associated with missed cancers. Among 730 patients with gastric cancer, 67 (9.2%) were missed during endoscopy 6 to 36 months prior to the cancer diagnosis. Missed cancers were more often located in the upper part of the stomach, of Lauren’s diffuse histologic type and more frequent in patients with previous Billroth II operation. The missed cancers were diagnosed at somewhat earlier stages than the non-missed cancers. In missed cancers, an ulceration was more often found in patients with shorter time interval between the first endoscopy and the endoscopy where the cancer was diagnosed. The factors associated with missed stomach cancers should be kept in mind by doctors performing endoscopies as this may lead to an earlier diagnosis of cancer.Background: The rates of missed gastric cancers (MGC) at upper endoscopy (UE) has been reported at 5–10% in Western countries. We aimed to calculate the rate of MGC and identify factors associated with MGC. Methods: Retrospective population-based cohort study including 730 patients diagnosed with gastric adenocarcinoma in Central Norway 2007–2016. MGCs were incident gastric adenocarcinomas diagnosed 6–36 months after a previous UE. Factors associated with MGC were examined. Definitely missed (UE 6–12 months prior) and potentially missed (UE 12–36 months prior) MGCs were compared. Results: Sixty-seven (9.2%) of 730 gastric cancers were MGC. MGC were associated with localization (p = 0.009) and more frequent in the corpus, Lauren’s histological type (p = 0.028) and diffuse type more prevalent, and previous Billroth 2-operation (14.9% vs. 4.7%, p = 0.001). MGCs were diagnosed at earlier stages (p = 0.037). An ulceration was more common in patients with definitely missed than potentially MGC (40.9% vs. 17.8%, p = 0.041). Conclusions: MGC accounted for 9.2% of gastric cancers in Central Norway. MGC were associated with localization in the corpus, Lauren´s diffuse type and previous Billroth-2-operation. Intensified follow-up and adequate biopsy sampling of patients with gastric ulcerations could reduce the rate of missed gastric cancers.
Highlights
Gastric adenocarcinoma is one of the most common cancers worldwide [1]
missed gastric cancers (MGC) were associated with localization (p = 0.009) and more frequent in the corpus, Lauren’s histological type (p = 0.028) and diffuse type more prevalent, and previous Billroth 2-operation (14.9% vs. 4.7%, p = 0.001)
MGC were associated with localization in the corpus, Lauren s diffuse type and previous Billroth-2-operation
Summary
Gastric adenocarcinoma is one of the most common cancers worldwide [1]. In Western populations, there has been a steep decline in incidence of adenocarcinomas of Lauren’s intestinal type, paralleling the prevalence of Helicobacter pylori (H. pylori) [2,3]. It is of interest to identify factors associated with MGC, and characteristics of the gastric lesion, the patient and the endoscopist have been proposed [13]. The aim of this population-based study was to calculate the rate of missed gastric cancers in Central Norway as well as to identify factors associated with missed gastric cancers. The rates of missed gastric cancers (MGC) at upper endoscopy (UE) has been reported at 5–10% in Western countries. MGC were associated with localization (p = 0.009) and more frequent in the corpus, Lauren’s histological type (p = 0.028) and diffuse type more prevalent, and previous Billroth 2-operation (14.9% vs 4.7%, p = 0.001). Intensified follow-up and adequate biopsy sampling of patients with gastric ulcerations could reduce the rate of missed gastric cancers
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