Diagnosis Of Gastric Malignancy Research Articles

Predictors of 30-day readmission rate after total gastrectomy in patients with gastric malignancy.

e16109 Background: Total gastrectomy with lymph node dissection is curative for early gastric malignancy which accounts for 1.5% of cancer cases in the U.S. Readmissions are common postoperatively, and are associated with increased morbidity, mortality, hospital costs and decreased quality of life. We hence aim to identify incidence, impact and independent predictors for readmission in patients who underwent total gastrectomy in gastric malignancy. Methods: We conducted a retrospective cohort study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for total gastrectomy with a concomitant diagnosis of gastric malignancy. T-test was used for continuous variables and chi square test was used for categorical variables. Multivariate regression was used to identify predictors for unplanned readmissions. ICD 10 codes were used to identify diagnoses and procedures. Results: A total of 1,779 patients with gastric malignancy underwent total gastrectomy. The 30-day readmission rate was 18.5%. Main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Readmitted patients were more likely to be on chemotherapy. (40.1% vs 27.2%; P<0.01) and more likely to be discharged to a skilled facility (13.5% vs 17.9%; P<0.01). The total health care in-hospital economic burden of readmission was $6.5 million in total charges and $25 million in total costs. Independent predictors of readmission were major bleeding, respiratory failure requiring mechanical ventilation, peripheral parenteral nutrition, history of non-alcoholic hepato-steatosis, and prolonged length of stay. Conclusions: Readmissions after gastrectomy in patients with gastric malignancies are associated with lower in-hospital mortality yet pose a substantial economic burden on healthcare. The lower mortality might be explained by the relatively stable course and lower comorbidities of patients who become eligible for discharge after surgery. Further studies are suggested. Modifiable risk factors like malnutrition and sepsis warrant special attention to decrease readmissions and improve overall outcomes.[Table: see text]

Diagnostics of stomach cancer in Russia: fi rst results of the multicenter study “RADIUS” (Early diagnosis of stomach cancer in dyspepsia)

The aim of the study was to evaluate the timeliness and eff ectiveness of the diagnosis of precancerous diseases and early forms of gastric cancer in primary health care. Materials and methods. A multicenter retrospective descriptive study was conducted with an analysis of the medical records of 426 patients who were diagnosed with malignant neoplasm of the stomach at the time of going to outpatient facilities. We used data from 125 outpatient facilities in 7 centers for the period from 2009 to 2019. Results. The average age of patients with a fi rst established diagnosis of malignant neoplasia was 61,7 (95% CI 58.6 ÷ 64.8) years. The prevailing form of malignant neoplastic disease was the option “Adenocarcinoma, intestinal cancer” — 77,7%, diff use type cancer — 12,7%, other histological types — 9,6%. The diagnosis of malignant neoplastic disease at the III and IV stages of the disease was fi rst established in 67,4% of patients. The number of years lived by patients with a diagnosis of gastric gastric cancer was 2,0 years. Over a 10-year follow-up, 75% of patients died. Risk factors for gastric cancer were identifi ed in 41% of respondents. Signs of dyspepsia syndrome were observed in 31,5% of patients, and they appeared on average 4,6 (95% CI 4,4 ÷ 4,8) years before the diagnosis of gastric malignancy. Among people with gastric cancer, dyspepsia symptoms occur every day in every third patient. The features of the manifestations of dyspepsia in the observed patients were: daily manifestations of symptoms (33,3%), symptoms at night — 9,4%, an increase in the intensity of dyspepsia (21,3%), the lack of a clinical response to the therapy (proton pump inhibitors, prokinetics, eradication of Helicobacter pylori infection) in 58% of cases. Anxiety symptoms were recorded 2,4 years before a diagnosis of stomach cancer.

Diagnostic utility of imprint cytology of endoscopic gastric biopsy: A cyto-histo correlation study

Background: Upper gastrointestinal endoscopy is a common procedure done for suspected cases of gastric malignancies. Histopathological examination of gastric tissue has been a gold standard for the diagnosis. Imprint smears of the gastric biopsy specimen is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of gastric biopsy imprint cytology as compared to the histopathology.
 Materials and Methods: Imprint smears were made from all cases of gastric biopsy specimens taken from suspected cases of gastric malignancies. They were evaluated by three pathologists and categorized in to negative for malignancy, suspicious of malignancy and positive for malignancy. The diagnosis given by imprint smears was compared with histopathology. With the help of sensitivity, specificity & accuracy and Kappa score, the agreement between the imprint smear and histopathology was determined.
 Results: Among the total 79 cases, 49 cases were chronic non specific gastritis and 22 were adenocarcinoma. The sensitivity, specificity, and overall accuracy of gastric biopsy imprint smear were 92.0%, 98.11% and 94.93% respectively. Kappa core was 0.88.
 Conclusions: The gastric biopsy imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of gastric malignancies.

A prospective comparison of brush cytology before and after biopsy in diagnosis of gastric malignancies

Gastric malignancies are the third most common causes of cancer-related death in the world. Here, we aimed to compare brush cytology before and after biopsy in the diagnosis of gastric malignancies. This prospective study included 74 cases referred to endoscopy clinic for suspected gastric lesions during 1 year. In 38 cases, brush cytology was done before and in 36 cases it was done after biopsy. All the cytology and biopsy slides were randomly coded and reviewed by a pathologist blindly without any knowledge of the surgical pathology result or clinical data of the patients. Diagnostic accuracy of brush cytology before biopsy was significantly higher than after biopsy (86.8 vs. 52.8 %, P = 0.003). This accuracy did not show any relations to the site of the lesion or endoscopic appearance of it (P > 0.05). We suggest endoscopic biopsy and cytology to be done together, especially in highly suspected cases to malignancy and also our study showed that it is better to do brushing before tissue biopsy.

Brush cytology and biopsy in the diagnosis of malignancy of gastrointestinal tract – A comparative study

Background: Since the introduction of image guided brush cytology in the mid1970s, the utilization of this technique has proliferated. So, currently it is the most frequently performed procedure in interventional radiology. Depending on the site of lesion, the diagnostic yield is 80%-95% and the complication rate is less than 2%. Material and Methods: It was a cross sectional study conducted in the pathology department, KEM Hospital, Mumbai, Cytology database were searched for all patients undergoing endoscopic guided brush cytology sampling of gastrointestinal lesions during the twenty six month period January 2009 to March 2011. A total of 200 cases identified where endoscopic guided brush cytology of gastrointestinal lesions was done and their cytology slides were retrieved and reviewed. Results: Cytological diagnosis proved to be effective in confirming the diagnosis as malignancy in 102 patients (56.3%) while 11 cases were reported as suspicious for malignancy, 19 cases (10.5%) were reported as inadequate or not suitable for opinion, 39 cases (21.5%) have been reported has negative for malignancy. Conclusion: Brush cytology is a safe, easy and rapid method of diagnosing gastric malignancies. It is a useful adjunct in the diagnosis of gastric malignancies and should be considered as a routine method in combination with biopsy. Multiple repeated endoscopies are recommended in cases of positive cytology and negative biopsy to rule out or confirm malignancy.

The real time pathological diagnosis value of confocal laser endomicroscopy in gastric cancer and precancerous disease

Objective To investigate the accuracy and the consistency with pathological diagnosis of confocal laser endomicroscopy (CLE) in real-time diagnosis of gastric malignancy and precancerous diseases.Methods From January 2010 to March 2011, the out-patients and hospitalized patients of suspected gastric malignancy or precancerous diseases in Shanghai Ruijin Hospital were screened and undergone confocal laser endomicroscopy.Fluorescein sodium was used as fluorescent agent in the examination.A four-tiered diagnostic system was applied in the real time diagnosis with CLE images, and targeted biopsy was performed accordingly. Surgery was performed in CLE diagnosed or highly malignancy suspected patients.The diagnosis of common endoscopy, CLE and pathology was reviewed.Results A total of 160 patients were enrolled in this study, of those one patient withdrew because of fluorescin allergy and the rest 159 patients completed the CLE examination.A total of 194 lesions were inspected, among them, 130 cases each with one lesion, 23 cases each with two lesions and 6 cases each with three lesions.Overall accuracy rate of CLE was 93.3％ (181/194).And the sensitivity and specificity of CLE in gastric malignancy diagnosis was 93.6 ％ and 99.3 ％ respectively.Ideal correlation was identified between confocal laser endomicroscopy and final pathology results (Kappa=0.876).The incidence of marked fluorescin-related adverse events was only 0.6％ (1/160). Conclusions CLE is consistent with histopathology and is helpful to make accurate diagnosis of gastric malignancy and precancerous diseases.It is important in early diagnosis of gastric malignancy and helps to avoid misdiagnosis and missed diagnosis. Key words: Gastric cancer; Precancerous disease; Endoscopy; Confocal Laser Endomicroscopy

W1162 Raman Endoscopy for In Vivo Diagnosis of Gastric Malignancy: Our Initial Experience

W1162 Raman Endoscopy for In Vivo Diagnosis of Gastric Malignancy: Our Initial Experience

W1073 Analysis of the Predictive Value of Alarm Symptoms in the Diagnosis of Gastric Malignancy in the Presence of Gastric Ulceration

W1073 Analysis of the Predictive Value of Alarm Symptoms in the Diagnosis of Gastric Malignancy in the Presence of Gastric Ulceration

A Teenager With X‐Linked Agammaglobulinemia and Vitamin B12 Deficiency Anemia

INTRODUCTION X-linked agammaglobulinemia (XLA or Bruton disease) is a genetic disorder mapped to q21.3-q22 on the long arm of the X chromosome and encodes the B-cell-protein tyrosine kinase Btk. Thus far, all males with XLA have low or undetectable Btk mRNA and kinase activity (1). Affected boys have a profound defect in B lymphocyte development resulting in severe hypogammaglobulinemia, absence of circulating B cells, small to absent tonsils, no palpable lymph nodes and abnormal lymph node architecture (2-5). After 6 to 9 months of life, the patients acquire infections with extracellular pyogenic organisms, such as Streptococcus pneumoniae and Haemophilus influenzae (2). The incidence of lymphatic and hematologic malignancies in patients with primary immunodeficiencies, e.g., common variable immunodeficiency, Chediak-Higashi syndrome, Wiskott-Aldrich syndrome and X-linked lymphoproliferative disorder, are 100-300 times the rate in the normal population (1). In contrast, solid tumors, especially gastric adenocarcinomas, may also occur in adults but are extremely rare in children (1,6,7). This finding corresponds to the rate of colonization with Helicobacter pylori and the development of chronic atrophic gastritis and gastric carcinoma in adults versus children, respectively (8). Gastrointestinal malignancies associated with primary immunodeficiencies generally occur in the colon or lymphatic tissue of the stomach (2,3,5). In XLA, to our knowledge, only two patients with gastric adenocarcinoma have been described (9,10); one of these patients was a young adult aged 23 years (10). CASE REPORT We report on the case of a teenager with XLA. Diagnosis was confirmed by typical clinical and laboratory findings (Tables 1 and 2) and by mutation analysis of the Btk gene SSCP analysis. Subsequent sequencing of polymerase chain reaction products revealed the mutation, Arginine 372 to Glycine (Adenine 1246 Guanine) (11). At age 15 years, the boy developed megaloblastic anemia, sensory deficit in both legs and ataxia. Diagnosis of combined iron deficiency and vitamin B12 deficiency was made. Schilling test confirmed a lack of intrinsic factor with reduced intestinal absorption of vitamin B12. Antibodies against parietal cells and intrinsic factor were not detectable. Chronic atrophic gastritis was suspected and gastroduodenoscopy revealed complete intestinal metaplasia with glandular epithelial dysplasia of the antral mucosa consistent with the suspected diagnosis. Helicobacter pylori was not detected in mucosal biopsies. Parenteral administration of vitamin B12 led to complete remission of the boy's complaints within 3 months. A second gastroduodenoscopy 6 months later revealed a polypoid lesion near the pylorus. Complete gastrectomy with gastroplasty using jejunal interposition (Longmire-Gütgemann procedure) was performed. Upper abdominal lymph nodes were resected for investigation. Histologic examination of the polypoid specimens revealed a highly differentiated gastric adenocarcinoma of the intestinal type (Fig. 1). Histologic examination of more than 32 abdominal lymph nodes revealed typical architectural derangements characteristic of XLA (Fig. 2). No metastases were found. After gastrectomy, the boy's condition improved rapidly. No symptoms of blind loop or short bowel syndrome developed. He received regular parenteral vitamin B12, and laboratory values remained normal. His weight gain was good and he remained in good health 10 years after diagnosis of gastric adenocarcinoma. Repeated follow-up investigations revealed no relapse.TABLE 1: Laboratory findings in our patient, suggestive for XLA and chronic atrophic gastritis.TABLE 2: Clinical findings in our patient, suggestive for XLA and chronic atrophic gastritis.FIG. 1: Well-differentiated adenocarcinoma of the stomach, early gastric cancer limited to the mucosa (pT1, pN0, pMX, G1, R0, intestinal type of the Lauren classification; hematoxylin and eosin stain, original magnification ×20).FIG. 2: Lymphoid nodular hyperplasia of lymph node in XLA (hematoxylin and eosin stain; Panel A). Immunohistochemistry demonstrates the predominance of CD3-positive T-lymphocytes (Panel B) and the absence of CD20-positive B-lymphocytes (Panel C) (all figures original magnification ×20).DISCUSSION This case demonstrates that XLA may be associated with chronic atrophic gastritis and subsequent upper gastrointestinal malignancy, especially gastric adenocarcinoma, as previously described in other primary immunodeficiency syndromes, even without colonization by Helicobacter pylori (1). Patients with chronic atrophic gastritis are especially prone to the development of gastric cancer. Therefore, children with XLA should be regularly screened for symptoms of chronic atrophic gastritis, i.e., vitamin B12 deficiency. In such cases, early gastroduodenoscopies should be performed to allow diagnosis of gastric malignancies before metastasis has occurred.

Brush Cytology of Gastric Malignancies

To compare endoscopic biopsy and cytology versus biopsy alone in the diagnosis of gastric malignancies. This prospective study included 229 cases referred for endoscopy for visible gastric lesions during a four-year period (1996-2000). Both biopsy and brush cytology were performed, and all the slides were screened by a cytotechnologist and reviewed by a pathologist. Of the 229 cases, 97 (42.4%) were proven to be malignant and 132 (57.6%) definitely benign. Biopsy was positive in 90 patients (92.7%), while brush cytology was positive in 85 (87.1%). Combined use of biopsy and brush cytology yielded higher diagnostic sensitivity (100%). Brush cytology is a safe, easy and rapid method of diagnosing gastric malignancies. Brush cytology is a useful adjunct in the diagnosis of gastric malignancies and should be considered a routine method in combination with biopsy. Multiple repeated endoscopies are recommended in cases of positive cytology and negative biopsy to rule out or confirm malignancy.

Ultrasonographic findings in gastric cancer: In vitro and in vivo studies

Ultrasonography was performed in 45 cases of gastric cancer. Specimens from all 45 cases of gastric cancer were subjects to ultrasonographic study by the water immersion method for comparison with histology. In 32 of these 45 cases in vivo ultrasonographic evaluation was performed prospectively. The overall accuracy rates for the diagnosis of the depth of cancerous invasion were almost 80% in both in vitro and in vivo studies. In vivo ultrasonographic findings agreed well with those from the specimen studies. Ultrasonography was considered to be useful in the diagnosis of gastric malignancies.

A prospective evaluation of biopsy site in the diagnosis of gastric malignancy: The margin or the base?

The diagnostic value of endoscopic biopsy from the ulcer margin (six specimens) and the base (six specimens) in 46 cases of gastric malignancy was evaluated. The biopsy positive rates for malignancy from the ulcer margin and the base were 42 of 46 (91.3%) and 37 of 46 (80.4%), respectively (P = 0.2312). The diagnostic positive rate was increased to 95.6% (44 of 46) when the results of 12 biopsy specimens obtained from the ulcer margin and the base were combined. The diagnostic positive rate was not statistically different when the morphology or the location of the gastric malignancy was considered. No complication of massive bleeding or perforation was found after both sites had been biopsied. It is concluded that the margin and the base of a gastric malignant ulcer are both suitable and diagnostically effective for endoscopic biopsy. If the ulcer margin of the gastric malignancy is difficult to approach, the ulcer base appears to be a satisfactory alternative site for endoscopic biopsy.

Over the counter sales of histamine-2 receptor antagonists.

Self treatment with H2 antagonists may have a positive impact on quality of life and costs. It may, however, also lead to incomplete peptic ulcer healing with frequent relapse and complications, inadequate long term treatment, neglectance of the life style type treatment for gastroesophageal reflux disease and a delay in the diagnosis of gastric malignancy. More research needs to be focused on the consequences of a more unrestricted and symptom guided use of H2 antagonists.

Pepsinogens

In this paper the role of pepsinogen has been reviewed in its physiological and clinical aspects. Although acid secretion has traditionally received far more attention clinically and has therefore been studied in great detail, the development of cellular systems has recently seen a revival in interest of pepsinogen secretion. These systems have made it possible to study pepsinogen secretion in more detail. Although many questions remain unanswered, a picture of a stimulus-secretion coupling mechanism of the chief cell has emerged that resembles in many aspects the pancreatic acinar cell, but also possesses some unique features of its own. The chief cell monolayer culture has also made it possible to study pepsinogen synthesis, and these studies seem to have solved the old controversy of whether or not modulation of pepsinogen synthesis occurs as a result of increased secretion. It now seems that pepsinogen synthesis does indeed increase in response to stimulated secretion. In addition to physiological studies, this review has discussed clinical aspects of the human pepsinogens in various gastric disorders. The clinical implications of genetic heterogeneity of the human pepsinogens are especially intriguing. Relationships between certain PGA phenotypes and certain gastric disorders have been described and some studies have tried to evaluate the relevance of these findings for diagnostic purposes. So far, it seems that PGA phenotyping alone has only limited diagnostic value, but, in combination with serum PGA determinations, could be of additional help in the diagnosis of gastric malignancy. In addition, various studies suggest that the ratio of serum PGA and PGC levels may be helpful in determining the histological status of the gastric mucosa. A very promising possibility in solving the many problems involved in exact genotype determinations through phenotyping is the recent availability of cDNA probes. With this technique, the question of whether the association between PGA phenotypes and gastric malignancy is primary or secondary may be solved in the near future. In view of the very poor prognosis for gastric cancer, further studies concerning the relationships between gastric cancer, serum pepsinogen levels, and PGA phenotypes or genotypes will hopefully lead to the possibility of an earlier diagnosis for gastric malignancy.

Gastroscopic cytology and biopsies in diagnosis of gastric malignancies

The outcome in gastric malignancy has changed in recent years owing to its early and accurate diagnosis employing fiber-optic endoscopy and histocytology. One hundred and two subjects with endoscopic demonstration of various gastric lesions were subjected for brush cytology and multiple biopsies. Observing a high degree of specificity, the accuracy of brush cytology was 81% and histology 72% with cumulative diagnostic yield of 91%. There was no false-positive report with cytology; histology, however, gave three false-positive results. The present study thus confirms the high diagnostic accuracy of brush cytology combined with multiple biopsies in gastric malignancies.

Failure of gastric cytologic technic in the diagnosis of gastric malignancy.

Failure of gastric cytologic technic in the diagnosis of gastric malignancy.

Diagnosis of gastric malignancy by blind gastric biopsy.

Two cases have been reported in which a histologic diagnosis of carcinoma of the stomach was made by means of biopsy by the Wood's tube.

Nuclear Size of Cells in Normal Stomachs, in Gastric Atrophy and in Gastric Cancer

Summary The measurement of gastric columnar cell nuclear size is simple and reliable. The gastric mucosal nuclei of patients with pernicious anemia are larger and more variable in size than are normal nuclei. The nuclei of patients with gastric cancer are still larger and more variable. The method offers potential usefulness as an adjunct to the diagnosis of gastric malignancy.

The Diagnosis of Gastric Malignancy in Pernicious Anemia

The Diagnosis of Gastric Malignancy in Pernicious Anemia

A source of error in the diagnosis of gastric malignancy.

The barium meal findings obtained from a case with a long history of dyspepsia with recent loss of weight are presented. At the first examination a persistent irregular filling defect was visualised on the greater curvature of the stomach. A radiological report suggesting an ulcerating carcinoma as the cause of this defect was made. The barium meal was repeated and the diagnosis was not confirmed. A gastrectomy was performed and the subsequent histological examination showed the presence of a small healed ulcer on the anterior wall of the stomach. It is suggested that the associated gastrospasm was the cause of the filling defect seen on the greater curvature.