Accuracy of the First Endoscopic Procedure in the Differential Diagnosis of Gastric Lesions

Llanos, O; Guzmán, Sergio; Duarte, Ignacio

doi:10.1097/00000658-198202000-00018

Cited by 40 publications

(14 citation statements)

References 4 publications

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“…The sensitivity and specificity of the potential malignant endoscopic characteristics were high. The sensitivity of endoscopic suspicion in combination with histologic examination at the first endoscopy was 100 %, which is in line with the 99 % accuracy of endoscopic characteristics in combination with histologic analysis found by others [11,17]. Also, Manas et al [9] discovered only one malignancy among the 279 second-look endoscopies performed in their prospective study.…”

Section: Discussionsupporting

confidence: 73%

Follow-up endoscopy for benign-appearing gastric ulcers has no additive value in detecting malignancy

Gielisse

Kuyvenhoven

2014

Gastric Cancer

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Objective To determine the diagnostic accuracy of endoscopic follow-up for gastric ulcers. Methods All cases of gastric ulcers diagnosed at our teaching hospital between September 2005 and November 2011 were reviewed. The cases were selected by using ENDOBASE, an endoscopy documentation system. The characteristics of the ulcers and their histology were analysed. Results During the study period 321 cases with a gastric ulcer were diagnosed, including 214 benign ulcers (67 %) and 107 malignant ulcers (33 %). The mean age of the population was 71 years. In 200 patients (62 %) the ulcers were classified as benign appearing at the first endoscopy. However, in five of these patients, the ulcers eventually were malignant. In all of these five patients the index gastroscopy revealed a non-benign histology. Therefore, the sensitivity of a benign appearance of the ulcer in combination with histology at the first endoscopy is 100 % to rule out malignancy. In 121 patients (38 %) the ulcers were explicitly labelled as potentially malignant in the report of the first endoscopy. Of these potentially malignant-appearing ulcers, 102 (84 %) were indeed malignant as confirmed by histology. The other 19 ulcers (16 %) were benign at follow-up. The sensitivity of the three potential malignant characteristics at endoscopy was: dirty base 79 %, elevated border 94 % and irregular border 91 %. The specificity was 93, 82 and 89 %, respectively. The median diameter of the ulcers was significantly higher in the malignant group compared to the benign ulcer group (p \ 0.0001). The accuracy of endoscopic malignancy diagnosis was as follows: sensitivity of 0.98 and specificity 0.84, positive predictive value 0.84 and negative predictive value 0.98. In total, 546 gastroscopies were performed in these 321 patients, of which 225 were follow-up endoscopies. By not monitoring ulcers considered benign in both appearance and histology, 173 gastroscopies would not have been performed, resulting in a decline of 77 % of the follow-up endoscopies performed. Conclusion Endoscopic follow-up of gastric ulcers considered benign by appearance and with benign histology showed no additive value in detecting unsuspected malignancy in this study. This strategy could reduce health costs and save distress to patients.

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Section: Discussionsupporting

confidence: 73%

Follow-up endoscopy for benign-appearing gastric ulcers has no additive value in detecting malignancy

Gielisse

Kuyvenhoven

2014

Gastric Cancer

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“…Upper digestive tract endoscopy is the gold standard for the diagnosis of gastric tumors and has improved the accuracy of diagnosis [8]. When combined with biopsy and brush cytology, endoscopy has an overall sensitivity of 95%–98% in the detection of gastric cancer [9], [10]. Unfortunately, endoscopy is not accepted by all patients, as it is rather invasive and traumatic.…”

Section: Introductionmentioning

confidence: 99%

Enhancement Patterns of Gastric Carcinoma on Contrast-Enhanced Ultrasonography: Relationship with Clinicopathological Features

Wei

Huang

et al. 2013

PLoS ONE

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The aim of this study was to assess the relationship between the enhancement patterns and clinicopathological features of gastric cancer using intravenous contrast-enhanced ultrasonography (CEUS). In this Ethics Committee-approved prospective study, five hundred fifty two patients with gastric cancer who gave informed consent were examined preoperatively with CEUS. The enhancement pattern of each tumor was analyzed visually. Gross and histopathological findings on the postoperative specimens were compared with the preoperative CEUS findings. The most common CEUS pattern in differentiated gastric cancer was homogeneous enhancement, whereas heterogeneous enhancement was the most common pattern in undifferentiated gastric cancer. The proportion of heterogeneous enhancement was significantly different between the two histological subtypes (Chi- square = 146.735, P<0.001). The sensitivity and specificity of early heterogeneous enhancement on CEUS in diagnosing undifferentiated gastric cancer were 78.84% and 72.59% respectively. Gastric cancers with heterogeneous enhancement were more often Borrmann III and IV macroscopic types than those with homogeneous enhancement (66.56% vs. 30.80%, P<0.001), more commonly T3 and T4 depth of invasion than those with homogeneous enhancement (71.52% vs. 59.60%, P<0.05), more often showed lymphatic invasion than those with homogeneous enhancement (84.44% vs. 76.40%, P<0.05), and were less likely to receive curative gastrectomy than those with homogeneous enhancement (74.83% vs. 86.40%, P<0.005). The intra- and inter-observer reproducibility were both almost perfect for assessing enhancement patterns, with Kappa values of 0.916 (P<0.001) for intra-observer and 0.842 (P<0.001) for inter-observer reproducibility. CEUS provided detailed information about tumor vascularity and contrast enhancement patterns in gastric cancer. CEUS is promising as a new and useful method to predict the histological type of gastric cancer.

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“…A few previous studies showed that overall endoscopic and bioptic accuracy rates are very high at 97.4 to 98.8% (19,20). Thus, initial gastroscopy has higher diagnostic accuracy than that of the second-look gastroscopy.…”

Section: Discussionmentioning

confidence: 98%

Clinical outcomes of endoscopic surveillance for gastric ulcers in populations with a high prevalence of gastric cancer

Lee¹,

Han²,

Cho³

et al. 2016

Turk J Gastroenterol

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Accuracy of the First Endoscopic Procedure in the Differential Diagnosis of Gastric Lesions

Cited by 40 publications

References 4 publications

Follow-up endoscopy for benign-appearing gastric ulcers has no additive value in detecting malignancy

Follow-up endoscopy for benign-appearing gastric ulcers has no additive value in detecting malignancy

Enhancement Patterns of Gastric Carcinoma on Contrast-Enhanced Ultrasonography: Relationship with Clinicopathological Features

Clinical outcomes of endoscopic surveillance for gastric ulcers in populations with a high prevalence of gastric cancer

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