Utility of subtyping intestinal metaplasia as marker of gastric cancer risk. A review of the evidence

Abstract

The identification and surveillance of patients with preneoplastic lesions at high risk of progressing to gastric cancer (GC) represents the most effective way of reducing the burden of GC. The incomplete type of intestinal metaplasia (IM) could be considered as the best candidate for surveillance. However, the usefulness of subtyping of IM has been considered by some authors as limited and inconsistent. A search was carried out to identify all cross-sectional (n=14) and follow-up (n=10) studies that assessed the risk of GC among subjects with different types of IM. Out of the 14 cross-sectional studies, 13 reported that the prevalence of incomplete IM was statistically significantly higher in GC than in other gastric lesions. Out of the ten follow-up studies, six found a statistically significant association between incomplete IM and subsequent GC risk. The relative risks of GC were from 4- to 11-fold higher for the presence of incomplete type in comparison to complete type or in comparison to the absence of incomplete type, among the studies that reported the magnitude of the risk. According to this comprehensive review, most of the scientific evidence supports the utility of subtyping IM as a predictor of GC risk. Recognizing its usefulness by gastroenterologists should encourage pathologists to subtype IM.

Prognostic significance of leucine-rich-repeat-containing G-protein-coupled receptor 5, an intestinal stem cell marker, in gastric carcinomas

“…This result may be explained by the fact that noncancerous gastric tissues obtained from the same stomach of GC patients are highly likely to harbor precancerous lesions, especially abundant foci of intestinal metaplasia. It is well known that intestinal-type GCs develop through a multistep process (chronic atrophic gastritis, intestinal metaplasia, and dysplasia), and most GCs are found in the background of intestinal metaplasia [32]. Given the remarkable increase of LGR5 expression in intestinal metaplasia [25], variable degrees of intestinal metaplasia in noncancerous gastric mucosa could result in higher levels of LGR5 than in GCs.…”

Atrophic Gastritis and Intestinal Metaplasia

“…Moreover, it reported that the relative risks of gastric cancer were from 4-to 11-fold higher for the presence of incomplete type in comparison to complete type or in comparison to the absence of incomplete type [ 73 ]. This systemic report concluded that subtyping of IM has the scientifi c evidence on the evaluation of gastric cancer risk [ 73 ]. …”

“…International guideline did not recommend subtyping of IM for clinical practice in 2012 [ 72 ]. However, a recent systemic review concluded that the incomplete IM was significantly related to the prevalence of gastric cancer [ 73 ]. Moreover, it reported that the relative risks of gastric cancer were from 4-to 11-fold higher for the presence of incomplete type in comparison to complete type or in comparison to the absence of incomplete type [ 73 ].…”

The stratification of gastric cancer risk in Latin America

“…Intestinal metaplasia appears to carry a measurable risk for progression, particularly the subsets of incomplete metaplasia (colonic-type) and extensive metaplasia (antrum plus corpus). 7,8 The gastric carcinoma index developed by Meining is another example of the use of histopathology to quantify risk. 9 Historically, the gastroenterology and endoscopy society guidelines have not been helpful due to the lack of definitive studies.…”