Lymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion . The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.
Tag Archives: gastric cancer
Helicobacter Pylori and its Determinations on Gastric Biopsies
Background and Aims. Gastric cancer, because of its aggressive evolution and the high mortality associated with it, remains one of the most debated subjects in medical literature with Helicobacter pylori (HP) as a major risk factor. Chronic inflammation caused by HP infection represents the initial site of the predisposing and afterwards premalignant lesions for gastric carcinoma. The purpose of this study was to evaluate the prevalence of HP infection, of predisposing and premalignant lesions on gastric biopsies, as well as to identify the correlations between them.
Material and method. A retrospective cross-sectional study was performed on gastric biopsies collected endoscopically from a single region, antrum or corpus, and from different regions, between January 2012 and July 2014. Incidence of HP infection, of predisposing and premalignant gastric lesions, the correlation of HP infection and these lesions, were evaluated.
Results. HP infection was diagnosed in 32.81%. Predisposing and premalignant lesions were present in 53.64% of biopsies with most of them in the antrum. HP infection stands out for the under 50 yo group (p=0.001). No correlation between frequency of HP infection and predisposing and premalignant lesions was observed.
Conclusions. Prevalence of HP infection in our study suggests that besides HP infection, other factors are also involved in gastric cancer development. Biopsies from different regions of the gastric mucosa do not offer extra information regarding HP infection prevalence but may be helpful in evaluating incidence and extension of predisposing and premalignant lesions.
The Detection of Premalignant and Malignant Gastric Lesions by Conventional Endoscopy in a General Population Sample
Background and Aims: The identification of patients with premalignant lesions and endoscopic surveillance could improve the early detection of gastric cancer, with better therapy and prognosis. We performed conventional endoscopy with biopsies to identify the incidence rates of premalignant and malignant gastric lesions and the risk of patients for this pathology.
Methods: A total of 1651 patients were investigated with conventional endoscopy. We took biopsies from 1493 patients. Biopsy specimens were analyzed for gastric inflammation, atrophy, intestinal metaplasia, dysplasia and neoplasia.
Results: We demonstrated that major symptoms had a sensitivity of 95.2%, and a specificity of 54.5% for the detection of gastric neoplasia, with a sensitivity of 61.6% and a specificity of 57.2% for the detection of premalignant lesions. We showed the risk of patients over 45 years, with major or minor symptoms, for premalignant and malignant gastric lesions (p < 0.001; RR = 3.34; 95%CI: 2.41–4.61). We emphasized the importance of histological evaluation by biopsies of entire gastric mucosa in case of polyps, ulcers, gastric atrophy detection or remnant stomach, for the evaluation of premalignant lesions (p < 0.,05). We showed that the prevalence of premalignant lesions increased with age and the presence of Hp infection. We demonstrated the risk of the inflammation in the gastric body for premalignant lesions.
Conclusions: The patient’s symptoms were not predictive of endoscopic and histologic findings. Not only symptoms, but also the age, the presence of Helicobacter pylori infection, the histological detection of the extent and location of gastric inflammation and premalignant lesions define the risk for the dyspeptic patients.
Endoscopic Examination: a Present and Future Challenge
The detection and surveillance of patients with premalignant gastric lesions could lead to early detection and treatment of gastric cancer. These lesions are mostly diagnosed in random biopsy samples obtained during conventional endoscopy. New endoscopic techniques, such as magnification endoscopy, may help the detection of neoplastic lesions. In this case series, we intended to emphasize the current problems in the detection and surveillance of gastric neoplasic lesions in clinical practice. Four cases with gastritis-like appearance on conventional endoscopy were identified with gastric dysplasia or carcinoma on histopathologic evaluation. We discussed the subjective interpretation of endoscopic findings, the challenges in the surveillance of low-grade dysplasia and the contribution of magnifying endoscopy on diagnostic accuracy. The performance of endoscopic examination and surveillance could be improved by magnified chromoendoscopy with targeted biopsies. An understanding of diagnostic challenges of gastric dysplasia is crucial in clinical management.
Preliminary Results Regarding the New Changes in the 7th AJCC/UICC Staging System of Gastric Carcinomas
Objective: The aim of the study was to analyze in parallel the 6th and the newest 7th AJJCC/UICC (American Joint Committee on Cancer/ International Union Against Cancer) staging system in order to highlight changes brought about the new staging system.
Methods: We analyzed data obtained retrospectively from 134 hospitalized patients diagnosed with gastric carcinomas, who underwent surgery at the Surgery Clinic of the Emergency County Hospital of Tîrgu Mureş, Romania between 2008–2010. The data have been obtained from histopathology reports, and the analyzed parameters were the following: age, gender and pTNM staging. For all cases included in the study restaging was performed according to the 7th AJJCC/UICC staging system. For statistical analysis we used GraphPad InStat software.
Results: 71.66% of cases were adenocarcinomas, 7.46% mucinous adenocarcinoma, 14.17% signet ring cell carcinoma, and 6.71% undifferentiated carcinoma. The signet ring cell carcinomas predominated before 65 years of age (p=0.003). Compared to the 6th staging system, in the new system, pT2 percentages decreased significantly from 38.8% to 6.71%, and pT4 increases from 11.19% to 55.97% (p<0.0001).The pN3 cases increased from 20.9% to 45.52%, because all cases classified as pN2 in the old staging system, become pN3 in the new system. Some of pN1 cases turned into pN2 in the new system (p=0.004). The stage IV cases also decreased from 29.85% to 14.94%, due to regrouping of stage III.
Conclusions: There are significant changes between the two staging systems. The new staging system aims to achieve a better postoperative follow-up.
Gastric Intestinal Metaplasia: Prevalence, Clinical Presentation, Endoscopic and Histological Features
Background and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pylori infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia.
Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings.
Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19).
Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies.
Individual Prognostic Factors in Gastric Cancer
Objectives: The objective of this research was to study the prognostic factors in gastric cancer.
Methods: We conducted a retrospective study on 5-year survival in 112 patients with gastric adenocarcinoma operated between 2004-2009. We used the Surgery Clinic I and Health Insurance House databases for study of the following parameters: age, sex, depth of invasion, histological type, surgery, number of lymph nodes excised and reported overrun / removed lymphnodes.
Results: There was no significant survival difference related to gender aspects. We found significant differences in the survival rate in relation to the tumours confined to the mucosa and muscularis mucosae (100% and 60% respectively), compared to the cases with deeper invasion (p<0.05). Intestinal type presented a superior however insignificant prognosis compared to diffuse type (22% versus 5.66%). Five years survival was slightly lower after D1 lymphadenectomy D1 compared to D2 lymphadenectomy (25.92% versus 29.16%). We found large differences among the number of perigastric lymph nodes (between 3 and 42 in groups of 1 to 6) nodules. Survival rates were significantly higher (p <0.05) in patients with overrun lymphnodes between 0 and <20%, compared to those with overrun ones over 20% of all excised nodes (23.07%, 55.55% vs. 3.89%).
Conclusions: Merely the number of removed lymph nodes may be a source of error in staging if not taken into account the groups they belong to; the most constant individual prognostic factors are the depth of invasion and overrun/removed lymph nodes report; D2 lymphadenectomy has superior results in terms of 5 years survival compared to D1 lymphadenectomy, but, at least in our study, the difference was insignificant.