Evaluation of confocal laser endomicroscopy for detection of occult gastric carcinoma in CDH1 variant carriers
Samuel A Schueler, Lauren A Gamble, Bryan F Curtin, Samantha M Ruff, Maureen Connolly, Cathleen Hannah, Martha Quezado, Markku Miettinen, Maureen George, Andrew M Blakely, Jonathan M Hernandez, Theo Heller, Christopher Koh, Jeremy L Davis, Samuel A Schueler, Lauren A Gamble, Bryan F Curtin, Samantha M Ruff, Maureen Connolly, Cathleen Hannah, Martha Quezado, Markku Miettinen, Maureen George, Andrew M Blakely, Jonathan M Hernandez, Theo Heller, Christopher Koh, Jeremy L Davis
Abstract
Background: Hereditary diffuse gastric cancer syndrome, attributed to inactivating germline CDH1 variants, is associated with an elevated lifetime risk of gastric cancer. We sought to evaluate cancer detection using probe-based confocal laser endomicroscopy (pCLE) during endoscopic surveillance.
Methods: A prospective, single-institution study was conducted in asymptomatic adults with pathogenic or likely pathogenic (P/LP) CDH1 variants. Subjects received endoscopic gastric surveillance using pCLE in conjunction with the Cambridge method (CM). Abnormalities visualized by pCLE were biopsied, followed by non-targeted mucosal biopsies according to the CM. Primary endpoint was to determine pCLE sensitivity for detection of occult SRC carcinoma compared to CM.
Results: Thirty-six patients with P/LP CDH1 variants underwent endoscopy using pCLE and CM. Majority were female (75%) with median age 47 years. Targeted biopsies of focal abnormalities on WLE were negative for carcinoma. Overall, 19.4% (7/36) patients had SRC detected on ≥1 biopsy. Non-targeted CM biopsies revealed SRC in 11.1% (4/36), whereas pCLE revealed SRC in 16.7% (6/36). Fifteen patients underwent total gastrectomy; all 15 explants contained occult carcinoma. In those 15 patients, the false-negative SRC detection rates for pCLE and CM were 67% and 87%, respectively.
Conclusions: Confocal endomicroscopy alone has low sensitivity for occult cancer detection in CDH1 variant carriers, although it appeared no worse than the current recommended method and required fewer biopsies per patient. A more reliable endoscopic surveillance is needed as a viable alternative to surgery in this high-risk population (ClinicalTrials.gov, Number: NCT03648879).
Keywords: Hereditary gastric cancer; endoscopy; stomach; surveillance.
Conflict of interest statement
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at: http://dx.doi.org/10.21037/jgo-20-430). The authors have no conflicts of interest to declare.
2021 Journal of Gastrointestinal Oncology. All rights reserved.
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Source: PubMed