Confocal endomicroscopy for phenotypic diagnosis of gastric cancer.
OBJECTIVE
Relationships between mucin phenotype and malignant potential in gastric cancers have attracted attention. We attempted to assess the possibility of obtaining phenotypic diagnoses by confocal endomicroscopy.


METHODS
Confocal images of target lesions were obtained in 29 of 40 patients with gastric cancer. Appearances of the brush border, goblet cells, and gastric foveolar epithelium were investigated with immunohistochemical staining using CD10, MUC2, and human gastric mucin to evaluate phenotypic expression in gastric carcinomas. Confocal images were compared with immunohistochemical findings for goblet cells and brush borders.


RESULTS
Both the endoscopists and the pathologist obtained high accuracy rates for differential diagnosis. Sensitivity and specificity for goblet cells were 85.7% and 92.3% (Endoscopist A), and 85.7% and 88.5% (Endoscopist B). The kappa-value for correspondence between two endoscopists for the diagnosis of goblet cells in confocal images was 0.73. Sensitivity and specificity for the brush border were 93.8% and 91.7% (Endoscopist A), and 81.3% and 91.7% (Endoscopist B). The kappa-value for correspondence between two endoscopists for diagnosis of the brush border in confocal images was 0.79. Intestinal phenotypic gastric cancers show a brush border, goblet cells, or both. Sensitivity and specificity for the intestinal phenotype in confocal endomicroscopy were 90.9% and 77.8% (Endoscopist A), and 86.4% and 83.3% (Endoscopist B).


CONCLUSIONS
The confocal endomicroscopic diagnosis of the mucin phenotype in gastric cancers was limited to intestinal and mixed phenotypes, but may be useful for the diagnosis of mucin phenotype and differential diagnosis.
Banno
Kakunori
K
Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Niwa
Yasumasa
Y
Miyahara
Ryoji
R
Nakamura
Masanao
M
Nagaya
Toshihiko
T
Nagasaka
Tetsuro
T
Watanabe
Osamu
O
Ando
Takafumi
T
Kawashima
Hiroki
H
Ohmiya
Naoki
N
Itoh
Akihiro
A
Hirooka
Yoshiki
Y
Goto
Hidemi
H
D000230:Adenocarcinoma / Q000737:chemistry / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002454:Cell Differentiation; D003937:Diagnosis, Differential; D005260:Female; D005752:Gastric Mucins / Q000032:analysis; D005773:Gastroscopy; D020397:Goblet Cells / Q000737:chemistry / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018613:Microscopy, Confocal; D008871:Microvilli / Q000737:chemistry / Q000473:pathology; D008875:Middle Aged; D055262:Mucin-2 / Q000032:analysis; D015260:Neprilysin / Q000032:analysis; D015588:Observer Variation; D010641:Phenotype; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000737:chemistry / Q000473:pathology*
D005752:Gastric Mucins; C524625:MUC2 protein, human; D055262:Mucin-2; D015260:Neprilysin