title: Confocal endomicroscopy for phenotypic diagnosis of gastric cancer.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Kakunori
authors.initials: K
authors.lastname: Banno
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Ryoji
authors.initials: R
authors.lastname: Miyahara
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nagaya
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nagasaka
authors.forename: Osamu
authors.initials: O
authors.lastname: Watanabe
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ando
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawashima
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: 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*
chemical_list: D005752:Gastric Mucins; C524625:MUC2 protein, human; D055262:Mucin-2; D015260:Neprilysin