title: Is pretreatment endoscopic biopsy a good predictor of signet ring cell histology in gastric carcinoma?
abstract: BACKGROUND
  Signet ring cell (SRC) carcinoma is defined as an adenocarcinoma in which >50% of the total operative specimen consists of isolated or small groups of malignant cells containing intracytoplasmic mucins (hSRCs). We previously demonstrated that hSRCs are a predictor of poor prognosis with specific tumoral characteristics suggesting the need for a dedicated therapeutic strategy before surgery. However diagnostic accuracy and prognostic value of SRCs on pretreatment biopsies (bSRCs) is unknown. The aim of the study was to determine if bSRCs can accurately predict hSRCs and survival.
  
  
  METHODS
  A retrospective analysis was performed among 254 patients with an adenocarcinoma. We performed pretreatment endoscopic biopsies and histopathologic analysis of the surgical specimen. Pretreatment endoscopic biopsy results were compared with definitive pathologic results and were correlated with long-term survival.
  
  
  RESULTS
  From 254 patients enrolled, 96 had bSRCs (37.8%), and 101 (39.8%) had hSRCs. Pretreatment biopsy results were correct in 89 of 101 patients with hSRC (sensitivity 88.1%) and in 146 of 153 with histologic non-SRCs (hNSRCs) (specificity 95.4%). The positive and negative predictive values for the biopsies were 92.7, and 92.4%, respectively, with an overall accuracy of 92.5%. When compared to the biopsy results, non-SRCs (bNSRCs), bSRCs were associated with poorer survival and were identified as an independent factor for poor prognosis (hazard ratio 1.89 with 95% confidence interval 1.35 to 2.64, P < 0.001).
  
  
  CONCLUSIONS
  The presence of signet ring cells in samples obtained from routine pretreatment endoscopic biopsies accurately predicts SRC histology and poor prognosis. The specific therapeutic strategy can consequently be considered from the initial diagnosis.
authors.affiliation: Department of Digestive and Oncological Surgery, Centre Hospitalier Régional Universitaire de Lille, University Hospital Claude Huriez, Place de Verdun, 59037, Lille cedex, France. guillaume.piessen@chru-lille.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Piessen
authors.forename: David
authors.initials: D
authors.lastname: Amielh
authors.forename: Mathieu
authors.initials: M
authors.lastname: Messager
authors.forename: Edouard
authors.initials: E
authors.lastname: Vinatier
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Leteurtre
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Triboulet
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000368:Aged; D001706:Biopsy; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D015996:Survival Rate
references.citation: Ann Oncol. 2003;14 Suppl 2:ii31-6
references.pmid: 12810455
references.citation: Eur J Cancer. 1994;30A(9):1263-9
references.pmid: 7999410
references.citation: Acta Pathol Microbiol Scand. 1965;64:31-49
references.pmid: 14320675
references.citation: Ann Surg. 2011 Nov;254(5):684-93; discussion 693
references.pmid: 22005144
references.citation: Cancer. 2000 Oct 1;89(7):1418-24
references.pmid: 11013353
references.citation: Oncology. 2007;72(1-2):64-8
references.pmid: 18004078
references.citation: N Engl J Med. 2001 Sep 6;345(10):725-30
references.pmid: 11547741
references.citation: N Engl J Med. 2006 Jul 6;355(1):11-20
references.pmid: 16822992
references.citation: APMIS. 1994 Sep;102(9):711-5
references.pmid: 7946275
references.citation: Curr Probl Surg. 2006 Aug-Sep;43(8-9):566-670
references.pmid: 17000267
references.citation: Scand J Gastroenterol. 1996 Jul;31(7):711-5
references.pmid: 8819223
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 Jul;18(7):1945-52
references.pmid: 19531677
references.citation: Gut. 1992 Jun;33(6):724-6
references.pmid: 1624148
references.citation: Endoscopy. 1993 Feb;25(2):162-6
references.pmid: 8491133
references.citation: Arch Pathol Lab Med. 2004 Jul;128(7):765-70
references.pmid: 15214826
references.citation: Br J Cancer. 1991 May;63(5):765-8
references.pmid: 2039701
references.citation: World J Surg. 2002 Feb;26(2):137-40
references.pmid: 11865338
references.citation: Arch Surg. 2009 Jun;144(6):506-10
references.pmid: 19528381
references.citation: Clin Cancer Res. 2005 Mar 15;11(6):2229-36
references.pmid: 15788671
references.citation: Ann Surg. 2009 Dec;250(6):878-87
references.pmid: 19855261
references.citation: J Gastrointest Surg. 2005 May-Jun;9(5):718-25
references.pmid: 15862270
references.citation: J Pathol. 2004 Aug;203(4):884-95
references.pmid: 15258990
references.citation: Ann Surg. 2010 Jul;252(1):70-3
references.pmid: 20562605
references.citation: Cancer Epidemiol Biomarkers Prev. 2001 Jan;10(1):75-8
references.pmid: 11205493
references.citation: Ann Surg. 2006 Jan;243(1):64-73
references.pmid: 16371738
references.citation: Virchows Arch. 2001 Jan;438(1):49-56
references.pmid: 11213835
references.citation: Oncol Rep. 2000 Jul-Aug;7(4):841-6
references.pmid: 10854555
references.citation: Br J Surg. 2004 Oct;91(10):1319-24
references.pmid: 15376179
references.citation: Hepatogastroenterology. 2009 Jul-Aug;56(93):1227-31
references.pmid: 19760976
references.citation: Surgery. 2011 Mar;149(3):356-63
references.pmid: 20727560
references.citation: Radiology. 1991 Nov;181(2):426-32
references.pmid: 1924784
references.citation: Gastroenterology. 1982 Feb;82(2):228-31
references.pmid: 7054024