title: Impact of the angulus biopsy for the detection of gastric preneoplastic conditions and gastric cancer risk assessment.
abstract: BACKGROUND
  Gastric atrophy and intestinal metaplasia (IM) are preneoplastic conditions in the development of gastric cancer. Histopathological assessment is based on the updated Sydney system and superordinate staging systems, operative link on gastritis assessment (OLGA) and operative link on gastritis assessment using IM (OLGIM), all requiring a biopsy from the incisura angularis (angulus).
  
  
  OBJECTIVE
  To determine the value of the angulus biopsy for the detection of preneoplastic conditions and cancer risk evaluation using OLGA and OLGIM prospectively.
  
  
  METHODS
  Biopsies from antrum (2), angulus (1) and corpus (2) were obtained from 213 patients (age 19-94 years, median 54 years, female to male ratio 138:75) undergoing upper endoscopy. Histological assessment according to the updated Sydney system, OLGA and OLGIM staging was performed by gastrointestinal pathologists. Statistical analysis used exact confidence limits for dichotomous variables and repeated measurement analysis of variance.
  
  
  RESULTS
  8% of the cases with atrophic gastritis and 3% with IM (17 vs 6/213) would have been missed without the angulus biopsy. More patients were diagnosed with a preneoplastic condition when the angulus biopsy was considered (13.1%, CI 8.9% to 18.4%), but the grade of atrophy, if present at both sides, did not vary significantly in angulus and antrum. OLGA and OLGIM scores dropped significantly when recalculated without the angulus (difference in means±SD 0.131±0.402 and 0.075±0.313, respectively). The impact on the identification of high-risk stages is limited.
  
  
  CONCLUSIONS
  The angulus biopsy adds to the detection of mild gastric atrophy in particular. It allows identifying a small additional number of patients with high-risk gastritis.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Varbanova
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany Department Molecular Genetics, Medical Laboratories for Clinical Chemistry, Microbiology and Infectious Diseases, Magdeburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wex
authors.affiliation: Institute of Pathology, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Jechorek
authors.affiliation: Institute of Biometrics and Medical Informatics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
authors.forename: F W
authors.initials: FW
authors.lastname: Röhl
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Langner
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Selgrad
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001706:Biopsy / Q000379:methods*; D005260:Female; D005757:Gastritis, Atrophic / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D016014:Linear Models; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology*; D055815:Young Adult
keywords: GASTRITIS; HELICOBACTER PYLORI; HISTOPATHOLOGY