title: Chromoendoscopy in combination with random biopsies does not improve detection of gastric cancer foci in CDH1 mutation positive patients.
abstract: Background and study aims:Hereditary diffuse gastric cancer (HGGC), an autosomal dominant tumor-syndrome, accounts for 1 % to 3 % of gastric cancers worldwide. Presumably 30 % to 40 % of all patients fulfilling the clinical guidelines for HDGC are carriers of a pathogenic mutation in theCDH1gene. Patients often show multiple foci of signet ring cell carcinoma at early age and are advised to undergo prophylactic total gastrectomy (PTG). Our aim was to improve the endoscopic detection of HDGC by using an enhanced endoscopic protocol.Patient and methods:Patients with a provenCDH1germline mutation identified in our institute were prospectively included. Patients were advised to undergo PTG and offered a baseline endoscopic examination prior surgery. Examination was performed by using high-resolution white-light endoscopy and pan-gastric chromoendoscopy with indigo carmine as dye combined with targeted and multiple random biopsies assessed by an expert histopathologist. Postoperative histopathology was compared with results from endoscopic biopsies.Results:Between September 2012 and November 2014 8 patients with a provenCDH1germline mutation were included. We conducted 44 targeted (6.3/patient) and 225 random (32.1/patient) biopsies in 7 patients. We detected 1 gastric cancer by random biopsy (14 %). All other examinations showed no signs of cancer. Histopathology of gastrectomy specimen revealed multiple foci of gastric carcinoma in 6 patients (86 %) with a total number of 27 cancer foci.Conclusions:Examination with targeted and random biopsies combined with chromoendoscopy is not able to detect small foci of gastric cancer inCDH1mutation carriers. Therefore PTG is advocated in these patients.
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hüneburg
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Marwitz
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: van Heteren
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Tobias J
authors.initials: TJ
authors.lastname: Weismüller
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.
authors.forename: Jonel
authors.initials: J
authors.lastname: Trebicka
authors.affiliation: Institute of Human Genetics, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Ronja
authors.initials: R
authors.lastname: Adam
authors.affiliation: Institute of Human Genetics, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Aretz
authors.affiliation: Institute of Pathology, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Alberto
authors.initials: A
authors.lastname: Perez Bouza
authors.affiliation: Department of Surgery, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pantelis
authors.affiliation: Department of Surgery, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Kalff
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Jacob
authors.initials: J
authors.lastname: Nattermann
authors.affiliation: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany.
authors.forename: Cristian P
authors.initials: CP
authors.lastname: Strassburg