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Published on: May 12, 2019
Mucin phenotype stratifies histological malignancy in superficial non-ampullary duodenal epithelial tumors: a
Atsushi Nakayama1, Kurato Miyazaki2, Kentaro Iwata3
1Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Background:
Superficial non-ampullary duodenal epithelial tumors (SNADETs) are being increasingly detected during routine endoscopy. However, biological malignancy and optimal risk stratification remain poorly defined. We aimed to clarify the association between mucin phenotypes and histological malignancies in SNADETs using a prospective study design.
Methods:
In this prospective observational study, patients with suspected SNADETs underwent a standardized magnified endoscopic examination with image-enhanced endoscopy (IEE-ME), followed by endoscopic resection. All specimens were centrally reviewed by expert gastrointestinal pathologists. Mucin phenotypes were classified as G type (gastric, predominantly gastric, or mixed) or I type (intestinal or predominantly intestinal). Histological malignancy was assessed using the Vienna classification (VCL). Clinicopathological and endoscopic factors associated with mucin phenotype and malignancy were systematically analyzed.
Results:
Among the 401 SNADETs, adenomas were predominant (72.1%), whereas submucosal invasive cancers were rare (2.5%). G-type SNADETs comprised 15.5% of lesions but demonstrated a markedly higher frequency beyond VCL category 4.1 compared to I-type SNADETs (P < 0.0001). The risk of histological malignancy increased stepwise with the proportion of gastric phenotypic components. Most invasive submucosal cancers exhibit a gastric phenotype. Multivariate analysis of the endoscopic findings identified a closed-loop structure, the absence of a white opaque substance on IEE-ME, and protruding morphology as independent predictors of G-type SNADETs.
Conclusion:
The gastric phenotype is strongly associated with increased histological malignancy in SNADETs. Specific endoscopic features can predict G-type SNADETs, suggesting that mucin phenotype-oriented endoscopic diagnosis may provide useful information for pretreatment risk stratification and treatment planning.
