Differential Diagnosis of Thickened Gastric Wall between Hypertrophic Gastritis and Borrmann Type 4 Advanced Gastric Cancer
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Background/Aims: Accurately diagnosing diffuse gastric wall thickening is challenging. Hypertrophic gastritis (HG), while benign, mimics the morphology of Borrmann type 4 advanced gastric cancer (AGC B-4). We compared the features of endoscopy and endoscopic ultrasonography (EUS) between them. Methods: We retrospectively reviewed patients who underwent EUS for gastric wall thickening between 2000 and 2021, selecting HG and pathologically confirmed advanced gastric cancer cases. Ulceration and antral wall thickening were determined via endoscopy, while EUS assessed the 5-layered gastric wall structure, measuring the proper muscle (PM) layer and total wall thickness. Results: Male dominance was observed in AGC B-4, and the hemoglobin and albumin levels were significantly lower. The rate of antral wall thickening and presence of ulceration were significantly higher in AGC B-4 cases. Destruction of the PM layers was observed only in AGC B-4 cases, and the PM was significantly thicker in AGC B-4 cases. Forceps biopsy had an excellent success rate in ulcer-present AGC B-4 cases, but only a 42.6% success rate was observed for cases without ulcers, necessitating additional diagnostic modalities. A PM thickness of 2.39 mm distinguished between AGC B-4 and HG effectively. The multivariable analysis showed that a thickened PM layer and the presence of ulceration were significant risk factors for the diagnosis of AGC B-4. Conclusions: Endoscopic findings of a thickened gastric wall, including antral involvement, and presence of ulcer were significant risk factors for the diagnosis of AGC B-4. EUS findings of destroyed wall layers and a thickened PM of >2.39 mm were the key points of differentiation between HG and AGC B-4.
Abstract
Background/Aims: Accurately diagnosing diffuse gastric wall thickening is challenging. Hypertrophic gastritis (HG), while benign, mimics the morphology of Borrmann type 4 advanced gastric cancer (AGC B-4). We compared the features of endoscopy and endoscopic ultrasonography (EUS) between them. Methods: We retrospectively reviewed patients who underwent EUS for gastric wall thickening between 2000 and 2021, selecting HG and pathologically confirmed advanced gastric cancer cases. Ulceration and antral wall thickening were determined via endoscopy, while EUS assessed the 5-layered gastric wall structure, measuring the proper muscle (PM) layer and total wall thickness. Results: Male dominance was observed in AGC B-4, and the hemoglobin and albumin levels were significantly lower. The rate of antral wall thickening and presence of ulceration were significantly higher in AGC B-4 cases. Destruction of the PM layers was observed only in AGC B-4 cases, and the PM was significantly thicker in AGC B-4 cases. Forceps biopsy had an excellent success rate in ulcer-present AGC B-4 cases, but only a 42.6% success rate was observed for cases without ulcers, necessitating additional diagnostic modalities. A PM thickness of 2.39 mm distinguished between AGC B-4 and HG effectively. The multivariable analysis showed that a thickened PM layer and the presence of ulceration were significant risk factors for the diagnosis of AGC B-4. Conclusions: Endoscopic findings of a thickened gastric wall, including antral involvement, and presence of ulcer were significant risk factors for the diagnosis of AGC B-4. EUS findings of destroyed wall layers and a thickened PM of >2.39 mm were the key points of differentiation between HG and AGC B-4.
참고문헌 (27)
- Téllez-Ávila FI, "EUS-guided tissue samples for the diagnosis of patients with a thickened gastric wall and prior negative endoscopic biopsies", Acta Gastroenterol Belg, 82, pp.359~362 (2019)
- Agarwala R, "Thickened gastric folds : approach", J Dig Endosc, 9, pp.149~154 (2018)
- Blaser MJ, "Association of infection due to Helicobacter pylori with specific upper gastrointestinal pathology", Rev Infect Dis, 13(Suppl 8), pp.S704~S708 (1991)
- Levine MS, "Scirrhous carcinoma of the stomach : radiologic and endoscopic diagnosis", Radiology, 175, pp.151~154 (1990)
- de Martel C, "Gastric cancer : epidemiology and risk factors", Gastroenterol Clin North Am, 42, pp.219~240 (2013)
- Shin A, "Gastric cancer epidemiology in Korea", J Gastric Cancer, 11, pp.135~140 (2011)
- Iwanaga T, "Treatment of macroscopical subtypes in Borrmann type 4 gastric carcinoma", Gan No Rinsho, 30(6Suppl), pp.724~728 (1984)
- Jung K, "Borrmann type 4 advanced gastric cancer : focus on the development of scirrhous gastric cancer", Clin Endosc, 49, pp.336~345 (2016)
- Andriulli A, "Endoscopic ultrasonographic evaluation of patients with biopsy negative gastric linitis plastica", Gastrointest Endosc, 36, pp.611~615 (1990)
- Thomas T, "Endoscopic-ultrasound-guided mural trucut biopsy in the investigation of unexplained thickening of esophagogastric wall", Endoscopy, 41, pp.335~359 (2009)
- Ginès A, "Endoscopic ultrasonography in patients with large gastric folds at endoscopy and biopsies negative for malignancy : predictors of malignant disease and clinical impact", Am J Gastroenterol, 101, pp.64~69 (2006)
- Mendis RE, "Large gastric folds : a diagnostic approach using endoscopic ultrasonography", Gastrointest Endosc, 40, pp.437~441 (1994)
- Lim H, "Use of endoscopic ultrasound to evaluate large gastric folds : features predictive of malignancy", Ultrasound Med Biol, 41, pp.2614~2620 (2015)
- Caletti G, "Endosonography in gastric lymphoma and large gastric folds", Eur J Ultrasound, 11, pp.31~40 (2000)
- Songür Y, "Endosonographic evaluation of giant gastric folds", Gastrointest Endosc, 41, pp.468~474 (1995)
- Kimmey MB, "Histologic correlates of gastrointestinal ultrasound images", Gastroenterology, 96(2 Pt 1), pp.433~441 (1989)
- Wu CW, "Incidence and factors associated with recurrence patterns after intended curative surgery for gastric cancer", World J Surg, 27, pp.153~158 (2003)
- Alici S, "Analysis of survival factors in patients with advanced-stage gastric adenocarcinoma", Med Sci Monit, 12, pp.CR221~229 (2006)
- Marrelli D, "Prognostic score in gastric cancer patients", Ann Surg Oncol, 14, pp.362~364 (2007)
- Saito H, "Effect of age on prognosis in patients with gastric cancer", ANZ J Surg, 76, pp.458~461 (2006)
- Kim BC, "Endoscopic characteristics of rugal hyperplasia and related acid condition in Helicobacter pylori-infected stomach", Clin Endosc, 54, pp.73~84 (2021)
- Akbas A, "Significance of gastric wall thickening detected in abdominal CT scan to predict gastric malignancy", J Oncol, 2019, pp.8581547~ (2019)
- Lambrecht NW, "Ménétrier's disease of the stomach : a clinical challenge", Curr Gastroenterol Rep, 13, pp.513~517 (2011)
- Myllylä V, "Ultrasonography of gastric tumours", Ann Clin Res, 16(Suppl 40), pp.65~68 (1984)
- Derchi LE, "Ultrasonographic appearances of gastric cancer", Br J Radiol, 56, pp.365~370 (1983)
- Rapaccini GL, "Gastric wall thickness in normal and neoplastic subjects : a prospective study performed by abdominal ultrasound", Gastrointest Radiol, 13, pp.197~199 (1988)
- Tongdee R, "A study of wall thickness of gastric antrum : comparison among normal, benign and malignant gastric conditions on MDCT scan", J Med Assoc Thai, 95, pp.1441~1448 (2012)