Introduction
The Kimura-Takemoto's (KT) classification, the endoscopic assessment for the extent of gastric atrophy, has been recommended to useful risk marker of gastric cancer (GC) in Japan. In Western countries, recent studies suggest the endoscopic findings with narrow band imaging (NBI) according to the classification of endoscopic grading of gastric intestinal metaplasia (EGGIM) are useful markers for GC risk. However we reported that both KT and EGGIM are useful stratification method for the GC in Japanese, the association between KT and EGGIM is unknown.
Aims & Methods
This study is a post-hoc analysis of a multicenter prospective study for a histological and endoscopic risk for GC in 10 Japanese facilities (UMIN00027023). We assessed the KT classification with white-light endoscopy and EGGIM score with NBI endoscopy in all subjects. We also evaluated the histological findings using biopsy specimens according to the operative link for gastritis assessment (OLGA) and the operative link for gastric intestinal metaplasia (OLGIM). The biopsy specimens were taken randomly according to the updated Sydney system, not guided target biopsy with NBI. We evaluated the association between KT and EGGIM. We also analyzed the diagnostic ability for histological findings (OLGA/OLGIM) using receiver operating characteristic (ROC) analysis. In OLGA, OLGIM and EGGIM analysis, We assessed four points (lesser and greater curvatures of antrum and corpus), not included angularis because of a questionable diagnostic benefit.
Results
The 380 subjects (115 GC and 265 non-GC) were analyzed. The white-light endoscopy revealed that 99 patients were non to mild atrophy (C-0, C-1; low risk for GC), 104 were moderate atrophy (C-2,C-3; moderate risk) and 177 were extent atrophy (O-1, O-2, O-3; high risk) in KT classification. The NBI findings showed that 109 were low risk (score 0), 158 were moderate risk (score 1 to 4), 113 were high risk (score 5-8) in EGGIM score. The high risk group in KT classification had significant association with that of EGGIM score (odds ratio (OR) 4.3 [95% confidence interval (CI) 2.6-6.8]). The high risk group in KT classification showed significant relationship not only high risk group of histological atrophy (OLGA stage III/IV) with OR 5.5 [3.4-8.8], and also that of histological IM (OGIM stage III/IV) with OR 8.5 [4.5-16.0]. The area under the ROC curve of diagnostic ability for OLGA III/IV were 0.786 in KT and 0.769 in EGGIM. Also those of OLGIM IIII/IV were 0.761in KT and 0.734 in EGGIM.
Conclusion
Endoscopic assessments according to the Japanese traditional method (KT) and Western method (EGGIM) showed significant association. The KT classification associated with not only extent of histological atrophy but also extent of histological IM.
References
1. Kawamura M, Uedo N, Koike T,et al : Kyoto classification risk scoring system and endoscopic grading of gastric intestinal metaplasia for gastric cancer: Multicenter observation study in Japan. Dig Endosc 2022; 34: 508-516.
2. Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969; 1: 87–97.
3. Pimentel-Nunes P, Libânio D, Lage J et al. A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions. Endoscopy 2016; 48 :723-730.
4. Esposito G, Pimentel-Nunes P, Angeletti S et al. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy 2019; 51: 515-521.
5. Marcos, P.; Brito-Gonçalves, G.; Libânio, D.; Pita, I.; Castro, R.; Sá, I.; Dinis-Ribeiro, M.; Pimentel-Nunes, P. Endoscopic grading of gastric intestinal metaplasia on risk assessment for early gastric neoplasia: Can we replace histology assessment also in the West? Gut 2020; 69: 1762–1768.
Disclosure
All authors disclose no financial relationships relevant to this study
