Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2015; 21(46): 13113-13123
Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13113
Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan
Shin Kono, Takuji Gotoda, Shigeaki Yoshida, Ichiro Oda, Hitoshi Kondo, Luigi Gatta, Greg Naylor, Michael Dixon, Fuminori Moriyasu, Anthony Axon
Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan
Shigeaki Yoshida, Aomori Prefectural Central Hospital, Aomori 0300913, Japan
Ichiro Oda, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Hitoshi Kondo, Center for Digestive Diseases, Tonan Hospital, Sapporo 060-0001, Japan
Luigi Gatta, Gastroenterology and Digestive Endoscopy Unit, Versilia Hospital, 335 Lido di Camaiore, Italy
Greg Naylor, Chesterfield Royal Hospital, S44 5BL Derbyshire, United Kingdom
Michael Dixon, Academic Unit of Pathology, University of Leeds, Leeds LS2 9JT, United Kingdom
Anthony Axon, Centre for Digestive Disease, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom
Author contributions: Kono S analyzed and interpreted the data, and drafted the paper; Gotoda T made contributions to data collection, conception and design, analysis and data interpretation; Gatta L, Naylor G and Dixon M collected data; Yoshida S, Oda I and Kondo H contributed to conception and study design; Axon A interpreted the data; Moriyasu F and Axon A are supervisors.
Institutional review board statement: The study protocol was approved by the local Ethics Committees, and all patients provided written informed consent.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have none to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Takuji Gotoda, MD, PhD, Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Telephone: +81-3-33426111
Received: June 9, 2015
Peer-review started: June 11, 2015
First decision: July 10, 2015
Revised: July 28, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: December 14, 2015

AIM: To assess the diagnostic concordance between endoscopic and histological atrophy in the United Kingdom and Japan.

METHODS: Using published data, a total of 252 patients, 126 in the United Kingdom and 126 in Japan, aged 20 to 80 years, were evaluated. The extent of endoscopic atrophy was classified into five subgroups according to a modified Kimura-Takemoto classification system and was compared with histological findings of atrophy at five biopsy sites according to the updated Sydney system.

RESULTS: The strength of agreement of the extent of atrophy between histology and visual endoscopic inspection showed good reproducibility, with a weighted kappa value of 0.76 (P < 0.001). Multivariate analysis showed that three factors were associated with decreased concordance: Japanese ethnicity [odds ratio (OR) 0.22, 95% confidence interval (CI) 0.11-0.43], older age (OR = 0.32, 95%CI: 0.16-0.66) and endoscopic atrophy (OR = 0.10, 95%CI: 0.03-0.36). The strength of agreement between endoscopic and histological atrophy, assessed by cancer risk-oriented grading, was reproducible, with a kappa value of 0.81 (95%CI: 0.75-0.87). Only nine patients (3.6%) were endoscopically underdiagnosed with antral predominant rather than extensive atrophy and were considered false negatives.

CONCLUSION: Endoscopic grading can predict histological atrophy with few false negatives, indicating that precancerous conditions can be identified during screening endoscopy, particularly in patients in western countries.

Keywords: Gastritis, Atrophy, Histology, Endoscopy, Diagnosis

Core tip: Gastric atrophy is generally regarded as a precancerous condition. Thus, improvements in methods used to diagnose atrophy may identify patients at risk for gastric cancer. Our data on endoscopic assessment could be compared with diagnosis by an expert histopathologist with a weighted kappa value. Our data of this agreement is better than the inter-observer agreement between two histopathologists reported before. Thus, our results suggest that endoscopic atrophy grading can predict extensive histological atrophy and may serve as a practical assessment of precancerous conditions during endoscopy in routine clinical practice, especially for patients in western countries.