Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13113
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
Processing time: 182 Days and 19.4 Hours
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.
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.