Pre‐ampullary location and size ≥10 mm are independent predictors for high‐grade superficial non‐ampullary duodenal epithelial tumors

Abstract

Background and Aim The incidence of identified superficial non‐ampullary duodenal epithelial tumors (SNADETs) has been increasing with recent advances in endoscopic diagnosis. Nevertheless, the clinical features of SNADETs with malignant potential remain unclear. The aim of the present study was to clarify the clinical characteristics of high‐grade SNADETs. Methods A total of 328 SNADETs that had been endoscopically or surgically resected between January 2013 and April 2019 were identified from an endoscopic and pathological database. Clinical characteristics were compared between mucosal low‐grade neoplasm (n = 154) and mucosal high‐grade neoplasm/submucosal carcinoma (HGN/SMC, n = 174). Results In univariate analysis, tumor size, pre‐ampullary tumor location, red color, and rough/nodular surface were significantly associated with HGN/SMC. In multivariate analysis (odds ratio [95% confidence interval]), large (≥10 mm) tumor size (odds ratio: 4.5, 95% confidence interval: 2.6–7.7, P < 0.001) and pre‐ampullary tumor location (odds ratio: 2.1, 95% confidence interval: 1.3–3.5, P = 0.004) were independent predictors for HGN/SMC. Analysis of histological phenotypes revealed that the proportion of tumors that were HGN/SMC was much greater for gastric‐type tumors (21/23 lesions, 91%) than for intestinal‐type tumors (150/302 lesions, 50%) (P < 0.001) and that all gastric‐type tumors were located in the pre‐ampullary portion. Conclusions Pre‐ampullary location and large tumor size are independent predictors for HGN/SMC SNADETs. Pre‐ampullary tumor location is significantly associated with gastric histological phenotype. These findings may help in decision making for endoscopic treatment, active indication for pre‐ampullary tumor or tumor ≥10 mm, and understanding the pathophysiology of SNADETs.

Current status and perspectives for endoscopic diagnosis of superficial nonampullary duodenal epithelial tumors

“…Several studies have shown that the rate of high-grade atypia is higher in the gastric type than the intestinal type. [50][51][52][53][54][55][56] Clinical and endoscopic features of gastric-type SNADETs are summarized as a predominantly preampullary location [52][53][54][55][56] and infrequent MWM or WOS (Fig. 6a,b).…”

“…Histopathological images of each mucin phenotype, including immunohistochemical stains, are shown in Figure 5. Several studies have shown that the rate of high‐grade atypia is higher in the gastric type than the intestinal type 50–56 . Clinical and endoscopic features of gastric‐type SNADETs are summarized as a predominantly pre‐ampullary location 52–56 and infrequent MWM or WOS (Fig.…”

Treatment of non-ampullary duodenal epithelial tumors: Does phenotype matter?

“…An association has been suggested between development of gastric NADETs and presence of Brunnerʼs gland hyperplasia, gastric foveolar metaplasia, and heterotopic gastric mucosa 4 5 6 . Recent studies have shown that gastric foveolar metaplasia and heterotopic gastric mucosa are more frequently observed in mucosa adjacent to gastric than intestinal NADETs, while Brunnerʼs gland hyperplasia is commonly found irrespective of tumor phenotype 7 8 . Moreover, a significant proportion of gastric foveolar metaplasia and heterotopic gastric mucosa harbored GNAS and/or KRAS mutations, which are commonly seen in gastric NADETs, suggesting that his type of NADET in the proximal duodenum develops with metaplastic gastric epithelium as a precursor 9 ( Fig.…”

“…In surgically resected cases, patients with gastric NADETs had worse overall and disease-free survival than those with intestinal NADETs 4 . Several observational studies have shown that gastric NADETs have a higher proportion of high-grade dysplasia or submucosal invasive cancer than intestinal NADETs 7 8 10 11 . Moreover, among gastric NADETs, most submucosal invasive cancers manifested as small lesions measuring ≤ 10 mm 8 .…”

The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors

“…The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors Some studies have focused on the association between clinicopathological features and immunohistochemical mucin phenotypes of NADETs [12][13][14][15][16][17][18]. Those reports have shown that NADETs of the gastric phenotype have a higher malignant potential than those of the intestinal type.…”