Clinicopathologic correlation of large gastric folds: Predictive factors for malignancy

According to a study presented at ASCP, held in September in Chicago, making a differential diagnosis of large gastric folds is a clinical challenge because the etiology is extremely varied, and standard biopsies are often inconclusive.

Korean researcher Dowhan Kim, M.D., and colleagues  retrospectively reviewed the clinical (age, gender, alarm symptom) and EUS features (thickness of the gastric wall, preservation of five-layered structure, presence of thickened layer and its thickness pattern, and presence of ascites and lymph node enlargement) and pathologic findings (proper muscle thickness, desmoplasia or fibrosis, abnormal gland formation or presence of cell cluster size larger than 200um at submucosal or proper muscle level) of patients with large gastric folds on EUS.  Sixty-five patients were included (26 benign diseases and 39 malignancies). Median age was 49 years;41.5% were male.

According to the data, in analysis of predictive factors for malignancy, non-preserved wall layer structure (odds ratio 27.5, 95% confidence interval, 2.45 to 334.27, P=0.010) was associated with abnormal gland or cluster formation at the submucosal or proper muscle level.

Inpatients with large gastric folds, non-preserved wall layer structure on EUS predicts infiltration of the abnormal glandular cell into submucosa and proper muscle and presence of the cell cluster in submucosa or proper muscle, which represents all well- and moderately-differentiated adenocarcinoma cases as well as many poorly-differentiated adenocarcinoma cases.