{"doi":"10.21037/jgo-20-430","title":"Evaluation of confocal laser endomicroscopy for detection of occult gastric carcinoma in CDH1 variant carriers","abstract":"Background: Hereditary diffuse gastric cancer syndrome, attributed to inactivating germline CDH1 variants, is associated with an elevated lifetime risk of gastric cancer. We sought to evaluate cancer detection using probe-based confocal laser endomicroscopy (pCLE) during endoscopic surveillance.Methods: A prospective, single-institution study was conducted in asymptomatic adults with pathogenic or likely pathogenic (P/LP) CDH1 variants. Subjects received endoscopic gastric surveillance using pCLE in conjunction with the Cambridge method (CM). Abnormalities visualized by pCLE were biopsied, followed by non-targeted mucosal biopsies according to the CM. Primary endpoint was to determine pCLE sensitivity for detection of occult SRC carcinoma compared to CM.Results: Thirty-six patients with P/LP CDH1 variants underwent endoscopy using pCLE and CM. Majority were female (75%) with median age 47 years. Targeted biopsies of focal abnormalities on WLE were negative for carcinoma. Overall, 19.4% (7/36) patients had SRC detected on ≥1 biopsy. Non-targeted CM biopsies revealed SRC in 11.1% (4/36), whereas pCLE revealed SRC in 16.7% (6/36). Fifteen patients underwent total gastrectomy; all 15 explants contained occult carcinoma. In those 15 patients, the false-negative SRC detection rates for pCLE and CM were 67% and 87%, respectively.Conclusions: Confocal endomicroscopy alone has low sensitivity for occult cancer detection in CDH1 variant carriers, although it appeared no worse than the current recommended method and required fewer biopsies per patient. A more reliable endoscopic surveillance is needed as a viable alternative to surgery in this high-risk population (ClinicalTrials.gov, Number: NCT03648879).","journal":"Journal of Gastrointestinal Oncology","year":2021,"id":186675,"datarank":0.80943990234238,"base_score":3.044522437723423,"endowment":3.044522437723423,"self_citation_contribution":0.4566783656585135,"citation_network_contribution":0.3527615366838664,"self_endowment_contribution":0.4566783656585135,"citer_contribution":0.3527615366838664,"corpus_percentile":null,"corpus_rank":null,"citation_count":20,"citer_count":14,"citers_with_citation_signal":11,"citers_with_endowment":11,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9562,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03648879"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":474950,"name":"Lauren A. Gamble","orcid":"0000-0002-1389-9196","position":1,"is_corresponding":false},{"id":374773,"name":"Bryan F. Curtin","orcid":"0000-0003-1997-5935","position":2,"is_corresponding":false},{"id":474952,"name":"Samantha M. Ruff","orcid":"0000-0001-5275-6705","position":3,"is_corresponding":false},{"id":570326,"name":"Maureen Connolly","orcid":"0000-0002-8697-0213","position":4,"is_corresponding":false},{"id":570327,"name":"Cathleen Hannah","orcid":"0009-0001-0787-7804","position":5,"is_corresponding":false},{"id":474953,"name":"Martha Quezado","orcid":"0009-0004-0941-8662","position":6,"is_corresponding":false},{"id":329927,"name":"Markku Miettinen","orcid":"0000-0002-3282-8107","position":7,"is_corresponding":false},{"id":570675,"name":"M. V. George","orcid":null,"position":8,"is_corresponding":false},{"id":381400,"name":"Andrew M. Blakely","orcid":"0000-0002-5013-3851","position":9,"is_corresponding":false},{"id":106391,"name":"Jonathan M. Hernandez","orcid":"0000-0001-7529-0557","position":10,"is_corresponding":false},{"id":334105,"name":"Theo Heller","orcid":"0000-0002-2643-6289","position":11,"is_corresponding":false},{"id":255441,"name":"Christopher Koh","orcid":"0000-0002-4755-5607","position":12,"is_corresponding":false},{"id":243365,"name":"Jeremy L. Davis","orcid":"0000-0002-6334-6936","position":13,"is_corresponding":false},{"id":474951,"name":"Samuel A. Schueler","orcid":"0000-0001-6663-7483","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-18T23:48:46.850806Z","pmid":"34012620","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}