Utility of subtyping intestinal metaplasia as marker of gastric cancer risk. A review of the evidence

Abstract

The identification and surveillance of patients with preneoplastic lesions at high risk of progressing to gastric cancer (GC) represents the most effective way of reducing the burden of GC. The incomplete type of intestinal metaplasia (IM) could be considered as the best candidate for surveillance. However, the usefulness of subtyping of IM has been considered by some authors as limited and inconsistent. A search was carried out to identify all cross-sectional (n=14) and follow-up (n=10) studies that assessed the risk of GC among subjects with different types of IM. Out of the 14 cross-sectional studies, 13 reported that the prevalence of incomplete IM was statistically significantly higher in GC than in other gastric lesions. Out of the ten follow-up studies, six found a statistically significant association between incomplete IM and subsequent GC risk. The relative risks of GC were from 4- to 11-fold higher for the presence of incomplete type in comparison to complete type or in comparison to the absence of incomplete type, among the studies that reported the magnitude of the risk. According to this comprehensive review, most of the scientific evidence supports the utility of subtyping IM as a predictor of GC risk. Recognizing its usefulness by gastroenterologists should encourage pathologists to subtype IM.

Keywords: gastric cancer; intestinal metaplasia; review; subtypes.

Figure 1

Intestinal metaplastic glands with H&E. Complete IM with brush border and globet cells (left). Incomplete IM with slight architectural glandular distortion and presence of globet cells and multivacuolated hybrid columnar intermediate cells, without brush border cells (right). (Courtesy of Dr. Blanca Piazuelo, Vanderbilt University).