Histochemical and immunohistochemical study of human gastric carcinoma differentiation with special reference to supplementary role for endosonography in evaluating depth of invasion.

The aim of this study was to evaluate the usefulness of gastric and intestinal epithelial phenotypic expression of gastric cancer cells, shown by mucin histochemical staining (paradoxical concanavalin A, galactose oxidase Schiff [GOS] and sialidase-GOS) and immunohistochemical reactivity (pepsinogens, SH-9, and TKH-2), as an adjunct to the assessment of depth of invasion of gastric carcinomas by endosonography (ES). In 110 resected adenocarcinomas, the proportion of intestinal-type cells increased with progression, as assessed by depth of invasion. The coincidence rate for gastric and intestinal phenotypic expression in biopsied and resected specimens was 96.3%. The positive predictive value of assessment of depth of invasion by ES was 73%. A low positive predictive value (45%) was achieved with type II-3 cases (according to our classification). However, the predictive value improved to 68% when depth of invasion was evaluated as the submucosal layer or deeper in cases in which more than 10% of cancer cells were of intestinal-type, although statistical analysis showed no significant difference between these predictive values. The sensitivity of diagnosis of submucosal invasion by cell differentiation in the type II-3 cases was significantly higher than that for the other types (89.5% versus 59.1%; P = 0.037). Phenotypic expression in biopsied specimens of gastric carcinomas proved helpful for evaluating the depth of invasion of gastric carcinoma by ES.