Patterns of sialyl-Lewis X expression predict gastric histopathology.

[INTRODUCTION] Gastric cancer develops through a series of pre-cancerous changes over decades of chronic inflammation. Chronic atrophic gastritis (CAG) represents a critical transition in the progression to gastric cancer, though validated histologic markers are needed to more accurately detect and assess the extent of CAG. We previously identified sialyl-Lewis X (sLe) as a marker of atrophic gastric epithelium in mice. Here, we establish patterns of sLe expression that can be used to detect and distinguish human gastric pre-cancerous lesions.

[METHODS] We obtained gastric corpus and/or antrum biopsies from 149 adult patients with dyspepsia. Biopsies were stained with hematoxylin/eosin and a commercially available antibody to sLe. Histologic diagnoses included normal, chronic non-atrophic gastritis (CNG), or CAG with or without intestinal metaplasia (IM) and were determined by a single pathologist. A second pathologist graded each biopsy according to consensus criteria, based on the presence, intensity, and glandular distribution of sLe staining. Log-linear models were used to determine the association between patterns of sLe expression and gastric pathology.

[RESULTS] The majority of patients (70%) had gastric pathology (CNG or CAG ± IM). The presence of sLe could be used to detect gastric pathology (97% sensitivity), and the absence of sLe staining could reliably predict normal histology (76% specificity). The intensity of sLe staining significantly correlated with gastric pathology. Moreover, a deeper (≥ 50%) glandular sLe distribution in the antrum was significantly associated with CAG, while a more superficial (< 50%) distribution significantly correlated with CNG.

[CONCLUSION] Patterns of sLe expression can be used to detect and refine the histologic assessment of gastric pre-neoplastic lesion severity.