Management of Suspicious Mucosa-Associated Lymphoid Tissue Lymphoma in Gastric Biopsy Specimens Obtained during Screening Endoscopy

• Published in: Journal of Korean medical science Vol. 31; no. 7; pp. 1075 - 1081
• Main Authors: Yang, Hyo-Joon, Lim, Seon Hee, Lee, Changhyun, Choi, Ji Min, Yang, Jong In, Chung, Su Jin, Choi, Seung Ho, Im, Jong Pil, Kim, Sang Gyun, Kim, Joo Sung
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01-07-2016; 대한의학회
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Biopsy; Female; Follow-Up Studies; Gastric Mucosa - pathology; Gastritis - diagnosis; Gastritis - etiology; Gastritis - microbiology; Gastroscopy; Helicobacter Infections - complications; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Humans; Lymphoma, B-Cell, Marginal Zone - complications; Lymphoma, B-Cell, Marginal Zone - diagnosis; Lymphoma, B-Cell, Marginal Zone - pathology; Male; Middle Aged; Original; Republic of Korea; Retrospective Studies; 의학일반; Non-Hodgkin Lymphoma; Primary Gastric Lymphoma; Helicobacter pylori; Marginal Zone B-cell Lymphoma; Cancer Screening
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2016.31.7.1075

It is often difficult to differentiate gastric mucosa-associated lymphoid tissue (MALT) lymphoma from Helicobacter pylori-associated follicular gastritis, and thus, it becomes unclear how to manage these diseases. This study aimed to explore the management strategy for and the long-term outcomes of suspicious gastric MALT lymphoma detected by forceps biopsy during screening upper endoscopy. Between October 2003 and May 2013, consecutive subjects who were diagnosed with suspicious gastric MALT lymphomas by screening endoscopy in a health checkup program in Korea were retrospectively enrolled. Suspicious MALT lymphoma was defined as a Wotherspoon score of 3 or 4 upon pathological evaluation of the biopsy specimen. Of 105,164 subjects who underwent screening endoscopies, 49 patients with suspicious MALT lymphomas who underwent subsequent endoscopy were enrolled. Eight patients received a subsequent endoscopy without H. pylori eradication (subsequent endoscopy only group), and 41 patients received H. pylori eradication first followed by endoscopy (eradication first group). MALT lymphoma development was significantly lower in the eradication first group (2/41, 4.9%) than in the subsequent endoscopy only group (3/8, 37.5%, P = 0.026). Notably, among 35 patients with successful H. pylori eradication, there was only one MALT lymphoma patient (2.9%) in whom complete remission was achieved, and there was no recurrence during a median 45 months of endoscopic follow-up. H. pylori eradication with subsequent endoscopy would be a practical management option for suspicious MALT lymphoma detected in a forceps biopsy specimen obtained during screening upper endoscopy.