Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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An Alternative Method for a Rapid Urease Test Using Back-table Gastric Mucosal Biopsies from Gastrectomy Specimen for Making the Diagnosis of Helicobacter pylori Infection in Patients with Gastric Cancer

위암 환자의 헬리코박터 파이로리 감염 진단에 있어서 위절제술 직후 생검된 위점막 조직을 이용한 신속 요소 분해 효소 검사법 도입의 의의

  • Kim, Sin-Ill (Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences) ;
  • Jin, Sung-Ho (Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences) ;
  • Lee, Jae-Hwan (Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences) ;
  • Min, Jae-Seok (Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences) ;
  • Bang, Ho-Yoon (Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences) ;
  • Lee, Jong-Inn (Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences)
  • 김신일 (한국원자력의학원 원자력병원 외과) ;
  • 진성호 (한국원자력의학원 원자력병원 외과) ;
  • 이재환 (한국원자력의학원 원자력병원 외과) ;
  • 민재석 (한국원자력의학원 원자력병원 외과) ;
  • 방호윤 (한국원자력의학원 원자력병원 외과) ;
  • 이종인 (한국원자력의학원 원자력병원 외과)
  • Received : 2009.09.15
  • Accepted : 2009.10.28
  • Published : 2009.12.30
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Abstract

Purpose: The rapid urease test is a rapid and reliable method for diagnosing Helicobacter pylori infection. However it requires gastric mucosal biopsies during endoscopy, and the test is not covered by national health insurance for patients with gastric cancer. So, we introduced an alternative method for a rapid urease test using back-table gastric mucosal biopsies from gastrectomy specimen. Materials and Methods: Ninety gastric cancer patients underwent an anti H. pylori IgG ELISA test and gastrectomy. Just after gastrectomy, two gastric mucosal biopsies from the prepyloric antrum and lower body of the gastrectomy specimen were taken from the back table in the operative room, and these were fixed immediately with the rapid urease test kit, and the color change was monitored for up to 24 hours. In this study, H. pylori infection was defined as positive when the serology or rapid urease test showed positive results. Results: The positive rate of the rapid urease test and serology was 91.1% and 77.8%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the rapid urease test and serology were 94.3 and 80.5%, 100 and 100%, 100 and 100%, and 37.5 and 15%, respectively. The accuracy of the rapid urease test was higher than that of serology (94.4 vs. 81.1%, respectively). The rapid urease test showed a higher rate of detecting H. pylori infection than that of serology (McNemar's test, P=0.019). Conclusion: The result of the rapid urease test using back-table gastric mucosal biopsies from a gastrectomy specimen is comparable to the reference data of the conventional rapid urease test using gastric mucosal endoscopic biopsies. Therefore, it can be an alternative diagnostic method for H. pylori infection.

목적: 신속 요소 분해 효소 검사법은 헬리코박터 파이로리 감염의 진단에 있어서 빠르고 신뢰성 높은 검사이다. 그러나 내시경을 통한 위점막의 생검이 필요할 뿐 아니라 국내의 의료보험에서는 위암 환자에 대해 급여 인정이 되지 않는 제한점이 있다. 따라서 저자들은 대체 방법으로 위절제술 직후 생검된 위점막 검체를 이용하여 신속 요소 분해 효소 검사를 시행하였고 이를 소개하고자 한다. 대상 및 방법: 위절제술을 시행 받은 위선암 환자들 중 90명을 대상으로 헬리코박터 파이로리에 대한 IgG 항체 검사를 시행하였으며, 위절제술 직후 위전정부와 위체부 각각에서 점막 생검을 하여 신속 요소 분해 효소 검사 키트에 고정한 후 24시간 이내에 색깔변화를 통해 양성 여부를 판독하였다. 본 연구에서는 면역 혈청학적 검사에서 양성이거나 신속 요소 분해 효소 검사에서 양성인 경우 헬리코박터 파이로리 감염이 있다고 정의하였다. 결과: 신속 요소 분해 효소 검사와 면역 혈청학적 검사에서 양성인 경우가 각각 91.1%와 77.8%였다. 신속 요소 분해 효소 검사의 민감도, 특이도, 양성 예측률, 음성 예측률은 94.3%, 100%, 100%, 37.5%였으며, 면역 혈청학적 검사는 80.5%, 100%, 100%, 15%로 나타났다. 신속 요소 분해 효소검사의 정확도는 94.4%로 면역 혈청학적 검사의 81.1%보다 높았다. 신속 요소 분해 효소 검사의 헬리코박터 파이로리 감염 진단률이 면역 혈청학적 검사보다 더 높았다. 결론: 본 연구에서 위선암 환자에서 위절제술 후 생검된 위점막 검체를 이용한 신속 요소 분해 효소 검사법은 문헌상에 보고된 통상적인 신속 요소 분해 효소 검사법의 진단률과 대등하였다. 따라서 위절제술을 시행 받는 환자에서 헬리코박터 파이로리 감염의 대체 검사법으로 유용할 것으로 기대된다.

Keywords

References

  1. International Agency for Research on Cancer. Monographs on the evaluation of carcinogenic risks to humans; Infection with Helicobacter pylori. Vol 60. Lyon: IARC Monogr Eval Carcinog Risks Hum, 1994:170-240.
  2. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process--First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res 1992; 52:6735-6740.
  3. Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N, Sibley RK. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 1991; 325:1127-1131. https://doi.org/10.1056/NEJM199110173251603
  4. Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, Taniyama K, Sasaki N, Schlemper RJ. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001;345:784-789. https://doi.org/10.1056/NEJMoa001999
  5. Rino Y, Imada T, Kabara T, Takahashi M, Shiozawa M, Ohshima T, Hasuo K, Inaba M, Yoneyama K, Yoshikawa T, et al. How to eradicate Helicobacter pylori using amoxicillin and omeprazole in the remnant stomach. Hepatogastroeneterology 2003;50:2267-2269.
  6. Kim ES, Park DK, Hong SH, Chung MG, Kwon OS, Kim SS, Koo YS, Kim YK, Kang DH, Choi DJ, et al. Helicobacter pylori infection in the remnant stomach after radical subtotal gastrectomy. Korean J Gastroenterology 2003;42:108-114.
  7. Lam SK, Talley NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol 1998;13:1-12. https://doi.org/10.1111/j.1440-1746.1998.tb00537.x
  8. Malfertheiner P, Mégraud F, O'Morain C, Hungin AP, Jones R, Axon A, Graham DY, Tytgat G; European Helicobacter pylori Study Group (EHPSG). Current concepts in the management of Helicobacter pylori infection the Maastricht 2‐2000
  9. Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, Terao S, Amagai K, Hayashi S, Asaka M; Japan Gast Study Group. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open‐label, randomized controlled trial. Lancet 2008;372:392-397. https://doi.org/10.1016/S0140-6736(08)61159-9
  10. Yoon BC. Diagnosis of H. pylori infection. J Korean Gastric Cancer Asso 2002;2:59-62. https://doi.org/10.5230/jkgca.2002.2.2.59
  11. Kim JM. Antibiotic Resistance in Helicobacter Pylori. Hanyang Med Rev 2007;27:76-91.
  12. Dweyer AJ. Matchmaking and McNemar in the comparison of diagnostic modalities. Radiology 1991;178:328-330. https://doi.org/10.1148/radiology.178.2.1987587
  13. Yim JY, Kim N, Choi SH, Kim YS, Cho KR, Kim SS, Seo GS, Kim HU, Baik GH, Sin CS, et al. Seroprevalence of Helicobacter pylori in South Korea. Helicobacter 2007;12:333- 340. https://doi.org/10.1111/j.1523-5378.2007.00504.x
  14. Helicobacter and Cancer Collaborative Group. Gastric Cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts. Gut 2001;49:347- 353. https://doi.org/10.1136/gut.49.3.347
  15. Watanabe Y, Kurata JH, Mizuno S, Mukai M, Inokuchi H, Miki K, Ozasa K, Kawai K. Helicobacter pylori infection and gastric cancer. A nested case‐control study in a rural area of Japan. Dig Dis Sci 1997;42:1383-1387. https://doi.org/10.1023/A:1018833819860
  16. Isomoto H, Kawazoe K, Inoue K, Kohno S. Usefulness of the immunological rapid urease test for detection of Helicobacter pylori in patients who are reluctant to undergo endoscopic biopsies. Dig Dis Sci 2006;51:2302-2305. https://doi.org/10.1007/s10620-006-9389-5