{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:24:19Z","timestamp":1789025059449,"version":"build-2803163510"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"10","funder":[{"name":"Addenbrookes Charitable Trust","award":["300132"],"award-info":[{"award-number":["300132"]}]},{"name":"Medical Research Council","award":["G111260"],"award-info":[{"award-number":["G111260"]}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"crossref","award":["EDDPJT-Nov23\/100006"],"award-info":[{"award-number":["EDDPJT-Nov23\/100006"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000265","name":"UK Medical Research Council","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Cancer Research UK Cambridge","award":["CTRQQR-2021\\100012"],"award-info":[{"award-number":["CTRQQR-2021\\100012"]}]},{"name":"Program of the Chinese Scholarship Council","award":["202206275012"],"award-info":[{"award-number":["202206275012"]}]},{"name":"CRUK grant","award":["EDDPJT-Nov23\/100006"],"award-info":[{"award-number":["EDDPJT-Nov23\/100006"]}]},{"DOI":"10.13039\/501100005370","name":"Gates Cambridge Trust","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005370","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University of Cambridge School of Clinical Medicine Elmore"},{"DOI":"10.13039\/501100000691","name":"Academy of Medical Sciences","doi-asserted-by":"crossref","award":["SGL029\/1060"],"award-info":[{"award-number":["SGL029\/1060"]}],"id":[{"id":"10.13039\/501100000691","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NIHR Cambridge Biomedical Research Centre","award":["NIHR203312"],"award-info":[{"award-number":["NIHR203312"]}]},{"name":"Experimental Cancer Medicine Centre and the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre","award":["BRC-1215\u201320014"],"award-info":[{"award-number":["BRC-1215\u201320014"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Prophylactic total gastrectomy is the definitive treatment for hereditary diffuse gastric cancer syndrome (HDGC). Endoscopic surveillance informs the requirement for and optimal timing of surgery. However, endoscopic recognition of early signet ring cell carcinoma (SRCC) remains challenging. We developed an endoscopic framework to optimize SRCC assessment during HDGC surveillance.<\/jats:p>\n                  <jats:p>We retrospectively analyzed data from 147 individuals with HDGC undergoing endoscopic surveillance to evaluate the diagnostic accuracy of the endoscopic Cambridge criteria. We used machine learning to develop a clinical decision tree (cDT) to guide the application of the Cambridge criteria. We then prospectively validated the cDT in 66 CDH1 pathogenic-variant carriers. The interobserver agreement and diagnostic accuracy of the Cambridge criteria and cDT were assessed through a multi-reader multi-case study.<\/jats:p>\n                  <jats:p>Retrospective analysis of 537 endoscopies showed that the Cambridge criteria achieved 82.8% (48\/58) sensitivity and 78.2% (140\/179) specificity for SRCC diagnosis. The presence and number of neoplastic pale areas were independent predictors of higher cancer burden in HDGC individuals. In the prospective study, cDT had 77.8% (21\/27) sensitivity and 90.7% (49\/54) specificity, and improved performance of both experts and non-experts.<\/jats:p>\n                  <jats:p>We developed and validated a practical endoscopic framework for enhancing SRCC assessment during HDGC endoscopic surveillance.<\/jats:p>","DOI":"10.1055\/a-2634-7895","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T19:36:28Z","timestamp":1749756988000},"page":"1118-1127","source":"Crossref","is-referenced-by-count":6,"title":["Clinical decision tree for optimizing endoscopic assessment of signet ring cell carcinoma in hereditary diffuse gastric cancer surveillance"],"prefix":"10.1055","volume":"57","author":[{"given":"Lianlian","family":"Wu","sequence":"additional","affiliation":[{"name":"Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom of Great Britain and Northern Ireland"},{"name":"Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Honing","sequence":"additional","affiliation":[{"name":"Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom of Great Britain and Northern Ireland"},{"name":"Department of Gastroenterology and Hepatology, Rotterdam Medical Centre, University Medical Centre Rotterdam, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjui","family":"Wu","sequence":"additional","affiliation":[{"name":"Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia S.","family":"Kupfer","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya M.","family":"Bisseling","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanda M.","family":"van Dieren","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas V.","family":"Hadjinicolaou","sequence":"additional","affiliation":[{"name":"Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom of Great Britain and Northern Ireland"},{"name":"Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland"},{"name":"Department of Medicine, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan de la Revilla","family":"Negro","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohmmed Tauseef","family":"Sharip","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui Jun","family":"Lim","sequence":"additional","affiliation":[{"name":"Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandini","family":"Karthik","sequence":"additional","affiliation":[{"name":"Early Cancer Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Markert","sequence":"additional","affiliation":[{"name":"Cancer Research UK Cambridge Institute, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Prew","sequence":"additional","affiliation":[{"name":"Cancer Research UK Cambridge Institute, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"O\u2019Donovan","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Tischkowitz","sequence":"additional","affiliation":[{"name":"Department of Medical Genetics, National Institute for Health Research, Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayendran","family":"Sujendran","sequence":"additional","affiliation":[{"name":"Cambridge Oesophagus-gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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