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D'Angelo et al. J Cancer Metastasis Treat 2019;5:30 I http://dx.doi.org/10.20517/2394-4722.2018.86 Page 5 of 18

Table 4. Characteristics of gastric metastasis
Variables Number of patients n (%)
Gastric Histology
Biopsy 45 80
Definitive specimen 11 20
ER status (stomach)
Positive 50 91
Negative 5 9
PgR status (stomach)
Positive 28 61
Negative 18 39
HER2 (stomach)
Positive 11 30
Negative 25 70
CK7 (stomach)
Positive 21 91
Negative 2 9
GCDFP-15 (stomach)
Positive 9 75
Negative 3 25
CK20 (stomach)
Positive 1 5
Negative 20 95
MGB (stomach)
Positive 6 86
Negative 1 14
GATA-3 (stomach)
Positive 4 100
Negative 0 0
CDX-2 (stomach)
Positive 0 0
Negative 7 100
E-cadherin
Positive 3 37
Negative 5 63
ER: estrogen receptor; PgR: progesterone receptor; HER: human epithelial receptor; CK: cytokeratin; GCDFP-15: gross cystic disease fluid
protein 15; MGB: mammoglobine

presentation, but they analyzed all gastric metastases from other primary tumors and not only the ones
related to breast cancer.

Alternative instrumental tools
Other instrumental tools were not frequently cited. Ayantude and Aurello mentioned that computed
tomography (CT) is commonly used to evaluate thickened visceral wall or the presence of other metastases.
Namikawa observed that PET has a low sensitivity in diagnosing metastasis, but it may be useful to evaluate
response to treatment in those tumors with intense FDG (F-18 fluorodeoxyglucose) uptake.

Gastric biopsy/histology
Two articles reported that gastric biopsy may be negative in 30% or even in 50% of the cases because the
tumor cells infiltrate the submucosal layer and not the mucosal layer, which shows a normal histological
aspect; there is thus a need for performing deeper biopsy in order to study also underlying layers, which is
essential in this particular metastatic pattern. The most common reported histological pattern is signet ring
cells, as cited in seven articles, which in some cases may be confused with tumor of gastric origin.

Gastric metastasis receptor
Immunohistochemistry is essential for differentiating gastric metastasis from primary tumor; positivity
for estrogen and progesterone receptors in gastric metastasis is reported in seven articles, and they are the
main receptors that direct the diagnosis to a secondary tumor of breast origin. Metastases of breast tumor