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Diagnosis of gastric epithelial neoplasia: Dilemma for Korean pathologists

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Author(s): Joon Mee Kim | Mee-Yon Cho | Jin Hee Sohn | Dae Young Kang | Cheol Keun Park | Woo Ho Kim | So-Young Jin | Kyoung Mee Kim | Hee Kyung Chang | Eunsil Yu | Eun Sun Jung | Mee Soo Chang | Jong Eun Joo | Mee Joo | Youn Wha Kim | Do Youn Park | Yun Kyung Kang | Sun Hoo Park | Hye Seung Han | Young Bae Kim | Ho Sung Park | Yang Seok Chae | Kye Won Kwon | Hee Jin Chang | The Gastrointestinal Pathology Study Group of Korean Society of Pathologists

Journal: World Journal of Gastroenterology
ISSN 1007-9327

Volume: 17;
Issue: 21;
Start page: 2602;
Date: 2011;
Original page

Keywords: Intraepithelial neoplasia | Stomach | Dysplasia | Adenoma | Carcinoma | Japanese | Western | Consensus | Vienna

ABSTRACT
The histopathological diagnosis of gastric mucosal biopsy and endoscopic mucosal resection/endoscopic submucosal dissection specimens is important, but the diagnostic criteria, terminology, and grading system are not the same in the East and West. A structurally invasive focus is necessary to diagnose carcinoma for most Western pathologists, but Japanese pathologists make a diagnosis of cancer based on severe dysplastic cytologic atypia irrespective of the presence of invasion. Although the Vienna classification was introduced to reduce diagnostic discrepancies, it has been difficult to adopt due to different concepts for gastric epithelial neoplastic lesions. Korean pathologists experience much difficulty making a diagnosis because we are influenced by Japanese pathologists as well as Western medicine. Japan is geographically close to Korea, and academic exchanges are active. Additionally, Korean doctors are familiar with Western style medical terminology. As a result, the terminology, definitions, and diagnostic criteria for gastric intraepithelial neoplasia are very heterogeneous in Korea. To solve this problem, the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists has made an effort and has suggested guidelines for differential diagnosis: (1) a diagnosis of carcinoma is based on invasion; (2) the most important characteristic of low grade dysplasia is the architectural pattern such as regular distribution of crypts without severe branching, budding, or marked glandular crowding; (3) if nuclear pseudostratification occupies more than the basal half of the cryptal cells in three or more adjacent crypts, the lesion is considered high grade dysplasia; (4) if severe cytologic atypia is present, careful inspection for invasive foci is necessary, because the risk for invasion is very high; and (5) other structural or nuclear atypia should be evaluated to make a final decision such as cribriform pattern, papillae, ridges, vesicular nuclei, high nuclear/cytoplasmic ratio, loss of nuclear polarity, thick and irregular nuclear membrane, and nucleoli.
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