Dysplasia in Gastric Mucosa and its Reporting Problems
DOI:
https://doi.org/10.3889/oamjms.2015.102Keywords:
gastric dysplasia, gastric cancer, interobserver variability, dysplasia, neoplasiaAbstract
BACKGROUND: The recognition, terminology used and histopathologic evaluation of two essential elements in gastric carcinogenesis, atrophy and dysplasia, are characterized by controversy.
MATERIALS AND METHODS: One hundred fifteen cases, with slides and their histopathologic reports from the archive of the Laboratory of Pathology were studied for the diagnostic value, reporting of dysplasia, interobserver variability, the relation of dysplastic lesions with inflammation, atrophy and metaplasia. After retrospectively studying the histopathologic reports from the archive we distributed the cases according to endoscopic and histopathologic diagnosis, together with the reexamination of the slides. The comparison of the median values of the numeric variables was made with the Mann-Whitney test (non-parametric equivalent of the Student’s “t†test).
RESULTS: The endoscopic clinical diagnosis were: malignancy/suspicious for malignancy 88 cases (76%) and non-neoplastic diagnosis (like ulcer or gastritis) 27 cases (24%). From the reexamination of the cases it resulted that there is no difference in reporting the malignancy, but there is a difference in the cases reported as dysplasia (p = 0.001) and negative for neoplasia (p = 0.063, borderline).
CONCLUSION: Clinicians and pathologists can feel directly the discrepancy called “interobserver variability†and should be assured that the use of guidelines will cause a lowering of this variability.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Kim JM, Cho MY, Sohn JH, Kang DY, Park CK, Kim WH, et al. Gastrointestinal Pathology Study Group of Korean Society of Pathologists. Diagnosis of gastric epithelial neoplasia: Dilemma for Korean pathologists. World J Gastroenterol. 2011;17:2602–2610.
http://dx.doi.org/10.3748/wjg.v17.i21.2602 DOI: https://doi.org/10.3748/wjg.v17.i21.2602
PMid:21677827 PMCid:PMC3110921
Stockbrugger Rw, Menon GG, Beilby JO, et al. Gastroscopic screening in 80 patients with pernicious anemia. Gut. 1983; 24:1141–7.
http://dx.doi.org/10.1136/gut.24.12.1141 DOI: https://doi.org/10.1136/gut.24.12.1141
Halter F, Witzel L, Grétillat PA, et al. Diagnostic value of biopsy, guided lavage, and brush cytology in esophagogastroscopy Am J Dig Dis. 1977;22(2):129-31.
http://dx.doi.org/10.1007/BF01072955 DOI: https://doi.org/10.1007/BF01072955
PMid:835554
Padda S, Shah I, Ramirez FC. Adequacy of mucosal sampling with the "two-bite" forceps technique: a prospective, randomized, blinded study. Gastrointest Endosc. 2003;57(2):170-3.
http://dx.doi.org/10.1067/mge.2003.75 DOI: https://doi.org/10.1067/mge.2003.75
PMid:12556778
Correa P. Human gastric carcinogenesis: a multistep and multifactorial process. First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention Cancer Res. 1992;52:6735–40.
PMid:1458460
Correa P. Is gastric carcinoma an infectious disease? N Engl J Med. 1991;325:1170–196.
http://dx.doi.org/10.1056/NEJM199110173251611 DOI: https://doi.org/10.1056/NEJM199110173251611
PMid:1891027
Fertitta AM, Comin U, Terruzzi V, et al. Clinical significance of gastric dysplasia: a multicenter follow-up study. Endoscopy. 1993;25:265–8.
http://dx.doi.org/10.1055/s-2007-1010311 DOI: https://doi.org/10.1055/s-2007-1010311
PMid:8330543
Graem N, Fisher AB, Beck H. Dysplasia and carcinoma in Billroth II resected stomach 27–35 years postoperatively. Acta Pathol Microbiol Immunol Scand. 1984;92:185–8. DOI: https://doi.org/10.1111/j.1699-0463.1984.tb04394.x
Grundmann E. Histologic types and possible initial stages in early gastric carcinoma. Beitr Path Bd. 1975;154:256–80.
http://dx.doi.org/10.1016/S0005-8165(75)80034-5 DOI: https://doi.org/10.1016/S0005-8165(75)80034-5
Plummer M, Buiatti E, Lopez G, et al. Histological diagnosis of precancerous lesions of the stomach: a reliability study. International Agency for Research on Cancer, Lyon, France. JNCI J Natl Cancer Inst. 2006;99(2):137-146.
http://dx.doi.org/10.1093/jnci/djk017 DOI: https://doi.org/10.1093/jnci/djk017
PMid:17227997
Aste H, Sciallero S, Puglieses V, et al. The clinical significance of gastric epithelial dysplasia. Endoscopy. 1986;18:174–6.
http://dx.doi.org/10.1055/s-2007-1018365 DOI: https://doi.org/10.1055/s-2007-1018365
PMid:3780582
Correa P, Tahara E. Stomach. In: Henson DE, Albores-Saavedra J, eds. Pathology of incipient neoplasia. 2nd edn. Philadelphia: WB Saunders, 1993: 85–103.
PMid:8093595
De Dombal FT, Price AB, Thompson H, et al. The British Society of Gastroenterology early gastric cancer/dysplasia survey: an interim report. Gut. 1990;31:115–20.
http://dx.doi.org/10.1136/gut.31.1.115 DOI: https://doi.org/10.1136/gut.31.1.115
PMid:2180790 PMCid:PMC1378352
Den Hoed CM1, Holster IL, Capelle LG, de Vries AC, den Hartog B, Ter BorgF, Biermann K, Kuipers EJ. Follow-up of premalignant lesions in patients at risk for progression to gastric cancer. Endoscopy. 2013;45(4):249-56.
http://dx.doi.org/10.1055/s-0032-1326379 DOI: https://doi.org/10.1055/s-0032-1326379
PMid:23533073
Danesh BJ, Burke M, Newman J, Aylott A, Whitfield P, Cotton PB. Comparison of weight, depth, and diagnostic adequacy of specimens obtained with 16 different biopsy forceps designed for upper gastrointestinal endoscopy. Gut. 1985;26(3):227-31.
http://dx.doi.org/10.1136/gut.26.3.227 DOI: https://doi.org/10.1136/gut.26.3.227
PMid:3972269 PMCid:PMC1432632
Solomon D, Nayar R. The Bethesda System for Reporting Cervical Cytology. 2nd Edit. Springer, 2004:xxi-xxiii. DOI: https://doi.org/10.1007/978-1-4612-2042-8
Lewin KJ, Appelman HD. Tumors of the esophagus and stomach. In: Atlas of tumor pathology (third series fascicle 18). Washington, DC: Armed Forces Institute of Pathology, 1996.
Marshal BJ, Armstrong JA et al. Attempt to fulfill Koch's postulates for pyloric Campylobacter. Med J Aust. 1985;142: 436-439. DOI: https://doi.org/10.5694/j.1326-5377.1985.tb113443.x
Nakamura K, Sugano H, Takagi K, et al. Histopathological study on early carcinoma of the stomach: criteria for diagnosis of atypical epithelium. GANN. 1966;57:613–20.
PMid:5973413
Ming S-C, Bajtai A, Correa P, et al. Gastric dysplasia. Significance and pathologic criteria. Cancer. 1984;54:1794–801.
http://dx.doi.org/10.1002/1097-0142(19841101)54:9<1794::AID-CNCR2820540907>3.0.CO;2-W DOI: https://doi.org/10.1002/1097-0142(19841101)54:9<1794::AID-CNCR2820540907>3.0.CO;2-W
Nagayo T. Histological diagnosis of biopsied gastric mucosae with special reference to that of borderline lesions. Gann Monogr. 1971;11:245–56.
Nishi M, Ishihara S, Nakajima T, Ohta K, Ohyama S, Ohta H. Chronological changes of characteristics of early gastric cancer and therapy: experience in the Cancer Institute Hospital of Tokyo, 1950–1994. J Cancer Res Clin Oncol. 1995;121:535–41.
http://dx.doi.org/10.1007/BF01197766 DOI: https://doi.org/10.1007/BF01197766
PMid:7559733
Schlemper RJ, Riddell RH, Kato Y et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000; 46:251-255.
http://dx.doi.org/10.1136/gut.47.2.251 DOI: https://doi.org/10.1136/gut.47.2.251
PMCid:PMC1728018
Bearzi I, Brancorsini D, Santinelli A, et al. Gastric dysplasia: a ten-year follow-up study. Pathol Res Pract. 1994;190:61–8.
http://dx.doi.org/10.1016/S0344-0338(11)80497-8 DOI: https://doi.org/10.1016/S0344-0338(11)80497-8
Serck-Hansen A. Precancerous lesions of the stomach. Scand J Gastroenterol. 1979;14(suppl 54):104–9.
Andreu FJ, Sáez A, SentÃs M, Rey M, et a; Breast core biopsy reporting categories--An internal validation in a series of 3054 consecutive lesions. Breast. 2007;16(1):94-101.
http://dx.doi.org/10.1016/j.breast.2006.06.009 DOI: https://doi.org/10.1016/j.breast.2006.06.009
PMid:16982194
You WC, Blot WJ, Li JY, et al. Precancerous gastric lesions in a population high risk of stomach cancer. Cancer Res. 1993;53:1317–21.
PMid:8443811
Mikhail Lisovsky, Karen Dresser, Stephen Baker, Andrew Fishe, Bruce Woda, Barbara Banner and Gregory Y Lauwers. Cell polarity protein Lgl2 is lost or aberrantly localized in gastric dysplasia and adenocarcinoma: an immunohisto-chemical study. Modern Pathology. 2009;22:977–984.
http://dx.doi.org/10.1038/modpathol.2009.68 DOI: https://doi.org/10.1038/modpathol.2009.68
PMid:19407852
Lauwers GY. Defining the pathologic diagnosis of metaplasia, atrophy, dysplasia, and gastric adenocarcinoma. J Clin Gastroenterol. 2003;36(5 Suppl): S37-43
http://dx.doi.org/10.1097/00004836-200305001-00007 DOI: https://doi.org/10.1097/00004836-200305001-00007
PMid:12702964
Shichijo S1, Hirata Y1, et al. Distribution of intestinal metaplasia as a predictor of gastric cancer development. J Gastroenterol Hepatol. 2015;30(8):1260-4.
http://dx.doi.org/10.1111/jgh.12946 DOI: https://doi.org/10.1111/jgh.12946
PMid:25777777
Farshid G, Downey P. Combined use of imaging and cytologic grading schemes for screen-detected breast abnormalities improves overall diagnostic accuracy. Cancer. 2005;105(5):282-8.
http://dx.doi.org/10.1002/cncr.21280 DOI: https://doi.org/10.1002/cncr.21280
PMid:15999361
Redman R, Yoder BJ, Massoll NA. Perceptions of diagnostic terminology and cytopathologic reporting of fine-needle aspiration biopsies of thyroid nodules: a survey of clinicians and pathologists Thyroid. 2006;16(10):1003-8.
http://dx.doi.org/10.1089/thy.2006.16.1003 DOI: https://doi.org/10.1089/thy.2006.16.1003
PMid:17042686
Rugge M, Correa P, Dixon MF, Hattori T, Leandro G, Lewin K, et al Gastric Dysplasia The Padova International Classification. The American Journal of Surgical Pathology. 2000;24(2):167–176.
http://dx.doi.org/10.1097/00000478-200002000-00001 DOI: https://doi.org/10.1097/00000478-200002000-00001
PMid:10680883
Schlemper RJ, Kato Y, Stolte M. Dignostic criteria for gastrointestinal carcinoma in Japan and Western countries: Proposal for a new classification system of gastrointestinal epithelial neoplasia. J Gastroenterol Hepatol. 2000;15:C52-C60.
http://dx.doi.org/10.1046/j.1440-1746.2000.02266.x DOI: https://doi.org/10.1046/j.1440-1746.2000.02266.x
Segal I, Kasamatsu E, Bravo LE, Bravo JC, et al. Reproducibility of histopathologic diagnosis of precursor lesions of gastric carcinoma in three Latin American countries. Salud Publica Mex. 2010;52(5):386-90.
http://dx.doi.org/10.1590/S0036-36342010000500005 DOI: https://doi.org/10.1590/S0036-36342010000500005
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0