Classification of gastrointestinal epithelial neoplasia

Abstract

Use of the terms ‘adenoma’, ‘dysplasia’ and ‘carcinoma’ without classification into clinically relevant categories has resulted in large variations in diagnoses of oesophageal, gastric and colorectal neoplastic lesions, and in discrepancies between biopsy-based and resection-based diagnoses. To overcome these problems, it is recommended that the categories of the revised Vienna classification are used. These are: (1) negative for neoplasia; (2) indefinite for neoplasia; (3) mucosal low-grade neoplasia; (4) mucosal high-grade neoplasia; and (5) submucosal invasion by carcinoma. These categories fit best with current clinical management considerations. The results of a review of both biopsy and resection specimens of 13 gastric neoplastic lesions by 31 pathologists show that neither Western nor Japanese pathologists can distinguish the subcategories of category 4 reproducibly. Moreover, these subcategories are clinically equivalent, as endoscopic or surgical local resection is indicated in all of them. Proper classification into the five main categories should contribute to better communication between pathologists and clinicians, and to a reduction of overtreatment.