The commencement and development of studies on discrepancies in pathologic diagnosis of early carcinoma of the GI tract

Abstract

To detect early cancers and perform endoscopic mucosal resection of them is one of the tasks of digestive endoscopists. It is also generally believed that the determination of whether a person has a carcinoma should be given unequivocally at the stage of the pathologic examination. At the stage of the pathologic diagnosis, however, the presence of discrepancies between pathologists in Japan and those in Europe and the United States was noted. A series of studies on the discrepancies was commenced when Dr. Schlemper, who was then practicing endoscopy at my institution, planned the study and we assisted him. In 1996, he invited eight pathologists from Japan, Europe, and the United States to participate in a group study on the occasion of the 52nd Congress of Japan Gastroenterological Endoscopy Society (President, Prof. Nakamura) and the Asian-Pacific Congress of Gastroenterology and Digestive Endoscopy in Yokohama. In the group study, invited pathologists individually examined the same set of histopathologic preparations of the stomach derived from 35 cases and gave a diagnosis in each case. Most of the preparations used in this study were presented by Fujigaoka Hospital of Showa University. Results of the group study were published in Lancet and awoke worldwide interest and attention (Lancet 1997;349:1725-9). The next year, 1997, “Premalignant and Early Malignant Lesions (Borderline Lesions) in the Digestive Tract: Diagnosis and Treatment” was the title of the International Session in that Congress of the Japan Gastroenterological Endoscopy Society (President, Prof. Oohara). In the session, chairpersons were Dr. Kato, Dr. Schlemper, and myself, and panelists from foreign countries were Drs. Fairclough, Ahnen, and Jass, while those from Japan were Drs. Yoshida, Shimoda, Kato, and Kuramoto. While discrepancies in diagnostic criteria for early carcinoma had been known vaguely but had not attracted much attention until then, presentations by endoscopists and pathologists from Japan and foreign countries in this session stirred up much discussion about the discrepancies. Presentations in the session also revealed that cases diagnosed as early gastric cancer in Japan were diagnosed as adenoma, dysplasia, or severe dysplasia in Western countries.