Gastric dysplasia is a neoplastic lesion and a precursor of gastric cancer. The Padova, Vienna, and World Health Organization classifications were developed to overcome the discrepancies between Western and Japanese pathologic diagnoses and to provide a universally accepted classification of gastric epithelial neoplasia. At present, the natural history of gastric dysplasia is unclear. Much evidence suggests that patients with high-grade dysplasia are at high risk of progression to carcinoma or synchronous carcinoma. Therefore, endoscopic resection is required. Although patients with low-grade dysplasia have been reported to be at low risk of progression to carcinoma, due to the marked histologic discrepancies between forceps biopsy and endoscopic specimens, endoscopic resection for this lesion is recommended, particularly in the presence of other risk factors. Helicobacter pylori eradication in patients with dysplasia after endoscopic resection appear to reduce the incidence of metachronous lesions.
Several dysplasia classification systems—including the Padova, Vienna, and WHO systems—have been developed to standardize the definition of gastric dysplasia and neoplasia between Western and Japanese pathologists. This standardization was necessary because of the marked discrepancies between Western and Japanese pathologic diagnosis of these lesions. Carcinoma is diagnosed in Japan based on cytological and architectural changes irrespective of the presence of invasion, whereas in the Western system it is based on invasion into the lamina propria; this emphasizes invasion as an indicator of metastatic potential. A weakness of the Japanese classification system is the lack of a distinction between noninvasive and invasive mucosal carcinoma; such a distinction seems to have prognostic importance. In contrast, the diagnostic discrepancies between biopsy specimens and corresponding resected specimens are a weakness of the Western classification system. The Japanese Society for Research on Gastric Cancer classification does not include the term dysplasia. Dysplasia is usually classified as low or high grade.
Low-grade dysplasia (LGD) and high-grade dysplasia (HGD) correspond to borderline lesions and strongly suspicious for invasive carcinoma, respectively, in this system. In contrast, there is no recognition of noninvasive carcinoma and mucosal carcinoma without submucosal invasion in the Western system. The Padova, Vienna, and WHO classification schemes aim to provide a universally accepted classification system for gastric epithelial neoplasia. On this basis, Japanese pathologists accepted use of the terms adenoma and dysplasia and Western pathologists accepted that of noninvasive carcinoma. LGD and HGD are classified as noninvasive, low-grade neoplasia of category 3 and noninvasive, high-grade neoplasia of category 4 in the Vienna and revised Vienna classification systems, respectively. In this classification system, the diagnoses “carcinoma in situ,” “suspicious for invasive carcinoma,” and “intramucosal carcinoma” were included in category 4. The WHO classification is similar to the Vienna classification; however, the term “dysplasia” is used synonymously with “intraepithelial neoplasia/dysplasia”. Therefore, categories 3 and 4 in the revised Vienna classification system correspond to low-grade and high-grade intraepithelial neoplasia/dysplasia, respectively, in the WHO classification.
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