Comparative study of Western and Japanese criteria for biopsy-based diagnosis of gastric epithelial neoplasia

Abstract

Background In Western countries, gastric cancer (GC) is diagnosed when there is histological evidence of invasion into the lamina propria or beyond the submucosa. In Japan and some other countries, however, diagnosis of GC is based on the degree of structural and cytological abnormality of tumor glands. The aim of the present study was to compare the accuracy of the Western and Japanese criteria for diagnosis of GC. Methods The study included 233 consecutive patients with a postoperative diagnosis of submucosal invasive GC who underwent gastrectomy or endoscopic submucosal dissection. All pretreatment biopsy specimens were independently reviewed by two experts in gastrointestinal pathology employing both the Western and Japanese diagnostic criteria. Diagnostic agreement between pretreatment biopsy specimens and the corresponding resected specimens was evaluated, together with the interobserver agreement for each of the criteria. Results On the basis of the Western and Japanese criteria, the pretreatment biopsy diagnosis was noncancerous (including dysplasia) in 44 lesions and 1 lesion, respectively. Diagnostic accuracy based on biopsy was 81.1 % for the Western criteria and 99.5 % for the Japanese criteria (P \ 0.001). Interobserver agreement based on the Western and Japanese criteria was 73.8 % and 96.5 %, respectively (P \ 0.001). Invasion into the submucosa was detected by biopsy in only 25 cases. Conclusions The Japanese criteria are significantly more accurate for pretreatment biopsy diagnosis of GC. The Western criteria could lead to underdiagnosis of a lesion as high-grade dysplasia, even if submucosal invasive cancer is present.

The incidence of non‐ampullary duodenal cancer in Japan: The first analysis of a national cancer registry

“…Japanese pathologists diagnose lesions as cancer on the basis of the degree of structural and cytological abnormality of tumor glands, while pathologists in the West make a diagnosis of cancer when there is histological evidence of invasion into the lamina propria or beyond the submucosa. 18 Although the carcinoma in situ of this study was only 6.1%, the pathological difference might affect the incidence. Further studies from Asian countries are required to clarify the trend and the incidence among ethnic groups.…”

“…Third, the pathological diagnostic system for gastrointestinal cancers has not been unified between Japan and the Western countries. Japanese pathologists diagnose lesions as cancer on the basis of the degree of structural and cytological abnormality of tumor glands, while pathologists in the West make a diagnosis of cancer when there is histological evidence of invasion into the lamina propria or beyond the submucosa 18 . Although the carcinoma in situ of this study was only 6.1%, the pathological difference might affect the incidence.…”

Natural History of Early Gastric Cancer: a Case Report and Literature Review

“…In Japan, it has been reported that 87% of new lesions are detected in the early stage [1112], and 81% to 95% of these lesions meet the indications for ESD [45]. However, due to differences in the pathological diagnostic criteria for EGC between Japan and Western countries, EGC in Western countries, especially mucosal cancer, is often followed up as a pre-malignant lesion or pseudo-disease that is not expected to invade into the deeper layer [1013]. This case might represent a milestone in appreciating the importance of ESD for mucosal EGC.…”

Clinicopathological characteristics of non‐ampullary duodenal tumors and their phenotypic classification

“…Adenocarcinoma was distinguished from adenoma based on the following findings: the presence of remarkable variation in nuclear size and shape; presence of hyperchromatic, large, spherical, and vesicular nuclei; irregularly clumped chromatin; increased frequency of mitotic figures; pseudostratified nuclei; poor cellular differentiation; increased nuclear-to-cytoplasmic ratio; loss of nuclear polarity as a nuclear feature; and increased crypt complexity with crowding, branching glandular epithelium, fused glands, budding, a cribriform pattern, and variability of crypt size and shape as structural abnormalities. 17,18 To evaluate the phenotype, immunostaining using antibodies against CD10 (Leica Biosystems, Newcastle upon Tyne, UK; dilution, 1:100), MUC2 (Leica Biosystems; dilution, 1:200), MUC5AC (Leica Biosystems; dilution, 1:200), and MUC6 (Leica Biosystems; dilution, 1:100) was performed. Cytoplasmic reactivity was determined as a positive result for MUC2, MUC5AC, and MUC6 and luminal membranous reactivity as a positive result for CD10.…”