The importance of the concept and histological criteria of “intraepithelial squamous cell carcinoma” of the esophagus: in comparison between Western and Japanese criteria

Abstract

BackgroundThere are differences in the histological diagnostic criteria for early stage gastrointestinal carcinoma between Western and Japanese pathologists. Western histological criteria of carcinoma are “presence of stromal invasion of neoplastic cells”, while Japanese criteria are “the degree of cytological and structural abnormality of neoplastic cells, regardless of stromal invasion”. The aim of the present study is to clarify and review the present status of the Western and Japanese histological criteria of early stage esophageal squamous cell carcinoma (SCC) and also to clarify their significance and accuracy.MethodsTwenty-nine Polish, German, and Japanese pathologists participated in this study. A total of 18 histological slides of biopsy, endoscopic submucosal dissection (ESD), and surgical resection of esophageal squamous lesions were diagnosed using a virtual slide system.ResultsMost of noninvasive (intraepithelial) carcinomas diagnosed by Japanese pathologists were diagnosed as high- or low-grade dysplasia (intraepithelial neoplasia) or reactive atypia by the majority of Polish and German pathologists. Diagnoses of not only high-grade dysplasia but also low-grade dysplasia or reactive lesion by Western criteria were given for many biopsy specimens of cases in which the corresponding ESD or surgical specimens showed definite stromal invasion.ConclusionThere still exist differences in the histological diagnostic criteria for early stage esophageal carcinoma between Western and Japanese pathologists. The Japanese diagnostic criteria could improve agreement of diagnoses between biopsy and resected specimens of esophageal SCC. Moreover, diagnostic approaches using Western criteria may cause delay in the early diagnosis and treatment of esophageal SCC.

Endoscopic resections for superficial esophageal squamous cell epithelial neoplasia: focus on histological discrepancies between biopsy and resected specimens

“…First, the pathological diagnostic criteria for squamous cell intraepithelial neoplasia are different from those of Western and Japanese pathologists, even among individual pathologist. Some lesions with stromal invasion in resected specimens may be diagnosed as HGIN, LGIN, or reactive atypical lesions on biopsy according to Western criteria [ 23 ]. In this study, the slides of biopsy and resected specimens were reviewed by two pathologists according to the fifth edition of the WHO classification of digestive tumors to reduce bias.…”

The role of Tannerella forsythia and Porphyromonas gingivalis in pathogenesis of esophageal cancer

“…The accumulation of genetic changes initiates the process of carcinogenesis, which causes histological changes in epithelial cells [26, 27]. In addition, the presence of chronic inflammation of the mucosa of the esophagus leads to the formation of intraepithelial neoplasia, which is considered a pre-cancerous lesion [28]. In endoscopic examination, this is hardly visible.…”

Use of Immunohistochemical p53 Mutant-Phenotype in Diagnosis of High-Grade Dysplasia of Esophageal Squamous Epithelia

“…However, often, an endoscopic biopsy of esophageal lesions, including endoscopic submucosal dissection (ESD) specimens, is underdiagnosed in pathology as low-grade dysplasia or atypical hyperplasia of squamous epithelia [2, 3]. This is inconsistent with the clinical and endoscopic diagnosis, as some high-grade squamous epithelial lesions have good histomorphology and are extremely difficult to differentiate from benign lesions.…”