The long term outcome of gastric non-invasive neoplasia

Abstract

Background: The cancer risk associated with gastric non-invasive neoplasia (formerly dysplasia) is debated. This prospective long term follow up study investigates the clinicopathological behaviour of non-invasive gastric neoplasia (and related lesions), focusing on the cancer risk associated with each different histological phenotype. Patients and methods: A total of 118 consecutive cases (nine indefinite for non-invasive neoplasia; 90 low grade non-invasive neoplasia; 16 high grade non-invasive neoplasia; and three suspicious for invasive adenocarcinoma) with a histological follow up of more than 12 months (average 52 months; range 12-206) were prospectively followed up with a standardised protocol. Patients in whom gastric cancer was detected within 12 months from the initial diagnosis of non-invasive neoplasia were excluded, assuming that invasive carcinoma had been missed at the initial endoscopy procedure. Results: Non-invasive neoplasia was no longer detectable in 57/118 cases (48%), was unchanged in 32 (30%), and evolved into gastric cancer in 20 patients (17%). Evolution to invasive adenocarcinoma was documented in both low and high grade non-invasive neoplastic lesions (8/90 low grade; 11/16 high grade) and correlated with histological severity (low versus high grade) at baseline (p<0.001). Seventy five per cent of cancers occurring during the long term follow up were stage I. Conclusions: The risk of invasive gastric cancer increases with the histological grade of the non-invasive neoplasia. Following up non-invasive gastric neoplasia increases the likelihood of gastric cancer being detected in its early stages.

Gene expression analysis of early and advanced gastric cancers

“…Several long-term follow-up clinical studies support the notion that human gastric carcinogenesis is a multistep and multifactorial process (Tsukuma et al, 1983(Tsukuma et al, , 2000Rugge et al, 2003). Progression of low-and high-grade non-invasive neoplastic lesions to invasive adenocarcinoma, and of early gastric lesions to advanced stages has been clinically documented (Tsukuma et al, 1983(Tsukuma et al, , 2000Rugge et al, 2003).…”

“…Progression of low-and high-grade non-invasive neoplastic lesions to invasive adenocarcinoma, and of early gastric lesions to advanced stages has been clinically documented (Tsukuma et al, 1983(Tsukuma et al, , 2000Rugge et al, 2003).…”

Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy

“…In this classification, "high-grade adenoma/dysplasia", "non-invasive carcinoma (carcinoma in situ)" and "suspected invasive carcinoma" were clustered into a single category (category 4), termed "noninvasive highgrade neoplasia" to eliminate the diagnostic discrepancies between western and Japanese pathologists. Because these three diagnoses cannot be reproducibly distinguished and the treatment recommendation would be the same for each diagnosis, these lesions are considered to be premalignant lesions [18][19][20] . At the beginning of 2000, the Vienna classification was revised [21] and, for a similar reason, intramucosal carcinoma was added as a fourth subcategory of category 4, because it is often hard to determine whether there is invasion into the lamina propria and because from a therapeutic viewpoint, the distinction between any of the four subcategories is irrelevant.…”

Gastric Adenoma with Low-Grade Dysplasia: Two Countries, Two Outcomes

“…From the Japanese viewpoint, gastric adenomas with LGD diagnosed by Western criteria include typical adenomas of the small intestinal type and gastric foveolar type which often have papillary and tubular structures, and thus diagnosed as ''carcinoma without invasion'' in Japan. Therefore, lesions diagnosed as gastric adenomas in Japan rarely progress to cancer [10], unlike adenomas diagnosed in other countries [11,12]. In Korea, pathological diagnosis is based on the Western criteria, and thus gastric neoplasia is classified as LGD, HGD, or adenocarcinoma, as reported by Kim et al [1].…”