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World J Gastroenterol. Jun 7, 2011; 17(21): 2602-2610
Published online Jun 7, 2011. doi: 10.3748/wjg.v17.i21.2602
Diagnosis of gastric epithelial neoplasia: Dilemma for Korean pathologists
Joon Mee Kim, Mee-Yon Cho, Jin Hee Sohn, Dae Young Kang, Cheol Keun Park, Woo Ho Kim, So-Young Jin, Kyoung Mee Kim, Hee Kyung Chang, Eunsil Yu, Eun Sun Jung, Mee Soo Chang, Jong Eun Joo, Mee Joo, Youn Wha Kim, Do Youn Park, Yun Kyung Kang, Sun Hoo Park, Hye Seung Han, Young Bae Kim, Ho Sung Park, Yang Seok Chae, Kye Won Kwon, Hee Jin Chang, The Gastrointestinal Pathology Study Group of Korean Society of Pathologists
Joon Mee Kim, Department of Pathology, Inha University Hospital, Incheon 400-711, South Korea
Mee-Yon Cho, Department of Pathology, Yonsei University Wonju College of Medicine Wonju Christian Hospital, Wonju, Kang won do 220-701, South Korea
Jin Hee Sohn, Department of Pathology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Medical Center, Seoul 100-634, South Korea
Dae Young Kang, Department of Pathology, Chungnam National University College of Medicine, Daejeon 301-747, South Korea
Cheol Keun Park, Kyoung Mee Kim, Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 135-710, South Korea
Woo Ho Kim, Department of Pathology, Seoul National University College of Medicine, Seoul 110-799, South Korea
So-Young Jin, Department of Pathology, Soonchunhyang University Hospital, Seoul 140-743, South Korea
Hee Kyung Chang, Department of Pathology, Kosin University College of Medicine, Busan 602-702, South Korea
Eunsil Yu, Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, South Korea
Eun Sun Jung, Department of Pathology, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 137-701, South Korea
Mee Soo Chang, Department of Pathology, Seoul National University Boramae Hospital, Seoul 156-707, South Korea
Jong Eun Joo, Department of Pathology, Eulji General Hospital, Seoul 139-711, South Korea
Mee Joo, Department of Pathology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do 411-706, South Korea
Youn Wha Kim, Department of Pathology, Kyunghee University College of Medicine, Seoul 130-701, South Korea
Do Youn Park, Department of Pathology, Pusan National University College of Medicine, Busan 602-739, South Korea
Yun Kyung Kang, Department of Pathology, Inje University Seoul Paik Hospital, Seoul 100-032, South Korea
Sun Hoo Park, Department of Pathology, Korea Cancer Center Hospital, Seoul 139-706, South Korea
Hye Seung Han, Department of Pathology, Konkuk University Medical Center, Seoul 143-729, South Korea
Young Bae Kim, Department of Pathology, Ajou University School of Medicine, Suwon, Gyeonggi-do 442-749, South Korea
Ho Sung Park, Department of Pathology, Chonbuk National University Medical School, Jeonju 561-180, South Korea
Yang Seok Chae, Department of Pathology, Korea University College of Medicine, Seoul 136-705, South Korea
Kye Won Kwon, Department of Pathology, Bundang Jesaeng Hospital, Bundang-gu, Gyeonggi-do 463-050, South Korea
Hee Jin Chang, Department of Pathology, National Cancer Center, Goyang, Gyeonggi-do 410-769, South Korea
The Gastrointestinal Pathology Study Group of Korean Society of Pathologists, The Korean Society of Pathologists, 4F, The Korean Medical Association Building, Seoul 140-721, South Korea
Author contributions: Kim JM, Cho MY, Kang DY, Jin SY, Kim KM, Chang HK, Yu E, Jung ES, Chang MS, Joo JE, Kim YW, Park DY, Kang YK, Park SH, Han HS, Kwon KW and Chang HJ submitted slides; Kim JM, Cho MY, Sohn JH, Kim KM, Joo JE and Joo M selected slides; Kim JM, Cho MY, Sohn JH, Park CK, Kim WH, Jin SY, Chang HK, Yu E, Jung ES, Chang MS, Joo JE, Joo M, Park DY, Kang YK, Park SH, Han HS, Kim YB, Park HS and Chae YS attended workshop for discussion; members of The Gastrointestinal Pathology Study Group of Korean Society of Pathologists reviewed the circulating slides and contributed by voting; Kim JM wrote the paper.
Supported by Korean Society of Pathologists
Correspondence to: Dr. Jin Hee Sohn, Department of Pathology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Medical Center, 108, Pyeong-dong, Jongro-gu, Seoul 100-634, South Korea. jhpath.sohn@samsung.com
Telephone: +82-2-20012391 Fax: +82-2-20012398
Received: June 29, 2010
Revised: September 9, 2010
Accepted: September 16, 2010
Published online: June 7, 2011
Abstract

The histopathological diagnosis of gastric mucosal biopsy and endoscopic mucosal resection/endoscopic submucosal dissection specimens is important, but the diagnostic criteria, terminology, and grading system are not the same in the East and West. A structurally invasive focus is necessary to diagnose carcinoma for most Western pathologists, but Japanese pathologists make a diagnosis of cancer based on severe dysplastic cytologic atypia irrespective of the presence of invasion. Although the Vienna classification was introduced to reduce diagnostic discrepancies, it has been difficult to adopt due to different concepts for gastric epithelial neoplastic lesions. Korean pathologists experience much difficulty making a diagnosis because we are influenced by Japanese pathologists as well as Western medicine. Japan is geographically close to Korea, and academic exchanges are active. Additionally, Korean doctors are familiar with Western style medical terminology. As a result, the terminology, definitions, and diagnostic criteria for gastric intraepithelial neoplasia are very heterogeneous in Korea. To solve this problem, the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists has made an effort and has suggested guidelines for differential diagnosis: (1) a diagnosis of carcinoma is based on invasion; (2) the most important characteristic of low grade dysplasia is the architectural pattern such as regular distribution of crypts without severe branching, budding, or marked glandular crowding; (3) if nuclear pseudostratification occupies more than the basal half of the cryptal cells in three or more adjacent crypts, the lesion is considered high grade dysplasia; (4) if severe cytologic atypia is present, careful inspection for invasive foci is necessary, because the risk for invasion is very high; and (5) other structural or nuclear atypia should be evaluated to make a final decision such as cribriform pattern, papillae, ridges, vesicular nuclei, high nuclear/cytoplasmic ratio, loss of nuclear polarity, thick and irregular nuclear membrane, and nucleoli.

Keywords: Intraepithelial neoplasia; Stomach; Dysplasia; Adenoma; Carcinoma; Japanese; Western; Consensus; Vienna