Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12513-12518
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12513
Diagnosis and therapies for gastric non-invasive neoplasia
Motohiko Kato
Motohiko Kato, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
Author contributions: Kato M solely contributed to this paper.
Conflict-of-interest statement: The author has no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Motohiko Kato, MD, PhD, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan. moto2hiko@icloud.com
Telephone: +81-3-34110111 Fax: +81-3-34129811
Received: April 28, 2015
Peer-review started: May 7, 2015
First decision: July 13, 2015
Revised: July 23, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: November 28, 2015
Processing time: 213 Days and 2.2 Hours
Abstract

There has been a great discrepancy of pathological diagnosis for gastric non-invasive neoplasia/dysplasia between Japanese and western pathologists. In Japan, lesions that most western pathologists diagnose as dysplasia are often considered adenocarcinoma based on nuclear and structural atypia regardless of the presence of invasion. In the Vienna classification, gastric non-invasive intraepithelial neoplasia (NIN) were divided into low grade and high grade (including intra-mucosal cancer of Japanese criteria). The diagnosis by both endoscopy and pathology of biopsy specimen is difficult. Recent advances of diagnostic modality such as magnified endoscopy and imaged enhanced endoscopy is expected to improve the diagnostic yield for NIN. There are two treatment strategies for NIN, observation and diagnostic therapy by endoscopic resection (ER). ER is acceptable because of its less invasiveness and high local control rate, on the other hand, cancer-developing rate of low-grade NIN is reported to be low. Therefore there is controversy for the treatment of gastric NIN. Prospective study based on unified pathological definition is required in the future.

Keywords: Gastric; Non invasive intraepithelial neoplasia; Gastric; Adenoma; Adenocarcinoma; Diagnosis

Core tip: The discrepancy of pathological diagnosis for gastric non-invasive neoplasia/dysplasia between Japanese and western pathologists was solved by Vienna classification. Although recent advances of diagnostic modality such as magnified endoscopy and imaged enhanced endoscopy is expected to improve the diagnostic yield for non-invasive intraepithelial neoplasia (NIN), precise prediction of histology is not easy by the findings of conventional white light endoscopy and pathologic findings of forceps biopsy. There is still a controversy regarding the treatment of NIN, observation and diagnostic therapy by endoscopic resection. Prospective study based on unified pathological definition is required in the future.