Elsevier

Human Pathology

Volume 22, Issue 10, October 1991, Pages 1002-1008
Human Pathology

Original contribution
Gastric epithelial dysplasia: A prospective multicenter follow-up study from the interdisciplinary group on gastric epithelial dysplasia

https://doi.org/10.1016/0046-8177(91)90008-DGet rights and content

Abstract

To assess the evolution of gastric epithelial dysplasia (GED), a prospective multicenter study was based on a protocol of repeated endoscopies and biopsies. To date, 134 cases (0.4% of all patients endoscopically examined in the same period) have been diagnosed as having GED and 80 of those have had an “adequate” follow-up (at least three endoscopies). Mean follow-up time was 18 months. Gastric epithelial dysplasia was mild in 59% of cases, moderate in 25%, and severe in 10%. Six percent of the patients had lesions that were “indefinite for dysplasia.” Chronic atrophic gastritis (40%), gastric ulcer (32%), gastrectomy (10%), and polyps (9%) were the most frequently associated lesions. The term “regression” was adopted for GED no longer detectable during follow-up and the term “progression” was used when more severe changes or cancer was detected. Mild GED regressed in 66% of cases, persisted in 15%, and progressed in 19% (three cases to moderate, one to severe, and five to cancer). Moderate GED regressed in 30% of patients, persisted in 30%, and progressed in 40% (one to severe GED and seven to cancer). Severe GED regressed in 12.5% of patients, persisted in 12.5%, and progressed to cancer in 75%. Of the five patients with lesions indefinite for dysplasia, two had no dysplastic changes at follow-up and three had cancer diagnosed. Ten of 21 cases of cancer (48%) were at the early stage. The diagnosis was reached within the first year of follow-up in 14 cases and after 1 year in seven (13 to 39 months). Fifteen of 21 cases of cancer were diagnosed in gastric ulcer patients. In conclusion, GED is an infrequent finding and its biologically neoplastic significance is confirmed by the results of the follow-up study: (1) in its mild form, it tends to regress but adequate subsequent check-ups are mandatory as it may associate with or evolve as cancer; (2) patients with moderate GED require strict follow-up since the lesion shows a higher cancer risk; (3) surgery is indicated for severe GED because gastric cancer develops in 75% of cases, and (4) patients with lesions indefinite for dysplasia should immediately undergo repeat endoscopy and biopsy. Such an approach allows gastric cancer to be detected at an early stage in a much higher percentage of cases than may be expected.

References (38)

  • F Pasic et al.

    A score for the evaluation of epithelial gastric dysplasia

    Ital J Gastroenterol

    (1989)
  • G Mezzanotte et al.

    Cancer mortality in broad Italian geographical areas, 1975–1977

    Tumori

    (1986)
  • A Medline et al.

    The multistep theory of neoplasia

  • R Riddell

    Dysplasia and cancer in ulcerative colitis: A soluble problem

    Scand J Gastroenterol

    (1984)
  • DA Antonioli

    Gastric carcinoma and its precursors

  • P Sipponen

    Gastric dysplasia

  • T Nagayo

    Histological diagnosis of biopsied gastric mucosae with special reference to that of borderline lesions

    Gann Monogr

    (1971)
  • SC Ming et al.

    Gastric dysplasia. Significance and pathologic criteria

    Cancer

    (1984)
  • C Cuello et al.

    Histopathology of gastric dysplasias. Correlations with gastric juice chemistry

    Am J Surg Pathol

    (1979)
  • W Oehlert et al.

    Die dysplasien der magenschleimhant

    Dtsch Med Wochenschr

    (1975)
  • ROK Schade

    The borderline between benign and malignant lesions in the stomach

  • L Ghandur-Mnaymneh et al.

    Dysplasia of nonmetaplastic gastric mucosa. A proposal for its classification and its possible relationship to diffuse-type gastric carcinoma

    Am J Surg Pathol

    (1988)
  • BC Morson et al.

    Stomach

    BC Morson et al.

    Stomach

  • SC Ming

    Dysplasia of gastric epithelium

    Front Gastrointest Res

    (1979)
  • BC Morson et al.

    Precancerous conditions and epithelial dysplasia in the stomach

    J Clin Pathol

    (1980)
  • JR Jass

    A classification of gastric dysplasia

    Histopathology

    (1983)
  • JF Riemann et al.

    On the ultrastructure of the gastric borderline lesion

    J Cancer Res Clin Oncol

    (1983)
  • H Sugano et al.

    An atypical epithelium of the stomach. A clinico-pathological entity

    Gann Monogr Cancer Res

    (1971)
  • K Oota et al.

    Histological typing of gastric and esophageal tumors

  • Cited by (0)

    Participants in the Interdisciplinary Group on Gastric Epithelial Dysplasia (IGGED) are as follows: Abano Terme: R. Rossoni; Bassano del Grappa: B. Crestani, A. Guerini, and E. Venza; Camposampiero; C. Chiavinato, P. Di Pietro, G. Mercante, and F. Saglimbeni; Castelfranco Veneto: D. Madia and G. Mastrapasqua; Chioggia: F. Casson, R. Giordano, and C. Sanavio; Cittadella: M. Guido, C. Militello, and L. Ragni; Dolo: A. D'Angelo, R. Marin, A. Montaguti, and G. Tosi; Feltre-Ospedale Civile: R. Cielo, M. De Boni, G. Doglioni, and J. Restelli; Feltre-Casa di Cura “Bellati”: R. De Bastiani; Legnago: E. Dall'Orso; Mestre: U. Dal Maschio, G. Chiozzini, F. Costa, and A. Saggioro; Mirano-Noale: M. De Bernardin and A. Manconi; Padova: R. Baffa, F. Cardin, F. Di Mario, M.C. Fanton, F. Farinati, A. Fassina, R. Naccarato, V. Ninfo, M. Rugge, and F. Valiante; Palermo: F. Aragona, A. Scialabba, and S. Vigneri; and Vicenza: V. Bertoncello, L. Bozzola, A. Campesato, and I. Meli.

    View full text