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The long term outcome of gastric non-invasive neoplasia
  1. M Rugge1,
  2. M Cassaro1,
  3. F Di Mario2,
  4. G Leo1,
  5. G Leandro3,
  6. V M Russo1,
  7. G Pennelli1,
  8. F Farinati4,
  9. for the Interdisciplinary Group on Gastric Epithelial Dysplasia (IGGED)
  1. 1Department of Oncological and Surgical Sciences, III Cattedra di Anatomia Patologica, Università degli Studi di Padova-Azienda Ospedale Padova, Italia
  2. 2Department of Gastroenterology, Università di Parma, Italia
  3. 3Department of Medicine, “Saverio de Bellis” Hospital, Castellana Grotte, Italia
  4. 4Department of Surgical and Gastroenterology Sciences, Università degli Studi di Padova- Azienda Ospedale Padova, Italia
  1. Correspondence to:
    Dr M Rugge, III Cattedra di Anatomia Patologica, Università degli Studi di Padova, Via Aristide Gabelli, 61, 35121, Padova, Italia;


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.

  • gastric neoplasia
  • gastric dysplasia
  • gastric cancer
  • GC, gastric cancer
  • EGC, early gastric cancer
  • AGC, advanced gastric cancer
  • EMR, endoscopic mucosal resections
  • GC-nos, gastric cancer not otherwise specified

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