Long-Term Follow-Up Study of Gastric Adenoma/Dysplasia

H. Yamada; M. Ikegami; T. Shimoda; N. Takagi; M. Maruyama

doi:10.1055/s-2004-814330

Endoscopy, Table of Contents

Endoscopy 2004; 36(5): 390-396
DOI: 10.1055/s-2004-814330

Original Article

Long-Term Follow-Up Study of Gastric Adenoma/Dysplasia

H. Yamada¹ , M. Ikegami² , T. Shimoda³ , N. Takagi⁴ , M. Maruyama⁴

¹Dept. of Internal Medicine, Kawaguchi Municipal Medical Center, Saitama, Japan
²Dept. of Pathology, Jikei University School of Medicine, Tokyo, Japan
³Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan
⁴Foundation for the Detection of Early Gastric Carcinoma, Tokyo, Japan

Abstract

Background and Study Aims: The natural course of gastric adenoma/dysplasia, regarded as a precancerous lesion, is still uncertain.
Patients and Methods: From 1976 to 2000, 48 lesions in 43 patients (37 men, six women; mean age 59 years) were diagnosed as having gastric adenoma/dysplasia based on their first biopsies. These lesions were followed for a median of 4.7 years (mean 6 years, range 3-18 years) to evaluate the risk of progression to invasive carcinoma. Retrospectively, histological diagnoses of the biopsy and resected specimens were reclassified according to the Vienna classification of gastrointestinal epithelial neoplasia, and macroscopic changes were evaluated.
Results: The diagnosis at first biopsy of the 48 lesions was low-grade adenoma/dysplasia (LGD; category 3) in 38 cases and high-grade adenoma/dysplasia (HGD; category 4) in 10 cases. Ninety-seven percent of the LGD (category 3) lesions (37 of 38) showed no histological changes during the follow-up period; the remaining lesion progressed to noninvasive carcinoma (category 4). Macroscopically, 84 % (32 of 38) of the LGD lesions (category 3) showed no remarkable changes in size, while 11 % (four of 38) shrank and 5 % (two of 38) grew larger. Nine of the 10 HGD lesions (category 4) remained histologically unchanged, while the other progressed to intramucosal carcinoma (category 5). Macroscopically, four of the 10 HGD lesions (category 4) (40 %) showed no remarkable changes in size, while the remaining six (60 %) grew larger.
Conclusions: LGD lesions (category 3) have a quite low risk of progressing to HGD or noninvasive carcinoma (category 4), and were never observed to progress to invasive carcinoma (category 5). HGD lesions (category 4) occasionally progressed to intramucosal carcinoma (category 5), with no instance of invasion into the submucosa or beyond.

Full Text

References

1 Oehlert W, Keller P, Henke M. et al . Gastric mucosa: what is its clinical significance?. Front Gastrointest Res. 1979; 4 173-182
2 Oehlert W. Biological significance of dysplasia of the epithelium and of atrophic gastritis. In: Herfath CH, Schlag T, editors Gastric cancer. Berlin; Springer 1979: 91-104
3 Ming S C, Bajtai A, Correa P. et al . Gastric dysplasia: significance and pathologic criteria. Cancer. 1984; 54 1794-1801
4 Nagayo T. Histopathology of gastric dysplasia. In: Filipe MI, Jass JR, editors Gastric carcinoma. Edinburgh; Churchill Livingstone 1986: 116-131
5 Ghandur-Mnaymneh L, Paz J, Roldan E. et al . Dysplasia of non-metaplastic gastric mucosa. Am J Surg Pathol. 1988; 12 96-114
6 Kamiya T, Morishita T, Asakura H. et al . Long-term follow-up study on gastric adenoma and its relation to gastric protruded carcinoma. Cancer. 1982; 50 2496-2503
7 Saraga E P, Gardiol D, Costa J. Gastric dysplasia: a histological follow-up study. Am J Surg Pathol. 1987; 11 788-796
8 Bearzi I, Brancorsini D, Santinelli A. et al . Gastric dysplasia: a ten-year follow-up study. Pathol Res Pract. 1994; 190 61-68
9 Kokkola A, Haapiainen R, Laxen F. et al . Risk of gastric carcinoma in patients with mucosal dysplasia associated with atrophic gastritis: a follow-up study. J Clin Pathol. 1996; 49 979-984
10 Coma del Corral M J, Pardo-Mindan F J, Razquin S. et al . Risk of cancer in patients with gastric dysplasia. Cancer. 1990; 65 2078-2085
11 Fertitta A M, Comin U, Terruzzi V. et al . Clinical significance of gastric dysplasia: a multicenter follow-up study. Gastrointestinal Endoscopic Pathology Study Group. Endoscopy. 1993; 25 265-268
12 Farinati F, Rugge M, Di Mario F. et al . Early and advanced gastric cancer in the follow-up of moderate and severe gastric dysplasia patients. a prospective study. Endoscopy. 1993; 25 261-264
13 Di Gregorio C, Morandi P, Fante R. et al . Gastric dysplasia: a follow-up study. Am J Gastroenterol. 1993; 88 1714-1719
14 Rugge M, Farinati F, Di Mario F. et al . Gastric epithelial dysplasia: a prospective multicenter follow-up study from the interdisciplinary group on gastric epithelial dysplasia. Hum Pathol. 1991; 22 1002-1008
15 Rugge M, Farinati F, Baffa R. et al . Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter prospective follow-up study. Gastroenterology. 1994; 107 1288-1296
16 Rugge M, Leandro G, Farinati F. et al . Gastric epithelial dysplasia: how clinicopathologic background relates to management. Cancer. 1995; 76 376-382
17 Fenoglio-Preiser C, Carneiro F, Correa P. et al . Gastric Carcinoma. In: Hamilton SR, Aaltonen LA (eds) Pathology and genetics of tumours of the digestive system. Lyons; IARC Press 2000: 39-52
18 Park D I, Rhee P L, Kim J E. et al . Risk factors suggesting malignant transformation of gastric adenoma. Endoscopy. 2001; 33 501-506
19 Sipponen P. Gastric dysplasia. Curr Top Pathol. 1990; 81 61
20 Lewin K J, Riddell R H, Weinstein W M. Gastrointestinal pathology and its clinical implications. New York; Igaku-Shoin 1992
21 Lansdown M, Quirke P, Dixon M F. et al . High grade dysplasia of the gastric mucosa: a marker for gastric carcinoma. Gut. 1990; 31 977-983
22 Lauwers G Y, Riddell R H. Gastric epithelial dysplasia. Gut. 1999; 45 784-790
23 Schlemper R J, Itabashi M, Kato Y. et al . Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists. Lancet. 1997; 349 1725-1729
24 Schlemper R J, Kato Y, Stolte M. Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: proposal for a new classification system of gastrointestinal epithelial neoplasia. J Gastroenterol Hepatol. 2000; 15 G49-G57
25 Schlemper R J, Riddell R H, Kato Y. et al . Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000; 47 251-255
26 Rugge M, Correa P, Dixon M F. et al . Gastric dysplasia: the Padova international classification. Am J Surg Pathol. 2000; 24 167-176
27 Schlemper R J, Hirata I, Dixon M F. The macroscopic classification of early neoplasia of the digestive tract. Endoscopy. 2002; 34 163-168
28 Moreto M. Diagnosis of esophagogastric tumors. Endoscopy. 2003; 35 36-42
29 Brito M J, Williams G T, Thompson H, Filipe M I. Expression of p53 in early (T1) gastric carcinoma and precancerous adjacent mucosa. Gut. 1994; 35 1697-1700

H. Yamada, M. D.

Dept. of Internal Medicine · Kawaguchi Municipal Medical Center

180 Nishi-araijuku, Kawaguchi-shi · Saitama 333-0833 · Japan

Fax: +81-48-280-1570

Email: hiroy@oak.ocn.ne.jp