Kato Motohiko
Motohiko Kato, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan.
World J Gastroenterol. 2015 Nov 28;21(44):12513-8. doi: 10.3748/wjg.v21.i44.12513.
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.
日本和西方病理学家对胃非侵袭性肿瘤/发育异常的病理诊断存在很大差异。在日本，大多数西方病理学家诊断为发育异常的病变，往往基于细胞核和结构异型性而被视为腺癌，无论是否存在浸润。在维也纳分类中，胃非侵袭性上皮内瘤变（NIN）分为低级别和高级别（包括日本标准中的黏膜内癌）。通过活检标本的内镜检查和病理诊断都很困难。预计放大内镜和图像增强内镜等诊断方式的最新进展将提高NIN的诊断率。NIN有两种治疗策略，即观察和内镜切除（ER）诊断性治疗。ER因其侵袭性较小和局部控制率高而被接受，另一方面，据报道低级别NIN的癌症发生率较低。因此，胃NIN的治疗存在争议。未来需要基于统一病理定义的前瞻性研究。
