Home > E. Pathology by systems > Digestive system > Stomach > Vienna classification of gastric epithelial tumors

Vienna classification of gastric epithelial tumors

Tuesday 2 October 2012

Vienna classification of gastric neoplasms

Vienna classification of gastric neoplasms

The proposed classification is a five categories system.

CATEGORY 1: NEGATIVE FOR NEOPLASIA/DYSPLASIA

This category encompasses either completely normal gastric mucosa or various gastritides (Helicobacter pylorigastritis) or gastropathies (bile reflux gastritis/non-steroidal anti-inflammatory drug (NSAID) related gastropathy) as well as intestinal metaplasia.

CATEGORY 2: INDEFINITE FOR NEOPLASIA/DYSPLASIA

This diagnosis should be rendered when there is uncertainty about the nature of the lesion, whether it represents a regenerative/reactive process or a neoplastic lesion.

The cause of the diagnostic difficulty might be secondary to inflammation (sometimes related to H pylorigastritis) or reactive chemical changes (bile reflux gastritis, NSAID gastropathy) or because of the inadequacy of the specimen (small size, crushing artefact).

CATEGORY 3: NON-INVASIVE NEOPLASIA, LOW GRADE (LOW GRADE ADENOMA/DYSPLASIA)

This represents an unequivocal neoplastic process with low risk of malignant degeneration. It roughly corresponds to the generally previously accepted low grade dysplasia.

CATEGORY 4: NON-INVASIVE NEOPLASIA, HIGH GRADE (HIGH GRADE ADENOMA/DYSPLASIA)

These are a group of lesions with features more severe than those seen in low grade dysplasia but without unequivocal invasion. This category has been subdivided into three groups:

- 4.1 high grade adenoma/dysplasia;
- 4.2 non-invasive carcinoma (carcinoma in situ);
- 4.3 suspicious for invasive carcinoma.

The grouping of those three different types of lesions is important in order to achieve a high interobserver agreement among pathologists, whether under Japanese or Western influence in terms of diagnosis of gastric dysplasia. The word “non-invasive” stands for the absence of evident invasion.

It places together a lesion that Japanese pathologists would classify as carcinoma based on the presence of notable cytological alterations (carcinoma in situ) but that most Western pathologists would interpret as high grade dysplasia because of the absence of invasion.

CATEGORY 5: INVASIVE NEOPLASIA

This category encompasses:

- 5.1 intramucosal carcinoma
- 5.2 submucosal carcinoma or beyond

  • 5.2.a “Non-invasive” stands for absence of evident invasion.
  • 5.2.b “Intramucosal” stands for invasion into the lamina propria or muscularis mucosae.

Intramucosal carcinoma corresponds to adenocarcinoma with invasion limited to the lamina propria or the muscularis mucosa.

It was also hoped that this classification could be applied throughout the gastrointestinal tract.

Several working groups have been set up to determine the feasibility of this system in different segments of the gastrointestinal tract including squamous oesophagus, Barrett’s oesophagus, stomach, small bowel, large bowel, and anus.

The different issues to be settled include:
- (a) the usefulness of the terminology, ensuring that the divisions between and within each category are defined well enough that there is good interobserver reproducibility, thereby allowing the system to be used internationally,
- (b) that there is consistency of terminology in different organs within the gastrointestinal tract,
- (c) its acceptability by the pathology and gastroenterology communities at large if all of these problems are resolved.

Participants at the Vienna Meeting

F Borchard, H S Cooper, S M Dawsey, M F Dixon, C M Fenoglio-Preiser, J-F Fléjou, K Geboes, T Hattori, T Hirota, M Itabashi, M Iwafuchi, A Iwashita, Y Kato, Y I Kim, T Kirchner, M Klimpfinger, M Koike, G Y Lauwers, K J Lewin, G Oberhuber, A B Price, R H Riddell, C A Rubio, M Rugge, R J Schlemper, M Shimizu, T Shimoda, P Sipponen, E Solcia, M Stolte, H Watanabe, H Yamabe.

Reference

- Gastric epithelial dysplasia. Gut 1999;45:784 by Gregory Y Lauwers, MD, Department of Pathology, University of Florida, PO Box 100275, Gainesville, FL 32610–0275, USA. E-mail: lauwers.pathology@mail.health.ufl.edu