The Vienna classification of gastrointestinal epithelial neoplasia.
BACKGROUND
Use of the conventional Western and Japanese classification systems of gastrointestinal epithelial neoplasia results in large differences among pathologists in the diagnosis of oesophageal, gastric, and colorectal neoplastic lesions.


OBJECTIVE
To develop common worldwide terminology for gastrointestinal epithelial neoplasia.


METHODS
Thirty one pathologists from 12 countries reviewed 35 gastric, 20 colorectal, and 21 oesophageal biopsy and resection specimens. The extent of diagnostic agreement between those with Western and Japanese viewpoints was assessed by kappa statistics. The pathologists met in Vienna to discuss the results and to develop a new consensus terminology.


RESULTS
The large differences between the conventional Western and Japanese diagnoses were confirmed (percentage of specimens for which there was agreement and kappa values: 37% and 0.16 for gastric; 45% and 0.27 for colorectal; and 14% and 0.01 for oesophageal lesions). There was much better agreement among pathologists (71% and 0.55 for gastric; 65% and 0.47 for colorectal; and 62% and 0.31 for oesophageal lesions) when the original assessments of the specimens were regrouped into the categories of the proposed Vienna classification of gastrointestinal epithelial neoplasia: (1) negative for neoplasia/dysplasia, (2) indefinite for neoplasia/dysplasia, (3) non-invasive low grade neoplasia (low grade adenoma/dysplasia), (4) non-invasive high grade neoplasia (high grade adenoma/dysplasia, non-invasive carcinoma and suspicion of invasive carcinoma), and (5) invasive neoplasia (intramucosal carcinoma, submucosal carcinoma or beyond).


CONCLUSIONS
The differences between Western and Japanese pathologists in the diagnostic classification of gastrointestinal epithelial neoplastic lesions can be resolved largely by adopting the proposed terminology, which is based on cytological and architectural severity and invasion status.
Schlemper
R J
RJ
Department of Internal Medicine, Fukuoka University School of Medicine, Japan.
Riddell
R H
RH
Kato
Y
Y
Borchard
F
F
Cooper
H S
HS
Dawsey
S M
SM
Dixon
M F
MF
Fenoglio-Preiser
C M
CM
Fléjou
J F
JF
Geboes
K
K
Hattori
T
T
Hirota
T
T
Itabashi
M
M
Iwafuchi
M
M
Iwashita
A
A
Kim
Y I
YI
Kirchner
T
T
Klimpfinger
M
M
Koike
M
M
Lauwers
G Y
GY
Lewin
K J
KJ
Oberhuber
G
G
Offner
F
F
Price
A B
AB
Rubio
C A
CA
Shimizu
M
M
Shimoda
T
T
Sipponen
P
P
Solcia
E
E
Stolte
M
M
Watanabe
H
H
Yamabe
H
H
D000236:Adenoma / Q000145:classification*; D001317:Austria; D002277:Carcinoma / Q000145:classification*; D003245:Consensus Statements as Topic; D005770:Gastrointestinal Neoplasms / Q000145:classification*; D006801:Humans; D007564:Japan; D009626:Terminology as Topic