[The new "Vienna Classification" for epithelial neoplasia of the gastrointestinal tract. Pros or cons?].
A number of seminars have shown considerable differences between Japanese and Western pathologists in the the diagnostic differentiation of regenerative changes, dysplasia, and well differentiated adenocarcinoma in gastroenterological biopsy material. Lesions which most Western pathologists identify as "dysplasia" are often considered adenocarcinomas in Japan. A comparison of the biopsy-based diagnoses with those established in resected mucosa, however, reveals appreciable diagnostic inexperience on the part of Western pathologists, with significant discrepancies between their diagnoses based on biopsies and those based on resected material. Against this background, a new classification of epithelial neoplasias of the gastrointestinal tract was drafted on the occasion of the World Congress of Gastroenterology in Vienna in 1998. By collapsing the diagnoses "high-grade adenoma/dysplasia, noninvasive carcinoma (carcinoma in situ), and suspected invasive carcinoma" into a single category ("noninvasive high-grade neoplasia," category 4), this scheme should largely eliminate the diagnostic discrepancies between Western and Japanese pathologists. As with every classification, the Vienna classification has its advantages and disadvantages; these are discussed here. The most important advantage of the Vienna classification is that the various categories are associated with different recommendations for further diagnostic and therapeutic measures. This applies particularly to category 4, with the recommendation for only local treatment initially (endoscopic mucosal resection or surgical excision). Since the introduction of the Vienna classification the new WHO classification of neoplasias of the gastrointestinal tract has recently been published, in which the term dysplasia has been replaced by "intraepithelial neoplasia." This means that the Vienna classification needs to be modified accordingly.
Stolte
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Institut für Pathologie, Klinikum Bayreuth, Preuschwitzer Strasse 101, 95445 Bayreuth.
D002294:Carcinoma, Squamous Cell / Q000145:classification* / Q000473:pathology*; D005770:Gastrointestinal Neoplasms / Q000145:classification* / Q000473:pathology*; D006801:Humans; D015203:Reproducibility of Results