title: Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification.
abstract: OBJECTIVE
  Therapeutic guidelines have not yet been established for low-grade gastric adenomas/dysplasias (LGD), which have a low risk of progression to high-grade adenomas/dysplasias (HGD) or to invasive carcinomas. This study aimed to evaluate risk factors for HGD/carcinoma that indicate a need for resection in biopsy-proven LGD lesions.
  
  
  METHODS
  In total, 236 LGD lesions from 208 consecutive patients treated with endoscopic resection (ER) were retrospectively studied between 2004 and 2008. The Vienna classification was used for histological diagnosis. A generalized estimating equation (GEE) logistic regression model was used for multivariate analysis.
  
  
  RESULTS
  Among the 236 LGD lesions, the final pathology diagnosed 9 (3.8 %) as invasive carcinoma (category 5), 71 (30.1 %) as HGD (category 4), 148 (62.7 %) as LGD (category 3), and 8 (3.4 %) as negative/indefinite for dysplasia (category 1/2). Lesions ≥ 1 cm were classified as HGD/carcinoma in 39.4 % of patients (65/165). Multivariate analysis indicated that size of ≥ 1 cm (OR 1.93 [95 % CI, 1.06 - 3.52]), depressed morphology (OR 3.81 [95 % CI, 1.22 - 11.9]), and erythema (OR 2.49 [95 % CI, 1.31 - 4.72]) were significantly associated with HGD/carcinoma. The OR increased to 47.6 (95 % CI, 4.27 - 530.65) when the risk factors were all positive. The sensitivity and negative predictive value for ≥ 1 risk factors were 93.8 % and 90.9 %, respectively. As the number of risk factors of a lesion increased, the specificity and positive predictive value also increased.
  
  
  CONCLUSIONS
  Endoscopic resection can be recommended if a low-grade dysplastic lesion has at least one of the following risk factors: depressed morphology, surface erythema, or a size of 1 cm or greater. For lesions that have none of the three risk factors, follow-up endoscopy is recommended.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Korea.
authors.forename: S-J
authors.initials: SJ
authors.lastname: Cho
authors.forename: I J
authors.initials: IJ
authors.lastname: Choi
authors.forename: C G
authors.initials: CG
authors.lastname: Kim
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
authors.forename: M-C
authors.initials: MC
authors.lastname: Kook
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.forename: K W
authors.initials: KW
authors.lastname: Ryu
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: Y-W
authors.initials: YW
authors.lastname: Kim
mesh_terms: D000236:Adenoma / Q000145:classification / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000145:classification / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery