title: Diagnosis of gastric epithelial neoplasia: Dilemma for Korean pathologists.
abstract: The histopathological diagnosis of gastric mucosal biopsy and endoscopic mucosal resection/endoscopic submucosal dissection specimens is important, but the diagnostic criteria, terminology, and grading system are not the same in the East and West. A structurally invasive focus is necessary to diagnose carcinoma for most Western pathologists, but Japanese pathologists make a diagnosis of cancer based on severe dysplastic cytologic atypia irrespective of the presence of invasion. Although the Vienna classification was introduced to reduce diagnostic discrepancies, it has been difficult to adopt due to different concepts for gastric epithelial neoplastic lesions. Korean pathologists experience much difficulty making a diagnosis because we are influenced by Japanese pathologists as well as Western medicine. Japan is geographically close to Korea, and academic exchanges are active. Additionally, Korean doctors are familiar with Western style medical terminology. As a result, the terminology, definitions, and diagnostic criteria for gastric intraepithelial neoplasia are very heterogeneous in Korea. To solve this problem, the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists has made an effort and has suggested guidelines for differential diagnosis: (1) a diagnosis of carcinoma is based on invasion; (2) the most important characteristic of low grade dysplasia is the architectural pattern such as regular distribution of crypts without severe branching, budding, or marked glandular crowding; (3) if nuclear pseudostratification occupies more than the basal half of the cryptal cells in three or more adjacent crypts, the lesion is considered high grade dysplasia; (4) if severe cytologic atypia is present, careful inspection for invasive foci is necessary, because the risk for invasion is very high; and (5) other structural or nuclear atypia should be evaluated to make a final decision such as cribriform pattern, papillae, ridges, vesicular nuclei, high nuclear/cytoplasmic ratio, loss of nuclear polarity, thick and irregular nuclear membrane, and nucleoli.
authors.affiliation: Department of Pathology, Inha University Hospital, Incheon 400-711, South Korea.
authors.forename: Joon Mee
authors.initials: JM
authors.lastname: Kim
authors.forename: Mee-Yon
authors.initials: MY
authors.lastname: Cho
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Sohn
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Kang
authors.forename: Cheol Keun
authors.initials: CK
authors.lastname: Park
authors.forename: Woo Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: So-Young
authors.initials: SY
authors.lastname: Jin
authors.forename: Kyoung Mee
authors.initials: KM
authors.lastname: Kim
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Chang
authors.forename: Eunsil
authors.initials: E
authors.lastname: Yu
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jung
authors.forename: Mee Soo
authors.initials: MS
authors.lastname: Chang
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Joo
authors.forename: Mee
authors.initials: M
authors.lastname: Joo
authors.forename: Youn Wha
authors.initials: YW
authors.lastname: Kim
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
authors.forename: Yun Kyung
authors.initials: YK
authors.lastname: Kang
authors.forename: Sun Hoo
authors.initials: SH
authors.lastname: Park
authors.forename: Hye Seung
authors.initials: HS
authors.lastname: Han
authors.forename: Young Bae
authors.initials: YB
authors.lastname: Kim
authors.forename: Ho Sung
authors.initials: HS
authors.lastname: Park
authors.forename: Yang Seok
authors.initials: YS
authors.lastname: Chae
authors.forename: Kye Won
authors.initials: KW
authors.lastname: Kwon
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Chang
mesh_terms: D003245:Consensus Statements as Topic; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000473:pathology*; D010338:Pathology, Clinical / Q000379:methods; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D000078329:Workforce