Long-Term Follow-Up Study of Gastric Adenoma/Dysplasia

H. Yamada; M. Ikegami; T. Shimoda; N. Takagi; M. Maruyama

doi:10.1055/s-2004-814330

Endoscopy, Table of Contents

Endoscopy 2004; 36(5): 390-396
DOI: 10.1055/s-2004-814330

Original Article

Long-Term Follow-Up Study of Gastric Adenoma/Dysplasia

H. Yamada¹ , M. Ikegami² , T. Shimoda³ , N. Takagi⁴ , M. Maruyama⁴

¹Dept. of Internal Medicine, Kawaguchi Municipal Medical Center, Saitama, Japan
²Dept. of Pathology, Jikei University School of Medicine, Tokyo, Japan
³Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan
⁴Foundation for the Detection of Early Gastric Carcinoma, Tokyo, Japan

Abstract

Background and Study Aims: The natural course of gastric adenoma/dysplasia, regarded as a precancerous lesion, is still uncertain.
Patients and Methods: From 1976 to 2000, 48 lesions in 43 patients (37 men, six women; mean age 59 years) were diagnosed as having gastric adenoma/dysplasia based on their first biopsies. These lesions were followed for a median of 4.7 years (mean 6 years, range 3-18 years) to evaluate the risk of progression to invasive carcinoma. Retrospectively, histological diagnoses of the biopsy and resected specimens were reclassified according to the Vienna classification of gastrointestinal epithelial neoplasia, and macroscopic changes were evaluated.
Results: The diagnosis at first biopsy of the 48 lesions was low-grade adenoma/dysplasia (LGD; category 3) in 38 cases and high-grade adenoma/dysplasia (HGD; category 4) in 10 cases. Ninety-seven percent of the LGD (category 3) lesions (37 of 38) showed no histological changes during the follow-up period; the remaining lesion progressed to noninvasive carcinoma (category 4). Macroscopically, 84 % (32 of 38) of the LGD lesions (category 3) showed no remarkable changes in size, while 11 % (four of 38) shrank and 5 % (two of 38) grew larger. Nine of the 10 HGD lesions (category 4) remained histologically unchanged, while the other progressed to intramucosal carcinoma (category 5). Macroscopically, four of the 10 HGD lesions (category 4) (40 %) showed no remarkable changes in size, while the remaining six (60 %) grew larger.
Conclusions: LGD lesions (category 3) have a quite low risk of progressing to HGD or noninvasive carcinoma (category 4), and were never observed to progress to invasive carcinoma (category 5). HGD lesions (category 4) occasionally progressed to intramucosal carcinoma (category 5), with no instance of invasion into the submucosa or beyond.

Full Text

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H. Yamada, M. D.

Dept. of Internal Medicine · Kawaguchi Municipal Medical Center

180 Nishi-araijuku, Kawaguchi-shi · Saitama 333-0833 · Japan

Fax: +81-48-280-1570

Email: hiroy@oak.ocn.ne.jp