PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of gutGutVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Gut. 2000 August; 47(2): 251–255.
PMCID: PMC1728018

The Vienna classification of gastrointestinal epithelial neoplasia

Abstract

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.
AIM—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).
CONCLUSION—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.


Keywords: early carcinoma; adenoma; dysplasia; oesophagus; stomach; colon

Figure 1
Extent of agreement between the viewpoints of 31 Western and Japanese pathologists; the diagnoses of (A) 35 gastric, (B) 20 colorectal, and (C) 21 oesophageal lesions are based on their currently used classification systems. ...
Figure 2
Gastric lesion in a man aged 73 years. (A) Endoscopic picture of a small area of redness (arrowheads) in the corpus amid atrophic gastric mucosa. (B) Endoscopic picture after spraying indigo carmine, revealing a shallow depressed lesion (arrowheads). ...
Figure 3
Extent of agreement between the viewpoints of 31 Western and Japanese pathologists; the diagnoses for (A) 35 gastric, (B) 20 colorectal, and (C) 21 oesophageal lesions are based on the five categories of the Vienna classification ...
Figure 4
Gastric lesion in a man aged 67 years. (A) Endoscopic picture of a slightly elevated lesion with a central depression (arrowheads) in the corpus. (B) Endoscopic picture after spraying indigo carmine, revealing the borders of the lesion more clearly ...

Articles from Gut are provided here courtesy of BMJ Group