Differences in the diagnostic criteria used by japanese and western pathologists to diagnose colorectal carcinoma

Schlemper, Ronald J.; Itabashi, Michio; Kato, Yukio; Lewin, Klaus J.; Riddell, Robert H.; Shimoda, Tadakazu; Sipponen, P; Stolte, Manfred; Watanabe, Hidenobu

doi:10.1002/(sici)1097-0142(19980101)82:1<60::aid-cncr7>3.0.co;2-o

Cited by 149 publications

(146 citation statements)

References 27 publications

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“…Yet the perioperative complication rate compared favorably with that of the TEM series, and the rate of abdominal surgery controlling complications was negligible. Postoperative histology assessment demonstrated a much higher incidence of adenocarcinoma in the ESD series, which was attributable to a different way of classifying intramucosal lesions [37]. The rates of unpredicted invasive cancers treated in the two groups were comparable, but this required further surgery for oncologic reasons about four times more often in the ESD group due to the higher incidence of R1 resections than in the TEM group.…”

Section: Discussionmentioning

confidence: 89%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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Background For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and fullthickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. Methods A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. Results This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). ConclusionsThe ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment. Keywords Rectal adenoma Transanal endoscopic microsurgery Endoscopic submucosal dissection Systematic review Meta-analysis For nearly 30 years, transanal endoscopic microsurgery (TEM) has been the optimal mainstay treatment for large rectal lesions. Initially conceived for treating benign lesions, its indications were extended to early rectal cancer treatment when Hermanek and Gall [1] assessed criteria to determine lesions at "low risk" for recurrence. One increasingly recognized advantage of the technique versus standard transanal surgery is the high rate of en bloc resection with disease-free margins, which is strictly related to the risk of recurrence [2]. With the advent of endoscopic submucosal dissection (ESD) about 10 years ago, flexible endoscopy permitted a surgical-like technique for en bloc resection of superficial lesions of the digestive trac...

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Section: Discussionmentioning

confidence: 89%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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“…1 These discrepancies are caused by differences in the histological criteria applied to colorectal intramucosal tumors according to accepted Western or Japanese protocols. [1][2] The presence of submucosal invasion is the most important diagnostic criterion for most Western pathologists, whereas in Japan, nuclear features and glandular structures are more important to the diagnosis. 2 In fact, the actual degree of histological concordance between Western and Japanese pathologists is reported to be poor.…”

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confidence: 99%

“…[1][2] The presence of submucosal invasion is the most important diagnostic criterion for most Western pathologists, whereas in Japan, nuclear features and glandular structures are more important to the diagnosis. 2 In fact, the actual degree of histological concordance between Western and Japanese pathologists is reported to be poor. 1, 2 Schlemper et al 2 indicated that the actual rate of concordance between Western and Japanese pathologists is less than 20% (3 of 20 cases).…”

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confidence: 99%

Molecular Validation of the Modified Vienna Classification of Colorectal Tumors

Sugai

Habano

Uesugi

et al. 2002

The Journal of Molecular Diagnostics

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Although the Vienna classification has been introduced to resolve discrepancies in histological diagnoses of colorectal tumors between Western and Japanese pathologists, practical applications of this classification scheme have been problematic because invasion of the lamina propria of tumor cells is often difficult to recognize. Therefore, the following refinements of the classification criteria are needed: category 3, low-grade adenoma/dysplasia; category 4, intramucosal borderline neoplasia; 4-a, high-grade adenoma/dysplasia; 4-b, well-differentiated adenocarcinoma; category 5, definite carcinoma; 5-a, intramucosal moderately-differentiated adenocarcinoma; and 5-b, submucosal carcinoma. We attempted to test whether molecular genetic alterations are related to the modified classification scheme and whether they may help to further categorize the various intramucosal neoplasia grades of colorectal tumors. Two-hundred-thirty-two colorectal tumors were examined using flow cytometric analysis of DNA content, polymerase chain reaction microsatellite assays, and single-strand conformational polymorphism assays to detect abnormalities of DNA content, chromosomal allelic loss, and Ki-ras and p53 gene mutations. Microsatellite instability (MSI) was also examined.

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“…In Japan, colorectal carcinoma is diagnosed on the basis of nuclear and cellular patterns, even in cases considered by Western pathologists as non-invasive lesions with low-grade dysplasia. The Japanese approach promotes a higher rate of discovery of the early stages of colorectal carcinomas than in Western countries (13). These studies showed that de novo-appearing carcinomas have most, if not all, of the same molecular and structural defects generally found in colorectal carcinomas (9).…”

Section: Introductionmentioning

confidence: 99%

The morphological pathway for mouse forestomach cancer

Kossoy

Ben‐Hur²,

Elhayany³

et al. 2006

Oncol Rep

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Abstract. We analyzed the morphological changes accompanying the development of cancer in the mouse forestomach. The main aim of the study was to evaluate whether cancer in this area of the stomach arises de novo or undergoes a series of precancerous changes. Tumors were induced by the 1,2-dimethylbenz(a)antracene (DMBA) at a total dose of 4 mg/mouse. The suspected areas of the stomach were studied morphologically in 79 mice. Benign tumors (squamous-cell papillomas) and malignant tumors (squamouscell carcinomas) were found in 40 mice. Tumors arose in all cases together with differential changes in the forestomach epithelium. These changes were seen as irregular diffuse hyperplasia or focal proliferation, with or without differential signs of dysplasia. Destruction of the basal epithelial membrane indicated transformation of the process into malignant invasive carcinoma. Thus, in chemically induced cancer of the forestomach, squamous-cell carcinoma develops as the final stage of morphologically recognizable precancerous changes in the epithelial layer. De novo formation of such tumors in the forestomach was not observed.

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Differences in the diagnostic criteria used by japanese and western pathologists to diagnose colorectal carcinoma

Cited by 149 publications

References 27 publications

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Molecular Validation of the Modified Vienna Classification of Colorectal Tumors

The morphological pathway for mouse forestomach cancer

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