Controversies and consensus in the diagnosis, work-up and treatment of gastric lymphoma: An international survey

Background: Variations in diagnostic criteria and staging procedures in can cer patients have important consequences for patient selection and often pr eclude meaningful comparison of published series. In gastric lymphoma, thes e effects will play a role, since diagnostic criteria are controversial. Mo reover, staging procedures and therapeutic choices are influenced by insigh ts from different clinical specialisms. Methods. To review the management of gastric lymphoma, formatted questonair es were mailed to leading institutes with a special interest in this field in Europe, the United States and Japan. Results. Nineteen centers aggreed to contribute. Minimum histological crite ria varied among pathologists with a notable influence of the classificatio n system used in the different countries. Detailed evaluation of the lympho ma distribution in the gastric wall and routine staging of the GI-tract dif fered between groups leaded by medical oncologists and gastroenterologists. This results in basically different patient selections and bias in treatme nt outcome. Similar effects were recorded for the role of gastric resection and radiotherapy. Conclusions: This study gives insight in the basis of the decisions that re sult in different approaches in the management of gastric MALT-NHL and in t he effects for patient selection and treatment results and may help in the design of future clinical trials.