The Vienna classification of gastrointestinal epithelial neoplasia

Background-Use of the conventional Western and Japanese classification syst ems of gastrointestinal epithelial neoplasia results in large differences a mong 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 c olorectal, and 21 oesophageal biopsy and resection specimens. The extent of diagnostic agreement between those with Western and Japanese viewpoints wa s assessed by kappa statistics. The pathologists met in Vienna to discuss t he 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 agre ement and kappa values: 37% and 0.16 for gastric; 45% and 0.27 for colorect al; and 14% and 0.01 for oesophageal lesions). There was much better agreem ent among pathologists (71% and 0.55 for gastric; 65% and 0.47 for colorect al; 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-invasi ve 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 lesion s can be resolved largely by adopting the proposed terminology, which is ba sed on cytological and architectural severity and invasion status.