Is type III intestinal metaplasia an obligatory precancerous lesion in intestinal-type gastric carcinoma?

This retrospective study was performed to assess whether type III intestina l metaplasia is an obligatory precancerous lesion of intestinal-type gastri c carcinoma and to determine its possible use as a marker of enhanced cance r risk. From 48 consecutive patients with gastric cancer who underwent a ga strectomy over a 3-year period (mean age 72.0 years; 29 M/19 F), at least t wo sections from antrum, corpus and tumour-surrounding mucosa were obtained for the examination of presence and subtypes of intestinal metaplasia (IM) . It was found that 77.1% of the carcinomas were of the intestinal type and 22.9% of the diffuse type. The intestinal-type was more often found in mal es (P = 0.01); the mean age at diagnosis in this type was higher than in th e diffuse cancer group (P = 0.004). There was a high prevalence of total IM in both the intestinal (75.7%) and diffuse group (88.9%). Type I IM was pr edominant in antrum and corpus of patients from both groups. Type III IM wa s only found among patients with intestinal-type carcinoma. However, its pr evalence was rather low (26.3%). Therefore the absence of this lesion in pa tients with other risk factors cannot be used as an argument for lowering t he degree of surveillance and its presence seems to be sufficient indicatio n for long-term follow-up. (C) 2001 Lippincott Williams & Wilkins.