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.
To develop common worldwide terminology for gastrointestinal epithelial neoplasia.
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
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).
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.