Diagnosis of gastric epithelial neoplasia: Dilemma for Korean pathologists

Table 1 Definitions and grading systems proposed for gastric epithelial neoplasia

References	Dysplasia and related lesions (from Rugge et al[40], modified)
Takagi et al[15]	Benign
	Borderline
	Carcinoma
Nagayo[14]	Atypical
	Borderline
	Probable cancer
	Definitive cancer
Grundmann[2]	Low-grade GED
	High-grade GED
	Invasive cancer
Oehlert et al[5]	Slight GED
	Moderate GED
	Severer GED
	Invasive cancer
Morson et al[4]	Regenerative
	Mild GED
	Moderate GED
	Severe GED
	Invasive cancer
Ming et al[7]	Grade 1 GED
	Grade 2 GED
	Grade 3 GED
	Grade 4 GED
	Invasive cancer
Japanese classification of gastric carcinoma[16]	Group I lesions
	Group II lesions
	Group III-IV lesions
	Group V lesions
Goldstein et al[9]	Reactive
	Indefinite for GED
	Low-grade GED
	High-grade GED
	Invasive cancer
Padova classification	Negative
	Indefinite for dysplasia
	Noninvasive neoplasia
	Suspect for invasive carcinoma
	Invasive carcinoma
Vienna classification	Negative
	Indefinite for dysplasia
	Low grade neoplasia
	High grade neoplasia
	Invasive neoplasia

GED: Gastric epithelial dysplasia.

Table 2 Differentiation of low and high grade dysplasia and gastric carcinomas

Histology	Feature	Low-grade dysplasia	High-grade dysplsia	Carcinoma
Structural atypia	Gland size	Uniform	Variable	Variable
	Gland arrangement	Regular	Slightly irregular	Irregular
	Glandular crowding	Slight	Moderate	Marked
	Glandular transition to surrounding mucosa	No	No	No
	Glandular branching/budding	Focal	Prominent	Prominent
	Glandular cribriform	No	Yes	Yes
	Surface maturation	No	No	No
Nuclear atypia	Shape	Elongated	Elongated and/or irregular	Oval/round
	Pseudostratification	Basal 1/2	Over basal 1/2	Irregular
	Membrane	Thin	Thick	Uneven
	Hyperchromasia	Hyperchromatic even	Hyperchromatic irregular	Vesicular
	Pleomorphism	No	Mild	Moderate to marked
	Prominent nucleoli	Absent	Present	Present
	Loss of polarity	No	No/yes	Yes
Stroma	Invasion	No	No	Yes

Table 3 Inter-observer agreement rate before and after consensus conferences

Agreement rate (%)	Before (%)	After (%)
0-50	16 (38.1)	1 (2.4)
51-60	13 (31.0)	4 (9.5)
61-70	3 (7.1)	8 (19.0)
71-80	5 (11.9)	6 (14.3)
81-90	3 (7.1)	6 (14.3)
91-100	2 (4.8)	17 (40.5)
Total	42 (100)	42 (100)