Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification

Background and aims: Therapeutic guidelines have not yet been established for low-grade gastric adenomas/dysplasias (LGD), which have a low risk of progression to high-grade adenomas/dysplasias (HGD) or to invasive carcinomas. This study aimed to evaluate risk factors for HGD/carcinoma that indicate a need for resection in biopsy-proven LGD lesions. Patients and methods: In total, 236 LGD lesions from 208 consecutive patients treated with endoscopic resection (ER) were retrospectively studied between 2004 and 2008. The Vienna classification was used for histological diagnosis. A generalized estimating equation (GEE) logistic regression model was used for multivariate analysis. Results: Among the 236 LGD lesions, the final pathology diagnosed 9 (3.8%) as invasive carcinoma (category 5), 71 (30.1%) as HGD (category 4), 148 (62.7%) as LGD (category 3), and 8 (3.4%) as negative/indefinite for dysplasia (category 1/2). Lesions >= 1 cm were classified as HGD/carcinoma in 39.4% of patients (65/165). Multivariate analysis indicated that size of >= 1 cm (OR 1.93 [95% CI, 1.06-3.52]), depressed morphology (OR 3.81 [95% CI, 1.22-11.9]), and erythema (OR 2.49 [95% CI, 1.31-4.72]) were significantly associated with HGD/carcinoma. The OR increased to 47.6 (95% CI, 4.27-530.65) when the risk factors were all positive. The sensitivity and negative predictive value for >= 1 risk factors were 93.8% and 90.9%, respectively. As the number of risk factors of a lesion increased, the specificity and positive predictive value also increased. Conclusions: Endoscopic resection can be recommended if a low-grade dysplastic lesion has at least one of the following risk factors: depressed morphology, surface erythema, or a size of 1 cm or greater. For lesions that have none of the three risk factors, follow-up endoscopy is recommended.