News Release

Revised Vienna Classification for diagnosing colorectal epithelial neoplasias

Peer-Reviewed Publication

World Journal of Gastroenterology

Considerable discrepancies have been reported between diagnoses of colorectal epithelial neoplastic lesions made by Western and Japanese pathologists from endoscopic cold biopsies and resected specimens of the same lesions

To overcome the differences between the conventional Western criteria and the Japanese Group Classification (JGC), the Vienna Classification (VC) attempted to combine the basic concepts of the conventional Western criteria, which emphasizes that invasion is an indicator of metastatic potential, with the strong points of the JGC, which values consistency between diagnoses from cold biopsies and resected specimens.

In the revised Vienna Classification (rVC), histopathologic diagnoses are classified into five categories according to neoplastic severity and depth of invasion. It also distinguishes between epithelial neoplastic lesions limited to the mucosa and those invading the submucosa.

To examine the efficacy of the rVC for diagnosing colorectal polyps ≥ 10 mm, and colorectal lesions suspected of being carcinomas invasive to the submucosa or beyond, including strictures, the research team led Tominaga K prospectively compared the diagnoses from cold biopsy specimens using the rVC guidelines with the diagnoses from resected specimens of the same lesions using the World Health Organization classification.

A research article to be published on May 21, 2009 in the World Journal of Gastroenterology addressed this question.

A total of 179 lesions were identified. The sensitivity, specificity, positive and negative predictive values of the rVC for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 22.2%, 100%, 100%, and 71.4%, respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 59.7%, 100%, 100%, and 37.6%, respectively. The sensitivity, specificity, positive and negative predictive values of the JGC for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 83.3%, 91.4%, 83.3%, and 91.4%, respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 95.1%, 91.4%, 97.9%, and 82.1%, respectively. A total of 137 of 144 carcinomas that had invaded the submucosa or beyond and three high-grade intraepithelial neoplasias were diagnosed as 'carcinoma' using the JGC system.

The use of the rVC guidelines for cold biopsy specimens has a high positive predictive value in diagnosing carcinomas invasive to the colorectal submucosa or beyond. However, it is of limited value in predicting the depth of invasion assigned to the resected specimens, especially for the diagnosis of submucosal invasive carcinomas. This should be supplemented by endoscopic assessment of the depth of invasion.

Diagnostic discrepancies do not matter to patients if Western and Japanese physicians understand the implications of their respective pathology reports and apply management strategies that are appropriate to the needs of their patients. However, continued attempts to unify Western and Japanese reporting systems are desirable because merging the terminologies of these systems will help codify the advantages of each into a language that is universally understood. The rVC of colorectal epithelial neoplastic lesions seeks to be more closely in tune patient management, however, it should be emphasized that cold biopsy-based diagnoses are subject to the limitations of superficiality and sampling errors.

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Reference: Tominaga K, Fujinuma S, Endo T, Saida Y, Takahashi K, Maetani I. Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias. World J Gastroenterol 2009; 15(19): 2351-2356 http://www.wjgnet.com/1007-9327/15/2351.asp

Correspondence to: Kenji Tominaga, Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan. ktominaga@oha.toho-u.ac.jp

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

About The WJG Press

The WJG Press mainly publishes World Journal of Gastroenterology.


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