Natural History of Sporadic Gastric Dysplasia in the U.S.A: Follow up Study of 54 Patients
F Ogawa, M Genevay, M Lisovsky, M Mino-Kenudson, V Deshpande, RD Odze, GY Lauwers. Massachusetts General Hospital, Boston; Brigham and Women's Hospital, Boston
Background: Our understanding of the natural history of sporadic gastric epithelial dysplasia (GED) has been shaped predominantly by Asian and European series. In these regions, GED has been shown to represent a high risk marker for undiagnosed gastric adenocarcinoma and that the histologic grade correlates with the propensity for progression into gastric cancer. To date, there are limited data regarding the natural history of GED in the U.S. where the incidence of gastric adenocarcinoma is low.
Design: Cases of consecutive non syndromic patients diagnosed with GED during a 5 1/2 year time period were accrued. All available biopsies were collected and evaluated for grade, location and histologic subtypes, i.e. type 1 (intestinal) and type 2(foveolar). Electronic clinical charts were reviewed for demographics and outcome.
Results: Fifty-four patients (M/F=29/25; mean age 66 years) were diagnosed with gastric dysplasia. The most frequent presenting symptoms were abdominal pain (33%) and anemia (16.7%). At initial endoscopy, 36 patients were diagnosed with low grade dysplasia (LGD) and 18 with high grade dysplasia(HGD). No carcinomas were detected at initial presentation. Twenty-three lesions were classified as type 1 dysplasia (42.6%) (LGD: 13,HGD:10) and 29 as type 2 dysplasia (53.7%) (LGD:23,HGD:6). Two cases reveled a mixed type 1 and 2 phenotype. The topographic distribution of type 1 and 2 GED was different between body /fundus and antrum (see table).Follow-up was available for 32 patients (mean 35.5,range 1-119 months), 34% of whom had persistent dysplasia. Regression occured in 34% of the patients, and was more common in type 2 dysplasia. Progression to early adenocarcinoma was observed in 31% of patients (n=10). None of the patients developed an advanced adenocarcinoma during the follow up.
Type, grade and progression of GED* Difference in distribution and regression was significant: p<0.01
|Type 1 (n=23)||70.1||18 (78%)||5 (22%)||2||1||7|
|Type 2 (n=29)||59.8||5 (17%)||24 (83%)||7||10||3|
Conclusions: In contrast to high risks regions, patients with GED in the United States show a very low rate of concurent gastric adenocarcinoma and progression to advanced neoplasms. Our data also show that type 1 and type 2 GED demonstrate differences in topography and biologic behavior. The role of ethnic differences and the impact of modern endoscopic modalities in these results remain to be evaluated.
Monday, March 9, 2009 11:30 AM
Platform Session: Section C, Monday Morning