Type or extension of intestinal metaplasia and immature/atypical "indefinite-for-dysplasia" lesions as predictors of gastric neoplasia

Francesca Tava, Ombretta Luinetti, Maria Rosa Ghigna, Costanza Alvisi, Maurizio Perego, Erminio Trespi, Catherine Klersy, Cesare Fratti, Roberto Fiocca, Enrico Solcia

Research output: Contribution to journalArticle

Abstract

At present, no information exists on the neoplastic potential of the immature hyperproliferative and atypical lesions of the gastric mucosa, which have been recently labeled "indefinite for dysplasia." In addition, uncertainties still exist concerning the risk contribution of intestinal metaplasia (IM) type and extension, as well as Helicobacter pylori infection. In this study, 471 dyspeptic patients showing IM 10% or higher (median, 40; 25th-75th percentile, 20-60) in antral, angulus, or corpus endoscopic biopsies were submitted to repeated examinations (median, 3; 2-5) over 52 (26-85) months of follow-up, during which 44 neoplastic cases were recorded. IM extension, incomplete, sulfomucin-positive, or CAR5 antigen-positive IM; H pylori infection; and indefinite-for-dysplasia lesions (IDLs), as found at first examination, all showed significant neoplastic potential. However, only IDL, ongoing H pylori infection, and patient's age retained independent predictive power in a multivariate model. On the other hand, IM extension 20% or higher proved to be more sensitive as first screening parameter for identification of subjects with increased neoplastic risk. We suggest that patients with IM, when infected, should undergo H pylori eradication to reduce their cancer risk; only those bearing IDL or very extensive IM (which strongly correlates with IDL) should be followed up with endoscopies and biopsies.

Original languageEnglish
Pages (from-to)1489-1497
Number of pages9
JournalHuman Pathology
Volume37
Issue number11
DOIs
Publication statusPublished - Nov 2006

Keywords

  • Atypical immaturity
  • Gastric precancerous lesions
  • Helicobacter pylori
  • Immature lesions
  • Intestinal metaplasia

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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