Gastric Cancer

, Volume 13, Issue 2, pp 123–130 | Cite as

Risk factors in malignant transformation of gastric epithelial neoplasia categorized by the revised Vienna classification: endoscopic, pathological, and immunophenotypic features

  • Sung Hoon Jung
  • Woo Chul Chung
  • Kang-Moon Lee
  • Chang Nyol Paik
  • Ji Han Jung
  • Min Kyoung Lee
  • Yun Kyung Lee
  • In-Sik Chung
Original Article



According to the revised Vienna classification, the surgical removal of gastric epithelial neoplasia category 3 (low-grade dysplasia) lesions is not necessary, whereas the removal of category 4 lesions (high-grade dysplasia and intramucosal cancer) is obligatory. However, approximately 15%–30% of low-grade adenomas/dysplasia progress to highgrade lesions or adenocarcinoma, and it is difficult to determine which lesions will advance to true malignancy. The aim of this study was to evaluate the endoscopic, pathological, and immunophenotypic differences between category 3 and 4 lesions according to the revised Vienna classification.


All tissue samples were excised by endoscopic mucosal resection. Fifty-two category 3 tissue samples and 54 category 4 samples were evaluated by endoscopic findings; by pathology examination of the surrounding mucosa; and by CD10, MUC2, MUC5AC, MUC6, and RUNX3 immunohistochemical staining.


Univariate analysis showed that the size of the lesion, color change, ulceration, gastritis score of the surrounding mucosa, and positive expression of MUC6 were associated with category 4 lesions. Multivariate analysis showed that the size of the lesion, ulceration, and positive expression of MUC6 were strongly associated with category 4 lesions.


Lesions more than 17 mm in diameter or lesions that are associated with ulceration have the potential for malignant transformation. Positive immunoreactivity for MUC6 appears to be a complementary marker for malignant transformation of gastric epithelial neoplasia.

Key words

Vienna classification Gastric epithelial neoplasia MUC6 


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2010

Authors and Affiliations

  • Sung Hoon Jung
    • 1
  • Woo Chul Chung
    • 1
    • 4
  • Kang-Moon Lee
    • 1
  • Chang Nyol Paik
    • 1
  • Ji Han Jung
    • 1
  • Min Kyoung Lee
    • 2
  • Yun Kyung Lee
    • 3
  • In-Sik Chung
    • 1
  1. 1.Department of Internal Medicine and Pathology, College of Medicinethe Catholic University of KoreaSeoulKorea
  2. 2.The Research Institute of St. Vincent Hospitalthe Catholic University of KoreaSuwonKorea
  3. 3.Department of PathologySamsung Medical Center of KoreaSeoulKorea
  4. 4.Department of Internal Medicine, St. Vincent Hospitalthe Catholic University of KoreaSuwon, Gyunggi-doKorea

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