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| |  Stomach Cancer: Pathologist's Findings Don't Agree LONDON -- June 13, 1997 -- Japan has a relatively high incidence but good prognosis for stomach (gastric) cancer. Rather than diet or genetic predisposition of Japanese people being the cause for this disease, the high incidence may be due to the diagnostic practice of Japanese pathologists. This topic is investigated in The Lancet this week. Dr. Ronald Schlemper and colleagues set four Japanese and four Western pathologists the task of diagnosing 35 microscope slides, which were of biopsy (preliminary sample) or resection (entire portion) samples of gastic tissue taken from 17 Japanese patients with stomach cancer. The pathologists noted down the criteria on which they made their diagnoses. When the opinion of the majority of the pathologists was taken as the final diagnosis there was agreement between Western and Japanese in 11 of the 35 slides. An example of the findings is: in seven slides most Western pathologists diagnosed low-grade adenoma/dysplasia, whereas the Japanese diagnosed definite carcinoma in four of the slides, suspected carcinoma in one, and adenoma in only two. This discrepancy is caused by choice of diagnostic criteria: "Presence of invasion was the most important diagnostic criterion for most Western pathologists whereas for the Japanese nuclear features and glandular structures were more important". The authors conclude that the diagnostic practice of the Japanese pathologists "results in almost no discrepancy between the diagnosis of a superficial biopsy sample and that of the final resection specimen.” This they say “may also contribute to the relatively high incidence and good prognosis of gastic carcinoma in Japan when compared with Western countries." In a commentary in the same issue of The Lancet, Dr. Junichi Sakamoto and Dr Mitsunori Yasue explain that the differing diagnoses reached suggest "some patients in Japan might undergo resections unnecessarily, but in the west some patients...at high risk of progressing to advanced carcinoma might remain untreated." The conclusion is that an international consensus on the accurate diagnosis and appropriate treatment of gastric cancer is needed.
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