Differences in the pathological diagnosis of colorectal neoplasia between the East and the West: Present status and future perspectives from Japan

Abstract

It is well known that there are discrepancies in the diagnosis of gastrointestinal neoplasia between Western and Japanese pathologists. In the West, colorectal cancer (CRC) is defined by invasion through the muscularis mucosa into the submucosa, especially depending on the presence of desmoplasia. In Japan, however, CRC is defined based on a combination of nuclear and architectural abnormalities, regardless of invasion status. As a result, intramucosal carcinoma is diagnosed as high-grade dysplasia and even intramucosal carcinoma with poorly differentiated component is classified as 'Tis' in the West. It is logical and reasonable that the term 'T1' is used to currently describe intramucosal carcinoma. Use of the term 'high-grade dysplasia' for intramucosal CRC is outdated. In order to determine appropriate clinical treatment of CRC, the various risk factors of metastasis should be fully evaluated. With improved contributions and communication between pathologists and clinicians, overtreatment and inadequate follow up can be avoided. The discrepancies in the diagnosis of CRC between Western and Japanese pathologists may be addressed by an increase in East-West exchange. In addition, in the future, molecular analysis may also be useful for establishment of standardized diagnostic criteria of CRC.