Is it possible with an immunophenotypic study to foresee the oncologic risk of epithelial gastric dysplasia?

Epithelial gastric dysplasia is considered the only true marker of gastric cancer. High-grade dysplasia is a surgical therapy needing lesion and low-grade dysplasia is considered a lesion with a low oncologic risk. The aim of this experience was to verify whether there are any immunohistochemical evaluations which may enable one to foresee more precisely the evolution of epithelial gastric dysplasia.

Immunophenotypic evaluation was effected in 70 cases of low-grade dysplasia (41 males, average age: 57.4) and in 50 cases of high-grade dysplasia (31 males, average age: 58). These cases were retrospectively selected and the studied samples are represented by gastric biopsies obtained in the course of endoscopy performed for dyspepsia. Epithelial gastric dysplasia diagnosis was done according to Goldstein and Lewin and the clinical subdivision was effected using the criteria of Rugge et al. Four antigens were studied using Abs against pepsinogen C, gastric foveolar M1, intestinal CAR-5 and pancreatic DU-PAN-2 Ags.

Epithelial gastric dysplasia is characterized by a progressive reduction of gastric markers with a progressive expression of enteropancreatic antigens. Low-grade dysplasia is characterized by a frequent gastro-enteropancreatic coexpression, and high-grade dysplasia by a frequent enteropancreatic coexpression or by no markers expression. Low-grade dysplasia with greater enteropancreatic markers progresses frequently towards gastric cancer; high-grade dysplasia with enteropancreatic markers only is associated/progresses to gastric cancer, while high-grade dysplasia with gastric markers or gastric-enteropancreatic markers is included in the group with persistent or regressed cases.

If confirmed in further studies, such results could modify the evaluation of epithelial gastric dysplasia, not only in terms of histochemical techniques, but also of immunohistochemical techniques.