[High and low grade gastric epithelial dysplasia: clinical management, endoscopic assessment of p53].

Epithelial dysplasia is considered the only one true histological marker of gastric cancer. In the present study we have evaluated the real clinical importance of epithelial dysplasia divided into low-grade (70 patients, mean age 59.2 years) and high-grade (50 patients, mean age 58 years) dysplasia. Furthermore, it has been made a comparison with the corresponding endoscopic picture and an evaluation of the real meaning of p53 positivity. The clinical outcome subdivision of epithelial dysplasia was effected according to the criteria of Rugge: association with or progression to gastric cancer, persistence or regression. The endoscopic patterns have been divided into ulcerous lesions and non-ulcerous lesions. The immunohistochemical study has been carried out with the utilization of a p53 antibody (Dako, Glostrup, Denmark). From the analysis of the data it comes out that low-grade dysplasia is associated with or progressed to gastric cancer in a low percentage of cases (about 8.5%), while high-grade dysplasia is associated with or progressed to gastric cancer in a high percentage of cases (about 74%), by this proving itself to be a real histological marker of gastric cancer. The cases of epithelial dysplasia associated with or progressed to gastric cancer are significantly associated with an endoscopic picture of gastric ulcer (ulcer-cancer). Nonetheless, the cases of epithelial dysplasia in correspondence of non-ulcerous lesions have been noticed to be associated with or progressed to advanced gastric cancer. The evaluation of p53 did not positively correlate with the clinical progression of the epithelial dysplasia and with TNM classification in case of gastric cancer. Therefore, the evaluation of p53 does not represent a useful marker in the clinical practice.