Post written by Makoto Nishimura, MD, from the Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Well-known discrepancies exist between the East and West classifications of colorectal neoplasia. For example, ‘intra-mucosal carcinoma’ in Japan is recognized as ‘high-grade dysplasia’ in the U.S. To resolve these interobserver discrepancies between pathologists, an international meeting was conducted, and the result corresponding to the agreement among pathologists was published as the Vienna classification (revised in 2000). Even with this classification system, pathology definitions and resection strategies have been different in the East and West. In this article, we have updated the similarities and differences in the Eastern and Western approaches to early colorectal neoplasia and its treatment strategies.

Even in the post-Vienna era, there were differences in the pathology definitions and management of early colorectal neoplasms. Therefore, experts from the East and West gathered and discussed bridging these differences.

Pathological classifications are different in the East and West for early colorectal neoplasms. For example, the T1 category is further divided into T1a/ T1b in Japan based on the depth of submucosal invasion and risk of lymph node metastasis (Table 3). On the contrary, there is no subgroup classification of the T1 category in the U.S. (Table 4); therefore, the endoscopic approach for submucosal cancer is different in both regions.

The Vienna/revised Vienna classification facilitated an understanding between the Eastern and Western approaches in constituting and formulating a unified guideline. Further efforts should focus on the harmonization of histopathologic diagnoses and the standardization of endoscopic management between the East and West.

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