Abstract
Among 131 patients with a polypoid lesion of the stomach whose biopsy diagnosis was classified into Group III (Borderline lesion), 63 patients with follow-up study were investigated to know whether these lesions showed any macroscopic and/or microscopic changes during a period of follow-up. In 15 of the patients (24%) a borderline lesion was finally diagnosed to be carcinoma. 8 of them were operated on within one-year of follow-up in which no apparent growth of the lesion was observed, indicating difficulty and limitation of an endoscopic biopsy to differentiate the borderline lesion from carcinoma at the time of initial biopsy. A repeated biopsy with careful observation of the lesion in a short-term follow-up should be performed to make a correct diagnosis of such lesion. On the other hand, the remaining 7 patients whose lesion was finally diagnosed to be carcinoma showed apparent growth of the lesion during a period of a long-term follow-up. In two patients followed up more than 9 years the lesions showed gradual but apparent growth and were disclosed to have focal carcinoma within the lesions, although the final biopsies were still diagnosed as Group III. In another patient gradual growth of the lesion was observed without histlogical changes by biopsy during a 6-year period. After absence from follow-up for 3 years, the lesion was found to be a Borrmann II type of advanced cancer with a supraclavicular lymphnode metastasis. From our experience in which 9 of 20 lesions followed up more than 3 years demonstrated apparent growth of the lesion and 7 of those were eventually diagnosed to be carcinoma, the borderline lesion could transform to carcinoma. Therefore, one should consider it as a surgical candidate, if apparent growth was observed in such a lesion. Even with negative biopsy for carcinoma, focal carcinoma may still be present. Finally, we would emphasize that biannual follow-up should be continued after a repeated diagnostic work-up at 3 month intervals in the initial 6 months.
