Approach for the Management of Indefinite-for-neoplasia Lesions Detected on Gastric Mucosal Biopsy

Indefinite-for-neoplasia is an expression used to describe lesions in which carcinoma or dysplasia cannot be clearly and conclusively established via biopsy. Gastric indefinite-for-neoplasia may represent a reactive change secondary to inflammation in some patients; however, some lesions are eventually diagnosed as dysplasia or carcinoma. Follow-up endoscopic biopsy is commonly performed in patients with gastric indefinite-for-neoplasia lesions. Nonetheless, patients may undergo resection based on a high index of clinical suspicion for dysplasia or carcinoma based on endoscopic findings. Accurate target biopsies of the lesion and effective communication with pathologists are required to improve diagnostic accuracy and avoid unnecessary re-examinations. It is important to establish endoscopic findings useful in differentiating lesions that require resection. In this review, we describe the approach for the management of indefinite-for-neoplasia lesions detected on gastric mucosal biopsy and the characteristics of lesions that require resection.