Background/Aims: Dysplasia, in gastric pathology, is an acquired abnormality of cell multiplication implicating evolution toward malignity but phenotype expression is confined only to the epithelium. Gastric dysplasia is generally regarded as a precancerous lesion, and it is believed that the risk of cancer increases in parallel with the histologic grade of dysplasia. Methods: Eleven patients who were initially diagnosed as gastric sevae dysplasia based on examination of endoscopie biopsy, received operative treatment at the Department of Surgery, Kyungpook National University Hospital between September 1991 and September 1997. The postoperative pathologic reports of the patients were compared with their endoscopic biopsy reports. Results: Of the 11patients diagnosed as gastric severe dysplasia on the endoscopic biopsy, only 4 patients (36%) were confirmed to have severe dysplasia on the pathologie examination of the surgical specimen. Gastric cancer was found in 5 cases (46%). Among them, four cases were early cancers and one case was advanced cancer. However, no lymph node metastasis was observed in all five cases. The remaining two cases were proved as mild dysplasia and moderate dysplasia each. Conclusions: Gastric severe dysplasia found on the endoscopic biopsy indicates a high risk of cancer, often a synchronous one, and it requires prompt surgical treatment. (Korean J Gastroenterol 1998;31:624 - 628)