Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists
Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists
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DOI：
10.1016/s0140-6736(96)12249-2
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发表时间：
1997-06-14
期刊：
影响因子：
168.9
通讯作者：
Fujita, R
中科院分区：
文献类型：
--
作者：
Schlemper, RJ;Itabashi, M;Fujita, R
背景：在癌症风险不同的人群中，有许多关于胃癌的研究，我们的目的是了解早期胃癌的组织学诊断标准在西方国家和日本是否具有可比性。方法来自日本、北美和欧洲的8名病理学家分别审查了来自17例日本患者的35张显微镜切片：17例胃活检标本和18例内窥镜黏膜切除，病变范围从早期胃癌到腺瘤、异型增生和反应性不典型。病理学家得到了一份病理标准的清单和一张表格，要求他们指出他们每一次诊断所依据的标准，大多数西方病理学家在七张幻灯片上诊断出低度腺瘤/不典型增生，而日本人在四张幻灯片中诊断出明确的癌，其中一张怀疑是癌，而腺瘤只有两张。根据大多数西方病理学家的说法，在12张高级别腺瘤/异型增生的幻灯片中，日本人确诊为癌的有11例，疑似癌的有1例。根据大多数西方病理学家的说法，在显示高级别腺瘤/异型增生并疑似癌症的六张幻灯片中，日本人总共诊断出明确的癌症。3张显示反应性上皮的切片和7张有明显浸润性癌的切片的诊断结果无显著差异，以大多数病理医师的意见作为最终诊断时，在35张切片中有11张与西方的诊断一致(kappa系数0.15[95%CI 0.01~0.29])。对于大多数西方病理学家来说，有无侵犯是最重要的诊断标准，而日本的核特征和腺体结构更重要。在日本，即使没有侵犯，胃癌也是根据核和结构标准诊断的。根据西方的观点，这种诊断实践导致浅表活检标本的诊断与最终切除标本的诊断几乎没有差异。这也可能是与西方国家相比，日本的胃癌发病率相对较高，预后较好的原因。
Background There have been many studies on gastric carcinoma in populations with contrasting cancer risks, We aimed to find out whether the criteria for the histological diagnosis of early gastric carcinoma were comparable in Western countries and Japan.Methods Eight pathologists from Japan, North America, and Europe individually reviewed 35 microscope slides: 17 gastric biopsy samples and 18 endoscopic mucosal resections taken from 17 Japanese patients with lesions ranging from early gastric cancer to adenoma, dysplasia, and reactive atypia. The pathologists were given a list of pathological criteria and a form on which they were asked to indicate the criteria on which they based each diagnosis,Findings For seven slides most Western pathologists diagnosed low-grade adenoma/dysplasia, whereas the Japanese diagnosed definite carcinoma in four slides suspected carcinoma in one, and adenoma in only two. Of 12 slides with high-grade adenoma/dysplasia according to most Western pathologists the Japanese gave the diagnosis of definite carcinoma in 11 and suspected in one. Of six slides showing high-grade adenoma/dysplasia with suspected carcinoma according to most Western pathologists the Japanese diagnosed definite carcinoma in all. There were no major differences in the diagnoses of three slides showing reactive epithelium and seven slides with clearly invasive carcinoma, When the opinion of the majority of the pathologists was taken as the final diagnosis there was agreement between Western and Japanese in 11 of the 35 slides (kappa coefficient 0.15 [95% CI 0.01-0.29]). Presence of invasion was the most important diagnostic criterion for most Western pathologists whereas for the Japanese nuclear features and glandular structures were more important.Interpretation In Japan, gastric carcinoma is diagnosed on nuclear and structural criteria even when invasion is absent according to the Western viewpoint, This diagnostic practice results in almost no discrepancy between the diagnosis of a superficial biopsy sample and that of the final resection specimen. This may also contribute to the relatively high incidence and good prognosis of gastric carcinoma in Japan when compared with Western countries.