An update on grading of salivary gland carcinomas.
An update on grading of salivary gland carcinomas.
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DOI：
10.1007/s12105-009-0102-9
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发表时间：
2009-03
影响因子：
2.1
通讯作者：
Seethala, Raja R
中科院分区：
文献类型：
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作者：
Seethala, Raja R
组织学分级是涎腺癌预后的重要预测因子。然而，肿瘤类型的多样性和这些肿瘤的罕见给设计高度预测的分级方案带来了挑战。随着我们的知识基础的发展，很明显，除多形性腺瘤外，癌并不像传统建议的那样自动成为高级别肿瘤。由于囊内癌和微侵袭性癌(多形性腺瘤除外)表现良好，这些肿瘤应进一步根据癌的类型/分级和范围进行鉴定。两种常见的肿瘤分级方案包括腺样囊性癌和粘液表皮样癌。腺样囊性癌仅根据形态进行分级，实体成分预示预后较差。偶尔，腺样囊性癌可能会转化为多形性高级别癌。这一特征具有很高的淋巴转移倾向，因此应该报告给临床团队。粘液表皮样癌根据囊性成分、边界、有丝分裂、间变和神经周围侵犯等一系列特征分为三级。所有的评分方案都有些繁琐，令人生畏，有时还会模棱两可，但有证据表明，使用一种方案始终比使用直观的方法显示出更大的重复性。中级等级显示了不同等级制度之间的最大差异，因此在管理中也是最具争议的。在AFIP系统中，中级肿瘤与高级别肿瘤聚集在一起，而在Brandwein系统中，它们与低级别肿瘤聚集在一起。
Histologic grade is a significant predictor of outcome in salivary gland carcinomas. However, the sheer variety of tumor type and the rarity of these tumors pose challenges to devising highly predictive grading schemes. As our knowledge base has evolved, it is clear that carcinoma ex pleomorphic adenoma is not automatically a high grade tumor as is traditionally suggested. These tumors should be further qualified as to type/grade of carcinoma and extent, since intracapsular and minimally invasive carcinomas ex pleomorphic adenoma behave favorably. The two carcinoma types for which grading schemes are common include adenoid cystic carcinoma and mucoepidermoid carcinoma. Adenoid cystic carcinomas are graded based solely on pattern with solid components portending a worse prognosis. Occasionally, adenoid cystic carcinomas may undergo transformation to pleomorphic high grade carcinomas. This feature confers a high propensity for lymph node metastasis and should thus be reported to alert the clinical team. Mucoepidermoid carcinomas are graded in a three tier fashion based on a constellation of features including cystic component, border, mitoses, anaplasia, and perineural invasion among others. All grading schemes are somewhat cumbersome, intimidating and occasionally ambiguous, but evidence suggests that using a scheme consistently shows greater reproducibility than using an intuitive approach. The intermediate grade category demonstrates the most variability between grading systems and thus the most controversy in management. In the AFIP system intermediate grade tumors cluster with high grade tumors, while in the Brandwein system, they cluster with low grade tumors.