Histological evaluation of the human testis - approaches to optimizing the clinical value of the assessment: Mini Review
Histological evaluation of the human testis - approaches to optimizing the clinical value of the assessment: Mini Review
复制标题
DOI：
10.1093/humrep/del279
复制
发表时间：
2007-01-01
影响因子：
6.1
通讯作者：
Skakkebaek, N. E.
中科院分区：
文献类型：
--
作者：
McLachlan, R. I.;Rajpert-De Meyts, E.;Skakkebaek, N. E.
在生殖实践中，睾丸活检是一项至关重要的评估，对辅助生殖技术（ARTs）和睾丸肿瘤的风险具有诊断和预后的重要性。内分泌和基因检测不能可靠地区分阻塞性无精子症（OA）和非阻塞性无精子症（NOA），也不能通过睾丸精子提取（TESE）预测成熟精子的恢复。目前，不同的组织学报告系统和使用不精确的术语严重降低了关于TESE恢复率的文献的价值，阻碍了对治疗的评估和基因型-表型关系的研究。睾丸癌和原位癌（CIS）的发病率不断上升，特别是在不育人群中，需要尽一切努力及早发现。我们提供了一个系统的方法，以组织学分类的精原性疾病和检测CIS在成人患者。我们评估了来自不育男性的大量连续双侧活检，并报告了(i)双侧或不一致模式的频率，支持使用双侧活检进行综合评估；（ii）混合模式的高流行率，特别是在低精子发生分类中，这有助于解释报道的TESE成功。我们提出了一种新的睾丸活检诊断代码，以满足ART临床医生的需求，并允许数据存储和检索在临床实践和研究中有价值。
Testicular biopsy is a crucial assessment in reproductive practice with diagnostic and prognostic importance for assisted reproductive technologies (ARTs) and risk of testicular neoplasia. Endocrine and genetic tests cannot reliably distinguish obstructive azoospermia (OA) from non-obstructive azoospermia (NOA) or predict recovery of mature spermatids by testicular sperm extraction (TESE). Currently, divergent histological reporting systems and the use of imprecise terminology seriously degrade the value of the literature on TESE recovery rates and hamper evaluation of treatments and research on genotype-phenotype relationships. The rising incidence of testis cancer and carcinoma in situ (CIS), especially in infertile populations, requires that every effort be made for its early detection. We provide a systematic approach to the histological classification of spermatogenic disorders and detection of CIS in adult patients. We evaluate a large consecutive series of bilateral biopsies from infertile men and report (i) the frequency of bilateral or discordant patterns that supports the use of bilateral biopsy for comprehensive evaluation and (ii) a high prevalence of mixed patterns, particularly within the hypospermatogenesis classification, that helps account for reported success of TESE. We propose a new diagnosis code for testicular biopsies that addresses the needs of ART clinicians and allows data storage and retrieval of value in clinical practice and research.