The Vienna classification of gastrointestinal epithelial neoplasia
The Vienna classification of gastrointestinal epithelial neoplasia
复制标题
DOI：
10.1136/gut.47.2.251
复制
发表时间：
2000-08-01
期刊：
影响因子：
24.5
通讯作者：
Yamabe, H
中科院分区：
文献类型：
--
作者：
Schlemper, RJ;Riddell, RH;Yamabe, H
背景-使用传统的西方和日本的胃肠道上皮肿瘤分类系统导致不同的病理学家在诊断食道、胃和结直肠肿瘤方面存在很大的差异。目的：发展全球通用的胃肠道上皮肿瘤术语。方法：来自12个国家的31位病理学家回顾了35例胃、20例结直肠和21例食道活检和切除标本。用kappa统计方法评估西方人和日本人之间的诊断一致性程度。病理学家在维也纳开会讨论结果，并制定一个新的共识术语。结果-确认了传统西方诊断和日本诊断之间的巨大差异(符合和kappa值的标本百分比：胃为37%和0.16；结直肠为45%和0.27；食道病变为14%和0.01)。病理学家之间的符合率要高得多(胃病分别为71%和0.55；结直肠分别为65%和0.47；和62%和0.31对于食道病变)，当最初对样本的评估被重新分组为提议的维也纳胃肠道上皮瘤分类的类别时：(1)肿瘤/异型增生阴性，(2)肿瘤/异型增生不确定，(3)非侵袭性低级别肿瘤(低级腺瘤/异型增生)，(4)非侵袭性高级别肿瘤(高级别腺瘤/异型增生，非浸润性癌和疑似浸润性癌)，和(5)浸润性肿瘤(粘膜内癌，结论：西方病理学家和日本病理学家在胃肠道上皮肿瘤病变的诊断分类上的差异可以通过采用建议的术语得到很大程度的解决，该术语基于细胞学和结构严重性以及侵袭状态。
Background-Use of the conventional Western and Japanese classification systems of gastrointestinal epithelial neoplasia results in large differences among pathologists in the diagnosis of oesophageal, gastric, and colorectal neoplastic lesions.Aim-To develop common worldwide terminology for gastrointestinal epithelial neoplasia.Methods-Thirty one pathologists from 12 countries reviewed 35 gastric, 20 colorectal, and 21 oesophageal biopsy and resection specimens. The extent of diagnostic agreement between those with Western and Japanese viewpoints was assessed by kappa statistics. The pathologists met in Vienna to discuss the results and to develop a new consensus terminology.Results-The large differences between the conventional Western and Japanese diagnoses were confirmed (percentage of specimens for which there was agreement and kappa values: 37% and 0.16 for gastric; 45% and 0.27 for colorectal; and 14% and 0.01 for oesophageal lesions). There was much better agreement among pathologists (71% and 0.55 for gastric; 65% and 0.47 for colorectal; and 62% and 0.31 for oesophageal lesions) when the original assessments of the specimens were regrouped into the categories of the proposed Vienna classification of gastrointestinal epithelial neoplasia: (1) negative for neoplasia/dysplasia, (2) indefinite for neoplasia/dysplasia, (3) non-invasive low grade neoplasia (low grade adenoma/dysplasia), (4) non-invasive high grade neoplasia (high grade adenoma/dysplasia, non-invasive carcinoma and suspicion of invasive carcinoma), and (5) invasive neoplasia (intramucosal carcinoma, submucosal carcinoma or beyond).Conclusion-The differences between Western and Japanese pathologists in the diagnostic classification of gastrointestinal epithelial neoplastic lesions can be resolved largely by adopting the proposed terminology, which is based on cytological and architectural severity and invasion status.