A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas.
A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas.
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DOI：
10.1097/pas.0000000000000533
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Baltimore Consensus Meeting
中科院分区：
文献类型：
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作者：
Basturk O;Hong SM;Wood LD;Adsay NV;Albores-Saavedra J;Biankin AV;Brosens LA;Fukushima N;Goggins M;Hruban RH;Kato Y;Klimstra DS;Klöppel G;Krasinskas A;Longnecker DS;Matthaei H;Offerhaus GJ;Shimizu M;Takaori K;Terris B;Yachida S;Esposito I;Furukawa T;Baltimore Consensus Meeting
国际专家们开会讨论了近期进展，并修订了2004年关于评估和报告胰腺浸润性癌前体病变的建议，这些病变包括胰腺上皮内瘤变（PanIN）、导管内乳头状黏液性肿瘤（IPMN）、黏液性囊性肿瘤以及其他病变。共识性建议如下：
1) 为了提高一致性并与实际结果相符，对所有前体病变提出了一个两级分类系统（低级别与高级别），规定目前的PanIN - 2以及具有中级别异型增生的肿瘤现在归类为低级别。因此，“高级别异型增生”应仅用于病变谱系的最顶端（“原位癌”类型病变）。
2) 目前的数据表明，在伴有浸润性癌的切除胰腺边缘的任何级别的PanIN都没有预后意义；在伴有无浸润性癌的IPMN的切除胰腺边缘的异型增生的临床意义仍有待确定。
3) 0.5 - 1厘米的导管内病变可能是大的PanIN或小的IPMN。“早期IPMN”这一术语应保留用于此大小且具有肠型或嗜酸细胞型乳头或GNAS突变的病变。
4) 建议测量IPMN与浸润性癌之间的距离以及对其间组织进行取样，以评估伴随与相关状态。从概念上讲，伴随性浸润性癌（与“相关性”组相对）在基因上应与腺体其他部位的IPMN不同。
5) 建议使用“浸润性癌的导管内扩散”（又名“定植”）来描述浸润性癌向后侵入并沿导管系统延伸的病变，其在形态上可能类似于高级别PanIN甚至IPMN。
6) 建议使用“单纯性黏液性囊肿”来描述大于1厘米、具有胃型扁平黏液性内衬且至多有极轻微异型性且无卵巢型间质的囊肿，以将其与IPMN区分开来。
7) 存在类似于基因工程小鼠模型中的腺泡 - 导管化生和非典型扁平病变的人类病变，它们可能反映了一种不同的致癌途径；然而，它们的生物学意义需要进一步研究。这些修订后的建议有望改善我们对胰腺前体病变的处理和理解。
International experts met to discuss recent advances and to revise the 2004 recommendations for assessing and reporting precursor lesions to invasive carcinomas of the pancreas, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm, and other lesions. Consensus recommendations include the following: 1) To improve concordance and to align with practical consequences, a two-tiered system (low vs. high-grade) is proposed for all precursor lesions, with the provision that the current PanIN-2 and neoplasms with intermediate-grade dysplasia now be categorized as low-grade. Thus, “high-grade dysplasia” is to be reserved for only the uppermost end of the spectrum (“carcinoma in situ” type lesions). 2) Current data indicate that PanIN of any grade at a margin of a resected pancreas with invasive carcinoma does not have prognostic implications; the clinical significance of dysplasia at a margin in a resected pancreas with IPMN lacking invasive carcinoma remains to be determined. 3) Intraductal lesions 0.5–1 cm can be either large PanINs or small IPMNs. The term “incipient IPMN” should be reserved for lesions in this size with intestinal- or oncocytic-papillae or GNAS mutations. 4) Measurement of the distance between an IPMN and invasive carcinoma and sampling of intervening tissue are recommended to assess concomitant versus associated status. Conceptually, concomitant invasive carcinoma (in contrast with the “associated” group) ought to be genetically distinct from an IPMN elsewhere in the gland. 5) “Intraductal spread of invasive carcinoma” (aka, “colonization”) is recommended to describe lesions of invasive carcinoma invading back into and extending along the duct system, which may morphologically mimic high-grade PanIN or even IPMN. 6) “Simple mucinous cyst” is recommended to describe cysts > 1 cm having gastric-type flat mucinous lining at most minimal atypia without ovarian-type stroma to distinguish them from IPMN. 7) Human lesions resembling the acinar-to-ductal metaplasia and atypical flat lesions of genetically engineered mouse models exist and may reflect an alternate pathway of carcinogenesis; however, their biological significance requires further study. These revised recommendations are expected to improve our management and understanding of precursor lesions in the pancreas.
影响因子：
0.6
作者：
Kawada N;Uehara H;Takada R;Yamai T;Fukutake N;Katayama K;Takenaka A;Nagata S;Tomita Y
通讯作者：
Tomita Y