WHO乳腺肿瘤组织学新分类的特点 问题与对策

WHO Classification of Breast Tumor Histology

WHO(2003)乳腺肿瘤组织学新分类较以往分类有许多优点:新分类体现了近代乳腺肿瘤病理学的最新进展,将新技术、新成果开始用于辅助诊断、分型及预测,并增加了一些新的肿瘤类型;重视与临床结合,增加术后病理分期和预后因素及预测因子,强调组织学分级和乳腺癌ER、PR及Her-2的表达与临床治疗及预后的意义;以人为本,体现人性化,提出导管上皮内瘤新概念,并将浸润性癌归为癌,导管内癌归入导管上皮内瘤,小叶原位癌归入小叶性肿瘤,对于疑似恶性病变要"降级"诊断,避免过度诊断、过度治疗给患者带来的身心损害;求同存异,新版分类将各家有代表性的观点均罗列出来供大家参考,待今后实践中进一步总结验证,而不是采用硬性统一的办法。新版分类虽然有许多优点,但其中也有一些值得进一步探讨与商榷的问题:该分类整体性、系统性较欠缺;某些肿瘤的命名与归类不合理;新版分类回避了以往WHO分类中一些常见而传统的病变,在应用新分类诊断这些病变时往往会感到无所适从;没有强调正确病理诊断、分型、分期必须的基本条件。我们认为目前实际工作中应用新分类时应认真学习、加深理解、掌握标准,结合实际、加强沟通、先易后难、逐步接轨过渡,重视克服病理诊断的局限性,多实践、总结、协作、提高。

The 2003 WHO classification of breast tumor histology represented the advances in breast tumor histology and new techniques used in diagnosis, histologieal typing and forecasting prognosis. Some new histological types were nominated. The new classification system emphasized the combination of clinic and pathology, pTNM stages and prognostic factors were also added. It mentioned the significance of histological grading and expression of ER, PR and Her-2, and defined duetal intraepithelial neoplasia. Invasive carcinoma was relabeled carcinoma, and duetal carcinoma in situ was relabeled ductal intraepithelial neoplasia. Lobular carcinoma in situ was reclassified as lobular neoplasia. The diagnosis of suspicious malignant lesions should be downgraded to avoid the harm to patients＇ physical and mental state of overdiagnosis and overtrealment. The new classification system will act as a reference instead of an imperative. In spite of the merits above, deficiencies still existed, such as poor systematies and irrationality in grades and classifications of some tumors. Because some frequently seen lesions are not included in the new classification, pathologists may feel confused in the process of diagnosis. In clinical practice, we should combine the new classification with our practical experience to benefit patients.