Golusiński W, Kaczmarek J P, Kaczmarek J, Biczysko W, Kedzia D
Klinika Otolaryngologii Katedry Chorób Ucha, Nosa, Gardła i Krtani AM im. K. Marcinkowskiego w Poznaniu.
Otolaryngol Pol. 2001;55(1):69-73.
Laryngeal carcinomas are preceded by precancerous lesions in about 20% of cases. The macroscopical appearance of these lesions is not enough characteristic to define their malignant potential. The accurate identification of epithelial abnormalities of the laryngeal mucosa requires biopsy and microscopic evaluation. There are many histological classifications of laryngeal precancerous lesions used at present. Many of them are highly subjective and have low reproducibility. Moreover, the different grades of these classifications not always give distinct guidelines for clinician concerning the treatment modality. The Ljubljana classification seems to be easier, more readily applied and more reproducible. It uses the name "epithelial hyperplastic laryngeal lesion" (EHLL) which includes all alterations in laryngeal squamous epithelium. The four grades of EHLL are: 1. simple hyperplasia (thickening of epithelium due to augmentation of normal prickle cells), 2. abnormal hyperplasia (with increase of basal-like cells), 3. atypical, or risky hyperplasia (epithelium thickened by increase of basal-like cells with pronounced atypical features), and 4. carcinoma in situ (i.e. full thickness change with the features of malignancy but without stromal invasion). The criteria of Ljubljana classification are precise and gives a possibility to make a more clear-cut separation of cases with risk of developing carcinoma from those without it.
约20%的喉癌病例之前存在癌前病变。这些病变的宏观表现不足以确定其恶性潜能。准确识别喉黏膜上皮异常需要活检和显微镜评估。目前使用的喉癌前病变组织学分类有很多。其中许多主观性很强，可重复性低。此外，这些分类的不同级别并不总是能为临床医生提供关于治疗方式的明确指导。卢布尔雅那分类似乎更简单、更易于应用且可重复性更强。它使用“喉上皮增生性病变”（EHLL）这一名称，包括喉鳞状上皮的所有改变。EHLL的四个级别为：1. 单纯增生（由于正常棘细胞增多导致上皮增厚），2. 异常增生（基底样细胞增多），3. 非典型或危险性增生（基底样细胞增多使上皮增厚，具有明显的非典型特征），4. 原位癌（即具有恶性特征的全层改变，但无基质浸润）。卢布尔雅那分类标准精确，能够更明确地区分有癌变风险的病例和无癌变风险的病例。
