Stolte Manfred
Institut für Pathologie, Klinikum Bayreuth, Preuschwitzerstrasse 101, 95445 Bayreuth, Germany.
Virchows Arch. 2003 Feb;442(2):99-106. doi: 10.1007/s00428-002-0680-3. Epub 2002 Dec 13.
A number of seminars have shown considerable differences between Japanese and Western pathologists in the diagnostic differentiation of reactive changes, dysplasia and well-differentiated adenocarcinoma in gastroenterological biopsy material. Lesions that most Western pathologists identify as "dysplasia" are often considered adenocarcinomas in Japan. A comparison of the biopsy-based diagnoses with those established in resected mucosa, however, reveals appreciable diagnostic inexperience on the part of Western pathologists, with significant discrepancies between their diagnoses based on biopsies and those based on resected material. Against this background, a new classification of epithelial neoplasia of the gastrointestinal tract was drafted on the occasion of the World Congress of Gastroenterology in Vienna in 1998. By collapsing the diagnoses "high-grade adenoma/dysplasia, noninvasive carcinoma (carcinoma in situ), and suspected invasive carcinoma" into a single category ("noninvasive high-grade neoplasia", category 4), this scheme should largely eliminate the diagnostic discrepancies between Western and Japanese pathologists. As with every classification, the Vienna classification has its advantages and disadvantages; these are discussed here. The most important advantage of the Vienna classification is that the various categories are associated with different recommendations for further diagnostic and therapeutic measures. This applies in particular to category 4, with the recommendation for only local treatment initially (endoscopic mucosal resection or surgical excision). Since the introduction of the Vienna classification, the new World Health Organization classification of neoplasia of the gastrointestinal tract has recently been published, in which the term dysplasia has been replaced by "intraepithelial neoplasia". This means that the Vienna classification needs to be modified accordingly.
一些研讨会表明，日本和西方病理学家在胃肠活检材料中反应性改变、发育异常和高分化腺癌的诊断鉴别上存在显著差异。大多数西方病理学家认定为“发育异常”的病变，在日本往往被视为腺癌。然而，将基于活检的诊断与切除黏膜中确立的诊断进行比较后发现，西方病理学家在诊断方面明显缺乏经验，他们基于活检的诊断与基于切除材料的诊断之间存在显著差异。在此背景下，1998年在维也纳召开的世界胃肠病学大会期间起草了一种新的胃肠道上皮肿瘤分类。通过将“高级别腺瘤/发育异常、非侵袭性癌（原位癌）和疑似侵袭性癌”的诊断归为单一类别（“非侵袭性高级别肿瘤”，第4类），该方案应能在很大程度上消除西方和日本病理学家之间的诊断差异。与每种分类一样，维也纳分类有其优点和缺点；在此进行讨论。维也纳分类最重要的优点是，各个类别与进一步诊断和治疗措施的不同建议相关。这尤其适用于第4类，建议最初仅进行局部治疗（内镜黏膜切除术或手术切除）。自维也纳分类推出以来，世界卫生组织最近公布了新的胃肠道肿瘤分类，其中“发育异常”一词已被“上皮内瘤变”取代。这意味着维也纳分类需要相应修改。
