Odze R D
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Clin Pathol. 2006 Oct;59(10):1029-38. doi: 10.1136/jcp.2005.035337.
This review focuses on the pathological features of dysplasia in Barrett's oesophagus. Two categorisation schemes are used for grading dysplasia in the gastrointestinal tract, including Barrett's oesophagus. The inflammatory bowel disease dysplasia morphology study group system is the one most commonly used in the USA. However, some European and most far Eastern countries use the Vienna classification system, which uses the term "non-invasive neoplasia" instead of low-grade dysplasia (LGD) or high-grade dysplasia (HGD) and also uses the term "suspicious for invasive carcinoma" for lesions that show equivocal cytological or architectural features of tissue invasion. The degree of dysplasia is based on a combination of cytological and architectural atypia. However, the precise number of HGD crypts that is necessary to upgrade a biopsy from LGD to HGD has never been investigated and varies widely among expert gastrointestinal pathologists. The extent of dysplasia, particularly LGD, has also been recognised recently as an important prognostic parameter in Barrett's oesophagus. Other problematic areas of dysplasia interpretation include differentiation of regenerating epithelium versus LGD and separating HGD from carcinoma. Dysplasia associated with macroscopically visible lesions, such as ulcers, nodules or polyps, carry a high risk of synchronous or metachronous adenocarcinoma. Recently, immunostaining for alpha-methylacyl-CoA-racemase has been shown to have a high degree of specificity for detection of dysplasia in Barrett's oesophagus and may be used to help distinguish negative from positive biopsies in this condition. In this review, the problematic areas in dysplasia interpretation are outlined and a specific approach to these issues is discussed.
本综述聚焦于巴雷特食管发育异常的病理特征。在胃肠道(包括巴雷特食管)发育异常分级中使用了两种分类方案。炎症性肠病发育异常形态学研究组系统是美国最常用的一种。然而,一些欧洲国家和大多数远东国家使用维也纳分类系统,该系统使用“非侵袭性肿瘤形成”一词来替代低级别发育异常(LGD)或高级别发育异常(HGD),并且对于显示组织侵袭的细胞学或结构特征不明确的病变使用“可疑侵袭性癌”一词。发育异常的程度基于细胞学和结构异型性的综合判断。然而,将活检结果从LGD升级为HGD所需的HGD隐窝的确切数量从未被研究过,并且在胃肠道病理专家之间差异很大。发育异常的范围,尤其是LGD,最近也被认为是巴雷特食管的一个重要预后参数。发育异常解读的其他问题领域包括再生上皮与LGD的鉴别以及HGD与癌的区分。与肉眼可见病变(如溃疡、结节或息肉)相关的发育异常具有发生同步或异时腺癌的高风险。最近,已证明α-甲基酰基辅酶A消旋酶免疫染色对检测巴雷特食管发育异常具有高度特异性,可用于帮助区分这种情况下的阴性和阳性活检。在本综述中,概述了发育异常解读中的问题领域,并讨论了针对这些问题的具体方法。