MacLennan Gregory T, Kirkali Ziya, Cheng Liang
Department of Pathology, Case Western Reserve University, Cleveland, OH, USA.
Eur Urol. 2007 Apr;51(4):889-97; discussion 897-8. doi: 10.1016/j.eururo.2006.10.037. Epub 2006 Oct 27.
In 1998, a revised system of classifying noninvasive papillary urothelial neoplasms of the urinary bladder was proposed and subsequently formally adopted by the World Health Organization (WHO). The introduction of this new system was justified as being potentially superior on a number of levels to the 1973 WHO classification system that it replaced. Specifically, a new category of neoplasms, designated papillary urothelial neoplasm of low malignant potential (PUNLMP), was considered advantageous for several reasons. The new system was expected to gain widespread acceptance, improve reproducibility of diagnoses among pathologists, and enhance the correlation between urine cytology and tumor histology. We examine the history of the changes in terminology for these lesions, the relative merits of PUNLMP terminology, the extent to which the expectations accompanying the new grading system have been met, and the extent to which the new system has enhanced the management of patients with noninvasive papillary urothelial neoplasms of the bladder.
A PubMed literature search after the introduction of this new classification was performed and relevant papers reviewed.
The 2004 WHO classification is a positive initiative in attempting to standardize urothelial tumor grading by expanding and clearly defining the morphologic characteristics of noninvasive papillary urothelial neoplasms. The new terminology used in this system is of questionable validity and utility. Full-genome searches for prognostic and predictive molecular gene expression signatures, GeneChip technology and proteomics techniques, and several new biomarkers and molecular tests may be useful in future grading schemes after their clinical utility is better established.
1998年，一种修订后的膀胱非浸润性乳头状尿路上皮肿瘤分类系统被提出，随后被世界卫生组织（WHO）正式采用。该新系统的引入被认为在多个层面上可能优于它所取代的1973年WHO分类系统。具体而言，新增加了一类肿瘤，即低恶性潜能乳头状尿路上皮肿瘤（PUNLMP），其具有多方面优势。新系统有望得到广泛认可，提高病理学家诊断的可重复性，并加强尿液细胞学与肿瘤组织学之间的相关性。我们研究了这些病变术语变化的历史、PUNLMP术语的相对优点、新分级系统所期望达到的目标的实现程度，以及新系统在多大程度上改进了膀胱非浸润性乳头状尿路上皮肿瘤患者的管理。
在新分类系统引入后进行了PubMed文献检索并对相关论文进行了综述。
2004年WHO分类是一项积极举措，试图通过扩展和明确界定非浸润性乳头状尿路上皮肿瘤的形态学特征来规范尿路上皮肿瘤分级。该系统中使用的新术语在有效性和实用性方面存在疑问。在全基因组中寻找预后和预测性分子基因表达特征、基因芯片技术和蛋白质组学技术，以及几种新的生物标志物和分子检测方法，在其临床效用得到更好确立后，可能会在未来的分级方案中发挥作用。
