Chandler I, Houlston R S
Department of Cellular Pathology, St George's Hospital, London, and Section of Cancer Genetics, Institute of Cancer Research, Sutton, UK.
Histopathology. 2008 Mar;52(4):494-9. doi: 10.1111/j.1365-2559.2008.02976.x.
Tumour grade represents a gestalt of all molecular changes in malignancy, reflecting aggressiveness and has been shown to add prognostic information independent of stage for many malignancies, including colorectal cancer. Despite the grade of colorectal cancer being reported routinely in the UK, there is paucity of data on the level of agreement between histopathologists and hence the value of this metric in clinical practice. The aim was to estimate the degree of inter-observer variation in grading by conducting a nationwide web-based survey of histopathologists.
Individuals were asked to grade a series of 20 tumours. Data from 104 pathologists surveyed indicates that agreement using both two and three grade systems is at best fair.
Given that for the foreseeable future the histopathological criteria of stage and grade will still provide the mainstay of prognostication and therefore clinical decision-making, efforts should be made to improve grading criteria and standardize use of the low- and high-grade categories.
肿瘤分级代表了恶性肿瘤中所有分子变化的整体情况，反映了侵袭性，并且已证明对于包括结直肠癌在内的许多恶性肿瘤，它能提供独立于分期的预后信息。尽管在英国结直肠癌的分级是常规报告的，但关于组织病理学家之间的一致性水平以及该指标在临床实践中的价值的数据却很少。目的是通过对组织病理学家进行全国性的基于网络的调查来估计分级中观察者间变异的程度。
要求个体对一系列20个肿瘤进行分级。对104名病理学家的调查数据表明，使用二级和三级系统的一致性充其量只是一般。
鉴于在可预见的未来，分期和分级的组织病理学标准仍将是预后判断乃至临床决策的主要依据，应努力改进分级标准并规范低级别和高级别分类的使用。
