van der Esch E P, Muir C S, Nectoux J, Macfarlane G, Maisonneuve P, Bharucha H, Briggs J, Cooke R A, Dempster A G, Essex W B
Antoni van Leewenhoekhuis, Netherlands Cancer Institute, Amsterdam.
Int J Cancer. 1991 Feb 20;47(4):483-9. doi: 10.1002/ijc.2910470402.
To assess whether the increase in malignant melanoma incidence could be due, at least in part, to changes in histological criteria of malignancy, pathologists in Australia, France, Italy, New Zealand, Norway, Sweden, the United Kingdom, the United States and the USSR reviewed diagnoses of 50 consecutive pigmented naevi (40 junctional and compound; 10 intradermal) and 20 consecutive malignant melanomas made in each participating centre around 1930, around 1955 and around 1980. Collaborating pathologists re-read the material, 2,665 cases in all, either from the original slide (82%) or from a recut block (17%), gave their diagnosis and indicated whether the lesion was benign (B), dubious benign (DB), dubious malignant (DM) or malignant (M). As the distribution of review diagnoses was much the same whether the original slide or one made from a recut block was read, the material was pooled. Overall, 2.8% of cases originally reported as B/DB were reviewed as DM/M, while 4.4% of the DM/M diagnoses were held to be B/DB. The shifts between categories were greatest around 1955 and least around 1980, suggesting increasing uniformity of interpretation. All available blocks were recut and sections sent to IARC for review: 1.7% (22) of 1293 B/DB diagnoses were considered to be DM/M and 3.3% (18) of 551 DM/M diagnoses were considered to have been B/DB. The consistently low frequency of shift in diagnostic category, whether the material was reviewed in the collaborating laboratories or by one pathologist at IARC, in a study designed to give maximum attention to those lesions--the junctional and compound naevi--in which a change in opinion as to malignancy would be most likely to arise, suggests that pathologists, irrespective of geographical location, are using common criteria. These findings argue against changes in histological interpretation as being responsible for more than a small portion of the continuous increase of some 3% to 8% per annum observed in malignant melanoma incidence. Other explanations, such as an increase in the frequency or potential for malignant transformation of precursor lesions, must be sought. The anatomical distribution of the malignant melanomas examined followed the usual site pattern by sex, and their thickness was observed to decrease over the period of the study in most centres.
为评估恶性黑色素瘤发病率的上升是否至少部分归因于恶性组织学标准的变化，澳大利亚、法国、意大利、新西兰、挪威、瑞典、英国、美国和苏联的病理学家回顾了各参与中心在1930年左右、1955年左右和1980年左右连续做出的50例色素痣（40例交界痣和复合痣；10例皮内痣）及20例恶性黑色素瘤的诊断。合作病理学家重新阅读了所有2665例病例的材料，其中82%来自原始切片，17%来自重新切片的蜡块，给出他们的诊断，并指出病变是良性（B）、可疑良性（DB）、可疑恶性（DM）还是恶性（M）。由于无论是阅读原始切片还是重新切片制作的切片，复查诊断的分布大致相同，因此将材料合并。总体而言，最初报告为B/DB的病例中有2.8%被复查为DM/M，而DM/M诊断中有4.4%被认为是B/DB。类别之间的变化在1955年左右最大，在1980年左右最小，这表明解释的一致性在增加。所有可用蜡块均重新切片，切片送至国际癌症研究机构进行复查：1293例B/DB诊断中有1.7%（22例）被认为是DM/M，551例DM/M诊断中有3.3%（18例）被认为原来是B/DB。在一项旨在最大程度关注那些最有可能出现恶性判断变化的病变（交界痣和复合痣）的研究中，无论材料是在合作实验室复查还是由国际癌症研究机构的一名病理学家复查，诊断类别变化的频率始终较低，这表明无论地理位置如何，病理学家都在使用共同的标准。这些发现表明，组织学解释的变化并非导致恶性黑色素瘤发病率每年持续上升约3%至8%的一大部分原因。必须寻找其他解释，例如前驱病变恶性转化的频率或可能性增加。所检查的恶性黑色素瘤的解剖分布遵循按性别划分的常见部位模式，并且在大多数中心观察到其厚度在研究期间有所下降。
