Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Am J Surg Pathol. 2010 Mar;34(3):300-13. doi: 10.1097/PAS.0b013e3181ce1447.
Epithelial neuroendocrine tumors (NETs) have been the subject of much debate regarding their optimal classification. Although multiple systems of nomenclature, grading, and staging have been proposed, none has achieved universal acceptance. To help define the underlying common features of these classification systems and to identify the minimal pathology data that should be reported to ensure consistent clinical management and reproducibility of data from therapeutic trials, a multidisciplinary team of physicians interested in NETs was assembled. At a group meeting, the participants discussed a series of "yes" or "no" questions related to the pathology of NETs and the minimal data to be included in the reports. After discussion, anonymous votes were taken, using the Delphic principle that 80% agreement on a vote of either yes or no would define a consensus. Questions that failed to achieve a consensus were rephrased once or twice and discussed, and additional votes were taken. Of 108 questions, 91 were answerable either yes or no by more than 80% of the participants. There was agreement about the importance of proliferation rate for tumor grading, the landmarks to use for staging, the prognostic factors assessable by routine histology that should be reported, the potential for tumors to progress biologically with metastasis, and the current status of advanced immunohistochemical and molecular testing for treatment-related biomarkers. The lack of utility of a variety of immunohistochemical stains and pathologic findings was also agreed upon. A consensus could not be reached for the remaining 17 questions, which included both minor points related to extent of disease assessment and some major areas such as terminology, routine immunohistochemical staining for general neuroendocrine markers, use of Ki67 staining to assess proliferation, and the relationship of tumor grade to degree of differentiation. On the basis of the results of the Delphic voting, a minimum pathology data set was developed. Although there remains disagreement among experts about the specific classification system that should be used, there is agreement about the fundamental pathology data that should be reported. Examination of the areas of disagreement reveals significant opportunities for collaborative study to resolve unanswered questions.
上皮神经内分泌肿瘤 (NETs) 的最佳分类一直存在诸多争议。尽管已经提出了多种命名、分级和分期系统，但没有一种系统得到普遍认可。为了帮助确定这些分类系统的潜在共同特征，并确定应报告的最小病理学数据，以确保一致的临床管理和治疗试验数据的可重复性，一个对 NETs 感兴趣的多学科医生团队成立了。在一次小组会议上，参与者讨论了一系列与 NET 病理学相关的“是”或“否”问题，以及应包含在报告中的最小数据。讨论后，采用德尔菲法进行匿名投票，即对于“是”或“否”的投票，有 80%的人同意即可定义为共识。未能达成共识的问题被重新表述一次或两次，并进行讨论，然后再次进行投票。在 108 个问题中，有 91 个问题得到了 80%以上参与者的“是”或“否”的回答。对于肿瘤分级的增殖率、分期的标志物、可通过常规组织学评估的预后因素、肿瘤通过转移发生生物学进展的潜力以及治疗相关生物标志物的先进免疫组织化学和分子检测的现状等问题，达成了一致意见。也同意各种免疫组织化学染色和病理学发现的无用性。对于其余 17 个问题，包括与疾病评估范围相关的一些次要问题和一些主要问题，如术语、一般神经内分泌标志物的常规免疫组织化学染色、使用 Ki67 染色评估增殖以及肿瘤分级与分化程度的关系，无法达成共识。基于德尔菲投票的结果，开发了一个最小的病理学数据集。尽管专家们对应该使用的具体分类系统仍存在分歧，但对于应该报告的基本病理学数据已达成一致。对存在分歧的领域进行检查，可以发现有很大的合作研究机会来解决未解决的问题。
