Department of Neuro-Oncology, Daniel den Hoed Oncology Center, 3008 AE Rotterdam, The Netherlands.
Acta Neuropathol. 2010 Sep;120(3):297-304. doi: 10.1007/s00401-010-0725-7. Epub 2010 Jul 20.
Several studies have provided ample evidence of a clinically significant interobserver variation of the histological diagnosis of glioma. This interobserver variation has an effect on both the typing and grading of glial tumors. Since treatment decisions are based on histological diagnosis and grading, this affects patient care: erroneous classification and grading may result in both over- and undertreatment. In particular, the radiotherapy dosage and the use of chemotherapy are affected by tumor grade and lineage. It also affects the conduct and interpretation of clinical trials on glioma, in particular of studies into grade II and grade III gliomas. Although trials with central pathology review prior to inclusion will result in a more homogeneous patient population, the interpretation and external validity of such trials are still affected by this, and the question whether results of such trials can be generalized to patients diagnosed and treated elsewhere remains to be answered. Although molecular classification may help in typing and grading tumors, as of today this is still in its infancy and unlikely to completely replace histological classification. Routine pathology review in everyday clinical practice should be considered. More objective histological criteria for the grade and lineage of gliomas are urgently needed.
几项研究充分证明了胶质瘤的组织学诊断存在显著的观察者间差异。这种观察者间的差异会影响胶质肿瘤的分型和分级。由于治疗决策是基于组织学诊断和分级，这会影响患者的治疗：错误的分类和分级可能导致过度治疗和治疗不足。特别是，肿瘤的放射治疗剂量和化疗的使用都受到肿瘤分级和谱系的影响。它还会影响到胶质瘤的临床试验的实施和解释，特别是 II 级和 III 级胶质瘤的研究。虽然在纳入前进行中心病理审查的试验将导致患者人群更加同质，但对这些试验的解释和外部有效性仍会受到影响，这些试验的结果是否可以推广到其他地方诊断和治疗的患者仍有待回答。尽管分子分类有助于对肿瘤进行分型和分级，但目前这仍处于起步阶段，不太可能完全取代组织学分类。在日常临床实践中应考虑进行常规病理检查。迫切需要更客观的胶质瘤分级和谱系的组织学标准。
