Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
J Neuropathol Exp Neurol. 2011 Feb;70(2):101-9. doi: 10.1097/NEN.0b013e31820681aa.
The development of concise grading schemes for diffuse gliomas with proven relevance to tumor behavior and susceptibility to therapy is important for clinical decision making. At present, there is unacceptably large interobserver discrepancy in the application of the current World Health Organization (WHO) criteria for accrual of patients in trials for patients with gliomas. Because of a lack of relevant studies, the WHO guidelines for grading are not yet as clear as would be desirable. The development of well-defined grading schemes consisting of features with low interobserver scoring variability and prognostic or predictive relevance is needed. Although interobserver concordance can be tested in retrospective studies, the prognostic or predictive qualities of histological parameters can only be tested in prospective studies. Only evidence-based histopathology will retain its critical role in the diagnosis and treatment of diffuse gliomas.
制定简明的弥漫性神经胶质瘤分级方案对于临床决策具有重要意义，这些方案与肿瘤行为和对治疗的敏感性有关。目前，在为胶质瘤患者进行临床试验时，当前世界卫生组织（WHO）标准的应用存在不可接受的观察者间差异。由于缺乏相关研究，WHO 分级指南还不够明确。需要制定明确的分级方案，其中包括观察者间评分变异性低且具有预后或预测相关性的特征。虽然可以在回顾性研究中测试观察者间一致性，但组织学参数的预后或预测质量只能在前瞻性研究中进行测试。只有基于证据的组织病理学才能在弥漫性神经胶质瘤的诊断和治疗中保留其关键作用。
