Weyers Wolfgang
Center for Dermatopathology, Freiburg, Germany.
Am J Dermatopathol. 2016 Jul;38(7):517-28. doi: 10.1097/DAD.0000000000000469.
Efforts at early detection of cancer have resulted in a sharp increase of overdiagnoses, ie, benign lesions being misinterpreted as malignant ones. Clinical overdiagnoses usually prompt a biopsy to be performed. The number of biopsies has risen dramatically, and the average time and diligence devoted to them have decreased. Biopsy specimens are often extremely small and sometimes crushed, leading to great difficulties in the assessment of histopathologic findings. In their fear not to overlook a malignant lesion, histopathologists confronted with an equivocal lesion tend to err on the malignant side, the results being histopathologic overdiagnoses and overtreatment. Epidemiologists have tried to counter those problems by cautioning against cancer screening and by inaugurating a change in nomenclature: the term "cancer" has been reserved for lesions likely to result in death, whereas earlier stages of the same process are referred to by different names emphasizing their ostensible innocuousness, and any diagnosis of a malignant neoplasm that does not produce symptoms or kill the patient is qualified as "overdiagnosis." In contrast to those suggestions that ignore biologic entities and sacrifice the foundations of morphologic diagnosis, measures are discussed that may help to overcome the problem of overdiagnosis and overtreatment in more substantial fashion.
癌症早期检测的努力导致过度诊断急剧增加，即良性病变被误诊为恶性病变。临床过度诊断通常会促使进行活检。活检的数量急剧上升，而用于活检的平均时间和精力却减少了。活检标本往往极小，有时还会被挤压，这给组织病理学结果的评估带来了极大困难。由于担心漏诊恶性病变，面对模棱两可的病变时，组织病理学家往往倾向于做出恶性的判断，结果导致组织病理学过度诊断和过度治疗。流行病学家试图通过告诫人们谨慎对待癌症筛查并启用术语变更来应对这些问题：“癌症”一词仅用于可能导致死亡的病变，而同一进程的早期阶段则用不同名称指代，强调其表面上的无害性，任何未产生症状或未导致患者死亡的恶性肿瘤诊断都被定性为“过度诊断”。与那些忽视生物学实体并牺牲形态学诊断基础的建议不同，本文讨论了一些措施，这些措施可能有助于以更切实的方式克服过度诊断和过度治疗的问题。
