Department of Veterinary medical Sciences (DIMEVET), 9296University of Bologna, Ozzano dell'Emilia, Italy.
Histopathology Consultant, Verona, Italy.
Vet Pathol. 2021 Sep;58(5):809-828. doi: 10.1177/0300985821999831. Epub 2021 Mar 26.
Tumor grading is a method to quantify the putative clinical aggressiveness of a neoplasm based on specific histological features. A good grading system should be simple, easy to use, reproducible, and accurately segregate tumors into those with low versus high risk. The aim of this review is to summarize the histological and, when available, cytological grading systems applied in veterinary pathology, providing information regarding their prognostic impact, reproducibility, usefulness, and shortcomings. Most of the grading schemes used in veterinary medicine are developed for common tumor entities. Grading systems exist for soft tissue sarcoma, osteosarcoma, multilobular tumor of bone, mast cell tumor, lymphoma, mammary carcinoma, pulmonary carcinoma, urothelial carcinoma, renal cell carcinoma, prostatic carcinoma, and central nervous system tumors. The prognostic relevance of many grading schemes has been demonstrated, but for some tumor types the usefulness of grading remains controversial. Furthermore, validation studies are available only for a minority of the grading systems. Contrasting data on the prognostic power of some grading systems, lack of detailed instructions in the materials and methods in some studies, and lack of data on reproducibility and validation studies are discussed for the relevant grading systems. Awareness of the limitations of grading is necessary for pathologists and oncologists to use these systems appropriately and to drive initiatives for their improvement.
肿瘤分级是一种基于特定组织学特征量化肿瘤潜在临床侵袭性的方法。一个好的分级系统应该简单、易用、可重复,并能准确地区分低风险和高风险的肿瘤。本综述的目的是总结兽医病理学中应用的组织学和(如有)细胞学分级系统,提供关于其预后影响、可重复性、实用性和缺点的信息。兽医中使用的大多数分级方案都是为常见的肿瘤实体开发的。软组织肉瘤、骨肉瘤、多房性骨肿瘤、肥大细胞瘤、淋巴瘤、乳腺肿瘤、肺肿瘤、尿路上皮肿瘤、肾细胞癌、前列腺癌和中枢神经系统肿瘤都有分级系统。许多分级方案的预后相关性已得到证实,但对于某些肿瘤类型,分级的实用性仍存在争议。此外,只有少数分级系统进行了验证研究。对于一些分级系统,关于其预后能力的对比数据、一些研究中材料和方法部分缺乏详细说明以及缺乏关于可重复性和验证研究的数据等问题进行了讨论。病理学家和肿瘤学家需要意识到分级的局限性,以便正确使用这些系统,并推动改进这些系统的计划。
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