Schlemper R J, Itabashi M, Kato Y, Lewin K J, Riddell R H, Shimoda T, Sipponen P, Stolte M, Watanabe H, Takahashi H, Fujita R
Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama-shi, Japan.
Lancet. 1997 Jun 14;349(9067):1725-9. doi: 10.1016/S0140-6736(96)12249-2.
There have been many studies on gastric carcinoma in populations with contrasting cancer risks. We aimed to find out whether the criteria for the histological diagnosis of early gastric carcinoma were comparable in Western countries and Japan.
Eight pathologists from Japan, North America, and Europe individually reviewed 35 microscope slides: 17 gastric biopsy samples and 18 endoscopic mucosal resections taken from 17 Japanese patients with lesions ranging from early gastric cancer to adenoma, dysplasia, and reactive atypia. The pathologists were given a list of pathological criteria and a form on which they were asked to indicate the criteria on which they based each diagnosis.
For seven slides most Western pathologists diagnosed low-grade adenoma/dysplasia, whereas the Japanese diagnosed definite carcinoma in four slides, suspected carcinoma in one, and adenoma in only two. Of 12 slides with high-grade adenoma/dysplasia according to most Western pathologists the Japanese gave the diagnosis of definite carcinoma in 11 and suspected in one. Of six slides showing high-grade adenoma/dysplasia with suspected carcinoma according to most Western pathologists the Japanese diagnosed definite carcinoma in all. There were no major differences in the diagnoses of three slides showing reactive epithelium and seven slides with clearly invasive carcinoma. When the opinion of the majority of the pathologists was taken as the final diagnosis there was agreement between Western and japanese in 11 of the 35 slides (kappa coefficient 0.15 [95% CI 0.01-0.29]). Presence of invasion was the most important diagnostic criterion for most Western pathologists whereas for the Japanese nuclear features and glandular structures were more important.
In Japan, gastric carcinoma is diagnosed on nuclear and structural criteria even when invasion is absent according to the Western viewpoint. This diagnostic practice results in almost no discrepancy between the diagnosis of a superficial biopsy sample and that of the final resection specimen. This may also contribute to the relatively high incidence and good prognosis of gastric carcinoma in Japan when compared with Western countries.
针对患癌风险不同的人群，已有多项关于胃癌的研究。我们旨在探究西方国家与日本对早期胃癌的组织学诊断标准是否具有可比性。
来自日本、北美和欧洲的八位病理学家分别对35张显微镜载玻片进行了检查：17份胃活检样本以及取自17例日本患者的18份内镜黏膜切除术样本，这些病变范围涵盖早期胃癌、腺瘤、发育异常和反应性异型增生。病理学家们收到了一份病理标准清单以及一张表格，要求他们在表格上注明做出每项诊断所依据的标准。
对于七张载玻片，大多数西方病理学家诊断为低级别腺瘤/发育异常，而日本病理学家在四张载玻片中诊断为确诊癌，一张为疑似癌，仅有两张诊断为腺瘤。在大多数西方病理学家诊断为高级别腺瘤/发育异常的12张载玻片中，日本病理学家诊断为确诊癌的有11张，疑似癌的有1张。在大多数西方病理学家诊断为高级别腺瘤/发育异常伴疑似癌的六张载玻片中，日本病理学家均诊断为确诊癌。在三张显示反应性上皮的载玻片和七张具有明显浸润性癌的载玻片的诊断上，没有重大差异。当以大多数病理学家的意见作为最终诊断时，35张载玻片中西方和日本病理学家有11张达成了一致（kappa系数0.15 [95% CI 0.01-0.29]）。对于大多数西方病理学家而言，浸润的存在是最重要的诊断标准，而对于日本病理学家来说，核特征和腺管结构更为重要。
在日本，即使按照西方观点不存在浸润，也会依据核和结构标准诊断胃癌。这种诊断做法使得浅表活检样本与最终切除标本的诊断几乎没有差异。与西方国家相比，这可能也是日本胃癌发病率相对较高且预后良好的原因之一。
