Schlemper R J, Itabashi M, Kato Y, Lewin K J, Riddell R H, Shimoda T, Sipponen P, Stolte M, Watanabe H
Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Cancer. 1998 Jan 1;82(1):60-9. doi: 10.1002/(sici)1097-0142(19980101)82:1<60::aid-cncr7>3.0.co;2-o.
In view of the many studies of early stage colorectal carcinoma from Japan, it is essential to know whether the criteria for the histologic diagnosis of colorectal carcinoma are similar in Japan and Western countries.
Eight expert pathologists from Japan (4), North America (2), and Europe (2) individually reviewed microscope slides of 20 colorectal lesions from Japanese patients who had undergone endoscopic mucosal resection or surgery because early stage carcinoma and/or adenoma was suspected. The pathologists indicated the pathologic findings on which they based each diagnosis.
For 11 slides that showed adenoma according to the Western pathologists with low grade dysplasia according to at least half of them, the Japanese diagnosed definite carcinoma with or without adenoma in 4 cases and adenoma in 5, and in 2 cases they were equally divided between a diagnosis of adenoma and carcinoma. For five slides showing adenoma with high grade dysplasia according to the Western pathologists, the Japanese diagnosed definite carcinoma with adenoma in three cases and adenoma in one, and in one case they were equally divided between a diagnosis of adenoma and carcinoma. For one case in which the Western pathologists were equally divided between a diagnosis of carcinoma and adenoma with high grade dysplasia, all the Japanese pathologists diagnosed definite carcinoma with or without adenoma. Three slides showed definite carcinoma with or without adenoma, according to both the Western and the Japanese pathologists. The presence of invasion was the most important diagnostic criterion of colorectal carcinoma for the Western pathologists, whereas for the Japanese the nuclear features and glandular structures were more important.
In Japan, colorectal carcinoma is diagnosed on the basis of nuclear and structural criteria, even in cases considered by Western pathologists to be noninvasive lesions with low grade dysplasia. This diagnostic practice may contribute to the relatively high incidence of early stage colorectal carcinoma reported in Japan as compared with Western countries.
鉴于日本有许多关于早期结直肠癌的研究，了解日本和西方国家结直肠癌组织学诊断标准是否相似至关重要。
来自日本（4名）、北美（2名）和欧洲（2名）的8名专家病理学家分别对20例日本患者的结直肠病变显微镜切片进行了检查，这些患者因疑似早期癌和/或腺瘤而接受了内镜黏膜切除术或手术。病理学家指出了他们做出每项诊断所依据的病理结果。
对于11张根据西方病理学家显示为腺瘤且至少一半认为是低级别异型增生的切片，日本病理学家诊断为确诊癌伴或不伴腺瘤的有4例，诊断为腺瘤的有5例，2例在腺瘤和癌的诊断上意见平分。对于5张根据西方病理学家显示为高级别异型增生腺瘤的切片，日本病理学家诊断为确诊癌伴腺瘤的有3例，诊断为腺瘤的有1例，1例在腺瘤和癌的诊断上意见平分。对于1例西方病理学家在癌和高级别异型增生腺瘤的诊断上意见平分的病例，所有日本病理学家均诊断为确诊癌伴或不伴腺瘤。根据西方和日本病理学家的诊断，有3张切片显示为确诊癌伴或不伴腺瘤。浸润的存在是西方病理学家诊断结直肠癌最重要的标准，而对日本病理学家来说，核特征和腺管结构更重要。
在日本，结直肠癌是根据核和结构标准进行诊断的，即使是西方病理学家认为是非浸润性低级别异型增生病变的病例。这种诊断做法可能导致日本报告的早期结直肠癌发病率相对高于西方国家。
