Riddell R H, Iwafuchi M
Department of Pathology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Histopathology. 1998 Sep;33(3):197-202. doi: 10.1046/j.1365-2559.1998.00520.x.
It has become increasingly apparent that the Japanese and Western systems of classifying dysplasia and carcinoma in the gastrointestinal tract are not the same. The implication of these differences is that in an article in a Western journal on gastrointestinal 'cancer' originating from Japan, it is often impossible to repeat the study to confirm or refute it, because of these differences in definitions. Although there is no reason why it should not be just as much of a problem if Western research is published in Japanese journals, this is currently not a major problem. The terminological differences do not mean that one is right and one wrong; they are simply different. We had an opportunity to look at these differences in detail in a series of 100 gastric biopsies. In this review, we outline these differences and indicate the similarities, differences and problems between these two systems. 'Carcinoma' is diagnosed in Japan by virtue of its structural and cytological features, but by invasion in the Western system. Adenoma does not mean a dysplastic lesion in the Japanese system (although it can) but in most cases is similar to low-grade dysplasia irrespective of the macroscopic/endoscopic appearances (hence flat and depressed adenomas in the Japanese system); however, most examples of high-grade dysplasia in the Western system, as well as some low-grade dysplasia, becomes 'cancer' in the Japanese system. Conversely, both have conceptual areas that are useful in the other's systems. Because we were ultimately able to use each other's systems, we were able to show where these systems come together and diverge. These provide hope that a common classification encompassing both systems that allows communication between both systems is feasible.
越来越明显的是，日本和西方对胃肠道发育异常和癌的分类系统并不相同。这些差异意味着，在西方期刊上发表的一篇关于源自日本的胃肠道“癌症”的文章中，由于定义上的这些差异，往往无法重复该研究以证实或反驳它。尽管如果西方的研究发表在日本期刊上，也同样可能存在问题，但目前这并不是一个主要问题。术语上的差异并不意味着一方正确而另一方错误；它们只是不同而已。我们有机会在一系列100例胃活检中详细研究这些差异。在这篇综述中，我们概述了这些差异，并指出了这两种系统之间的异同及问题。在日本，“癌”是根据其结构和细胞学特征来诊断的，而在西方系统中则是根据浸润来诊断。在日本系统中，腺瘤并不一定意味着发育异常病变（尽管它可能是），但在大多数情况下，无论大体/内镜表现如何，腺瘤都类似于低级别发育异常（因此在日本系统中有平坦和凹陷性腺瘤）；然而，西方系统中的大多数高级别发育异常病例以及一些低级别发育异常病例，在日本系统中都成为了“癌”。相反，两者都有在对方系统中有用的概念范畴。因为我们最终能够使用对方的系统，所以我们能够展示这些系统的交汇点和分歧点。这些给人带来希望，即一个涵盖这两种系统、允许两者之间进行交流的通用分类是可行的。
