世界卫生组织膀胱尿路上皮癌病理分级标准变化要点解读  

Review of different WHO pathologic classifications of bladder urothelial carcinoma

作　　者：郑闪[1] 田军[2] 吕宁[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所病理科,北京100021 [2]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所泌尿外科,北京100021

出　　处：《肿瘤研究与临床》2013年第8期555-558,共4页Cancer Research and Clinic

基　　金：北京希望马拉松基金

摘　　要：世界卫生组织（WHO）曾先后于1973年、1999年和2004年提出膀胱尿路上皮癌病理分级标准。1973年版标准在国内应用时间最长，而2004年版正在推广普及中。目前，国内在膀胱尿路上皮癌分级上存在以下两方面主要问题：把握2004年版病理分级标准存在困难，不能简单快速分级；混淆各版本之间的区别，将不同版本的分级进行错误的转换。文章系统回顾膀胱尿路上皮癌分级标准的变化，详细解读各版本WHO膀胱尿路上皮癌病理分级标准要点。3个版本分级标准均以细胞间变为分级依据，但1973年版缺乏准确的量化指标，1999年版仍沿用1973年版的3级分类法，各级间的标准虽有一定量化，但3级间的区别仍不甚明确。2004年版病理分级将3级分类标准改为2级，很好地解决了3级级别中Ⅱ级占大多数的问题。WHO has issued three editions of pathologic classification of bladder urothelial carcinoma in 1973, 1999 and 2004. The 1973 version classification had been widely and the longest applied. However, WHO 2004 classification had been prevalent in past years. There were two issues in the applications of WHO 2004 classification. On one hand, there were some difficulties in quick grading in a given case. On the other hand, there were some misunderstandings in the conversion of different WHO classification. In this article, the changes of different pathologic classification of bladder urothelial carcinoma were reviewed and the outline of different pathologic classification was generalized. The criterion of all the systems was cell anaplasia. In WHO 1973 version classification, the definition of the various grades was vague. It was relatively precise in WHO 1999 classification. However, the grading of Ⅰ, Ⅱ and Ⅲ in WHO 1999 classification still remained confusions. The major changes in WHO 2004 classification was that this system divided urothelial carcinoma into low- and high-grade, which may solve the heterogenesis of grade Ⅱ in the other two classifications.

关 键 词：膀胱尿路上皮癌 病理分级 世界卫生组织 

分 类 号：R737.14[医药卫生—肿瘤]