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WHO(2003)乳腺肿瘤组织学新分类较以往分类有许多优点:新分类体现了近代乳腺肿瘤病理学的最新进展,将新技术、新成果开始用于辅助诊断、分型及预测,并增加了一些新的肿瘤类型;重视与临床结合,增加术后病理分期和预后因素及预测因子,强调组织学分级和乳腺癌ER、PR及Her-2的表达与临床治疗及预后的意义;以人为本,体现人性化,提出导管上皮内瘤新概念,并将浸润性癌归为癌,导管内癌归入导管上皮内瘤,小叶原位癌归入小叶性肿瘤,对于疑似恶性病变要“降级”诊断,避免过度诊断、过度治疗给患者带来的身心损害;求同存异,新版分类将各家有代表性的观点均罗列出来供大家参考,待今后实践中进一步总结验证,而不是采用硬性统一的办法。新版分类虽然有许多优点,但其中也有一些值得进一步探讨与商榷的问题:该分类整体性、系统性较欠缺;某些肿瘤的命名与归类不合理;新版分类回避了以往WHO分类中一些常见而传统的病变,在应用新分类诊断这些病变时往往会感到无所适从;没有强调正确病理诊断、分型、分期必须的基本条件。我们认为目前实际工作中应用新分类时应认真学习、加深理解、掌握标准,结合实际、加强沟通、先易后难、逐步接轨过渡,重视克服病理诊断的局限性,多实践、总结、协作、提高。
WHO (2003) The new classification of breast tumor histology has many advantages over the previous classification: the new classification reflects the recent progress of modern breast tumor pathology, the new technology, new results began to be used to diagnose, type and predict, and increased Some new types of tumor; emphasis on clinical combination, increased postoperative pathological staging and prognostic factors and predictors, emphasizing histological grade and breast cancer ER, PR and Her-2 expression and clinical treatment and prognostic significance; people-oriented, embodied Humanity, put forward a new concept of ductal intraepithelial neoplasia, and will be classified as invasive carcinoma, intraductal carcinoma classified as ductal intraepithelial neoplasia, lobular carcinoma in situ lobular cancer, for suspected malignant lesions to “downgrade” Diagnosis, to avoid over-diagnosis, over-treatment of patients with physical and psychological damage; seeking common ground while reserving differences, the new version of each representative viewpoints are listed for your reference, to be further verified in practice in the future, rather than the use of hard and uniform approach . Although there are many advantages of the new classification, but there are also some issues worth further discussion and discussion: the classification of the overall system is relatively lacking; some of the tumor naming and classification unreasonable; the new classification to avoid the WHO classification of some common The traditional lesions, in the application of new classification of these lesions often feel confused; did not emphasize the correct pathological diagnosis, classification, staging must basic conditions. We think that we should study hard now, deepen our understanding and grasp the standards, combine the actual situation, strengthen the communication, make it easy for the first to emerge later, and gradually merge with the transition. We should attach importance to overcoming the limitations of pathological diagnosis, practice more, summarize and collaborate, improve.