Abstract：
The clinical management of patients with dysplasia in chronic inflammatory bowel disease (IBD) is currently guided by Riddell et al.\'s grading system (negative, indefinite, low grade, high grade) from 1983 which was based primarily on nuclear cytoarchitectural characteristics. Although most dysplasia in IBD resembles sporadic adenomas morphologically, other distinctive potential cancer precursors in IBD have been described over time. Recognizing the need for a updated comprehensive classification for IBD-associated dysplasia, an international working group of pathologists with extensive clinical and research experience in IBD devised a new classification system and assessed its reproducibility by having each participant assess test cases selected randomly from a repository of electronic images of potential cancer precursor lesions. The new classification system now encompasses three broad categories and nine sub-categories: 1) intestinal dysplasia (tubular/villous adenoma-like, goblet cell deficient, crypt cell, traditional serrated adenoma-like, sessile serrated lesion-like and serrated NOS), 2) gastric dysplasia (tubular/villous and serrated), and 3) mixed intestinal-gastric dysplasia. In the interobserver analysis, 67% of the diagnoses were considered definitive and achieved substantial inter-rater agreement. The key distinctions between intestinal and gastric lesions and between serrated and non-serrated lesions achieved substantial and moderate inter-rater agreement overall, respectively, however, the distinctions among certain serrated sub-categories achieved only fair agreement. Based on the Riddell grading system, definite dysplasia accounted for 86% of the collective responses (75% low grade, 11% high grade). Based on these results, this new classification of dysplasia in IBD can provide a sound foundation for future clinical and basic IBD research.
摘要：
目前，Riddell等人指导慢性炎症性肠病（IBD）发育不良患者的临床治疗。的评分系统(否定，不确定,低等级,高等级）从1983年开始，主要基于核细胞结构特征。尽管IBD中的大多数发育不良在形态上类似于散发性腺瘤，随着时间的推移，已经描述了IBD中其他独特的潜在癌症前体。认识到需要更新IBD相关发育不良的综合分类，一个在IBD方面具有丰富临床和研究经验的国际病理学家工作组设计了一种新的分类系统,并通过让每个参与者评估从潜在癌症前体病变的电子图像库中随机选择的测试病例来评估其可重复性.新的分类系统现在包括三大类和九个子类别：1）肠发育不良（管状/绒毛状腺瘤样，杯状细胞缺陷，地穴细胞,传统的锯齿状腺瘤样，无柄锯齿状病变样和锯齿状NOS)，2）胃发育不良（管状/绒毛和锯齿状），3)肠-胃混合性发育不良。在观察者间分析中，67％的诊断被认为是确定的，并达成了评估者之间的实质性共识。肠和胃病变之间以及锯齿状和非锯齿状病变之间的关键区别总体上在评估者之间取得了实质性和中等的一致性，分别,然而,某些锯齿子类别之间的区别只有公平的协议。根据Riddell的评分系统,明确的发育不良占集体反应的86%(75%低等级，11%的高品位)。基于这些结果,这种新的IBD异型增生分类可以为未来的临床和基础IBD研究提供良好的基础。
