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PubMed1996

[Currently available classifications of lymphoid neoplasia and their clinical applicability].

Controversy and confusion in the classification of lymphoid neoplasia have long been sources of frustration as exemplifed by the statement of Rupert A. Willis in 1948, that "Nowhere in pathology has a chaos of names so clouded clear concept as in the subject of lymphoid tumors." Taxonomically, "Classifications are theories about the basis of natural order, not dull catalogues compiled only to avoid chaos." (Stephen J. Gould, 1989), but this definition can not always be applicable to the classifications of human diseases, even though they themselves are also biologic phenomena. The International Lymphoma Study Group has recently proposed "a revised European-American classification of lymphoid neoplasms", which has again resulted in the time of "the great debate". The major purpose of this article is, therefore, to assess the above classification.

Humans↗
PubMed1996

[Classification of malignant lymphomas--current status and clinical implications].

New techniques such as cytogenetics, molecular biology and immunology have provided new insights into the pathogenesis and development of malignant lymphomas. By this way they provided a new basis for a classification of lymphoid malignancies which is increasingly oriented on biology and pathogenesis. This process resulted in the 'Revised European-American Lymphoma' (R.E.A.L.) classification, which was recently proposed by an international group of pathologists. This classification comprises a preliminary end point of a continuing process which will require a reevaluation and adaptation to new knowledge in the future again. In order to facilitate the clinical use of this histopathologically and biologically oriented classification, a proposal for a clinical grouping was developed, which divides the R.E.A.L. lymphoma subtypes into the following categories: I. Indolent lymphomas (low risk group). II. Aggressive lymphomas (intermediate risk group). III. Very aggressive lymphomas (high risk group). IV. Morbus Hodgkin. This internationally developed consensus of a histopathologic classification and a clinical grouping is a substantial step forward towards an international cooperation in the management of malignant lymphomas. It is background for cooperative studies and justifies the hope that further advances will be achieved in the treatment of malignant lymphomas and that more effective strategies can be developed in the near future.

Cytogenetics↗
PubMed1977

Transthoracic aspiration biopsy. Cytological classification of aspirated malignant tumour cells.

On correlating our cytological classification of aspirated malignant tumour cells from intrathoracic lesions with the histological classification of the same lesions, agreement was found in 75 per cent. The cytological criteria used for the classification of the differentiated types of tumour cells were convenient. It is proposed to utilize the cytological classification in the planning of an individualized tumour therapy in cases not accessible to pretreatment bioptic histological classification.

Adenocarcinoma↗
PubMed1996

[A new classification of the motor disorders in patients who have had a cerebral stroke].

A new classification of motor disorders in patients after brain hemisphere's stroke as well as with its sequelae was proposed on the basis of clinical electromyographic studies. The classification validity was confirmed by mathematic statistic methods. The classification was composed of motor syndromes and is based on the following criteria: the severity of paresis, the correlation between gravity of paresis of the upper and lower limbs, muscular spasticity, alteration of integral estimation of active movements (the motor algorithm). The most informative signs of classification are the following: the paresis gravity, the degree of muscular spasticity, the alteration of motor algorithm, the parameters of stimulative electromyography. The described classification permits to carry out differentiated actions of neurorehabilitation directed to intensification of effectivity of treatment after hemisphere's stroke.

Algorithms↗
PubMedDate not supplied

[Non-Hodgkin's lymphoma: morphologic, immunologic and cytogenetic classification].

Malignant lymphomas (ML) encompass about 1/6 of all malignant neoplasms. They have been divided into two major categories: Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL). While the classification of Hodgkin's disease is clearly established, classification of non-Hodgkin's lymphomas is still a histopathological problem, and requires a great pathological experience. Many morphological classifications of NHL are used in different countries. In the last few years the "Working formulation for clinical usage" is widely used. Advances in immunology allowed immunological determination of different histopathological lymphoma cell types. Progress in the field of cytogenetics discovered particular cytogenetics abnormalities in patients with different types of NHL. Modern diagnostic procedures in each patient with NHL, besides clinical staging, require a detailed morphological-immunological-cytogenetical (MIC) classification. MIC classification provides the basis for the modern therapeutical management and better estimation of prognosis and evolution of the disease.

Humans↗
PubMed1997

EORTC classification for primary cutaneous lymphomas: a proposal from the Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer.

Primary cutaneous lymphomas represent a heterogeneous group of T- and B-cell lymphomas that show considerable variation in histology, phenotype, and prognosis. Recently, the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group has reached consensus on a new classification for this group of diseases. The EORTC classification for primary cutaneous lymphomas is based on a combination of clinical, histologic, and immunophenotypic criteria, and thus contains well-defined disease entities rather than histologic subgroups. In addition, this new classification contains a number of provisional entities, which may display characteristic histologic features, but are not yet well defined clinically. These provisional entities account for less than 5% of all primary cutaneous lymphomas. In this report the basic principles of this new classification, as well as the characteristic features of the different disease entities, are described. In addition, survival data of 626 patients with primary cutaneous lymphomas derived from the registry of the Dutch Cutaneous Lymphoma Working Group, illustrating the clinical validity of this new classification, are presented.

Humans↗
PubMed1997

[TNM classification of bone and soft tissue sarcomas].

TNM classification of bone and soft tissue sarcomas was published by UICC in 1987. Histological grading (G) is an important factor in this classification, but the criteria of G categories are not so clear. In addition, lymph node metastasis is very rare in bone and soft tissue sarcoma. Therefore, prognostic factors are limited to T, M and G categories. Since correlation between the stage (UICC) and the survival rate was not found in patients with osteosarcoma, TNM classification (UICC) has not been used widely in the field of orthopedic oncology. The Musculoskeletal Tumor Committee of the Japanese Orthopaedic Association proposed another TNM classification of osteosarcoma based on multivariate analysis. T1 is less than 15 cm and T2 is 15 cm or larger in maximal diameter. N and M are same with the UICC criteria. Serum alkaline phosphatase level (A) is included in this classification in which A0 is less than the normal value x2.5, and A1 is the normal value x2.5 or more. G categories are separated into two groups according to the mitotic rate in a high power field (x200); G1 is assigned to the tumor with 0-9/1 HPF and G2 is assigned to those with 10 or more/1 HPF. Reclassification of osteosar-coma by this modified TNM system indicated that there was a correlation between the survival rate and the stage.

Bone Neoplasms↗
PubMedDate not supplied

Histological classification of chronic hepatitis.

The 1968 classification of chronic hepatitis distinguished cirrhotic and non-cirrhotic stages, and classified the disease according to the histological degree of disease activity into chronic persistent and chronic aggressive (active) varieties. This seemed appropriate at a time when the aetiology of chronic hepatitis was unknown, and presumed to be auto-immune. Immunosuppressive treatment was reserved for more severe variant of the disease, thus validating the usefulness of the classification. Over the past thirty years, several aetiologies were discovered for chronic hepatitis: the hepatitis viruses B, D, C, and G, side-effects of several therapeutic drugs, and autoimmune hepatitis. This progress created a growing need for a new or adapted classification of chronic hepatitis, since different aetiologies require divergent therapeutic approaches. In 1994, proposals for a new classification of chronic hepatitis came from two international organizations: the International Association for the Study of the Liver and the World Congresses of Gastroenterology. The essence of the proposals includes: primary classification according to aetiology, and determination of disease severity (grading) and stage of progression (staging). Several semiquantitative scoring systems for histological grading and staging of liver biopsies from patients with chronic hepatitis are available. Semiquantitative scoring is useful in the evaluation of new treatment regimens, and in comparing pre- and posttreatment biopsies. It is not indicated in the routine reporting of liver biopsies.

Biopsy↗
PubMed1998

Modern concepts of endometriosis. Classification and its consequences for therapy.

OBJECTIVE: To review the development of the American Society for Reproductive Medicine (ASRM) classification forms for endometriosis and assess efforts to validate their clinical utility. STUDY DESIGN: The relevant medical literature was reviewed. RESULTS: ASRM has established classification forms for endometriosis in women with infertility and pelvic pain. The utility of these new forms has not been assessed. Studies using earlier versions of the ASRM classification reported that the stage of disease correlates better with pain symptoms than fertility outcome. CONCLUSION: The ASRM classification form for infertility and the form to assist in the management of pelvic pain in women with endometriosis permit clear documentation of the extent and morphologic type of disease. Further studies are needed to refine the classification and enhance its predictive ability.

Endometriosis↗
PubMed1998

[TNM classification of gynecological tumors].

Gynecological tumors of cervix uteri, corpus uteri, ovary, vagina, and vulva are classified by the TNM systems. The definitions of the T categories correspond to several stages accepted by FIGO (Federation Internationale de Gynecologie et d'Obstetrique). Those of regional lymph nodes are different among primary sites. The relationships between 5-year survival rates and TNM stages were investigated in cervical and endometrial carcinoma cases in 1985 by the Japan Society of Obstetrics and Gynecology (JSOG). The pTNM pathological classification had a better relationship with survival than the TNM clinical classification, respectively. According to the rules for TNM classification, T categories should be assessed by physical examination, cytoscopy and urography. These data indicate that prognostic factors could not be accurately assessed by these procedures. Radiotherapy for cervical carcinoma is selected in many cases. The JSOG adopts the clinical classification in 1997, but it had a pathological classification for corpus uteri and ovary in 1995.

Female↗
PubMedDate not supplied

[The classification of nervous system tumors].

The paper presents the classification of tumors of the nervous system, which is based on the Second Variant of the International Histological Classification of Tumors of the Nervous System which was developed by the WHO experts in 1993 and on the section "Morphology of Neoplasms" of the International Classification of Diseases, Xth review. These classifications were critically reviewed by taking into account the experience gained by the Laboratory of Pathomorphology, Academician N. N. Burdenko Research Institute, Russian Academy of Medical Sciences. The proposed classification may unify the material of our country's neurosurgical clinics and provide more corrective statistic data.

Humans↗
PubMed1997

[The degrees of burns--classifications].

Since 1996, a new three-degree classification has been adopted for determination of the depth of lesions caused by the thermal agent, published in Bulletin N(o) 7, XLII, 1996 of the Ministry of Health. The present report is aimed at facilitating surgeons in its practical implementation by making a comparative assessment of the various numerical classifications, employed both in this country and abroad, and adapting them to the three groups of nonnumerical classifications. In the field of scientific communication between doctors from different countries, the numerical classifications give rise to confusion and on account of that utilization of the verbal classification for evaluating the deepness of a burn lesion is strongly recommended.

Bulgaria↗
PubMed1998

Consistency achieved by 23 European pathologists in categorizing ductal carcinoma in situ of the breast using five classifications. European Commission Working Group on Breast Screening Pathology.

The increased detection of ductal carcinoma in situ (DCIS) by mammographic screening, the greater use of breast-conserving surgery, and the recognition that certain histological subtypes are associated with a greater risk of local recurrence has led to the formulation of several new classifications of DCIS in recent years. There are, however, no data concerning the degree of consistency with which these schemes can be applied by reasonable numbers of pathologists. Thirty-three cases of DCIS were thus examined by a working group of 23 European pathologists who categorized them using five recently published classifications: (1) that of the European Pathologists' Working Group based on differentiation (a combination of nuclear grade and cell polarization) with categories of poorly, intermediately, and well differentiated; (2) one based entirely on nuclear grade with categories of high, intermediate, and low, currently in use in the UK national and EC-funded breast screening programs; (3) the same classification in which only two categories, high nuclear grade and other, were used; (4) the Van Nuys system in which lesions are divided into high grade, non-high grade with necrosis and non-high grade without necrosis; and (5) a two-category classification based entirely on the presence or absence of comedo necrosis. Of the three systems with three categories, Van Nuys gave the highest overall kappa statistic of 0.42. Others gave similar values of 0.37 and 0.35 showing that assessing cell polarization in addition to nuclear grade neither improves nor worsens consistency. In all three systems, the middle category was associated with the lowest value for kappa. Of the two systems with two categories, that based on nuclear grade gave the highest overall kappa of 0.46 and that based on comedo necrosis the lowest of 0.34. The most robust histological features were thus high- and low-grade nuclei and necrosis as long as the latter did not involve the recognition of a comedo growth pattern. These values probably represent the maximum achievable, at least by reasonable numbers of pathologists in everyday practice. They are better than those previously reported for classification based entirely on architecture, but further improvement is needed.

Breast Neoplasms↗
PubMed1998

[FPSUND: a pan-Canadian evaluation of a clinical classification of urinary incontinence].

Historically, urinary incontinence is divided into 3 subtypes: stress, urge and mixed. This latter group, which according to many studies can account for up to 50% of the patients, is very heterogenous. For this same reason, the reports of treatments of urinary incontinence are very difficult to analyse using this simple classification. In a attempt to clarify this situation and to help the acquisition of useful clinical information relating to urinary incontinence, were have developed a clinical classification of urinary incontinence (FPSUND) in which 6 symptoms are graded in severity from 0 to 3. In this acronym, the F stands for frequency, the P for the use of protection, the S for stress-related complaints, the U for urge-related complaints, the N for nocturia and the D for the number of daily micturitions. Urologists across Canada were sent the French or English version of the classification and used it to evaluate 148 female patients aged from 18 to 70, suffering from urinary incontinence. A second, independent evaluation, was also performed on the same patients by registered nurses or urodynamic technicians. Reproducibility between observers, as assessed by the weighted Kappa score ranged from 0.47 and 0.74 (p < 0.05), was very good. Generally, the users of the classification found it very easy to use. In summary, we propose the FPSUND clinical classification of urinary incontinence as a useful and accurate tool to classify urinary incontinence and as a means to assess treatment outcome.

Adolescent↗
PubMed1998

[Classification of ethmoid malignancies].

The UICC and AJCC never classified ethmoid malignancies prior to the latest edition (1997). Most classifications in the literature refer to a single histological type (estensioneuroblastoma or carcinoma) while others basically consider the intracranial extension, without distinguishing between intra or extradural. Still others consider invasion of the orbit. There is as yet no classification which considers all the prognostic factors associated with the extension of this neoplasm. The authors reviewed 84 patients with ethmoid malignancy who had undergone anterior cranio-facial resection between 1987 and 1994 and had been followed up for a minimum of 36 months. Of these patients, 43 were recurrences of previous treatment while 42 had not previously been treated. The breakdown was as follows: 45 adenocarcinoma, 14 squamous cell carcinoma (more or less differentiated), 8 etesioneuroblastoma, 6 adenoidocistic carcinoma, 5 melanoma and 6 rare forms. These cases were staged according to a new classification identifying the worst prognostic factors: invasion into the dura and, above all, intradural extension; invasion of the sphenoid sinus, orbit, and in particular the orbit apex, the frontal sinus, the maxillary sinus, the pterygoid, infratemporal fossa and the skin. Until 1994 we used this classification which is similar to the one proposed by the UICC in 1997. On the basis of this classification our case breakdown is as follows: T2 35, T3 24, T4 25 (there were no cases of T1). Since a patient can live as much as 4-5 years with a recurrence but the recurrences all appeared within 2 years after surgery, we used a NED survival at 36 months as index of healing. The NED survival at 36 months was: T2 54%, T3 41%, T4 8%. In patients which had not received prior treatment the NED survival was: T2 63%, T3 45%, T4 9%. The progressive worsening of prognosis from T2 to T4, particularly in patients which had not been pretreated, leads us to assume that the true prognostic factors for malignant ethmoid tumors have been identified.

Ethmoid Sinus↗
PubMed2004

The classification of glomerulonephritis in systemic lupus erythematosus revisited.

The currently used classification reflects our understanding of the pathogenesis of the various forms of lupus nephritis, but clinicopathologic studies have revealed the need for improved categorization and terminology. Based on the 1982 classification published under the auspices of the World Health Organization (WHO) and subsequent clinicopathologic data, we propose that class I and II be used for purely mesangial involvement (I, mesangial immune deposits without mesangial hypercellularity; II, mesangial immune deposits with mesangial hypercellularity); class III for focal glomerulonephritis (involving <50% of total number of glomeruli) with subdivisions for active and sclerotic lesions; class IV for diffuse glomerulonephritis (involving > or =50% of total number of glomeruli) either with segmental (class IV-S) or global (class IV-G) involvement, and also with subdivisions for active and sclerotic lesions; class V for membranous lupus nephritis; and class VI for advanced sclerosing lesions. Combinations of membranous and proliferative glomerulonephritis (i.e., class III and V or class IV and V) should be reported individually in the diagnostic line. The diagnosis should also include entries for any concomitant vascular or tubulointerstitial lesions. One of the main advantages of the current revised classification is that it provides a clear and unequivocal description of the various lesions and classes of lupus nephritis, allowing a better standardization and lending a basis for further clinicopathologic studies. We hope that this revision, which evolved under the auspices of the International Society of Nephrology and the Renal Pathology Society, will contribute to further advancement of the WHO classification.

Humans↗
PubMed2025

Hierarchical Multi-Label Classification With Gene-Environment Interactions in Disease Modeling.

In biomedical studies, gene-environment (G-E) interactions have been demonstrated to have important implications for analyzing disease outcomes beyond the main G and main E effects. Many approaches have been developed for G-E interaction analysis, yielding important findings. However, hierarchical multi-label classification, which provides insightful information on disease outcomes, remains unexplored in G-E analysis literature. Moreover, unlabeled data are commonly observed in practical settings but omitted by many existing methods of hierarchical multi-label classification. In this study, we consider a semi-supervised scenario and develop a novel approach for the two-layer hierarchical response with G-E interactions. A two-step penalized estimation is then proposed using an efficient expectation-maximization (EM) algorithm. Simulation shows that it has superior performance in classification and feature selection. The analysis of The Cancer Genome Atlas (TCGA) data on lung cancer demonstrates the practical utility of the proposed method. Overall, this study can fill the important knowledge gap in G-E interaction analysis by providing a widely applicable framework for hierarchical multi-label classification of complex disease outcomes.

Humans↗
PubMed1995

Classification-algorithm evaluation: five performance measures based on confusion matrices.

OBJECTIVE: The objective of this paper is to introduce, explain, and extend methods for comparing the performance of classification algorithms using error tallies obtained on properly sized, populated, and labeled data sets. METHODS: Two distinct contexts of classification are defined, involving "objects-by-inspection" and "objects-by-segmentation." In the former context, the total number of objects to be classified is unambiguously and self-evidently defined. In the latter, there is troublesome ambiguity. All five of the measures of performance here considered are based on confusion matrices, tables of counts revealing the extent of an algorithm's "confusion" regarding the true classifications. A proper measure of classification-algorithm performance must meet four requirements. A proper measure should obey six additional constraints. RESULTS: Four traditional measures of performance are critiqued in terms of the requirements and constraints. Each measure meets the requirements, but fails to obey at least one of the constraints. A nontraditional measure of algorithm performance, the normalized mutual information (NMI), is therefore introduced. Based on the NMI, methods for comparing algorithm performance using confusion matrices are devised. CONCLUSIONS: The five performance measures lead to similar inferences when comparing a trio of QRS-detection algorithms using a large data set. The modified NMI is preferred, however, because it obeys each of the constraints and is the most conservative measure of performance.

Algorithms↗