- 间质核分裂活性是叶状肿瘤良性 / 交界性 / 恶性分级的关键标准，但计数方法此前一直没有说清楚：取最活跃区（热点），还是多区取平均？
- 国际专家组（Tan PH、Rakha、Ellis、Schnitt、Lakhani 等）主张：在热点区取最高间质核分裂计数，再结合其他组织学参数分级。
- 文中给出热点评估的操作流程，按不同显微镜视野直径换算，并讨论数字工具辅助计数；目的是提高观察者间可重复性。
收录范围：PubMed 英文摘要及中文翻译（abstract-only）。原文为订阅制（Wiley TDM 许可，非 OA），出版社全文页对本站返回 Cloudflare 验证页，未采集全文、图表。
摘要
背景：乳腺叶状肿瘤（PT）是罕见的双相性纤维上皮性肿瘤，分为良性、交界性和恶性三类。间质核分裂活性是 PT 分级的关键标准，但核分裂评估的方法学尚未得到清晰阐述。
材料与方法：我们讨论了确定 PT 间质核分裂活性的方法，评述应采用核分裂最活跃区域（热点）还是多个肿瘤区域的平均计数，并概述了核分裂热点评估的操作规程，其中考虑到不同型号显微镜视野直径的差异。
结果：建议采用标准化方法确定 PT 的间质核分裂，以提高 PT 分级的观察者间可重复性和准确性。文中还讨论了数字工具在间质核分裂计数中的应用。
结论：我们主张采用热点法获取最高间质核分裂计数，并结合其他组织学参数对 PT 进行分类。
- Stromal mitotic activity is a key grading criterion for benign / borderline / malignant phyllodes tumours, yet the counting method (hotspot vs. averaged regions) has not been clearly articulated.
- An international expert group (Tan PH, Rakha, Ellis, Schnitt, Lakhani et al.) advocates the hotspot method — the highest stromal mitotic count — combined with other histological parameters.
- An operational protocol accounting for microscope field diameter is outlined, and digital tools for mitotic counting are discussed, to improve interobserver reproducibility.
Scope: PubMed abstract only. The article is subscription-only (Wiley TDM licence, not OA) and the publisher full-text page returned a Cloudflare challenge to this site, so full text, figures and tables were not collected.
Abstract
BACKGROUND: Breast phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms, classified into benign, borderline and malignant categories. Stromal mitotic activity is a key criterion in grading PT, but the methodology for mitotic assessment has not been clearly articulated.
MATERIALS AND METHODS: We discuss the approach to determining stromal mitotic activity in PTs. Whether the most mitotically active area (hotspot) or an average count across several tumour regions should be adopted is reviewed. We also outline the operational protocol for mitotic hotspot evaluation, accounting for different microscope models with varying field diameters.
RESULTS: A standardized method of determining stromal mitoses in PTs is recommended in order to improve interobserver reproducibility and accuracy in grading PTs. The application of digital tools in stromal mitotic counting is also addressed.
CONCLUSION: We advocate using the hotspot method of obtaining the highest stromal mitotic count, together with other histological parameters, to classify PTs.