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PubMed2005

[A revised scheme for LeFort classification of upper jaw fractures].

OBJECTIVE: To put forward a revised scheme on LeFort classification for the upper jaw fractures. METHODS: 193 consecutive cases with the primary diagnoses of upper jaw fractures were involved in this study, for each one of which water's and CT scan were available to decide the fracture site and pattern. Data were filed in term of classification items as LeFort I, II and III fracture, as well as sagittal fracture and alveolar fracture. Statistical analysis was done to validate the meliorating thought on and revised scheme on LeFort classification. RESULTS: It was validated that of 185 cases with upper jaw fractures only 30.81% which presented single-line fracture and 34.06% which presented multiple-line fracture were covered with LeFort classification. Additional 13.51% with single-line fracture and 21.61% with multiple-line fracture could be included when LeFort classification was extended with increase of items of sagittal fracture and alveolar fracture. Further results revealed that among total 344 sites or fracture lines included in 193 cases, 81.10% could be diagnosed fracture pattern of LeFort classification. Of 65 fracture sites presenting LeFort III type, 92.31% were concomitant with LeFort II type or LeFort I and II type, very few being alone. CONCLUSIONS: A revised classification was proposeded that upper jaw fractures could be classified into four types as follows: (1) high horizontal fracture (corresponding to LeFort II and III type), (2) low horizontal fracture (corresponding to LeFort I type), (3) sagittal fracture (including midline and para-midline fracture) and (4) alveolar fracture.

Adolescent↗

PubMed2005

Development of an expert system for classification of medical errors.

The 1999 report published by the Institute of Medicine (IOM) indicated that between 44,000 and 98,000 unnecessary deaths per year occurred in hospitals alone, as a result of errors committed by medical professionals in the United States. There has been considerable speculation that these figures are either overestimated or underestimated. For example, the possibility that they focus on isolated injuries rather than error, or the majority of surveyed respondents did not know what constitutes a (medical) error. These disagreements have led experts to challenge the estimates of patient harm attributable to error, as well as the methodologies used to enumerate them. Of particular concern is the process used in the identification, classification and prevention of medical errors. There have been numerous attempts to develop classifications of medical errors, and currently an abundance of taxonomies exist to describe their mechanism.In previous research, (Kopec, Kabir, Reinharth, Rothschild & Castiglione, 2003) a new taxonomy of Medical Errors was designed by expanding the IOM classification. This model and its extension can be used as a blueprint for future design, development and implementation of an expert system for classification of medical errors. Effective classification can facilitate pattern recognition, and pattern recognition will help in understanding the nature, background and abatement of medical errors. Such a system's goal will be to perform convincingly as an advisory consultant, exhibiting expertise on a par with and beyond human experts in specified domains. Despite substantial disagreement on the validity of the published figures for fatalities in hospitals in the IOM report, what is of importance is that the number of deaths caused by such errors is nonetheless alarming. The identification and classification of errors in medical care delivery is a very complex process, and this process can be facilitated and simplified by the implementation of an effective classification system.

Delivery of Health Care↗

PubMed2005

A proposal for a five-dimensional patient-oriented epilepsy classification.

The recent proposal by the ILAE Task Force for Epilepsy Classification consists of a multi-axial syndrome-oriented approach. Epilepsy syndromes, as defined by the ILAE, group patients according to various, poorly defined parameters. The resulting syndromes have frequently no biological significance, with overlap among different syndromes and syndromes changing with age. Additionally, only a minority of patients can be classified syndromatically, and the axes of this classification system convey redundant information. We propose a five-dimensional, patient-oriented approach to classifying epilepsies. This approach shifts from the syndrome-oriented approach to a standard, neurological, methodological, patient-oriented approach, using independent criteria in each of the five dimensions. Similar to general neurology, the first step in each patient-physician encounter in epileptology is to take a history of the presenting symptoms and generate a hypothesis regarding the localization and etiology of the symptom within the nervous system. Therefore, the main dimensions of this classification consist of: 1) localization of the epileptogenic zone, 2) seizure semiology classified according to the semiological seizure classification, 3) etiology, 4) seizure frequency, and 5) related medical conditions. These dimensions characterize all of the information necessary for patient management, are independent parameters, and include more pertinent information with regards to patient management than the ILAE axes. All patients can be classified according to this five-dimensional system even at the initial patient encounter when no detailed test results are available. Information from clinical tests, such as MRI and EEG, are translated into the best possible working hypothesis at the time of classification, allowing for increasing precision of the classification as additional information becomes available. This patient-oriented classification envisions an epileptic seizure as an independent symptom of a central nervous system dysfunction due to different causes, with various cortical localizations, occurring at various frequencies, and in conjunction with other diseases and clinical symptoms.

Adult↗

PubMed2006

Interobserver variability in cytologic subclassification of squamous intraepithelial lesions--the Bethesda System vs. World Health Organization classification.

The aim of the study was to compare interobserver variability for The Bethesda System (TBS) and World Health Organization (WHO) classification of cervical squamous intraepithelial lesions. A total of 1,000 conventional Papanicolaou smears (156 positive and 884 negative) were examined "blindly" by three cytologists and one cytotechnician. The degree of observer agreement was expressed by kappa statistics using a program for the calculation of interobserver variation and association "Agree" (Svanholm and Jergensen, 1989). Kappa (kappa) was determined for each cytologic diagnosis within a particular classification and total for either classification. The association with and separation from other diagnoses was determined for each cytologic diagnosis in the form of conditional probability (P(j)). In WHO classification, the diagnoses of dysplasia media and dysplasia gravis showed poor reproducibility (kappa = 0.114 and kappa = 0.259, respectively), the diagnosis of dysplasia levis good reproducibility (kappa = 0.639), and the diagnosis of carcinoma in situ excellent reproducibility (kappa = 0.762). WHO classification yielded pool kappa of 0.741. In TBS classification, the diagnosis of LSIL showed good, and HSIL excellent reproducibility (kappa = 0.542 and kappa = 0.763, respectively). TBS classification yielded pool kappa of 0.699. Dysplasia media (P(j) = 0.121) and dysplasia gravis (P(j) = 0.274) were found to be morphologically poorly defined, and carcinoma in situ (P(j) = 0.777) and dysplasia levis (P(j) = 0.651) well defined diagnoses. LSIL was morphologically moderately defined (P(j) = 0.587) and HSIL well defined (P(j) = 0.789) diagnosis. Accordingly, TBS does not substantially improve diagnostic reproducibility of the cytologic diagnoses of squamous intraepithelial lesions, while providing considerably less information to the clinician than the four-grade dysplasia/CIS terminology, thus eliminating the opportunity of choosing a different procedure for the diagnosis of dysplasia media, which is of utmost importance in the population of young nulliparae.

Carcinoma in Situ↗

PubMed2003

[Classification and differential diagnosis of NK/T-cell lymphomas].

The first classifications deviding B- and T-cell lymphomas were given with the Kiel classification and in the classification of Lukes and Collins. Those entities first described like T-zone lymphomas or T-CLL are the rarest types of the known entities today. The updated Kiel classification contained a large number of especially nodal peripheral T-cell lymphomas and seperated lymphoblastic ones from those which derive from peripheral T-cells. The increasing knowledge on T-cell differentiation allowed a more detailed description of entities according either to their primary organ manifestation (subcutaneous panniculitis-like T-cell lymphoma), their immunophenotype (NK/T-cell lymphomas with expression of CD56) or their rearrangement of the T-cell receptor (predominantly gamma/sigma-rearrangement in hepatosplenic T-cell lymphoma). The today's nodal and extranodal NK/T-cell lymphoma entities are summarized by the WHO classification. They can be seperated in primary leukemic ones, primary nodal ones, primary extranodal and primary cutaneous ones. In extranodal sites some lymphoma entities show a characteristic picture which is unique for this localisation. It has become clear that morphology alone is not able to lead to a reproducable classification of T-cell lymphomas. Today immunhistochemistry together with the distinct primary organ localisation are the major tools for classifying peripheral NK/T-cell lymphomas. In this paper distinct examples which are interesting in the differential diagnosis or which are distinct clinico-pathological entities are described. Moreover, an indication is given on some new rare entities which have not yet been listed in the WHO classification.

Antigens, CD↗

PubMed2006

[Classification-based surgical approach in surgical management of thoracolumbar fractures of the spine].

INTRODUCTION: The decision on the surgical approach in the operative treatment of the fractures of thoracolumbar spine is possible only by following a detailed classification. However, the application of the classification systems is not reliable without a complex imagination of the bony and fibrous structures involved into the fracture. Pre-op investigation should include x-rays, CT-scans and MRI. MATERIAL AND METHODS: Patient series consists of 21 females and 43 males treated surgically for the unstable thoracolumbar fracture during 2001. The average age was 43 years. Patients suffering form osteoporosis, fresh spinal cord injury and multiple spine fractures were excluded. All fractures were examined by plain x-rays, CT-scans and MRI and classified according the AO-ASIF classification system. In patients with A-type fractures the single anterior approach was used. Patients with B- or C-type of fracture were operated by the posterior approach. These fractures were complementary classified according to the Load-sharing classification and those with 6 or more points were additionally operated also from the front. Patients were divided into the three groups: the anterior approach (22 pts), the combined procedure (22 pts) and the posterior approach (20 pts). In the third group, the hardware was removed after 15 months on average. No posterolateral fusion was carried out. Minimum follow-up was 22 months. RESULTS: No implant failure was found in any patient. No significant loss of correction was found in the first and the second group. The loss of correction in the third group was 3.1 degree on average. CONCLUSION: Overall graphical imagination of the thoracolumbar fractures (including MRI) is essential for their classification. The classification helps to choose the optimum surgical approach. The approach related to the fracture classification prevents the treatment failure.

Adult↗

PubMed2006

Classification of pediatric lumbosacral spondylolisthesis.

A surgical classification of pediatric lumbosacral spondylolisthesis has been proposed recently. In this classification involving 8 distinct types of spondylolisthesis, the patient is classified according to: 1) the slip grade (low- vs. high-grade), 2) the degree of dysplasia (low- vs. high-dysplastic), and 3) the sagittal spinopelvic balance. The objective of this preliminary study is to assess the reliability of the classification. Two observers classified on two separate occasions 40 subjects with lumbosacral spondylolisthesis, based on standing postero-anterior and lateral radiographs of the spine and pelvis. No direct measurements on the radiographs were performed. All 8 types of spondylolisthesis were identified by the observers. Intra-observer agreement for the first and second observers was respectively 92.5% and 87.5%, while inter-observer agreement was 75.0%. Thirty-nine of 40 subjects had agreement among both observers according to the slip grade. Within these 39 subjects, observers disagreed for 8 subjects with respect to the degree of dysplasia and for only one subject with respect to the spinopelvic balance. The proposed classification could be used to better evaluate and compare available surgical techniques, and to develop a treatment algorithm for spondylolisthesis. This new classification results in good intra- and inter-observer agreement. Further studies with observers not involved in the design of the classification are however needed in order to confirm the relevance of the classification.

Humans↗

PubMed1991

[Diagnosis and classification of tricuspid valve insufficiency with dynamic magnetic resonance tomography: comparison with right ventricular angiography].

To evaluate the diagnostic potential of magnetic resonance imaging (MRI) to diagnose and evaluate tricuspid incompetence (TI), right ventricular angiography (RVA) and MRI were compared in 51 patients. For angiographic semi-quantification a 4-grade modified Sellers classification was used. Several MRI-parameters (jet volume, jet area, number of slices with visible jet, duration of the regurgitation and volume of the right atrium) were examined concerning their validity to evaluate TI and compared to the angiographic data. Limits for MRI jet areas and volumes for each angiographic group were defined to obtain the best agreement with angiographic results. Thirty of 34 patients with angiographically visible TI (sensitivity = 88%) were diagnosed correctly with MRI. The 4 remaining patients also showed a small regurgitant jet which was, however, interpreted as physiologic. One of the 17 patients without angiographic TI was diagnosed as mild TI by MRI (specificity = 94%). MRI classification using jet volume (46/51 = 90% correct classifications) was not significantly better than the easier and faster MRI classification using jet area (43/51 = 84%). The other parameters (number of slices, duration of regurgitation and volume of the right atrium) showed considerable overlap between angiographic groups and did therefore not allow a classification into 4 grades. However, simple classification into hemodynamic relevant and irrelevant TI was possible. Thus MRI is able to diagnose TI with good sensitivity and specificity. Classifications based on jet volume and jet area showed good agreement with angiographic results. However, both parameters depend on the magnet and the pulse sequence used and must therefore be specifically determined for each imaging routine.

Adult↗

PubMedDate not supplied

[Anatomo-pathological classification of gastric tumors].

Pathological classification of gastric tumours. The authors propose a pathological classification of gastric tumours based on topography of lesions. The tumours are related to their origin and localization in the gastric wall: mucosal, extramucosal and metastatic. Among the mucosal tumours, the most frequent are benign polyps, mostly of the hyperplastic type. The classification of mucosal malignant tumours (adenocarcinomas) is dual: macroscopic and microscopic. From the macroscopic point of view, the authors recommend Borrman's classification for invasive cancer and Murakami's classification for early cancer. At the microscopic level, they suggest Lauren's classification in intestinal and diffuse forms or Ming's classification in expanding and infiltrating types. The decreasing incidence of gastric adenocarcinomas in Western countries has artificially increased the relative frequency of gastric lymphomas. The differential diagnosis with reactive lymphoïd hyperplasias may sometimes be troublesome for the pathologist. Among extramucosal tumours, the most frequent are stromal tumours, formerly called leiomyomas and leiomyosarcomas; most are benign. The criteria of malignity are: tumour size, focal necrosis, hypercellularity and mitotic index. The metastatic tumours are mostly melanomas and mammary carcinomas.

Gastric Mucosa↗

PubMed1988

Empirical classification of infant-mother relationships from interactive behavior and crying during reunion.

Multiple discriminant function analysis (MDFA) was conducted with data from 255 Strange Situations conducted and scored by Ainsworth and her colleagues. Cross-validated discriminant functions and classification weights were obtained, allowing attachment classifications (A, B, C) to be assigned directly from scores on interactive behavior and crying during reunion episodes. In the past, classification agreement within laboratories has often been used as a training criterion. Unfortunately, this does not insure that classification criteria agreed upon within a laboratory are comparable across laboratories, nor does it insure that agreed upon criteria will yield the same classifications that would have been assigned by the researchers who developed the scoring system. The present results enable researchers who have mastered the scoring systems for reunion behavior and crying to obtain attachment classifications directly from scores on these variables. Alternatively, this procedure may be used to guide the training of, and validate classification decisions by, local judges.

Crying↗

PubMed1986

Classification of nerves is modified by the delayed recognition of Mycobacterium leprae.

Biopsies of 42 concurrent nerve and skin lesions across the spectrum of leprosy were classified and compared histologically and bacteriologically. Observations were made as follows: a) The bacterial load was higher in nerve than in skin lesions of the same histological classification, and it was higher in nerve than in concurrent skin lesions irrespective of classification, although not at the lepromatous pole. b) There was some discrepancy between the histological classification of nerve and skin lesions in half the cases. Skin classification appeared to represent the general tissue response and, insofar as discrepancies existed, the skin classification was thought to give the better evaluation. Nerve classification was subject to minor variations of a random nature which were thought to be the outcome of local reactions due to the build up of antigen as a result of delayed recognition in an immunologically protected situation. Upgrading or downgrading ensued locally, depending on the level of antigen at the time of its detection. In such cases, the corresponding skin classification was usually BT, which occupied a critical point in the spectrum. A certain autonomy of the response between lesions of skin and nerve suggests an explanation for downgrading reactions. Although Mycobacterium leprae, alone among mycobacteria, has some sort of affinity for Schwann cells, it is the role of the nerves as protected sites which is fundamental to the course of the disease.

Biopsy↗

PubMed1985

[Difference in clinical treatment between patients histologically diagnosed as group III by the old and new "group classifications" of gastric biopsy].

Since 1971, when the first draft of the "Group Classification", which classifies the atypism of histological structure in biopsy specimens of the stomach, was proposed by the Japanese Research Society For Gastric Cancer, this classification has come into wide use in Japan. It was, however, revised in 1983, and, according to the revised classification, group III was defined as general histological findings in which it is difficult to make a differentiation between benign and malignant by biopsy specimens. Consequently, the new group III includes, various borderline histologies, in addition to the old group III, which had been defined as the histological features corresponding to those observed in gastric adenoma in biopsy specimens. At the National Cancer Center Hospital, 13,909 gastric biopsies were performed during the period between 1973 and 1982. By retrospective review of these, histological findings in 247 lesions of 231 cases corresponded to group III by the old classification (adenomatous type) and in addition to these, 54 lesions of 54 cases to group III by the new classification (non-adenomatous type). We compared the endoscopic and pathological features between the two types, and the following results were obtained: The false-negative rate of malignancy in the non- adenomatous type (24%) was much higher than that in the adenomatous type (6%). The difference between the two may suggest that, with the adoption of the new group classification, clinical treatment of the patients with group III becomes more complicated due to the increase of the false-negative rate. Endoscopically, most (84%) of the lesions in the adenomatous type were seen as polypoid, while in the non-adenomatous type, depressed lesions were dominant (80%). And, endoscopic details of the polypoid or depressed appearances were mostly different between the two types. These nuances of endoscopic appearance between adenomatous and non-adenomatous types are applicable to decisions regarding, adequate clinical treatment for patients diagnosed as group III by the new "group classification." Good communication between the endoscopist and pathologist is indispensable.

Adenoma↗

PubMed1993

A new prognostic classification for esophageal atresia.

BACKGROUND: Waterston's risk categories have been extensively used in the past for the classification and management of neonates with esophageal atresia. Advances in neonatal care have affected the prognostic usefulness of the Waterston classification. The purpose of this study is to formulate a new classification of risk factors that would more accurately predict outcome. METHODS: We retrospectively reviewed 95 consecutive cases of esophageal atresia and/or tracheoesophageal fistula treated at the Montreal Children's Hospital. Fifteen patients were in the Waterston class A, with a 6.7% mortality; 35 patients, in class B with a 5.7% mortality; and 45 patients, in class C with a 26.7% mortality. Logistic regression analysis of the influence of each risk factor (weight, pulmonary status, and severity of associated anomalies) on mortality was performed. RESULTS: Birth weight was not found to independently influence mortality. Only severe pulmonary dysfunction with preoperative ventilator dependence and severe associated anomalies had a prognostic influence. We therefore revised the classification to include only significant factors. The new high-risk class II consists of patients with either life-threatening anomalies or both major anomalies and ventilator dependence; the low-risk class I includes all other patients. These criteria radically changed the stratification of both the number of cases and the mortality among classes: the 82 patients in class I had a 7.3% mortality; the 13 patients in class II had a 69.2% mortality. Logistic regression analysis confirmed the validity of this new classification by showing displacement of individual variables by the revised classification but not by Waterston's. CONCLUSIONS: This new "Montreal classification" can simplify and improve the stratification of patients with esophageal atresia. It also reflects the more favorable outcome of low birth weight neonates.

Abnormalities, Multiple↗

PubMed1996

Demarcation of potentially mineral-deficient areas in central and northern Namibia by means of natural classification systems.

Mineral deficiencies that lead to production losses often occur concurrently with climatic and management changes. To diagnose these deficiencies in time to prevent production losses, long-term monitoring of mineral status is advisable. Different classification systems were examined to determine whether areas of possible mineral deficiencies could be identified, so that those which were promising could then be selected for further monitoring purposes. The classification systems addressed differences in soil, vegetation and geology, and were used to define the cattle-ranching areas in the central and northern districts of Namibia. Copper (Cu), Iron (Fe), zinc (Zn), manganese (Mn) and cobalt (Co) concentrations were determined in cattle livers collected at abattoirs. Pooled faecal grab samples and milk samples were collected by farmers, and used to determine phosphorus (P) and calcium (Ca), and iodine (I) status, respectively. Areas of low P concentrations could be identified by all classification systems. The lowest P concentrations were recorded in samples from the Kalahari-sand area, whereas faecal samples collected from cattle on farms in the more arid areas, where the harder soils are mostly found, rarely showed low P concentrations. In the north of the country, low iodine levels were found in milk samples collected from cows grazing on farms in the northern Kalahari broad-leaved woodland. Areas supporting animals with marginal Cu status, could be effectively identified by the detailed soil-classification system of irrigation potential. Copper concentrations were lowest in areas of arid soils, but no indication of Co, Fe, Zn, or Mn deficiencies were found. For most minerals, the geological classification was the best single indicator of areas of lower concentrations. Significant monthly variation for all minerals could also be detected within the classification system. It is concluded that specific classification systems can be useful as indicators of areas with lower mineral concentrations or possible deficiencies.

Analysis of Variance↗

PubMed1996

Computer-aided classification of breast cancer nuclei.

Breast cancer is the most common malignancy affecting the female population in industrialized countries. Prognostic factors, such as steroid receptors visualized in biopsy slides, provide critical information to oncologists regarding the hormonal status of the individual tumors. These factors influence the choice of treatment and help in predicting patient survival and probability of recurrence. The objective of this paper is to introduce a new computer-aided system for the classification of breast cancer nuclei based on neural networks. Currently, medical experts assess steroid receptors in breast cancer biopsy slides mostly manually using four- or five-level grading schemes. These schemes are based on the assessment of two parameters: number of nuclei positive and their staining intensity. Available computerized systems define their own grading schemes based on automated measurements of low-level features, such as optical density, texture, area, and others. However, the findings produced by these systems may not be readily comprehensible by the majority of medical experts who have been accustomed to manual assessment schemes. Moreover, findings from one system cannot be directly compared to findings obtained from other computerized systems. To date, no standardized assessment scheme exists for computerized systems, while interobserver and intraobserver variabilities limit the utility of the routinely used manual assessment schemes. In this paper a new system for computer-aided biopsy analysis is introduced. Here, we focus on the system's nuclear classification module. The input to this module consists of a set of six local and global features: optical density, two chromaticity indices, a variance based texture measure, global nuclei density mean, and variance. The output of the nuclei classification module consists of a membership label in a zero to four grading scheme for each detected nucleus. The classification module is based on a feedforward neural network trained in a supervised fashion to classify the nuclear feature vectors. The sample data comprises 3015 nuclei from 28 images that were classified by a human expert. A Sammon plot visualization of the six dimensional input feature space shows that the classification problem is quite difficult. The neural network used in the classification module achieved 72% accuracy. Our result indicate that by using a nuclear classification module such as the one introduced in this paper it is possible to translate low-level system measurements into a vocabulary that is familiar to medical experts. Thus, a contribution is made to the standardization of grading schemes in addition to improving the accuracy in grading breast cancer nuclei.

Biopsy↗

PubMed1996

Prognostic validity of different classifications in assessment of war inflicted nerve injury.

In this study, the relation of postoperative peripheral nerve recovery following war inflicted nerve injuries and the injury classification according to the projectile energy, Abbreviated Injuries Scale, 1985 revision, as well as the fracture and metallic bodies criteria (Red Cross Wound Classification), was investigated. During the war against Croatia, the authors followed-up 137 wounded people, suffering a total of 147 various war nerve injuries that were surgically treated. The prospective classification of all wounded based on the projectile energy data and retrospective classification based on the Abbreviated Injury Scale and Red Cross Wound Classification were performed. The recovery was independently evaluated by a neurologist according to the British Medical Research Council for arm and Millesi scale for leg nerve injuries. A statistically significant relation was obtained between the peripheral nerve function recovery, Abbreviated Injury Scale and fracture criteria from the Red Cross Wound Classification. There was no significant influence on the projectile energy and presence of metallic body criteria on the nerve function recovery. The Abbreviated Injury Scale was concluded to be the most valid prognostic classification in the assessment of war inflicted peripheral nerve injuries. The fracture criteria were also found to be an additional valuable source of information.

Abbreviated Injury Scale↗

PubMed1997

Current classification of fractures. Rationale and utility.

Fracture classification systems are used on a daily basis in any busy orthopedic clinic. They are an essential means by which physicians communicate, make treatment decisions, estimate prognosis, and report and compare results. Until recently, these classifications have been designed, accepted, and utilized without formal critique. By studying and understanding the shortcomings of previous systems, we can use this knowledge to construct better ones. Ideally, a fracture classification, like any classification, should be reliable, reproducible, all inclusive, mutually exclusive, logical, and clinically useful. The AO/ASIF classification of long bone fractures provides a unified scheme of classification for fractures of the entire skeleton. Despite addressing many of the faults of previous classifications, the observer agreement for this system drops to unacceptable levels at the group and subgroup levels. Further study is warranted to determine how this agreement can be improved.

Communication↗

PubMed1997

[Current lymphoma classification: a step forward for pathologists and clinicians].

Non-Hodgkin lymphomas encompass a heterogeneous group of lymphoid malignancies from the clinical as well as from the pathological point of view. Consequently, one condition of optimal communication among pathologists, clinicians and scientific researchers is an adequate classification system. A new classification of lymphomas was proposed in September 1994, the Revised European-American Lymphoma Classification (REAL classification). The REAL classification is aiming at integration of pathological and clinical data, making it possible to distinguish clinical-pathological entities each of which has its characteristic pathological spectrum, clinical evolution and clinical presentation. The REAL classification is based not only on morphological and immunohistochemical but also on molecular and cytogenetic data. Such a system may make it possible to develop specific therapies for specific pathological entities. The REAL classification constitutes an important step forward in haemato-oncology.

Hodgkin Disease↗