《臨床病理交流》課件

急需加強(qiáng)Patients-DiseasesSurgeons

Pathologists現(xiàn)狀PresentsituationACOMMUNICATIONGAPEXISTBETWEENPATHOLOGISTSANDSURGEONS

PowsnerSMetal.ArchPatholLabMed2000;124:1040病理醫(yī)師和外科醫(yī)師的交流存在差距Clinicians

Mars

and

Pathologists

Venus

ClinicianInterpretationofPathologyReports

PowsnerSMetalArchPatholLabMed2000;124:1040-1046THEARTOFCOMMUNICATION

BETWEENPATHOLOGISTSANDTHEIRCLINICALCOLLEAGUESClinicianInterpretationofPathologyReports

ConfusionorComprehension

RubySG.ArchPatholLabMed2000;124:943-944臨床醫(yī)師解釋病理報(bào)告混淆

or

理解魚水之情TEAM不大了解病理避免誤會外科醫(yī)師應(yīng)用病理學(xué)Manyofourclinicalcolleaguesoftenneedtobereminedofthisfact;evensimpleinformation

concerningage,sexorlocationmaybemissingontherequestform…請求單上甚至漏寫有關(guān)性別，年齡和部位等簡單的信息認(rèn)真填寫病理檢查申請單Todiagnoseatumorintheabsenceofclearandcompleteclinicaldataisfoolhardy,dangerousandsometimesimpossible缺乏清楚而完整的臨床資料診斷腫瘤莽撞，危險(xiǎn)，有時(shí)不可能“Icanseeonlywhatisinthetissuesyougaveme”我只能看到你給我的組織如果沒有臨床資料事實(shí)并非如此不大了解臨床Innoareaofsurgicalpathologydoesthepathologistplayamoreimportantandcrucialrolethaninthediagnosisoftumors

病理學(xué)家腫瘤診斷決定性的作用病理醫(yī)師如是說Thepatientorlaypersonoftenisentirelyignoraqntofthisroleandfondlyimagines

thattheirsurgeon,otherclinicianoroncologististhetruediagnostician病人并不了解這種作用天真地認(rèn)為...LimitationsofHistologicDiagnosis組織學(xué)診斷局限性金標(biāo)準(zhǔn)差距太大培訓(xùn)Trainpersonnel全科病理醫(yī)師GENERAL

?？撇±磲t(yī)師SPECIAL

UNIVERSITYHOSPITAL分科齊全的大學(xué)醫(yī)院？全科病理醫(yī)師很難滿足臨床（正當(dāng)）需要Clearly,surgicalpathologyevolvedinresponsetotheneedsofsurgeons.很明顯，外科病理學(xué)是應(yīng)外科醫(yī)師的需求而發(fā)展起來的專科病理醫(yī)師只有少數(shù)病例留給…‘未分化的病理醫(yī)師’病理學(xué)會診PathologicconsultationThedifficultdiagnosisinsurgicalpathology

病理診斷困難Somequestionsremainunansweredafterextensivetextbookreview,eitherbecause

thelesioninquestionisnotcoveredinthetext

orbecause

itspresentationisatypical.

教科書中找不到病變表現(xiàn)不典型會診雙方病人THEDIFFICULTDIAGNSISINSURGICALPATHOLOGY

病理診斷困難Wealloccasionallyencountersurgicalpathologycasesthatposesignificantdiagnosticdifficulty.

TheseareresolvedeitherbyCONSULTINGatextbookorone’scolleaguesorsendingthecaseoutinconsultation.

請人會診學(xué)會尊重他人意見會診意見有時(shí)差別很大教科書會診Theappearanceisconsistentwith…,but…cannotberuledoutbecauseofthematerialinsufficientforevaluation病變符合...不能除外...不能不用，不能多用冰凍切片F(xiàn)rozensectionsThefrequencyoffalsepositivediagnosisisinverselyrelatedtothatofdeferreddiagnosis,sotheattempttoFORCEadiagnosisinadifficultsituationislikelytoleadtothefearedresultofafalsepositiveinterpretation

強(qiáng)行作出(冰凍)診斷可能導(dǎo)致可怕的假陽性結(jié)果避免假陽性結(jié)果Mostfalsenegativeinterpretationsareprobablyduetosamplingerrorandarethusunavoidable

多數(shù)假陰性結(jié)果取材不當(dāng)所致不可避免85%90%95%…話是這么說提高冰凍切片診斷水平Whenoneortwosectionsaretakenfroma10cmspecimen,wewillinvariablyencountersituationsinwhichthedefinitivediagnosisisnotmadeuntilmanymoresectionsareexaminedthefollowingday

一個(gè)10cm的標(biāo)本

一或兩張5μ冰凍切片檢查多數(shù)(石蠟)切片之后才能作出最后診斷ThedefinitivediagnosiswillhavetowaitforthepermanentH&Esections最后診斷必須等待石蠟切片常識冰凍切片不宜作出特異診斷盡量弄清良性抑或惡性Adenoma?Carcinoma?Goiter?…軟組織腫瘤冰凍切片診斷About50%收益ThereAreNoGuaranteesinThisLife

(withtheexceptionsofdeathandtaxes)世間沒有絕對保證死亡和納稅例外‘BENIGN’Theneedfortimely,accurateanddetailedreportshasneverbeengreater,especia