临床病理交流 .ppt

急需加强,Patients-Diseases,Surgeons,Pathologists,现状,Presentsituation,ACOMMUNICATIONGAPEXISTBETWEENPATHOLOGISTSANDSURGEONSPowsnerSMetal.ArchPatholLabMed2000;124:1040,病理医师和外科医师的交流存在差距,CliniciansMarsandPathologistsVenusClinicianInterpretationofPathologyReportsPowsnerSMetalArchPatholLabMed2000;124:1040-1046,临床医师来自火星病理医师来自金星,THEARTOFCOMMUNICATIONBETWEENPATHOLOGISTSANDTHEIRCLINICALCOLLEAGUES,病理医师和临床医师交流方法艺术,ClinicianInterpretationofPathologyReportsConfusionorComprehensionRubySG.ArchPatholLabMed2000;124:943-944,临床医师解释病理报告混淆or理解,鱼水之情,TEAM,不大了解病理,避免误会,外科医师应用病理学,Manyofourclinicalcolleaguesoftenneedtobereminedofthisfact;evensimpleinformationconcerningage,sexorlocationmaybemissingontherequestform,请求单上甚至漏写有关性别，年龄和部位等简单的信息,认真填写病理检查申请单,Todiagnoseatumorintheabsenceofclearandcompleteclinicaldataisfoolhardy,dangerousandsometimesimpossible,缺乏清楚而完整的临床资料诊断肿瘤莽撞，危险，有时不可能,“Icanseeonlywhatisinthetissuesyougaveme”,我只能看到你给我的组织如果没有临床资料,事实并非如此,不大了解临床,Innoareaofsurgicalpathologydoesthepathologistplayamoreimportantandcrucialrolethaninthediagnosisoftumors,病理学家肿瘤诊断决定性的作用,病理医师如是说,Thepatientorlaypersonoftenisentirelyignoraqntofthisroleandfondlyimaginesthattheirsurgeon,otherclinicianoroncologististhetruediagnostician,病人并不了解这种作用天真地认为.,LimitationsofHistologicDiagnosis,组织学诊断局限性,金标准,差距太大,培训,Trainpersonnel,全科病理医师GENERAL专科病理医师SPECIAL,UNIVERSITYHOSPITAL,分科齐全的大学医院,？,全科病理医师很难满足临床（正当）需要,Clearly,surgicalpathologyevolvedinresponsetotheneedsofsurgeons.,很明显，外科病理学是应外科医师的需求而发展起来的,专科病理医师,只有少数病例留给,未分化的病理医师,病理学会诊,Pathologicconsultation,Thedifficultdiagnosisinsurgicalpathology病理诊断困难,Somequestionsremainunansweredafterextensivetextbookreview,eitherbecausethelesioninquestionisnotcoveredinthetextorbecauseitspresentationisatypical.,教科书中找不到,病变表现不典型,会诊双方病人,THEDIFFICULTDIAGNSISINSURGICALPATHOLOGY病理诊断困难,Wealloccasionallyencountersurgicalpathologycasesthatposesignificantdiagnosticdifficulty.TheseareresolvedeitherbyCONSULTINGatextbookoronescolleaguesorsendingthecaseoutinconsultation.,请人会诊,学会尊重他人意见,会诊意见有时差别很大,教科书会诊,Theappearanceisconsistentwith,butcannotberuledoutbecauseofthematerialinsufficientforevaluation,病变符合.不能除外.,不能不用，不能多用,冰冻切片,Frozensections,Thefrequencyoffalsepositivediagnosisisinverselyrelatedtothatofdeferreddiagnosis,sotheattempttoFORCEadiagnosisinadifficultsituationislikelytoleadtothefearedresultofafalsepositiveinterpretation,强行作出(冰冻)诊断可能导致可怕的假阳性结果,避免假阳性结果,Mostfalsenegativeinterpretationsareprobablyduetosamplingerrorandarethusunavoidable,多数假阴性结果取材不当所致不可避免,85%90%95%,话是这么说,提高冰冻切片诊断水平,Whenoneortwosectionsaretakenfroma10cmspecimen,wewillinvariablyencountersituationsinwhichthedefinitivediagnosisisnotmadeuntilmanymoresectionsareexaminedthefollowingday,一个10cm的标本一或两张5冰冻切片检查多数(石蜡)切片之后才能作出最后诊断,ThedefinitivediagnosiswillhavetowaitforthepermanentH&Esections,最后诊断必须等待石蜡切片,常识,冰冻切片不宜作出特异诊断,尽量弄清良性抑或恶性,Adenoma?Carcinoma?Goiter?,软组织肿瘤冰冻切片诊断,About50%,收益,ThereAreNoGuaranteesinThisLife(withtheexceptionsofdeathandtaxes),世间没有绝对保证死亡和纳税例外BENIGN,Theneedfortimely,accurateanddetailedreportshasneverbeengreater,especiallyinourincreasinglysubspecializedandlitigioussociety,要求及时，准确而详尽的