临床病理交流

急需加强,Patients-Diseases,Surgeons,Pathologists,现 状,Present situation,A COMMUNICATION GAP EXIST BETWEEN PATHOLOGISTS AND SURGEONS Powsner SM et al. Arch Pathol Lab Med 2000; 124:1040,病理医师和外科医师的交流存 在 差 距,Clinicians Mars and Pathologists VenusClinician Interpretation of Pathology ReportsPowsner SM et al Arch Pathol Lab Med 2000; 124:1040-1046,临床医师来自火星病理医师来自金星,THE ART OF COMMUNICATION BETWEEN PATHOLOGISTS AND THEIR CLINICAL COLLEAGUES,病理医师和临床医师交流方法艺术,Clinician Interpretation of Pathology ReportsConfusion or ComprehensionRuby SG. Arch Pathol Lab Med 2000; 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,Many of our clinical colleagues often need to be remined of this fact; even simple information concerning age, sex or location may be missing on the request form,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,To diagnose a tumor in the absence of clear and complete clinical data is foolhardy, dangerous and sometimes impossible,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,“I can see only what is in the tissues you gave me”,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,In no area of surgical pathology does the pathologist play a more important and crucial role than in the diagnosis of tumors,病 理 学 家肿 瘤 诊 断决定性的作用,病理医师如是说,The patient or lay person often is entirely ignoraqnt of this role and fondly imagines that their surgeon, other clinician or oncologist is the true diagnostician,病人并不了解这种作用天真地认为.,Limitations of Histologic Diagnosis,组织学诊断局限性,金标准,差距太大,培 训,Train personnel,全科病理医师GENERAL专科病理医师SPECIAL,UNIVERSITY HOSPITAL,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, surgical pathology evolved in response to the needs of surgeons.,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,Pathologic consultation,The difficult diagnosis in surgical pathology病理诊断困难,Some questions remain unanswered after extensive textbook review, either because the lesion in question is not covered in the text or because its presentation is atypical.,教科书中找不到,病变表现不典型,会诊双方病 人,THE DIFFICULT DIAGNSIS IN SURGICAL PATHOLOGY病理诊断困难,We all occasionally encounter surgical pathology cases that pose significant diagnostic difficulty. These are resolved either by CONSULTING a textbook or ones colleagues or sending the case out in consultation.,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,The appearance is consistent with , but cannot be ruled out because of the material insufficient for evaluation,病变符合 .不能除外 .,不能不用，不能多用,冰冻切片,Frozen sections,The frequency of false positive diagnosis is inversely related to that of deferred diagnosis, so the attempt to FORCE a diagnosis in a difficult situation is likely to lead to the feared result of a false positive interpretation,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,Most false negative interpretations are probably due to sampling error and are thus unavoidable,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,When one or two sections are taken from a 10 cm specimen, we will invariably encounter situations in which the definitive diagnosis is not made until many more sections are examined the following day,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,The definitive diagnosis will have to wait for the permanent H&E sections,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,About 50%,收益,There Are No Guarantees in This Life (with the exceptions of death and taxes),世间没有绝对保证死亡和纳税例外BENIGN,The need for timely, accurate and detailed reports has never been greater, esp