臨床病理交流課件

急需加強急需加強1Patients-DiseasesSurgeons

PathologistsPatients-DiseasesSurgeonsPath2現(xiàn)狀Presentsituation現(xiàn)狀Presentsituation3ACOMMUNICATIONGAPEXISTBETWEENPATHOLOGISTSANDSURGEONS

PowsnerSMetal.ArchPatholLabMed2000;124:1040病理醫(yī)師和外科醫(yī)師的交流存在差距ACOMMUNICATIONGAPEXISTBETW4Clinicians

Mars

and

Pathologists

Venus

ClinicianInterpretationofPathologyReports

PowsnerSMetalArchPatholLabMed2000;124:1040-1046臨床醫(yī)師來自火星病理醫(yī)師來自金星CliniciansMarsandPathologis5THEARTOFCOMMUNICATION

BETWEENPATHOLOGISTSANDTHEIRCLINICALCOLLEAGUES病理醫(yī)師和臨床醫(yī)師交流方法藝術THEARTOFCOMMUNICATIONBETWE6ClinicianInterpretationofPathologyReports

ConfusionorComprehension

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

or

理解ClinicianInterpretationofPa7魚水之情TEAM魚水之情TEAM8不大了解病理不大了解病理9避免誤會避免誤會10外科醫(yī)師應用病理學外科醫(yī)師應用病理學11Manyofourclinicalcolleaguesoftenneedtobereminedofthisfact;evensimpleinformation

concerningage,sexorlocationmaybemissingontherequestform…請求單上甚至漏寫有關性別，年齡和部位等簡單的信息認真填寫病理檢查申請單Manyofourclinicalcolleague12Todiagnoseatumorintheabsenceofclearandcompleteclinicaldataisfoolhardy,dangerousandsometimesimpossible缺乏清楚而完整的臨床資料診斷腫瘤莽撞，危險，有時不可能Todiagnoseatumorintheabs13“Icanseeonlywhatisinthetissuesyougaveme”我只能看到你給我的組織如果沒有臨床資料事實并非如此“Icanseeonlywhatisinthe14不大了解臨床不大了解臨床15Innoareaofsurgicalpathologydoesthepathologistplayamoreimportantandcrucialrolethaninthediagnosisoftumors

病理學家腫瘤診斷決定性的作用病理醫(yī)師如是說Innoareaofsurgicalpatholo16Thepatientorlaypersonoftenisentirelyignoraqntofthisroleandfondlyimagines

thattheirsurgeon,otherclinicianoroncologististhetruediagnostician病人并不了解這種作用天真地認為...Thepatientorlaypersonofte17LimitationsofHistologicDiagnosis組織學診斷局限性金標準LimitationsofHistologicDiag18差距太大差距太大19培訓Trainpersonnel培訓Trainpersonnel20全科病理醫(yī)師GENERAL

專科病理醫(yī)師SPECIAL

UNIVERSITYHOSPITAL分科齊全的大學醫(yī)院？全科病理醫(yī)師GENERAL

?？撇±磲t(yī)師SPECIALUN21全科病理醫(yī)師很難滿足臨床（正當）需要全科病理醫(yī)師很難滿足臨床（正當）需要22Clearly,surgicalpathologyevolvedinresponsetotheneedsofsurgeons.很明顯，外科病理學是應外科醫(yī)師的需求而發(fā)展起來的Clearly,surgicalpathologyev23專科病理醫(yī)師?？撇±磲t(yī)師24只有少數(shù)病例留給…‘未分化的病理醫(yī)師’只有少數(shù)病例留給…‘未分化的病理醫(yī)師’25病理學會診Pathologicconsultation病理學會診Pathologicconsultation26Thedifficultdiagnosisinsurgicalpathology

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Thedifficultdiagnosisinsur27會診雙方病人會診雙方28THEDIFFICULTDIAGNSISINSURGICALPATHOLOGY

病理診斷困難Wealloccasionallyencountersurgicalpathologycasesthatposesignificantdiagnosticdifficulty.

TheseareresolvedeitherbyCONSULTINGatextbookorone’scolleaguesorsendingthecaseoutinconsultation.

請人會診THEDIFFICULTDIAGNSISINSURG29學會尊重他人意見會診意見有時差別很大學會尊重他人意見會診意見有時差別很大30教科書會診教科書會診31Theappearanceisconsistentwith…,but…cannotberuledoutbecauseofthematerialinsufficientforevaluation病變符合...不能除外...不能不用，不能多用Theappearanceisconsistentw32冰凍切片F(xiàn)rozensections冰凍切片F(xiàn)rozensections33Thefrequencyoffalsepositivediagnosisisinverselyrelatedtothatofdeferreddiagnosis,sotheattempttoFORCEadiagnosisinadifficultsituationislikelytoleadtothefearedresultofafalsepositiveinterpretation

強行作出(冰凍)診斷可能導致可怕的假陽性結果Thefrequencyoffalsepositiv34避免假陽性結果避免假陽性結果35Mostfalsenegativeinterpretationsareprobablyduetosamplingerrorandarethusunavoidable

多數(shù)假陰性結果取材不當所致不可避免Mostfalsenegativeinterpreta3685%90%95%…85%90%95%…37話是這么說提高冰凍切片診斷水平話是這么說提高冰凍切片診斷水平38Whenoneortwosectionsaretakenfroma10cmspecimen,wewillinvariablyencountersituationsinwhichthedefinitivediagnosisisnotmadeuntilmanymoresectionsareexaminedthefollowingday

一個10cm的標本

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Whenoneortwosectionsaret39ThedefinitivediagnosiswillhavetowaitforthepermanentH&Esections最后診斷必須等待石蠟切片常識Thedefinitivediagnosiswill40冰凍切片不宜作出特異診斷冰凍切片不宜作出特異診斷41盡量弄清良性抑或惡性盡量弄清良性抑或惡性42Adenoma?Carcinoma?Goiter?…Adenoma?Carcinoma?Goiter?…43軟組織腫瘤冰凍切片診斷軟組織腫瘤冰凍切片診斷44About50%收益About50%收益45ThereAreNoGuaranteesinThisLife

(withtheexceptionsofdeathandtaxes)世間沒有絕對保證死亡和納稅例外‘BENIGN’ThereAreNoGuaranteesinThi46Theneedfortimely,accurateanddetailedreportshasneverbeengreater,especiallyinourincreasinglysubspecializedandlitigioussociety要求及時，準確而詳盡的報告...愛打官司的社會認真對待，實事求是Theneedfortimely,accurate47PATHOLOGISTSAREPHYSICIANSANDHUMANBEINGS病理醫(yī)師是醫(yī)師,也是人PATHOLOGISTSAREPHYSICIANSAN48Fortune-tellerFortune-teller49考慮全面留有余地考慮全面留有余地50急需加強急需加強51Patients-DiseasesSurgeons

PathologistsPatients-DiseasesSurgeonsPath52現(xiàn)狀Presentsituation現(xiàn)狀Presentsituation53ACOMMUNICATIONGAPEXISTBETWEENPATHOLOGISTSANDSURGEONS

PowsnerSMetal.ArchPatholLabMed2000;124:1040病理醫(yī)師和外科醫(yī)師的交流存在差距ACOMMUNICATIONGAPEXISTBETW54Clinicians

Mars

and

Pathologists

Venus

ClinicianInterpretationofPathologyReports

PowsnerSMetalArchPatholLabMed2000;124:1040-1046臨床醫(yī)師來自火星病理醫(yī)師來自金星CliniciansMarsandPathologis55THEARTOFCOMMUNICATION

BETWEENPATHOLOGISTSANDTHEIRCLINICALCOLLEAGUES病理醫(yī)師和臨床醫(yī)師交流方法藝術THEARTOFCOMMUNICATIONBETWE56ClinicianInterpretationofPathologyReports

ConfusionorComprehension

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

or

理解ClinicianInterpretationofPa57魚水之情TEAM魚水之情TEAM58不大了解病理不大了解病理59避免誤會避免誤會60外科醫(yī)師應用病理學外科醫(yī)師應用病理學61Manyofourclinicalcolleaguesoftenneedtobereminedofthisfact;evensimpleinformation

concerningage,sexorlocationmaybemissingontherequestform…請求單上甚至漏寫有關性別，年齡和部位等簡單的信息認真填寫病理檢查申請單Manyofourclinicalcolleague62Todiagnoseatumorintheabsenceofclearandcompleteclinicaldataisfoolhardy,dangerousandsometimesimpossible缺乏清楚而完整的臨床資料診斷腫瘤莽撞，危險，有時不可能Todiagnoseatumorintheabs63“Icanseeonlywhatisinthetissuesyougaveme”我只能看到你給我的組織如果沒有臨床資料事實并非如此“Icanseeonlywhatisinthe64不大了解臨床不大了解臨床65Innoareaofsurgicalpathologydoesthepathologistplayamoreimportantandcrucialrolethaninthediagnosisoftumors

病理學家腫瘤診斷決定性的作用病理醫(yī)師如是說Innoareaofsurgicalpatholo66Thepatientorlaypersonoftenisentirelyignoraqntofthisroleandfondlyimagines

thattheirsurgeon,otherclinicianoroncologististhetruediagnostician病人并不了解這種作用天真地認為...Thepatientorlaypersonofte67LimitationsofHistologicDiagnosis組織學診斷局限性金標準LimitationsofHistologicDiag68差距太大差距太大69培訓Trainpersonnel培訓Trainpersonnel70全科病理醫(yī)師GENERAL

專科病理醫(yī)師SPECIAL

UNIVERSITYHOSPITAL分科齊全的大學醫(yī)院？全科病理醫(yī)師GENERAL

?？撇±磲t(yī)師SPECIALUN71全科病理醫(yī)師很難滿足臨床（正當）需要全科病理醫(yī)師很難滿足臨床（正當）需要72Clearly,surgicalpathologyevolvedinresponsetotheneedsofsurgeons.很明顯，外科病理學是應外科醫(yī)師的需求而發(fā)展起來的Clearly,surgicalpathologyev73專科病理醫(yī)師?？撇±磲t(yī)師74只有少數(shù)病例留給…‘未分化的病理醫(yī)師’只有少數(shù)病例留給…‘未分化的病理醫(yī)師’75病理學會診Pathologicconsultation病理學會診Pathologicconsultation76Thedifficultdiagnosisinsurgicalpathology

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Thedifficultdiagnosisinsur77會診雙方病人會診雙方78THEDIFFICULTDIAGNSISINSURGICALPATHOLOGY

病理診斷困難Wealloccasionallyencountersurgicalpathologycasesthatposesignificantdiagnosticdifficulty.

TheseareresolvedeitherbyCONSULTINGatextbookorone’scolleaguesorsendingthecaseoutinconsultation.

請人會診THEDIFFICULTDIAGNSISINSURG79學會尊重他人意見會診意見有時差別很大學會尊重他人意見會診意見有時差別很大80教科書會診教科書會診81Theappearanceisconsistentwith…,but…cannotberuledoutbecauseofthematerialinsufficientforevaluation病變符合...不能除外...不能不用，不能多用Theappearanceisconsistentw82冰凍切片F(xiàn)rozensections冰凍切片F(xiàn)rozensections83Thefrequencyoffalsepositivediagnosisisinverselyrelatedtothatofdeferreddiagnosis,sotheattempttoFORCEadiagnosisinadifficultsituationislikelytoleadtothefearedresultofafalsepositiveinterpretation

強行作出(冰凍)診斷可能導致可怕的假陽性結果Thefrequencyoffalsepositiv84避免假陽性結果避免假陽性結果85Mostfalsenegativeinterpretationsareprobablyduetosamplingerrorandarethusunavoidable

多數(shù)假陰性結果取材不當所致不可避免Mostfalsenegativeinterpreta8685%90%95%…85%90%95%…87話是這么說提高冰凍切片診斷水平話是這么說提高冰凍切片診斷水平88Whenoneortwosectionsaretakenfroma10cmspecimen,wewillinvariablyencountersituationsinwhic