急需加強(qiáng)急需加強(qiáng)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(lái)自火星病理醫(yī)師來(lái)自金星CliniciansMarsandPathologis5THEARTOFCOMMUNICATION

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

ConfusionorComprehension

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

or

理解ClinicianInterpretationofPa7魚(yú)水之情T(mén)EAM魚(yú)水之情T(mén)EAM8不大了解病理不大了解病理9避免誤會(huì)避免誤會(huì)10外科醫(yī)師應(yīng)用病理學(xué)外科醫(yī)師應(yīng)用病理學(xué)11Manyofourclinicalcolleaguesoftenneedtobereminedofthisfact;evensimpleinformation

concerningage,sexorlocationmaybemissingontherequestform…請(qǐng)求單上甚至漏寫(xiě)有關(guān)性別，年齡和部位等簡(jiǎn)單的信息認(rèn)真填寫(xiě)病理檢查申請(qǐng)單Manyofourclinicalcolleague12Todiagnoseatumorintheabsenceofclearandcompleteclinicaldataisfoolhardy,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Todiagnoseatumorintheabs13“Icanseeonlywhatisinthetissuesyougaveme”我只能看到你給我的組織如果沒(méi)有臨床資料事實(shí)并非如此“Icanseeonlywhatisinthe14不大了解臨床不大了解臨床15Innoareaofsurgicalpathologydoesthepathologistplayamoreimportantandcrucialrolethaninthediagnosisoftumors

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

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

專(zhuān)科病理醫(yī)師SPECIAL

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

專(zhuān)科病理醫(yī)師SPECIALUN21全科病理醫(yī)師很難滿(mǎn)足臨床（正當(dāng)）需要全科病理醫(yī)師很難滿(mǎn)足臨床（正當(dāng)）需要22Clearly,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(lái)的Clearly,surgicalpathologyev23專(zhuān)科病理醫(yī)師專(zhuān)科病理醫(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(xué)會(huì)診Pathologicconsultation病理學(xué)會(huì)診Pathologicconsultation26Thedifficultdiagnosisinsurgicalpathology

病理診斷困難Somequestionsremainunansweredafterextensivetextbookreview,eitherbecause

thelesioninquestionisnotcoveredinthetext

orbecause

itspresentationisatypical.

教科書(shū)中找不到病變表現(xiàn)不典型Thedifficultdiagnosisinsur27會(huì)診雙方病人會(huì)診雙方28THEDIFFICULTDIAGNSISINSURGICALPATHOLOGY

病理診斷困難Wealloccasionallyencountersurgicalpathologycasesthatposesignificantdiagnosticdifficulty.

TheseareresolvedeitherbyCONSULTINGatextbookorone’scolleaguesorsendingthecaseoutinconsultation.

請(qǐng)人會(huì)診THEDIFFICULTDIAGNSISINSURG29學(xué)會(huì)尊重他人意見(jiàn)會(huì)診意見(jiàn)有時(shí)差別很大學(xué)會(huì)尊重他人意見(jiàn)會(huì)診意見(jiàn)有時(shí)差別很大30教科書(shū)會(huì)診教科書(shū)會(huì)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(qiáng)行作出(冰凍)診斷可能導(dǎo)致可怕的假陽(yáng)性結(jié)果Thefrequencyoffalsepositiv34避免假陽(yáng)性結(jié)果避免假陽(yáng)性結(jié)果35Mostfalsenegativeinterpretationsareprobablyduetosamplingerrorandarethusunavoidable

多數(shù)假陰性結(jié)果取材不當(dāng)所致不可避免Mostfalsenegativeinterpreta3685%90%95%…85%90%95%…37話(huà)是這么說(shuō)提高冰凍切片診斷水平話(huà)是這么說(shuō)提高冰凍切片診斷水平38Whenoneortwosectionsaretakenfroma10cmspecimen,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Whenoneortwosectionsaret39ThedefinitivediagnosiswillhavetowaitforthepermanentH&Esections最后診斷必須等待石蠟切片常識(shí)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(méi)有絕對(duì)保證死亡和納稅例外‘BENIGN’ThereAreNoGuaranteesinThi46Theneedfortimely,accurateanddetailedreportshasneverbeengreater,especiallyinourincreasinglysubspecializedandlitigioussociety要求及時(shí)，準(zhǔn)確而詳盡的報(bào)告...愛(ài)打官司的社會(huì)認(rèn)真對(duì)待，實(shí)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(qiáng)急需加強(qiáng)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(lái)自火星病理醫(yī)師來(lái)自金星CliniciansMarsandPathologis55THEARTOFCOMMUNICATION

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

ConfusionorComprehension

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

or

理解ClinicianInterpretationofPa57魚(yú)水之情T(mén)EAM魚(yú)水之情T(mén)EAM58不大了解病理不大了解病理59避免誤會(huì)避免誤會(huì)60外科醫(yī)師應(yīng)用病理學(xué)外科醫(yī)師應(yīng)用病理學(xué)61Manyofourclinicalcolleaguesoftenneedtobereminedofthisfact;evensimpleinformation

concerningage,sexorlocationmaybemissingontherequestform…請(qǐng)求單上甚至漏寫(xiě)有關(guān)性別，年齡和部位等簡(jiǎn)單的信息認(rèn)真填寫(xiě)病理檢查申請(qǐng)單Manyofourclinicalcolleague62Todiagnoseatumorintheabsenceofclearandcompleteclinicaldataisfoolhardy,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Todiagnoseatumorintheabs63“Icanseeonlywhatisinthetissuesyougaveme”我只能看到你給我的組織如果沒(méi)有臨床資料事實(shí)并非如此“Icanseeonlywhatisinthe64不大了解臨床不大了解臨床65Innoareaofsurgicalpathologydoesthepathologistplayamoreimportantandcrucialrolethaninthediagnosisoftumors

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

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

專(zhuān)科病理醫(yī)師SPECIAL

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

專(zhuān)科病理醫(yī)師SPECIALUN71全科病理醫(yī)師很難滿(mǎn)足臨床（正當(dāng)）需要全科病理醫(yī)師很難滿(mǎn)足臨床（正當(dāng)）需要72Clearly,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(lái)的Clearly,surgicalpathologyev73專(zhuān)科病理醫(yī)師專(zhuān)科病理醫(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(xué)會(huì)診Pathologicconsultation病理學(xué)會(huì)診Pathologicconsultation76Thedifficultdiagnosisinsurgicalpathology

病理診斷困難Somequestionsremainunansweredafterextensivetextbookreview,eitherbecause

thelesioninquestionisnotcoveredinthetext

orbecause

itspresentationisatypical.

教科書(shū)中找不到病變表現(xiàn)不典型Thedifficultdiagnosisinsur77會(huì)診雙方病人會(huì)診雙方78THEDIFFICULTDIAGNSISINSURGICALPATHOLOGY

病理診斷困難Wealloccasionallyencountersurgicalpathologycasesthatposesignificantdiagnosticdifficulty.

TheseareresolvedeitherbyCONSULTINGatextbookorone’scolleaguesorsendingthecaseoutinconsultation.

請(qǐng)人會(huì)診THEDIFFICULTDIAGNSISINSURG79學(xué)會(huì)尊重他人意見(jiàn)會(huì)診意見(jiàn)有時(shí)差別很大學(xué)會(huì)尊重他人意見(jiàn)會(huì)診意見(jiàn)有時(shí)差別很大80教科書(shū)會(huì)診教科書(shū)會(huì)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(qiáng)行作出(冰凍)診斷可能導(dǎo)致可怕的假陽(yáng)性結(jié)果Thefrequencyoffalsepositiv84避免假陽(yáng)性結(jié)果避免假陽(yáng)性結(jié)果85Mostfalsenegativeinterpretationsareprobablyduetosamplingerrorandarethusunavoidable

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