专家会诊2800例病理诊断分析

Pathological Diagnosis Rest on Specialists' Opinions: Analysis of 2800 Cases

目的：探讨如何正确看待和运用病理学专家会诊结果。方法：收集专家会诊病理诊断2800例，其中2400例由上级1家医院专家会诊，400例由2—4家医院专家会诊。将2400例上级医院专家会诊结果与我院初步诊断结果进行比较，将400例由多家医院专家诊断的结果进行对比分析。结果：经上级1家医院专家会诊2400例中，我院诊断明确（Ⅰ类）260例（10．83％），疑难诊断（Ⅱ类）2008例（83．67％），描述性诊断（Ⅲ类）110例（4．58％），无法诊断（Ⅳ类）22例（0．92％）；会诊诊断明确（Ⅰ类）1581例（65．88％），疑难诊断（Ⅱ类）692例（28．83％），描述性诊断（Ⅲ类）109例（4．54％），无法诊断（Ⅳ类）18例（0．75％）。专家会诊后疑难诊断率显著下降，与原诊断相比差异显著（P〈0．01）；描述性诊断和无法诊断率与原诊断相比无明显差异（P〉0．05）。经多家医院会诊400例中专家诊断一致或相近204例（51．00％），定性一致分类不同193例（48．25％），良恶意见相反3例（0．75％），其中病例1经随访一专家会诊意见与随访结果不符。结论：专家会诊使较多疑难病理诊断得以明确，但疾病具有复杂性，不同专家会诊结果有分歧；仍有部分疑难病理诊断需要随访病人才能得到确诊；制作优质的组织蜡块和切片，加强临床医生、主检病理医师及病理会诊专家三者之间沟通，并对患者长期随访是获得正确结果的最好方法。

Objective ：To search how to hold a right attitude for junior physician to the expert＇s opinion and how to rightly use these results in clinical practice. Methods ：2 800 patients＇paraffin wax embedded tissue sections which had been examined by pathological specialists （experts） were retrospectively analysed. 2 400 patients＇pathologieal diagnosis resting on one expert and 400 patients ＇pathological diagnosis resting on 2 to 4 experts were compared to the initial diagnosis made by thejunior pathological physician. Results：In the diagnosis of 2 400 patients made by junior physician, Definite diagnosis was made in 260 patients （10.83%） , Indefinite diagnosis in 2 008 patients （ 83.67% ） , Descriptive diagnosis in 110 patients （4. 58% ）, No diagnosis in 22 patients （0. 92% ）. After consulted experts, Definite diagnosis was made in 1 581 patients （65.88%） ,Indefinite diagnosis in 692 patients （28. 83% ） ,Descriptive diagnosis in 109 patients （4. 54% ） ,No diagnosis in 18 patients （0. 75% ） ,there was a significant difference in number of indefinite diagnosis between the junior doctor and expert （ P 〈 0. 01 ） ,the number of indefinite diagnosis was deceased in expert group, there were no significant differences （P 〉 0. 05） in number of descriptive diagnosis and no diagnosis between the two groups. In 400 pateints, after consulted 2 - 4 experts,204 patientspathologieal diagnosises were consistent or similar （51.00%）, 193 patients＇ diagnosises were different in classification of the lesion （48.25%） ,there was contrary opinions in 3 patients＂ diagnosises, malign or benign（0.75% ）. Conclusion ： Pathological specialists＂ consultation can increase the accuracy of the diagnosis, but the results consulted different experts are not all the same, some suspicious pathology diagnosis cant be definite without a long term follow up. The right diagnosis is based on a high quality tissue sections, patient＇s long-term follow up and enhancing communication among clinic physician, pathological physician and expert.