12 206例外院病理会诊分析

Analysis of 12 206 cases of external pathology consultation

目的通过一组病理会诊资料，回顾性分析会诊疾病的主要类型、会诊结论与原病理诊断一致率，探讨会诊的主要原因及价值。方法统计近5年南京军区南京总医院接受外院病理会诊的12206例会诊资料，对其中3289例的原病理诊断与会诊结论进行对比分析。根据诊断的意见分为：（1）诊断完全一致；（2）诊断部分一致；（3）诊断完全不一致。结果外院会诊病例数在逐年增加，平均年增长率11％。在12206例会诊中，以消化系统、淋巴造血系统、软组织和乳腺疾病最多，共7198例（59．0％）。7865例来自三级乙等以下医院病理科室，占64．4％，而三级甲等医院者948例，占7．8％。直接由原切片会诊后明确病理诊断者1842例，占15．1％；需要重新制片后再做病理诊断者2569例，占21．1％；而需要免疫组织化学标记或特殊染色等检查后明确诊断者7795例，占63．8％。对其中3289例会诊资料分析显示，会诊结论与原病理诊断完全一致者582例，占17．7％；诊断部分一致者2594例，占78．9％；而诊断完全不一致者仅113例，占3．4％。原病理诊断为良性病变，经会诊被确定恶性病变者31例（0．9％），相反，恶性病变诊断良性病变者38例（1．1％），更改原疾病诊断类型者为44例（1．3％）。结论病理会诊是解决基层中小医院病理科室疑难病例病理诊断的重要手段之一，免疫组织化学是病理会诊主要的辅助检查技术之一，会诊结果对进一步明确病理诊断十分必要，对临床治疗和预后判断有明显的影响。

Objective To study the concordance rate of external pathology consultation referred by hospitals of various scales and to evaluate the value of such practice. Methods A total of 12 206 external pathology consultation cases referred by outside institutions were encountered during a 5-year period. The final pathologic diagnoses in 3289 cases were compared with the original interpretations. Each case was reviewed by at least two experienced pathologists. Immunohistochemical study was carried in selected examples. The pathologic findings were categorized as follows ： （ 1 ） no diagnostic discrepancy, （2） minor diagnostic discrepancy and （3） major diagnostic discrepancy. Results Amongst the 12 206 cases studied, 7198 cases （59. 0% ） were sampled from the digestive tract, hematolymphoid system, soft tissue or breast. Seven thousand eight hundred and sixty-five cases （64.4%） were referred by small and medium-sized hospitals, while only 948 cases （7. 8% ） were referred by large hospitals （ranked ILIA）. The diagnoses in 1842 cases （15. 1% ） were confirmed upon examination of the original paraffin sections, while the diagnoses in 2569 cases （21.1%） were made with cutting of additional sections from the paraffin blocks. On the other hand, the diagnoses in 7795 cases （63.8%） were arrived with the application of ancillary studies, including histochemistry and immunohistochemistry. Amongst the 3289 cases reviewed, diagnostic agreement was noted in 582 cases （ 17. 7% ） , while major diagnostic discrepancy was observed in 113 cases （3.4%） , including a change in diagnosis from ＂benign＂ to ＂malignant＂ in 31 cases （0. 9% ） and from ＂malignant＂ to ＂benign＂ in 38 cases （ 1.1% ）. The pathologic classification of the original diagnoses was modified in 44 cases （ 1.3% ）. Conclusions External pathology consultation is useful for patient management in small and medium-sized hospitals, especially in resolving difficult and controversial pathologic diagnoses. Application of ancillary techniques, including immunohistochemistry, further helps to clear up the potential diagnostic dilemma.