2022例乳腺病理会诊病例分析

Analysis of 2022 consulting cases of breast pathology

目的通过总结华西医院病理科院外乳腺病理会诊的疾病构成、申请会诊原因和会诊前后诊断符合率等,探讨乳腺病理会诊的特点、常见会诊病例病理诊断及鉴别诊断的难点和要点,避免误诊和漏诊。方法参照WHO乳腺肿瘤分类及相关文献对2004~2008年华西医院乳腺会诊病例进行分类整理。结果该组共2 022例乳腺会诊病例,良性669例（33.1%）,恶性1 328例（65.7%）,交界性25例（1.2%）。申请会诊的原因包括明确病理诊断（1 379例）和进行肿瘤标记物检测（643例）,前者中最常见的疑难会诊是导管内增生性病变、纤维上皮性肿瘤和导管内乳头状肿瘤。本组会诊前后诊断的整体符合率为79.3%。误诊病例中,将良性、交界性病变过诊断为恶性者居多,主要原因是切片质量不佳、对诊断标准和假恶性病变缺乏充分认识以及缺少IHC的辅助。鉴别诊断经常使用的免疫组化标记是基底型细胞角蛋白、肌上皮标记和E-cadherin。结论乳腺病理会诊在确诊乳腺疑难病例、准确检测肿瘤标记物和减少医疗差错等方面具有重要作用。掌握常见乳腺会诊疾病的病理特征,合理和适时地选择病理会诊将有助于避免常见的误诊。

Purpose To analyse the morphologic spectrum of consulting breast cases,reasons for consultation and diagnostic agreement between the prior and consulting reports,and to investigate the characteristics of breast pathology consultation and the key points of pathologic diagnosis.Methods The consulting breast cases at the Pathology Department,West China Hospital from 2004 to 2008 were summarized according to the World Health Organization classification of mammary tumors and related references.Results A total of 2022 consulting cases were analyzed,including 669 benign cases（33.1%）,1328 malignant cases（65.7%） and 25 borderline cases（1.2%）.The reasons for consultation were confirming diagnoses（1 379 cases） and tumor markers testing（643 cases）.The most common breast lesions encountered in consultation practice were intraductal proliferative lesions,fibroepithelial tumors and intraductal papillary neoplasms.The percentage of diagnostic agreement was 79.3%.Among misdiagnosis cases,it is common that benign or borderline cases confirmed by consultation were diagnosed as malignant cases in prior report because of poor staining,being unfamiliar with diagnostic criteria and having no immunohistochemical stain.Basal-type cytokeratin,myoepithelial markers and E-cadherin were helpful in solving most of the diagnostic dilemmas.Conclusions Pathology consultation is very important for the diagnosis and treatment of the breast disease.Being familiar with the diagnostic features of the lesions frequently encountered in consultation and seeking a second opinion when necessary would be helpful in avoiding misdiagnosis.