某医院头颈部肿瘤病理诊断与临床诊断不一致成因及对治疗的影响

Causes and effects of pathology discrepancy in head and neck cancer patients-based on clinical evaluation

目的 研究头颈部肿瘤患者病理诊断之间、病理诊断与临床诊断之间不一致以及无病理诊断的发生率及成因以及由此而对临床治疗产生的影响。方法 收集安徽医科大学第二附属医院肿瘤中心2014年8月1日~2015年4月30日所有住院患者的临床资料,由资深临床、病理及影像专家组成的多学科团队,共同确定头颈部及其他部位肿瘤患者各种不一致及无病理诊断的发生情况,分析其成因及对临床治疗的影响。结果 118例取得病理的头颈部肿瘤患者中,16例病理诊断与临床诊断不一致,原因包括取材质量不佳7例、病变复杂病理难以准确定性8例、病理医生误判1例。病理诊断与临床诊断不一致对患者无伤害1例（6.3%）,未造成伤害3例（18.8%）,轻度伤害1例（6.3%）,中度伤害11例（68.8%）和重度伤害0例。结论 头颈部肿瘤病理诊断与临床诊断不一致的主要原因是取材不佳和病情复杂（尤其是原发灶不明淋巴结转移癌和甲状腺肿瘤）。临床医生对病理的采集及选择恰当的处理至关重要。

Objective To study the incidence, causes and effects of pathology discrepancy in head and neck canc- er patients. Methods From August 2014 to April 2015 in the Second Affiliated Hospital of Anhui Medical University, 118 hospitalized patients with head and neck cancers were included in this study. The accuracy and absence of pathological di- agnosis, discrepancy between clinical and pathological diagnosis and the prognosis of all the patients were assessed. The effects of discrepancy between pathological diagnosis and clinical diagnosis were categorized as follows： no harm, near miss, minimal harm, moderate harm and major harm. Results Among the 118 cases studied, there were 16 discrepancy between pathological diagnosis and clinical diagnosis. The causes of them include the underperforming pathologic sampling quality in 7 cases, complex pathological characteristics in 8 cases, experience of pathologist in 1 cases. Pathology error re- sult in no harm was noted in 1 cases （6. 3% ）. Near miss was observed in 3 cases （ 18.8% ）. Minimal harm was observed in 1 cases （6. 3% ） , moderate harm was found in 11 cases （68.8%） while major harm was not modified. Conclusions The major reason of discrepancy between pathological diagnosis and clinical diagnosis are sampling and lesions complex （ especially lymph node metastasis from unknown primary tumors and thyroid tumor）. The large majority of diagnostic errors do not result in severe harm, and it depends on the experience of clinician.