毒性病理诊断实验室诊断能力影响因素分析

Influencing factor of diagnosis capacity in toxicologic pathology diagnostic laboratories

目的了解我国毒性病理诊断实验室的毒性病理诊断能力及其影响因素。方法由中国毒理学会毒性病理学专业委员会和广东省职业病防治院组织开展毒性病理诊断实验室间比对活动,制作9例消化系统病变的数字切片作为比对样品,各参加毒性病理比对活动的机构(以下简称"参比机构")在规定的时间内完成诊断,对各参比机构进行单个病例结果评价和总体结果评价。结果全国共有24个省和直辖市的74家机构156名病理诊断人员参加比对活动;参比机构数量地区分布以华北、华南和华东地区居前3位,平均每个参比机构配备2名病理诊断人员;其中初级、中级和高级职称人员分别有15、70、46人。单个病例结果评价中,对寄生虫性肝囊肿、小肠腺癌、胰腺结节性多动脉炎病例诊断结果的"优秀"率最高,分别为97.3%、95.9%和89.2%;对十二指肠腺炎症、结肠黏膜固有层泡沫细胞聚集、肝细胞腺瘤病例诊断结果的"不满意"率最高,分别为67.6%、40.5%和32.4%。参比机构总体评价为"优秀"及"满意"等级者分别占78.4%和21.6%。各参比机构配备的病理诊断人员数量对总体评价成绩和单个病例(肿瘤性病变)成绩均有影响(P<0.05),而参比机构的类型、地区分布和病理诊断人员的职称等级均对诊断能力无影响(P>0.05)。结论参比机构对此次实验室间比对活动的消化系统病变的诊断能力较优;参比机构配备的病理诊断人员数量是其诊断能力的影响因素之一。

Objective To observe the diagnostic capacity and its influencing factors in the toxicologic pathology diagnostic laboratories in China. Methods Inter-laboratory comparison of toxicologic pathology diagnosis was cosponsored by Chinese Society of Toxicology-Toxicologic Pathology Specialty Section and Guangdong Province Hospital for Occupational Disease Prevention and Treatment. Nine digital slices of digestive system lesions were screened as comparison samples, and the reference institution with toxicologic pathology diagnostic laboratories completed the diagnosis within the prescribed time. According to the three grades of ＂excellent＂, ＂satisfaction＂ and ＂dissatisfaction＂, the evaluation was carried out. Results A total of 74 reference institution participated in this comparison, which distributed in 20 provinces and 4 municipalities and 156 pathologists. The reference institutions were mainly distributed in North China, Southern China and East China. There was an average of 2 pathologists per laboratory, and in the quantity of academic title, the junior, intermediate, and senior was 15, 70 and 46 persons respectively. Parasitic hepatocyte cysts （97.3%）, adenocarcinoma of small intestine （95. 9% ） and polyarteritis nodosa of the pancreas （89. 2% ） had the highest rate of ＂excellent＂ grade, while the duodenal gland inflammation （67.6%）, foam cell aggregation in colonic propria （40. 5% ） and hepatoma adenoma （32.4%） had the highest rate of dissatisfaction grade in the evaluation of single case. In the overall evaluation, reference laboratories reached the ＂excellent＂ grade and the ＂satisfaction＂ grade were 78.4% and 21.6% respectively. The number of pathologists provided by each reference laboratory had impacts on the overall evaluation level and the single case evaluation （ neoplastic lesions） in the evaluation of single case （ P 〈 0. 05）. The types of the reference laboratory, the regional distribution and the grade of the academic title had no effect on the diagnostic ability （ P 〉 0. 05 ）. Conclusion The reference laboratory is superior in diagnosing the digestive system lesions in the inter-laboratory comparison activity. The number of pathologists in the reference laboratory is one of the influencing factors of its diagnostic ability.