临床病理交流课件.ppt

1、CLINICOPATHOLOGICCOMMUNICATION临临床床病病理理交交流流COMMON LANGUAGE急需加强急需加强临床病理交流1Patients-Diseases Pathologists临床病理交流2临床病理交流3A COMMUNICATION GAP EXIST BETWEEN PATHOLOGISTS AND SURGEONS Powsner SM et al.Arch Pathol Lab Med 2000;124:1040病理医师和外科医师的交流病理医师和外科医师的交流存存 在在 差差 距距临床病理交流4Clinicians and Pathologists Clin

2、ician Interpretation of Pathology ReportsPowsner SM et al Arch Pathol Lab Med 2000;124:1040-1046临床医师临床医师来自火星来自火星病理医师病理医师来自金星来自金星临床病理交流5THE ART OF COMMUNICATION BETWEEN PATHOLOGISTS AND THEIR CLINICAL COLLEAGUES病理病理医师医师和和临床临床医师医师交流方法交流方法艺术艺术临床病理交流6Clinician Interpretation of Pathology ReportsConfusio

3、n or ComprehensionRuby SG.Arch Pathol Lab Med 2000;124:943-944临床医师解释病理报告临床医师解释病理报告混混 淆淆 or 理理 解解临床病理交流7鱼水之情鱼水之情TEAM临床病理交流8不大了解病理不大了解病理临床病理交流9Differences in understanding of reports by various readers was noted and was based on the readers level of experience and training不不同同的的临临床床医医师师对对于于病病理理报报告告有有不

4、不同同的的解解释释不不同同的的经经验验和和受受教教育育的的水水平平避免误会避免误会临床病理交流10外科医师应用病理学外科医师应用病理学临床病理交流11Many of our clinical colleagues often need to be remined of this fact;even simple information concerning age,sex or location may be missing on the request form认真填写病理检查申请单认真填写病理检查申请单临床病理交流12To diagnose a tumor in the absence o

5、f clear and complete clinical data is foolhardy,dangerous and sometimes impossible莽撞，危险，有时不可能莽撞，危险，有时不可能临床病理交流13“I can see only what is in the tissues you gave me”我只能看到你给我我只能看到你给我的组织的组织如果没有临床资料如果没有临床资料事实并非如此事实并非如此临床病理交流14不大了解临床不大了解临床临床病理交流15In no area of surgical pathology does the pathologist play

6、a more important and crucial role than in the diagnosis of tumors 病病 理理 学学 家家肿肿 瘤瘤 诊诊 断断决定性的作用决定性的作用病理医师如是说病理医师如是说临床病理交流16The patient or lay person often is entirely ignoraqnt of this role and fondly imagines that their surgeon,other clinician or oncologist is the true diagnostician病人并不了解这种作用病人并不了解这

7、种作用天真地认为天真地认为.临床病理交流17Limitations of Histologic Diagnosis组织学诊断组织学诊断局限性局限性金标准金标准临床病理交流18差距太大差距太大临床病理交流19临床病理交流20全科病理医师全科病理医师GENERAL专科病理医师专科病理医师SPECIAL UNIVERSITY HOSPITAL分科齐全的大学医院分科齐全的大学医院临床病理交流21全科病理医师很难满足临床（正当）需要全科病理医师很难满足临床（正当）需要临床病理交流22临床病理交流23专科病理医师专科病理医师临床病理交流24未分化的病理医师未分化的病理医师临床病理交流25临床病理交流26T

8、he difficult diagnosis in surgical pathologySome questions remain unanswered after extensive textbook review,either because the lesion in question is not covered in the text or because its presentation is atypical.教科书中找不到教科书中找不到病变表现不典型病变表现不典型临床病理交流27CONSULTATIONbenefits the referring pathologist,the

9、 consultant,and the patient会会诊诊三三 方方 受受 益益会诊双方会诊双方病病 人人临床病理交流28THE DIFFICULT DIAGNSIS IN SURGICAL PATHOLOGYWe all occasionally encounter surgical pathology cases that pose significant diagnostic difficulty.These are resolved either by CONSULTING a textbook or ones colleagues or sending the case out

10、in consultation.请人会诊请人会诊临床病理交流29TIME IS OFTEN A BETTER DIAGNOSTICIAN时时间间常常常常是是一一个个最最好好的的诊诊断断医医师师学会尊重他人意见学会尊重他人意见会诊意见有时差别很大会诊意见有时差别很大临床病理交流30“Should be kept adjacent to the microscope.”THE BOOK应应该该存存放放在在显显微微镜镜的的旁旁边边教科书会诊教科书会诊临床病理交流31The appearance is consistent with,but cannot be ruled out because of

11、 the material insufficient for evaluation不能不用，不能多用不能不用，不能多用临床病理交流32临床病理交流33The frequency of false positive diagnosis is inversely related to that of deferred diagnosis,so the attempt to FORCE a diagnosis in a difficult situation is likely to lead to the feared result of a false positive interpretati

12、on 强行作出强行作出(冰冻冰冻)诊断诊断可能导致可怕的假阳性结果可能导致可怕的假阳性结果临床病理交流34The frequency of false positive diagnosisis inversely related to that of deferred diagnosis,so the attempt to FORCE a diagnosis in a difficult situation is likely to lead to the feared result of a false positive interpretation强行作出强行作出(冰冻冰冻)诊断诊断可能导

13、致可怕的假阳性结果可能导致可怕的假阳性结果避免假阳性结果避免假阳性结果临床病理交流35Most false negative interpretations are probably due to sampling error and are thus unavoidable 多数假阴性结果多数假阴性结果取材不当所致取材不当所致不可避免不可避免临床病理交流3685%90%95%临床病理交流37Sometimes a pathologist cannot reach a decision on the basis of the frozen section.When this is true,h

14、e need not be apologetic.病病理理医医师师不不必必为为作作不不出出冰冰冻冻切切片片诊诊断断而而表表示示歉歉意意话是这么说话是这么说提高冰冻切片诊断水平提高冰冻切片诊断水平临床病理交流38When one or two sections are taken from a 10 cm specimen,we will invariably encounter situations in which the definitive diagnosis is not made until many more sections are examined the following

15、day 一个一个10cm10cm的标本的标本 一或两张一或两张5 5冰冻切片冰冻切片检查多数检查多数(石蜡石蜡)切片之后切片之后才能作出最后诊断才能作出最后诊断临床病理交流39The definitive diagnosis will have to wait for the permanent H&E sections最后诊断最后诊断常识常识临床病理交流40冰冻切片不宜作出特异诊断冰冻切片不宜作出特异诊断临床病理交流41尽量弄清良性抑或恶性尽量弄清良性抑或恶性临床病理交流42Adenoma?Carcinoma?Goiter?临床病理交流43软组织肿瘤冰冻切片诊断软组织肿瘤冰冻切片诊断临床病理

16、交流44收益收益临床病理交流45(with the exceptions of death and taxes)世间没有绝对保证世间没有绝对保证死亡和纳税例外死亡和纳税例外BENIGN临床病理交流46The need for timely,accurate and detailed reports has never been greater,especially in our increasingly subspecialized and litigious society要求要求及时及时，准确准确而而详尽详尽的报告的报告.爱打官司的社会爱打官司的社会认真对待，实事求是认真对待，实事求是临床

17、病理交流47PATHOLOGISTS ARE PHYSICIANS AND HUMAN BEINGS病理医师是医病理医师是医师师,也是也是人人临床病理交流48临床病理交流49S Su ur rg ge er ry y&S Su ur rg gi ic ca al l S Su ur rg ge er ry y&S Su ur rg gi ic ca al l P Pa at th ho ol lo og gy yP Pa at th ho ol lo og gy yN Ne ev ve er r S Sa ay y 1 10 00 0 P Pe er rc ce en nt tN Ne ev ve er r S Sa ay y 1 10 00 0 P Pe er rc ce en nt t从从不不说说满满从从不不说说满满考虑全面留有余地考虑全面留有余地临床病理交流50