临床病理交流.pptVIP

教科书会诊 The appearance is consistent with …, but … cannot be ruled out because of the material insufficient for evaluation 病变符合 ... 不能除外 ... 不能不用，不能多用 冰冻切片 Frozen sections The 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 interpretation 强行作出(冰冻)诊断 可能导致可怕的假阳性结果 避免假阳性结果 Most false negative interpretations are probably due to sampling error and are thus unavoidable 多数假阴性结果 取材不当所致 不可避免 85% 90% 95%… 话是这么说 提高冰冻切片诊断水平 When 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 day 一个10cm的标本 一或两张5μ冰冻切片 检查多数(石蜡)切片之后 才能作出最后诊断 The definitive diagnosis will have to wait for the permanent HE sections 最后诊断 必须等待石蜡切片 常识 冰冻切片不宜作出特异诊断 尽量弄清良性抑或恶性 Adenoma? Carcinoma? Goiter? … 软组织肿瘤冰冻切片诊断 About 50% 收益 There Are No Guarantees in This Life (with the exceptions of death and taxes) 世间没有绝对保证 死亡和纳税例外 ‘BENIGN’ The need for timely, accurate and detailed reports has never been greater, especially in our increasingly subspecialized and litigious society 要求及时，准确而详尽的报告 ...爱打官司的社会 认真对待，实事求是 PATHOLOGISTS ARE PHYSICIANS AND HUMAN BEINGS 病理医师是医师,也是人 Fortune-teller 考虑全面留有余地 急需加强 Patients-Diseases Surgeons Pathologists 现 状 Present situation A 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 存 在 差 距 Clinicians Mars and Pathologists VenusClinician Interpretation of Pathology ReportsPowsner SM et al Arch Pathol Lab Med 2000; 124:1040-1046 临床医师来自火星 病理医师来自金星 THE ART OF COMMUNICATION BETWEEN PATHOLOGISTS AND THEIR CLINICAL COLLEAGUES 病理医师和临床医师 交流方法艺术 Clinician Interpretation of Pathology ReportsConfusion or ComprehensionRuby SG. Arch Pathol Lab Med 2000; 124:943-944 临床医师解释病理报告 混 淆 or 理 解 鱼水之情 TEAM 不大了解病理 避免误会 外科医师应用病理学 Many of