Assessment of the Intraoperative Consultation Service Rendered by General Pathologists in a Scenario Where a Well-Defined Decision Algorithm Is Followed
Assessment of the Intraoperative Consultation Service Rendered by General Pathologists in a Scenario Where a Well-Defined Decision Algorithm Is Followed
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DOI：
10.1093/ajcp/aqw223
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发表时间：
2017-03-01
影响因子：
3.5
通讯作者：
Winterhoff, Boris
中科院分区：
文献类型：
--
作者：
Khalifa, Mahmoud A.;Salama, Sherine;Winterhoff, Boris
目的：术中会诊(IOC)仍然是全科医学的一个领域，甚至在次专科病理科也是如此。方法：分析2003年1月至2015年6月在本院接受手术治疗的子宫内膜腺癌患者的手术决定。结果：对子宫切除标本中肿瘤的大小、组织学分级和侵袭深度进行了IOC评估。结果：对801例患者进行了冰冻切片检查。与永久性切片分析相比，FS国际妇产科联合会(FIGO)分级的总体准确率为0.95(95%可信区间[CI]，0.93-0.98)。FS侵袭深度的总体准确率为0.92(95%CI，0.89~0.94)。47.8%的病理报告未记录FIGO分级，45.2%的子宫肌层侵犯深度，41.8%的肿瘤大小。结论：普通病理医生对所需参数的高漏检率将质疑他们对该算法意图的范式转换的整体理解。对这种现象的可能解释和可能的解决方案进行了讨论。
Objectives: Intraoperative consultation (IOC) remains an area of general practice even within subspecialized pathology departments. This study assesses the IOCs rendered in a general pathology setting where surgeons integrate these results in a well-defined algorithm, developed with the input of specialized pathologists.Methods: The surgical decisions to perform lymphadenectomy in patients with endometrial adenocarcinoma operated on at our institution between January 2003 and June 2015 as a result of the IOC assessment of tumor size, histologic grade, and depth of invasion in the hysterectomy specimen were analyzed.Results: Frozen section (FS) was examined in 801 cases. In comparison to permanent section analysis, FS International Federation of Gynecology and Obstetrics (FIGO) grade had an overall accuracy of 0.95 (95% confidence interval [CI], 0.93-0.98). The FS depth of invasion had an overall accuracy of 0.92 (95% CI, 0.89-0.94). FIGO grade was not documented in 47.8%, the depth of myometrial invasion in 45.2%, and tumor size in 41.8% of the pathology reports.Conclusions: The high omission rate of the needed parameters by the general pathologists would question their overall understanding of the paradigm shift intended by this algorithm. Possible explanations of this phenomenon and potential solutions are discussed.