Coindre J M, Blanc-Vincent M P, Collin F, Mac Grogan G, Balaton A, Voigt J J, Arnould L, Bailly C, Brifford M, Bibeau F, Fontanière B, Ghnassia J P, Guinebretière J M, Le Doussal V, Mauriac L, Merrouche Y, Sabourin J C, Sastre-Garau X, Sigal-Zafrani B, Verriele-Beurrier V, Vielh P
Standards, Options et Recommandations, 101, rue de Tolbiac, 75654 Paris Cedex 13, France.
Bull Cancer. 2001 Aug;88(8):765-73.
The "Standards, Options and Recommendations" (SOR) project, started in 1993 is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for difficult diagnoses in surgical pathology or cytopathology in cancer patients.
Data were identified by searching Medline and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 71 independent reviewers.
The main recommendations to prevent and reduce the number of difficult diagnoses in surgical pathology or cytopathology are: 1) The development of quality insurance programs with use of written procedures in each pathology laboratory (standard). 2) The knowledge of clinical data in order to explain surgical pathology or cytopathology results (standard). 3) The availability of complementary patient informations (radiologic data . . .) can be useful to explain surgical pathology or cytopathology results (option). The main recommendations to detect lesions associated with difficult diagnosis in surgical pathology or cytopathology are: 1) Tumor types known as potential difficult diagnosis in surgical pathology or cytopathology should be reviewed by a second pathologist. 2) The systematic second reviewing for every case is expensive but has to be done when the difficulty is know (sarcoma, lymphoma . . .) by experienced pathologists. The main recommendations to solve difficult diagnosis in surgical pathology or cytopathology are: 1) Block recuts, use of special techniques (immunocytohistochemistry and molecular biology), additional data from clinicians, second opinion by a local pathologist, or new specimen can be required for establishing the diagnosis (options). 2) Outside second opinion by expert pathologist has to be considered once the other steps did not allow to establish surgical or cytopathology diagnosis (recommendations, expert agreement).
“标准、选项与建议”（SOR）项目始于1993年，是法国癌症中心联合会（FNCLCC）、20家法国癌症中心以及法国公立大学、综合医院和私立诊所的专家之间的合作项目。主要目标是制定临床实践指南，以提高癌症患者的医疗质量和治疗效果。该方法基于多学科专家小组的文献综述和批判性评估，并结合癌症护理专家的反馈意见。
根据“标准、选项与建议”项目的定义，制定针对癌症患者手术病理学或细胞病理学中疑难诊断的临床实践指南。
通过检索Medline并使用专家组成员的个人参考文献列表来确定数据。一旦指南确定，该文件将提交给71名独立评审员进行审核。
预防和减少手术病理学或细胞病理学中疑难诊断数量的主要建议如下：1）在每个病理实验室制定使用书面程序的质量保证计划（标准）。2）了解临床数据以解释手术病理学或细胞病理学结果（标准）。3）提供补充患者信息（放射学数据等）有助于解释手术病理学或细胞病理学结果（选项）。检测手术病理学或细胞病理学中与疑难诊断相关病变的主要建议如下：1）对于手术病理学或细胞病理学中已知的潜在疑难诊断肿瘤类型，应由另一位病理学家进行复查。2）对每个病例进行系统的二次复查成本高昂，但在已知疑难情况（肉瘤、淋巴瘤等）时，必须由经验丰富的病理学家进行。解决手术病理学或细胞病理学中疑难诊断的主要建议如下：1）可能需要进行组织块重切、使用特殊技术（免疫细胞组织化学和分子生物学）、获取临床医生的额外数据、征求当地病理学家的第二意见或获取新标本以确立诊断（选项）。2）一旦其他步骤无法确立手术或细胞病理学诊断，必须考虑征求专家病理学家的外部第二意见（建议，专家共识）。
