Arbiser Z K, Folpe A L, Weiss S W
Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Rd, Atlanta, GA 30322, USA.
Am J Clin Pathol. 2001 Oct;116(4):473-6. doi: 10.1309/425H-NW4W-XC9A-005H.
We reviewed 500 consecutive soft tissue lesions referred for expert consultation to determine types of lesions and/or situations in which major discrepancies occur. Of 266 cases (53.2%) accompanied by a diagnosis, essential agreement with the second opinion was noted in 68%, minor discrepancy in 7%, and major discrepancy in 25%. The 65 major discrepancies were distributed proportionally to the referring sources and could be divided into 4 groups: benign mesenchymal lesions diagnosed as sarcomas (45%), sarcomas diagnosed as benign tumors (23%), nonmesenchymal lesions diagnosed as sarcoma (20%), and major grading discrepancies (12%). Relatively few lesions accounted for a major proportion of major discrepancies. Problematic lesions were lipoma and fasciitis and their variants and desmoplastic-neurotropic melanoma. Needle biopsy specimens were somewhat more likely to be associated with a discrepant opinion. With the exception of nonmesenchymal lesions, the diagnosis for all major discrepant cases could be made on the basis of the H&E-stained slides, suggesting that failure to perform immunostains did not account for discrepancies. Lack of familiarity with rare or unusual lesions is probably more significant in explaining diagnostic discrepancies than is the increasing use of needle biopsy or the failure to perform immunohistochemical analysis.
我们回顾了500例连续转诊至专家处进行会诊的软组织病变，以确定病变类型和/或出现重大差异的情况。在266例（53.2%）有诊断结果的病例中，与二次诊断基本一致的占68%，轻微差异的占7%，重大差异的占25%。65例重大差异按转诊来源成比例分布，可分为4组：诊断为肉瘤的良性间叶性病变（45%）、诊断为良性肿瘤的肉瘤（23%）、诊断为肉瘤的非间叶性病变（20%）和重大分级差异（12%）。相对较少的病变占重大差异的很大比例。有问题的病变是脂肪瘤、筋膜炎及其变体以及促结缔组织增生性神经性黑色素瘤。针吸活检标本出现不同意见的可能性略高。除了非间叶性病变外，所有重大差异病例的诊断都可以根据苏木精-伊红染色切片做出，这表明未进行免疫染色并非导致差异的原因。在解释诊断差异方面，对罕见或不寻常病变的不熟悉可能比针吸活检的使用增加或未进行免疫组化分析更为重要。
