Lerch M M
Department of Medicine B, Westfälische Wilhelms-Universität Münster.
Verh Dtsch Ges Pathol. 2001;85:87-90.
To the disadvantage of physician in training and quality control the number of post mortem examinations has declined in many Western countries including Germany. The frequency at which surgical or biopsy specimens are investigated by pathologist, on the other hand, appears to increase and clinicians have become increasingly more reliant on a pathologists assessment in terms of diagnosis and treatment strategy. There are some areas where communication between clinician and pathologist could be improved. The first regards the classification of malignancies which should, wherever possible, follow international guidelines such the WHO's. From a clinicians perspective assessment of tumour staging and grading should be based on the patient's prognosis rather than morphological criteria alone. In the case of rare tumours, for which the clinician can be assumed to be ignorant, reference to the literature is helpful. If the surgical or biopsy specimen reveals a malignancy that cannot be classified suggestions for a differential diagnosis can be still helpful. Frequently, at least in my field of speciality, the only tissue accessible is a hepatic or lymphatic metastasis. Determination of the tumour of origin is often essential in deciding on treatment options and every effort including immonocytochemical methods should be made to help to determine the tumour's original site. It spares enormous cost and makes many unpleasant interventional procedures redundant. Further areas where clinicians increasingly need help from pathologists are the diagnosis of inflammatory and infectious diseases and in the usage of molecular genetic methods.
对正在接受培训的医生以及质量控制而言不利的是,包括德国在内的许多西方国家尸检数量都有所下降。另一方面,病理学家对外科手术或活检标本进行检查的频率似乎在增加,并且临床医生在诊断和治疗策略方面越来越依赖病理学家的评估。在一些领域,临床医生和病理学家之间的沟通还有待改进。首先是恶性肿瘤的分类,只要有可能,就应遵循国际指南,如世界卫生组织的指南。从临床医生的角度来看,肿瘤分期和分级的评估应基于患者的预后,而不仅仅是形态学标准。对于罕见肿瘤,临床医生可能对此并不了解,参考相关文献会有所帮助。如果手术或活检标本显示为无法分类的恶性肿瘤,提供鉴别诊断建议仍会有所帮助。通常,至少在我的专业领域,唯一可获取的组织是肝转移瘤或淋巴转移瘤。确定肿瘤的起源对于决定治疗方案往往至关重要,应尽一切努力,包括采用免疫细胞化学方法,来帮助确定肿瘤的原发部位。这可节省大量成本,并使许多不愉快的介入性操作变得多余。临床医生越来越需要病理学家帮助的其他领域包括炎症和感染性疾病的诊断以及分子遗传学方法的应用。