Coffin Carla S, Burak Kelly W, Hart John, Gao Zu-hua
Department of Medicine, University of Calgary, Calgary, AB, Canada.
Mod Pathol. 2006 Jun;19(6):832-8. doi: 10.1038/modpathol.3800605.
We studied the impact of pathologist experience on liver transplant biopsy interpretation for cases designated 'nonspecific' by pathologists at a nontransplant center. Among 102 consecutive liver transplant biopsies from 92 patients performed at the Foothills Medical Center, 30 liver biopsies from 23 patients were designated 'nonspecific' by the local pathologist. These biopsy slides were independently reviewed by an expert in liver transplant pathology at a major US transplant center. The expert pathologist was given only the information on the original requisition. In seven biopsies from five patients, there was full agreement between the external expert and the local pathologist. In 10 biopsies from six patients, the expert concurred with the initial assessment but emphasized critical negatives such as 'no evidence of rejection or recurrent hepatitis'. A discrepant diagnosis was found in 13 biopsies from 12 patients. In five biopsies from four patients, the revised diagnoses were inaccurate due to insufficient or misleading clinical information on the requisition. In eight biopsies from eight patients, the revised diagnoses were proven to be correct by clinicopathologic correlation. Our study shows that pathology expertise helped to clarify the diagnosis in about 27% of cases, which justifies the cost of obtaining a second opinion in difficult biopsies. Misinterpretation by the expert pathologist in up to 17% of biopsies highlights the importance of direct communication between hepatologist and pathologist in order to achieve a correct diagnosis. Familiarity with those cases with relatively uncommon histology, a diligent search for subtle morphologic changes, and use of standard terminology could improve the quality of liver transplant biopsy interpretation in a nontransplant center.
我们研究了病理学家经验对一家非移植中心被病理学家判定为“非特异性”的肝移植活检病例解读的影响。在山麓医疗中心对92名患者进行的102例连续肝移植活检中，当地病理学家将23名患者的30例肝活检判定为“非特异性”。这些活检玻片由美国一家主要移植中心的肝移植病理学专家独立复查。这位专家病理学家仅被告知原始申请单上的信息。在来自5名患者的7例活检中，外部专家与当地病理学家完全一致。在来自6名患者的10例活检中，专家同意初始评估，但强调了关键的阴性结果，如“无排斥或复发性肝炎证据”。在来自12名患者的13例活检中发现了不同的诊断结果。在来自4名患者的5例活检中，由于申请单上临床信息不足或有误导性，修订后的诊断不准确。在来自8名患者的8例活检中，经临床病理对照证明修订后的诊断是正确的。我们的研究表明，病理专业知识有助于在约27%的病例中明确诊断，这证明了在疑难活检中获取第二种意见的成本是合理的。专家病理学家在高达17%的活检中出现误判，凸显了肝病学家与病理学家之间直接沟通以实现正确诊断的重要性。熟悉那些组织学相对不常见的病例、认真寻找细微的形态学变化以及使用标准术语，可提高非移植中心肝移植活检解读的质量。
