Pereira Telma C, Clayton Amy C, Tazelaar Henry D, Liu Yulin, Leon Marino, Silverman Jan F
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Diagn Cytopathol. 2006 Jun;34(6):447-51. doi: 10.1002/dc.20443.
The concept of critical values (CVs) is well established in clinical pathology, and has only recently been suggested in surgical pathology. To evaluate CVs in cytology, we reviewed 2,000 cytology reports at two large academic medical centers. Cases considered CV included unexpected malignancy, disagreement between immediate interpretation and final diagnosis in fine-needle aspirations (FNAs), and evidence of microorganisms in non-gynecology (non-GYN) and FNA specimens. We identified 52 CV cases (2.6%), including 0.25% (1/400) GYN, 1.88% (15/800) non-GYN, and 4.5% (36/800) FNA. Most of these (42 cases) were unexpected malignancies. Documentation of physician notification was present in 30 out of 52 cases. We also did a survey with 22 cytopathologists and 13 clinicians at large academic medical centers. The participants were asked to rate 18 different possible CVs from 1 to 3 as follows: (1) no phone call necessary, (2) phone call within 24 hr, (3) phone call as soon as possible (ASAP). Participants could also list additional diagnoses they believed constituted a CV. Most respondents agreed on the need for a phone call ASAP in many situations, and important additional CV cases were suggested. We suggest that a consensus conference of leaders in anatomic pathology and clinicians might prove useful to propose guidelines for CVs in cytology.
危急值（CVs）的概念在临床病理学中已得到充分确立，而在外科病理学中直到最近才被提出。为了评估细胞学中的危急值，我们回顾了两家大型学术医疗中心的2000份细胞学报告。被视为危急值的病例包括意外的恶性肿瘤、细针穿刺抽吸术（FNA）中即时解读与最终诊断之间的不一致，以及非妇科（非GYN）和FNA标本中微生物的证据。我们识别出52例危急值病例（2.6%），包括0.25%（1/400）的妇科病例、1.88%（15/800）的非妇科病例和4.5%（36/800）的FNA病例。其中大多数（42例）是意外的恶性肿瘤。52例病例中有30例记录了通知医生的情况。我们还对大型学术医疗中心的22位细胞病理学家和13位临床医生进行了一项调查。要求参与者对18种不同的可能危急值从1到3进行如下评分：（1）无需打电话，（2）24小时内打电话，（3）尽快打电话（ASAP）。参与者还可以列出他们认为构成危急值的其他诊断。大多数受访者同意在许多情况下需要尽快打电话，并提出了重要的额外危急值病例。我们建议解剖病理学领域的领导者和临床医生召开一次共识会议，这可能有助于提出细胞学危急值的指导方针。
