Jara-Lazaro Ana Richelia, Tan Puay Hoon
Department of Pathology, Singapore General Hospital, Outram Road, Singapore.
Pathology. 2008 Oct;40(6):564-72. doi: 10.1080/00313020802320457.
We aimed to identify common reasons for second opinion breast pathology referrals at the Pathology Department, Singapore General Hospital, focusing on queries and diagnostic issues raised by referring clinicians and pathologists.
Request forms for breast pathology consultations were retrieved from a specialist's correspondence files consisting of pathologists' referrals, and from centralised laboratory records, comprising clinician-initiated referrals. Clinical and histomorphological queries raised by the referrals were collated.
Of 299 cases evaluated, clinician-initiated referrals (n = 137, 46%) included requests for review of overall histopathology to confirm carcinoma subtype (n = 47), grade (n = 2), size (n = 4), lymphovascular invasion (n = 1) and confirm hormonal receptor and c-erbB-2 assays (n = 33). Also required were: comparison of recurrent with previous lesions (n = 8); settling discrepant diagnoses between two or more prior pathology reports (n = 4); verification of microinvasion (n = 6), in situ carcinomas (n = 6) or atypical ductal hyperplasias (n = 4); delineation of benign (n = 8) and spindle cell lesions (n = 3); to establish a breast origin of metastatic lesions (n = 5); and distinction of carcinoma from lymphoma (n = 2). Pathologist-initiated referrals (n = 162, 54%) sought arbitration between borderline proliferative lesions (n = 46) and papillary lesions (n = 34); verification of microinvasion (n = 23), stromal lesions (n = 16), and carcinoma subtype (n = 13), especially if the patient was young (n = 5); clarification of metaplastic changes (n = 4) and lobular neoplasia (n = 8); and comparison of fibroepithelial lesions (n = 11).
Clinicians sought a second opinion mainly to verify histological diagnoses and report important pathological details for staging and confirmation of hormonal receptor and c-erbB-2 status prior to therapy. Borderline breast lesions are worrisome for both clinicians and pathologists in view of implications for management.
我们旨在确定新加坡总医院病理科二次乳腺病理会诊的常见原因，重点关注转诊临床医生和病理学家提出的疑问及诊断问题。
从由病理学家转诊组成的专家通信文件以及由临床医生发起转诊的集中实验室记录中检索乳腺病理会诊申请表。整理转诊提出的临床和组织形态学疑问。
在评估的299例病例中，临床医生发起的转诊（n = 137，46%）包括请求复查整体组织病理学以确认癌亚型（n = 47）、分级（n = 2）、大小（n = 4）、脉管侵犯（n = 1）以及确认激素受体和c-erbB-2检测结果（n = 33）。还需要：比较复发病变与先前病变（n = 8）；解决两份或多份先前病理报告之间的诊断差异（n = 4）；核实微浸润（n = 6）、原位癌（n = 6）或非典型导管增生（n = 4）；明确良性病变（n = 8）和梭形细胞病变（n = 3）；确定转移性病变的乳腺来源（n = 5）；以及区分癌与淋巴瘤（n = 2）。病理学家发起的转诊（n = 162，54%）寻求对交界性增生性病变（n = 46）和乳头状病变（n = 34）进行仲裁；核实微浸润（n = 23）、间质病变（n = 16）和癌亚型（n = 13），尤其是患者年轻的情况（n = 5）；阐明化生改变（n = 4）和小叶肿瘤（n = 8）；以及比较纤维上皮病变（n = 11）。
临床医生寻求二次会诊主要是为了核实组织学诊断，并报告重要的病理细节以用于分期以及在治疗前确认激素受体和c-erbB-2状态。鉴于对治疗的影响，交界性乳腺病变对临床医生和病理学家来说都令人担忧。
