Winters Ryan, Waters Brenda L
Department of Pathology, University of Vermont College of Medicine, Burlington, VT, USA.
Arch Pathol Lab Med. 2008 Dec;132(12):1920-3. doi: 10.5858/132.12.1920.
It is the generally accepted practice to submit 1 or 2 membrane rolls when examining placentas.
To determine whether obtaining additional sections would increase diagnostic yield and, if so, to what degree.
A membrane roll section was prospectively procured from each quadrant of its respective singleton placenta. These placentas were submitted for routine pathologic examination, the process of which was entirely separate from this study. All study sections were randomized and assigned new numbers, thereby blinding the pathologist to the placenta of origin. We evaluated the incidence of acute chorionitis/chorioamnionitis (AC/A) and atherosis when 1, 2, 3, or 4 slides were examined. The diagnostic yield from all possible combinations of single, pairs, and triplets of sections was tabulated. When an additional slide identified more extensive acute inflammation than what was demonstrated initially, the AC/A was upstaged.
With 1 section examined, 7 to 10 placentas had AC/A. With 2 sections, 10 to 15 placentas had AC/A; with 3 sections, 16 to 18 cases; and with 4 sections, 19 cases. Additional sections upstaged the AC/A diagnosis infrequently. A total of 4 of 53 placentas had atherosis, based on review of all 4 slides. One slide identified 1 to 3 cases of atherosis. With a second and third section, the yield increased to 2 to 4 and 3 to 4, respectively.
Review of a single membrane roll identified, at most, 53% of cases of AC/A and 50% of cases of atherosis. Additional sections increased the yield for both diagnoses in a roughly linear manner.
在检查胎盘时提交1或2个胎膜卷是普遍接受的做法。
确定获取更多切片是否会提高诊断率，如果是，提高到何种程度。
从各自单胎胎盘的每个象限前瞻性获取一个胎膜卷切片。这些胎盘被送去进行常规病理检查，该过程与本研究完全分开。所有研究切片都进行了随机化并分配了新的编号，从而使病理学家对胎盘的来源不知情。我们评估了检查1、2、3或4张切片时急性绒毛膜羊膜炎（AC/A）和动脉粥样硬化的发生率。列出了单张、成对和三联切片的所有可能组合的诊断率。当额外的一张切片显示出比最初所见更广泛的急性炎症时，AC/A的分级会提高。
检查1张切片时，有7至10个胎盘存在AC/A。检查2张切片时，有10至15个胎盘存在AC/A；检查3张切片时，有16至18例；检查4张切片时，有19例。额外的切片很少会提高AC/A的诊断分级。在对所有4张切片进行复查后，53个胎盘中共有4个存在动脉粥样硬化。一张切片发现1至3例动脉粥样硬化。第二张和第三张切片时，检出率分别提高到2至4例和3至4例。
对单个胎膜卷的检查最多能发现53%的AC/A病例和50%的动脉粥样硬化病例。额外的切片以大致线性的方式提高了两种诊断的检出率。
