Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2010 Mar;183(3):921-7. doi: 10.1016/j.juro.2009.11.049. Epub 2010 Jan 20.
The value of pathological reinterpretation of tissue slides has long been questioned. At the Cleveland Clinic subspecialization in genitourinary pathology began in 2003 and has been maintained. We evaluate the role of second review on transurethral bladder tumor resection pathology slides before and after subspecialization and potential impact on treatment.
Transurethral bladder tumor resection specimens from 78 and 116 patients with bladder cancer in 2002 and 2004, respectively, were reviewed. Initial surgical pathology reports from institutions outside the Cleveland Clinic were compared with review report by a pathologist with genitourinary pathology specialization (HSL). Those cases with differences in diagnosis or staging were then evaluated by a urologist (JSJ) considering current standards of care.
The reinterpretation differed substantially from the initial report in 26 of 78 cases (33.3%) in 2002 and in 31 of 116 (26.7%) in 2004 (p = 0.3), resulting in a possible impact on management in 28.2% (22 of 78) in 2002 and 23.3% (27 of 116) in 2004 (p = 0.54). In each year 4 cases diagnosed with bladder cancer elsewhere were determined to have no malignancy. The majority of discrepancies related to the presence of carcinoma in situ in 2002 and to the presence or absence of muscularis propria and/or muscle involvement by carcinoma in 2004.
Second review of transurethral bladder tumor resection specimens shows differences of interpretation in 26.7% to 33.3% of cases, which is sufficient to alter management. There was no significant difference in the rate of discrepancies before and after genitourinary pathology subspecialization. Referral centers must assume responsibility for establishing the diagnosis before consultation and/or therapy.
组织切片的病理重新解读价值一直受到质疑。克利夫兰诊所的泌尿生殖系统病理学专业于 2003 年开始，并一直延续至今。我们评估了专业分工前后对经尿道膀胱肿瘤切除病理切片的二次审查的作用，以及其对治疗的潜在影响。
分别对 2002 年和 2004 年 78 例和 116 例膀胱癌患者的经尿道膀胱肿瘤切除标本进行了回顾。与克利夫兰诊所以外机构的初始外科病理报告进行了比较，并由泌尿生殖系统病理专业医生（HSL）进行了复查报告。对于那些在诊断或分期上存在差异的病例，然后由泌尿科医生（JSJ）根据当前的护理标准进行评估。
在 2002 年的 78 例病例中有 26 例（33.3%）和 2004 年的 116 例病例中有 31 例（26.7%）的重新解读与初始报告有显著差异（p = 0.3），导致管理方面的可能影响分别为 2002 年的 22 例（28.2%）和 2004 年的 27 例（23.3%）（p = 0.54）。在每一年中，有 4 例在其他地方诊断为膀胱癌的病例被确定为无恶性肿瘤。大多数差异与 2002 年原位癌的存在以及 2004 年固有肌层和/或肌肉受累的存在或不存在有关。
经尿道膀胱肿瘤切除标本的二次审查显示，在 26.7%至 33.3%的病例中存在解释上的差异，足以改变治疗方法。在泌尿生殖系统病理学专业分工前后，差异发生率没有显著差异。转诊中心必须承担在咨询和/或治疗前建立诊断的责任。
