Demers R Y, Neale A V, Budev H, Schade W J
Department of Family Medicine, Wayne State University School of Medicine, Detroit, Michigan.
Am J Gastroenterol. 1990 Apr;85(4):417-21.
Practicing physicians commonly perform flexible sigmoidoscopy in their offices. Polyploid lesions are frequently biopsied and sent to community hospitals for pathological interpretation. The pathologist's opinion often determines the course of medical follow-up for the patient, especially in cases in which early malignancy is suspected. This paper addresses the agreement of community-based pathologists regarding the interpretation of colorectal polyp pathology. Ten pathological slide sections were sent to 22 different community-based pathologists in southeast Michigan. These pathologists were asked to record their diagnosis of the specific histologies represented in each of the slides. The results indicated a high level of agreement of histologies in the dichotomous categories of hyperplasia versus adenoma. However, there was considerable disagreement on the presence of moderate or severe atypia. The results of this study indicate that clinicians performing biopsies on patients at risk for colorectal cancer should be aware of the potential for diagnostic variability among pathologists, and should plan follow-up strategies which may include seeking second pathological opinions when a significant patient management decision must be made.
执业医师常在其办公室进行乙状结肠镜检查。多倍体病变常进行活检，并送往社区医院进行病理诊断。病理学家的意见往往决定了患者的医学随访进程，尤其是在怀疑早期恶性肿瘤的情况下。本文探讨了社区病理学家对结直肠息肉病理诊断的一致性。将10份病理切片分发给密歇根州东南部22位不同的社区病理学家。要求这些病理学家记录他们对每张切片中特定组织学的诊断。结果表明，在增生与腺瘤的二分法类别中，组织学诊断的一致性较高。然而，对于中度或重度异型增生的存在存在相当大的分歧。本研究结果表明，对有结直肠癌风险的患者进行活检的临床医生应意识到病理学家之间诊断差异的可能性，并应制定随访策略，其中可能包括在必须做出重大患者管理决策时寻求第二种病理意见。
