Hamza Ameer, Alrajjal Ahmed, Edens Jacob, Khawar Sidrah, Khurram Muhammad Siddique, Szpunar Susanna, Bonnett Michelle
1 St John Hospital and Medical Center, Detroit, MI, USA.
Int J Surg Pathol. 2018 Aug;26(5):392-401. doi: 10.1177/1066896918755008. Epub 2018 Feb 1.
To avoid diagnostic errors such as missed diagnosis and errors in staging tumors due to inadequate tissue sampling, pathologists submit additional sections (AS).
This study assessed frequency, diagnostic yield, distribution, and cost of AS.
Among 1542 AS cases, we calculated mean AS per case; fraction of AS that altered diagnosis or stage; AS variation by tissue, malignant versus benign lesions, presence or absence of neoadjuvant therapy, mass, margin, lymph nodes, or other source, resident versus pathologist assistant (PA) dissector; and AS cost per case.
Overall 9.2 ± 8.8 AS were collected per case. In only 3.8% (58/1542) of cases AS altered diagnosis or stage. Urinary bladder cases provoked the most AS: 19.5 ± 15.1 per case. Significantly more AS came from malignant versus benign lesions (10.8 ± 9.7 vs 7.6 ± 7.5, P = <.0001) and from specimens treated with neoadjuvant therapy versus malignant lesions not so treated (12.3 ± 9.4 vs 10.3 ± 9.8, P = .02). Lymph nodes were sampled more heavily compared with mass, margin, and other sites combined (11.8 ± 11.4 vs 8.9 ± 8.4, P = .003), but in 78.4% (1209/1542) of cases, AS were from mass. Of diagnosis or stage altering AS cases, two thirds (38/58) were from masses, one fifth (11/58) from lymph nodes, a 10th (6/58) from margins, and a 20th (3/58) from other specimen sites. Resident versus pathologist assistant dissection caused no significant AS difference. AS contributed 40% cost per case.
AS per case ranged widely; their diagnostic yield was low; they were highest in urinary bladder specimens, in malignant and particularly neoadjuvant-treated lesions. Although lymph nodes were most heavily sampled, most AS were from masses. Resident dissection did not increase AS and cost of AS was high.
为避免因组织取样不足导致漏诊及肿瘤分期错误等诊断失误，病理学家会提交额外切片（AS）。
本研究评估了AS的频率、诊断价值、分布及成本。
在1542例AS病例中，我们计算了每例的平均AS数量；改变诊断或分期的AS比例；按组织、恶性与良性病变、是否接受新辅助治疗、肿块、切缘、淋巴结或其他来源、住院医师与病理科助理（PA）解剖者分类的AS差异；以及每例的AS成本。
每例总体收集9.2±8.8张AS切片。仅3.8%（58/1542）的病例中AS改变了诊断或分期。膀胱病例引发的AS最多：每例19.5±15.1张。恶性病变比良性病变产生的AS显著更多（10.8±9.7对7.6±7.5，P =<.0001），接受新辅助治疗的标本比未接受新辅助治疗的恶性病变产生的AS更多（12.3±9.4对10.3±9.8，P =.02）。与肿块、切缘及其他部位总和相比，淋巴结的取样更密集（11.8±11.4对8.9±8.4，P =.003），但在78.4%（1209/1542）的病例中，AS来自肿块。在改变诊断或分期的AS病例中，三分之二（38/58）来自肿块，五分之一（11/58）来自淋巴结，十分之一（6/58）来自切缘，二十分之一（3/58）来自其他标本部位。住院医师与病理科助理解剖导致的AS差异无统计学意义。AS占每例成本的40%。
每例的AS数量差异很大；其诊断价值较低；在膀胱标本、恶性病变尤其是接受新辅助治疗的病变中AS数量最多。虽然淋巴结取样最密集，但大多数AS来自肿块。住院医师解剖并未增加AS数量，且AS成本较高。
