Khong T Y, Stewart C J, Mott C, Chambers H M, Staples A J
Department of Pathology, Queen Victoria Hospital, Australia.
Am J Clin Pathol. 1994 Jul;102(1):72-5. doi: 10.1093/ajcp/102.1.72.
This study compared conventional light microscopy with immunohistochemistry in the histopathologic diagnosis of intrauterine pregnancy in curettings in which fetal parts and chorionic villi were absent. Hematoxylin and eosin-stained sections of the curettings, which were from 50 consecutive patients in whom incomplete abortion had been diagnosed clinically, were circulated to four pathologists who graded their diagnoses with a confidence score. Immunohistochemical examination using a standard streptavidin-biotin-peroxidase method with anti-HPL and antikeratin antisera was performed. The pathologists in the maternity hospitals achieved a high level of diagnostic confidence compared with those working in the general hospitals. However, there were erroneous diagnoses by the one pathologist in the former group and none by the latter. Critical path analysis showed that the best performing pathologist could accurately diagnose all but two of the cases that had been diagnosed with a degree of doubt by the other pathologists without recourse to immunohistochemical examination. These results suggest that immunohistochemistry may be used discriminately in uncertain cases or if relatively inexperienced pathologists are reporting.
本研究比较了传统光学显微镜检查与免疫组织化学方法在刮宫组织中诊断宫内妊娠的组织病理学应用，这些刮宫组织中未发现胎儿组织和绒毛膜绒毛。选取了50例临床诊断为不全流产的连续患者的刮宫组织，制成苏木精-伊红染色切片，分发给4位病理学家，他们对诊断进行分级并给出信心评分。采用标准链霉亲和素-生物素-过氧化物酶法，使用抗人胎盘催乳素（HPL）和抗角蛋白抗血清进行免疫组织化学检查。与综合医院的病理学家相比，妇产医院的病理学家诊断信心更高。然而，前一组中有一位病理学家出现了错误诊断，而后一组则没有。关键路径分析表明，表现最佳的病理学家能够准确诊断出其他病理学家诊断存疑的所有病例，但有两例除外，且无需借助免疫组织化学检查。这些结果表明，在诊断不确定的情况下或由经验相对不足的病理学家进行报告时，可以有选择地使用免疫组织化学方法。
