Prescott R J, Wells S, Bisset D L, Banerjee S S, Harris M
Department of Histopathology, Bolton General Hospital.
J Clin Pathol. 1995 Mar;48(3):245-9. doi: 10.1136/jcp.48.3.245.
To analyse the diagnostic differences in reporting tumour histopathology between a district general hospital and a regional oncology centre.
Tumour histopathology reports (n = 227) extracted from Bolton General Hospital files between 1988 and 1992 were compared with the corresponding Christie Hospital (oncology centre) reports, the same material having been seen at both hospitals.
Diagnostic agreement existed in 77% of all cases. The incidence of major discrepancies was 8.37%. Of the diagnoses, 19 (36%) cases involved major discrepancies and 34 (64%) cases minor discrepancies. Most discrepancies occurred in the lymphoma group and involved subclassification of Hodgkin's and non-Hodgkin's lymphoma. Ki1 anaplastic large cell lymphoma and T cell rich B cell lymphoma were problematic diagnoses. The correct grading of follicle centre cell lymphomas using the Kiel classification was another problem area. In 19 cases certain aspects of immunohistochemistry produced discrepancies. In one case an incorrect diagnosis was made at the oncology centre and in another both centres gave an incorrect diagnosis.
Areas of diagnostic difficulty mainly involve the subclassification of lymphomas. Review of tumour pathology by experts is recommended, at least in certain categories, to ensure correct diagnosis and uniformity in subclassification of tumours.
分析地区综合医院与区域肿瘤中心在报告肿瘤组织病理学诊断方面的差异。
将1988年至1992年间从博尔顿综合医院档案中提取的227份肿瘤组织病理学报告与相应的克里斯蒂医院（肿瘤中心）报告进行比较，两家医院观察的是相同材料。
所有病例中77%存在诊断一致性。主要差异的发生率为8.37%。在诊断中，19例（36%）涉及主要差异，34例（64%）涉及次要差异。大多数差异发生在淋巴瘤组，涉及霍奇金淋巴瘤和非霍奇金淋巴瘤的亚分类。Ki1间变性大细胞淋巴瘤和富于T细胞的B细胞淋巴瘤是诊断难题。使用基尔分类法对滤泡中心细胞淋巴瘤进行正确分级是另一个问题领域。19例中免疫组化的某些方面产生了差异。1例在肿瘤中心做出了错误诊断，另1例两个中心均做出了错误诊断。
诊断困难的领域主要涉及淋巴瘤的亚分类。建议至少在某些类别中由专家对肿瘤病理学进行审查，以确保正确诊断和肿瘤亚分类的一致性。
