McBroom H M, Ramsay A D
Department of Histopathology, Southampton University Hospitals, England.
Am J Surg Pathol. 1993 Jan;17(1):75-80.
The clinicopathological meeting is one of the major areas of contact between clinician and pathologist, and the review of histology reports at such meetings can be regarded as an aspect of quality control for diagnostic pathology. To assess the effects of this review, we have conducted a formal analysis of clinicopathological meetings in the Southampton University Hospitals. Over a 14-week period, 416 cases were reviewed at 58 meetings. Seven categories of meeting were involved; Breast; Dermatology; Ear, Nose, and Throat (ENT) and Oral Surgery; Gastroenterology; General Surgery; Oncology; and Urology. A proforma was completed for each case that was reviewed, evaluating changes in diagnosis, the reason for such changes, and the effect, if any, on patient management. Participating consultants, both clinicians and pathologists, were questioned regarding the aims of their particular meeting, and how successful they felt the meeting to be. Histological review resulted in an altered diagnosis in 9% of cases, a refined diagnosis in 10% of cases, and no diagnostic change in 81%. Most (88.1%) of the diagnostic changes were attributable to the specialist expertise of the reviewing pathologist, and only 4.8% resulted from the clinicians providing extra information. Amended diagnoses led to major management changes in 16 cases (3.8%), minor management changes in 12 cases (2.9%), and no management change in 388 cases (93.3%). The Gastroenterology meeting showed the highest figures for clinically significant diagnostic changes; there was an amended diagnosis in 44.2% of cases reviewed, 83.3% of which altered patient management. These figures were related to the specialist review of endoscopic biopsy specimens. Although the variation in the methods used to select cases for review and the different roles of individual meetings prevent their adoption into a formal systematic audit scheme, analysis of case review at clinicopathological meetings can yield valuable information concerning departmental diagnostic performance.
临床病理讨论会是临床医生和病理学家主要的交流领域之一，在此类会议上对组织学报告进行审查可视为诊断病理学质量控制的一个方面。为评估这种审查的效果，我们对南安普敦大学医院的临床病理讨论会进行了正式分析。在为期14周的时间里，在58次会议上审查了416例病例。涉及七类会议：乳腺科；皮肤科；耳鼻喉科（ENT）及口腔外科；胃肠病学；普通外科；肿瘤学；以及泌尿外科。对每例审查病例都填写了一份表格，评估诊断的变化、变化的原因以及对患者管理的影响（如有）。参与的临床医生和病理学家顾问被问及他们特定会议的目的，以及他们认为会议的成功程度。组织学审查导致9%的病例诊断改变，10%的病例诊断细化，81%的病例无诊断改变。大多数（88.1%）诊断改变归因于审查病理学家的专业知识，只有4.8%是临床医生提供额外信息导致的。修正诊断导致16例（3.8%）患者的主要管理改变，12例（2.9%）患者的次要管理改变，388例（93.3%）患者无管理改变。胃肠病学会议在具有临床意义的诊断改变方面比例最高；在审查的病例中有44.2%修正了诊断，其中83.3%改变了患者管理。这些数据与内镜活检标本的专家审查有关。尽管用于选择审查病例的方法存在差异以及各个会议的不同作用妨碍了将其纳入正式的系统审核方案，但对临床病理讨论会上病例审查的分析可以产生有关科室诊断表现的有价值信息。
