Zarbo R J, Schmidt W A, Bachner P, Howanitz P J, Meier F A, Schifman R B, Boone D J, Herron R M
Department of Pathology, Henry Ford Hospital, Detroit, MI 48202, USA.
Arch Pathol Lab Med. 1996 Jan;120(1):19-25.
To evaluate the reasons (indications) for and immediate intraoperative surgical results (outcomes) associated with pathology intraoperative consultation.
In 1992 and 1993, surgeons collaborated with pathologists in 472 voluntarily participating institutions from the United States (462), Canada (7), Australia (2), and New Zealand (1) in a study jointly sponsored by the College of American Pathologists and the Centers for Disease Control and Prevention. Pathologists selected 20 consecutive intraoperative consultations and assembled a cover letter, a checklist questionnaire, and a copy of the corresponding surgical pathology report, all of which were sent to the surgeon(s) for retrospective evaluation.
The study was distributed to participants in the College of American Pathologists voluntary Q-Probes quality improvement and Surgical Pathology Performance Improvement programs and to Canadian and Australian hospitals with more than 200 beds.
Evaluation of 9164 cases established the five most common indications for intraoperative consultation: (1) establish or confirm diagnosis to determine type or extent of operation (51%), (2) confirm adequacy of margins (16%), (3) confirm nature of tissue to direct sampling for immediate culture or other laboratory study (10%), (4) expedite obtaining diagnosis to inform family or patient (8%), and (5) confirm sufficient tissue submitted to secure diagnosis in permanent section (8%). The information provided by the intraoperative consultation resulted in changed surgical procedures that were either modified, terminated, or newly initiated in 47%, 30%, 6%, 9%, and 28% of cases, corresponding respectively to each of the above five common indications. Rarely cited reasons for intraoperative consultation were to expedite obtaining diagnosis for surgeon's knowledge (3%), to facilitate patient management, other professional communication or discharge planning prior to permanent section availability (3%), academic protocol (< 1%), and consultation not needed or no reason for request (< 1%).
This multi-institutional, interdisciplinary database confirms that pathology intraoperative consultations, regardless of the initial indications, influence immediate patient care decisions, resulting in changed surgical procedures in an average of 39% of all operative cases.
评估术中病理会诊的原因（指征）及与之相关的术中即时手术结果（转归）。
1992年和1993年，外科医生与来自美国（462家）、加拿大（7家）、澳大利亚（2家）和新西兰（1家）的472家自愿参与机构的病理学家合作，开展了一项由美国病理学家学会和疾病控制与预防中心联合赞助的研究。病理学家挑选了连续20例术中会诊病例，并整理了一封附函、一份清单问卷以及相应手术病理报告的副本，所有这些都发送给外科医生进行回顾性评估。
该研究分发给了美国病理学家学会自愿参与的Q-Probes质量改进和外科病理性能改进项目的参与者，以及加拿大和澳大利亚拥有200张以上床位的医院。
对9164例病例的评估确定了术中会诊的五个最常见指征：（1）确立或确认诊断以确定手术类型或范围（51%），（2）确认切缘是否足够（16%），（3）确认组织性质以指导立即采样进行培养或其他实验室检查（10%），（4）加快获得诊断以告知家属或患者（8%），以及（5）确认送检组织足够以确保在永久切片中获得诊断（8%）。术中会诊提供的信息导致手术程序改变，在上述五个常见指征对应的病例中，手术程序分别有47%、30%、6%、9%和28%进行了修改、终止或新启动。术中会诊极少被提及的原因包括加快获得诊断以增加外科医生的知识（3%）、在永久切片可用之前便于患者管理、其他专业沟通或出院计划（3%）、学术规程（<1%）以及不需要会诊或无请求理由（<1%）。
这个多机构、跨学科的数据库证实，术中病理会诊，无论最初的指征如何，都会影响患者的即时护理决策，平均在所有手术病例中有39%导致手术程序改变。
