Lowy A, Willis D, Abrams K
Department of Epidemiology and Public Health, University of Leicester, Faculty of Medicine.
BMJ. 1997 Aug 16;315(7105):406-8. doi: 10.1136/bmj.315.7105.406.
To examine whether histological examination of all tissue removed by general practitioners in minor surgery increases the rate of detection of clinically important skin lesions, and to assess the impact of such a policy on pathologists' workload.
Before and after comparison.
Stratified random sample of 257 general practitioner partnerships from the catchment areas of 19 English pathology laboratories.
Tissue removed in minor surgery by general practitioners during the control period (September 1992 to February 1993) and intervention period (September 1993 to February 1994).
General practitioners referred to their local pathology laboratory all solid tissue removed in all minor surgery, irrespective of their previous policy.
Numbers of specimens referred for histology by general practitioners during intervention and control periods; numbers of primary malignant melanomas, non-melanoma malignancies, premalignant lesions, and benign lesions.
257/330 partnerships participated (response rate 78%). During the intervention period 5723 specimens were sent, compared with 4430 during the control period. The referral rate increased by an estimated 1.34 specimens per 1000 patient years (95% confidence interval 0.93 to 1.76, P < 0.0001). General practitioners sent 204 specimens that were malignant (including 16 malignant melanomas) in the control period and 188 that were malignant (including 15 malignant melanomas) during the intervention period (change in total number of malignancies, -1.0 per 100,000 patient years (-5.9 to 3.8, non-significant).
The intervention was associated with a substantial increase in laboratory workload, all of which was accounted for by increases in non-serious lesions. This observation should be taken into account when considering the merits of a policy requiring histological examination in every case.
研究全科医生在小手术中切除的所有组织进行组织学检查是否会提高临床重要皮肤病变的检出率，并评估该政策对病理学家工作量的影响。
前后对照研究。
从19个英国病理实验室服务区域中抽取的257个全科医生合作诊所的分层随机样本。
在对照期（1992年9月至1993年2月）和干预期（1993年9月至1994年2月）由全科医生在小手术中切除的组织。
无论之前的政策如何，全科医生将所有小手术中切除的实体组织都送往当地病理实验室。
干预期和对照期全科医生送检组织学检查的标本数量；原发性恶性黑色素瘤、非黑色素瘤恶性肿瘤、癌前病变和良性病变的数量。
257/330个合作诊所参与研究（回复率78%）。干预期送检标本5723份，对照期为4430份。转诊率估计每1000患者年增加1.34份标本（95%置信区间0.93至1.76，P<0.0001）。对照期全科医生送检204份恶性标本（包括16例恶性黑色素瘤），干预期为188份恶性标本（包括15例恶性黑色素瘤）（恶性肿瘤总数变化为每100,000患者年-1.0（-5.9至3.8，无统计学意义）。
干预措施使实验室工作量大幅增加，且全部是由非严重病变数量增加导致的。在考虑每项病例均需进行组织学检查这一政策的优点时，应考虑到这一观察结果。
