Ji Xiaolong, we can only know the known world

Ji Xiaolong is not known because he is a "big coffee" in China's pathology community, nor because he is the first doctor in China to dissect the remains of aids patients, but from television: he often talks about health and cancer in TV programs.

Pathology is the most authoritative and quietest discipline in medicine, and the popular and lively science is different, Ji Xiaolong decided to personally go out because he "really can't see the irresponsible statement". Ji Xiaolong, who has been immersed in the cell world for more than forty years and is looking for evidence for the disease every day, is most intolerable to things that lack factual basis.

On the lintel of the pathology department of the Chinese Armed Police General Hospital, Ji Xiaolong had people post a sentence that Goethe had said: "We can only know the world that we already know." This is also the whole interview process, which is constantly mentioned by Ji Xiaolong. He was helpless and unwilling to do so, which was also his original intention to build the "Institute of Nano Medicine", and he wanted to use the more subtle ruler of the nano to discover a new world in the world that people did not yet know.

The doctor's kindness buried the hidden danger

Beijing Morning Post: Why did you study pathology in the first place?

Ji: When I was a hygienist when I was a soldier, there was a fellow villager who joined the army with me, and I was only in my twenties at that time, and I watched his illness get worse and worse, and finally he was cured, and he died, and then I learned that he had esophageal cancer. Although I was only Chinese at that time, I still thought that I would do nothing else in the future and study cancer! Later, after graduating from college, it was the first time to recruit graduate students after the reform and opening up, and I saw "tumor pathology" in the enrollment brochure of 301 Hospital and did not hesitate to apply.

Beijing Morning Post: People don't understand pathology, what do they do?

Ji: Pathology is the "gold standard" when diagnosing diseases. To give a few examples: there is a 32-year-old female patient, because of stomach pain was diagnosed with "appendicitis", the surgeon determined by his own experience in surgery, her appendix is not a big problem, kindly said to the patient: "Save you some money, no need to do pathological examination!" However, this has laid the foundation for this. Two years later, the patient suffered from abdominal pain again, and came to check again, and the results of the examination were unexpected: she was diagnosed with "metastatic carcinoid carcinoma of the liver." This kind of cancer is metastasized from the appendix, the surgery at that time did not do pathology, so it was not found in time, and the opportunity for treatment has been lost to the stage of multiple metastases of the liver.

There was also a male patient with a grain-sized bleeding spot on the thumb of his right hand, and the outpatient doctor thought it was just a very ordinary small hemangioma, and only did a simple expulsion operation, and did not mention that he should go for a pathological examination. Soon, a lump grew in the right armpit of the patient, and it was finally diagnosed as "malignant melanoma metastasis", and its original occurrence was the rice-sized bleeding spot on the thumb. There are many such examples, and pathological examination is one of the most reliable and accurate medical diagnosis methods at present, but unfortunately they miss it.

Accuracy: CT, MRI 75%, pathology 99%

Beijing Morning Post: When it comes to the accuracy of the examination, people immediately think of CT and NUCLEAR magnetism.

Ji: The human body is composed of cells, disease is to start from the cell, pathology is to diagnose the disease by observing the changes in the cells, so it is the most timely and accurate, but this point, not only ordinary people do not understand, our doctors do not fully understand.

A senior cadre routinely examined the body and did a gastroscopy, and the doctor said while doing it: "Chief, your stomach looks normal, and the color of the mucous membrane is the same as that of young people." The chief said, "Since it's all right, don't take the meat for examination." So did not take, the gastroscopy report said: "The esophagus and stomach are generally normal, and no tumors and ulcers are seen." The next year, a routine high-dry examination, gastroscope just entered the stomach, immediately saw a 2cm ulcer in the antrum, took 3 pieces of diseased tissue to send pathology, the pathological result is "gastric adenocarcinoma", and the cancer tissue has penetrated the entire layer of the stomach wall, and the lymph nodes have been widely metastasized.

According to the law of the occurrence and development of gastric cancer, in a year's time, it is impossible to start from scratch and has reached the middle and advanced stages, that is to say, the "normal" when the first gastroscopy is done is only seen by the naked eye of the doctor, and the cancer has been lurking under the "normal" at that time. Therefore, an effective gastroscope must be done at the same time as a pathological biopsy.

In gastroscopy, the size that the doctor can see with the naked eye is 5 mm, but the cancer cells are only 1 mm large when they are 10 to the 6th power, and by the time they see it with the naked eye, it is generally too late. And even if you look at the smooth mucous membrane, it is likely that the cells have changed, are preparing for the situation, do not rely on pathology, only do gastroscopes, and are likely to "lie about military information."

Lung cancer is now relatively well cured, why? It's related to early detection. Lung cancer diagnosis relies on imaging, relying on CT, MRI can find 1, 2 mm of mass, because this test makes money, the hospital is willing to do, the popularity is high, so lung cancer is found early. And pathology, so far, a piece of pathology slice only charges 40 yuan, but the cost is very high, equivalent to doing a piece of hospital loss, naturally it is ignored.

The accuracy rate of the first-level examination methods such as symptoms, signs, physical examination, and medical history is about 50%,00% of the first-level examination methods; the accuracy rate of imaging and experimental examinations such as CT and X-ray is about 75%,, while the accuracy of pathological diagnosis is required to be more than 99%."

Beijing Morning Post: Is the low cure rate of cancer in China related to the late diagnosis?

Ji: Taking stomach cancer, esophageal cancer, and bowel cancer as an example, before Japan, South Korea, and other East Asian regions were high, and the mortality rate was very high, and there were fewer countries in Europe and the United States, which was related to economic backwardness, and these cancers were "poor cancers". By 2000, the incidence and mortality rate of stomach cancer in Japan had dropped a lot, and South Korea had followed The Study of Japan, although it was ten years late, but it had also declined, but China had never changed significantly, especially in relatively backward areas. The improvement of diet is on the one hand, and on the other hand, whether the gastroscopy is taken at the same time as the biopsy. The early lesions found by the biopsy, like the apple that is broken, dig out the piece, the apple can be eaten as usual, but unfortunately, the biopsy rate during our gastroscopy is only 5%.

According to the law of medicine, the biopsy rate is less than 10% of the gastroscopy, there is no value, and it is almost the same as not doing; when the biopsy rate reaches 30%, the gastroscopy is initially qualified; when it reaches 50%, the gastroscopy can be carried out, and reaching 100% is a formal gastroscopy requirement, which is what Japan does. China's cancer cure rate is low, can not be detected early is an important problem, the key is the lack of attention to pathology.

"Medicine only works 8 percent", the phrase is often asked now, but there is a mistake in understanding, as if medicine is useless, and it is the same whether it is seen or not. It is true that we cannot expect the omnipotence of medicine, but this 8%, if it can really be played, is a very large contribution to human beings, and the biopsy rate of gastroscopy is included in this 8%.

(Scroll down to B02 version)

Ji Xiaolong

Chief Physician of the Department of Pathology, Armed Police Academy of China, Professor, Doctoral Supervisor

Expert of the State, the Military, and the Beijing Municipal Medical Malpractice Appraisal Committee

Chairman of the Pathology Committee of the Beijing Branch of the Chinese Anti-Cancer Association

Member of the Standing Committee of the Tumor Marker Professional Committee of the Chinese Anti-Cancer Association

Standing Director of the Fifth Council of the Beijing Branch of the Chinese Anti-Cancer Association

Leader of the Digestive Pathology Professional Group of the Digestive Disease Branch of the Chinese Medical Association

Consultation expert of the Health Committee of the Central Military Commission

Every year, more than 3,000 cases of difficult and critical consultations are completed in various places

In 1993, he enjoyed special government allowances