Sunflower Volunteer: Shi Lizhe
Sunflower Kids' 35th Q&A has begun! In this issue, we have the honor to invite Teacher Zhu Kun to answer our questions about pathology.
Expert introduction
Kun Zhu, Attending Physician of Pathology, Children's Hospital Affiliated to Zhejiang University School of Medicine, Ph.D. in Pediatrics, visiting scholar at Los Angeles Children's Hospital, Keck School of Medicine, UNIVERSITY of Southern California, USA, trained in the International Advanced Pediatric Pathologist Training Program.
He is good at pediatric tumor pathology and molecular pathological diagnosis; as the main completer, he has participated in 1 general project of the Provincial Natural Science Foundation, participated in 1 practical patent invention, and published 6 sci papers.
We have summarized some common problems in pathology, asked Teacher Zhu to answer, and hoped to give some reference to the parents of the children.
1
q: What are the parts of the pathological diagnosis report?
a: There are many types of pathological diagnosis reports, including: general living tissue examination routine pathological diagnosis report, rapid living tissue examination routine pathological diagnosis report during surgery, cytology examination routine pathological diagnosis report, molecular pathology diagnosis report, cadaver autopsy diagnosis routine report, etc.; different types of reports have slightly different modes.
In general, the pathology report mainly includes: the basic information of the patient, the general or microscopic description, the pathological diagnosis and other parts, of which the pathological diagnosis part may be one of the most concerned contents of doctors and patients.
2
q: What are the words that are easy to misunderstand in the pathological diagnosis report?
a: Taking the common general biopsy routine pathological diagnosis report as an example, the pathological diagnosis expression is mainly divided into four categories: I., II., III., and IV.
Among them, class I is a more definite pathological diagnosis;
Class II, often with "in line with", "consider", "do not exclude", "prompt", "tendency" or "may" and other words, indicating that the pathological diagnosis is not yet completely certain, there are reservations, the need to combine clinical comprehensive judgment, etc. When reading such reports, non-professionals are prone to misunderstanding and need to be paid attention to.
Class III is a descriptive diagnosis and is usually used when the lesions shown in the slices are not sufficient to diagnose a disease.
Class IV is generally only used when, for some special reason, a pathological diagnosis cannot be made.
3
q: Multiple pathologies are different, what does it mean?
a: Pathology includes basic pathology and clinical pathology, which is a bridge discipline connecting basic medicine and clinical medicine; among them, clinical pathology belongs to clinical medicine and is an empirical and practical discipline.
Although for a long time, clinical pathological diagnosis has been regarded as the "gold standard" for disease diagnosis, especially tumor diagnosis, and has been valued by practitioners in the medical field at home and abroad.
However, due to the unknownness and complexity of the disease, the experience of the pathologist, and the differences in the diagnostic methods and strategies adopted, the same patient and the pathological diagnosis reports given by multiple medical institutions may be inconsistent.
It should be emphasized here that the inconsistencies in pathological diagnosis reports do not refer to the inconsistencies of simple text descriptions, but the differences in the core content that affect the treatment and prognosis of patients.
The same disease is expressed in different words or different names are used for the same disease, but the core content of the expression is consistent and should not be understood as inconsistent pathological diagnosis.
Understanding the logic and connotation of the pathological diagnosis report requires a large amount of clinical medicine and basic medical knowledge as a background; the pathological diagnosis report must be issued by a pathologist with corresponding qualifications, and the diagnostic report also requires interpretation by professionals in the relevant professional field.
4
q: A recent pathology shows that the cell morphology and immunohistochemistry are consistent with synovial sarcoma, but the synovial sarcoma molecules are negative, and the diagnosis results support synovial sarcoma.
a: It should be pointed out that the routine pathological diagnosis report of rapid living tissue examination in surgery and the routine pathological diagnosis report of cytology examination are allowed to have a certain false positive or false negative rate due to the limitations of technical means, and when the above two types of diagnostic reports do not match the results of the ordinary living tissue examination routine pathological diagnosis report, the latter should prevail.
The molecular pathology diagnosis report is a supplement to the routine pathological diagnosis report of ordinary biopsy and can play a certain auxiliary role.
5
q: Do I need to re-do immunohistochemistry after chemoradiation? Is immunohistochemistry necessary to do pathology? What is the relationship between pathology and immunohistochemistry?
A: Immunohistochemical staining (immunohistochemistry) results are generally integrated in the above report issued, as to whether a disease is necessary to do immunohistochemistry, which part, which projects, under what circumstances, usually by the pathologist according to the histomorphological results of the comprehensive judgment; sometimes also need to be based on the patient's individual situation and clinician communication after implementation.
Histomorphology is the "cornerstone" of pathological diagnosis; without histomorphology, simply talking about molecular pathology and immunohistochemistry, pathological diagnosis has become "passive water, no wood without roots". Therefore, when the molecular pathology and/or immunohistochemical results are inconsistent with the histomorphological results, we should first refer to the histomorphological results for interpretation.
6
q: If it cannot be diagnosed at present, will it affect the treatment plan?
a: With the rapid development of medicine, whether at home or abroad, the status of the "gold standard" of pathological diagnosis is constantly being impacted and challenged, and a small number of cases may still not be able to provide a strong diagnosis to clinicians and patients after consultation with many medical institutions at home and abroad.
At this time, pathologists often use the previously mentioned class III pathological diagnosis to make a descriptive diagnosis; such diseases are often rare, and we know that the choice of treatment plan is generally carried out after the pathological diagnosis.
For a small number of rare diseases that cannot be diagnosed by pathology, the choice of treatment plan still needs to collect more cases with similar clinical pathological characteristics for induction, analysis and summary, which is also one of the directions of clinical pathology research.
Children's Hospital Affiliated to Zhejiang University School of Medicine
The Children's Hospital Affiliated to Zhejiang University School of Medicine (Zhejiang Children's Hospital, Zhejiang Provincial Children's Health Hospital) was formerly known as the "Zhejiang Provincial Maternal and Child Health Hospital" established in 1951, and the founder and first president was Professor Li Qihua, a famous pediatric expert in China. After more than 60 years of construction and development, the hospital's discipline level, clinical business ability and comprehensive strength are in the forefront of national children's hospitals.
Hospital Website: http://www.zjuch.cn/
Department of Pathology
The Department of Pathology is a comprehensive clinical pathology department composed of pediatric surgical pathology, gastrointestinal biopsy pathology, kidney biopsy pathology, bone marrow pathology, cytology pathology, molecular biology pathology, immunohistochemistry pathology and respiratory virus detection.
The annual external examination volume of the pathology department has reached more than 10,000 cases, the number of renal puncture disease examinations exceeded 250, and the number of respiratory virus tests exceeded 20,000. The Department of Pathology has accumulated rich experience in the pathological diagnosis of various childhood diseases, especially pediatric tumors, gastrointestinal and renal diseases, and has a strong ability to diagnose difficult and rare diseases.
"Pathology is the foundation of medicine", with the improvement of the diagnostic level of the department of pathology and the continuous updating of new equipment and technology, the department will provide more comprehensive and high-quality diagnosis for the clinic.