• 1. 四川大學(xué)華西醫(yī)院病理科,成都,6100412. 四川大學(xué)華西醫(yī)院消化內(nèi)科3. 四川大學(xué)華西臨床醫(yī)學(xué)院;

目的 　探討統(tǒng)一診斷標(biāo)準(zhǔn)對(duì)乳腺導(dǎo)管增生性病變?cè)\斷重復(fù)性的影響,尋求提高病理診斷可重復(fù)性和準(zhǔn)確性的措施.
方法 　參照Page標(biāo)準(zhǔn)收集43例乳腺導(dǎo)管增生性病變,每例選取一張切片并隨機(jī)排序.10位病理醫(yī)師兩兩配對(duì)后隨機(jī)進(jìn)入試驗(yàn)組(統(tǒng)一診斷標(biāo)準(zhǔn)組)和對(duì)照組,各自獨(dú)立讀片后從輕度普通型增生、中-重度普通型增生、輕度非典型增生、中-重度非典型增生、導(dǎo)管原位癌和導(dǎo)管原位癌伴浸潤(rùn)這6種診斷中選取一種,并采用STATA統(tǒng)計(jì)軟件對(duì)兩組病理醫(yī)師間的診斷重復(fù)性進(jìn)行Kappa分析.同時(shí)以兩位乳腺?？撇±磲t(yī)師按照Page標(biāo)準(zhǔn)確認(rèn)的診斷作為參照,對(duì)兩組病理醫(yī)師診斷的準(zhǔn)確性和過(guò)度診斷進(jìn)行統(tǒng)計(jì)學(xué)分析.
結(jié)果 　統(tǒng)一使用Page標(biāo)準(zhǔn)的試驗(yàn)組的診斷重復(fù)性和準(zhǔn)確性均高于對(duì)照組(兩組6種、3種和2種診斷時(shí)的總K值分別為0.289 3,0.337 1,0.492 8和0.100 3,0.150 3,0.340 5),說(shuō)明統(tǒng)一診斷標(biāo)準(zhǔn)有利于提高診斷重復(fù)性.同時(shí),診斷類別簡(jiǎn)化也提高了診斷的可重復(fù)性.試驗(yàn)組醫(yī)師仍存在不同程度的過(guò)度診斷.
結(jié)論 　統(tǒng)一診斷標(biāo)準(zhǔn)是提高病理診斷可重復(fù)性和準(zhǔn)確性的重要措施;對(duì)診斷標(biāo)準(zhǔn)的掌握需要在實(shí)踐中進(jìn)一步提高.

引用本文： 魏兵,張紅英,王玉芳,步宏,陳卉嬌,郭華,戴晴晴,湯曦,郎志強(qiáng),李新軍. 統(tǒng)一診斷標(biāo)準(zhǔn)對(duì)乳腺導(dǎo)管增生性病變病理診斷重復(fù)性的影響. 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(11): 766-770. doi: 復(fù)制

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3. ［2］Greenhalgh T. How to read a paper. Papers that report diagnostic or screening tests[J]. BMJ, 1997; 315(7107):540-543.
4. ［3］Wang JS. Research and evaluation of diagnostic test[A]. See: Wang JL. Clinical epidemiology[M]. 2st ed. Shanghai: Shanghai science and Technology Publishing House; 2001. p.258-272.
5. 王覺生.診斷性試驗(yàn)的研究與評(píng)價(jià)[A]. 見:王家良,主編.臨床流行病學(xué)[M]. 第2版.上海:上?？茖W(xué)技術(shù)出版社; 2001. p.258～272.
6. ［4］Bu H, Wei B. Reproducibility and limitation in pathological diagnosis[J]. Chinese Journal of Clinical and Experimental Pathology, 2003; 19(1): 349-350.
7. 步宏, 魏兵.病理學(xué)診斷的重復(fù)性與局限性[J]. 臨床與實(shí)驗(yàn)病理學(xué)雜志, 2003; 19(1): 349～350.
8. ［5］Creagh T, Bridger JE, Kupek E, Fish DE, Martin-Bates E, Wilkins MJ. Pathologist variation in reporting cervical borderline epithelial abnormalities and cervical intraepithelial neoplasia[J].J Clin Pathol,1995; 48(1): 59-60.
9. ［6］Bergeron C, Nogales FF, Masseroli M, Abeler V, Duvillard P, Muller-Holzner E, Pickartz H, Wells M. A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens[J]. Am J Surg Pathol,1999; 23(9): 1 102-1 108.
10. ［7］Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnoses of mammary atypical ductal hyperplasia[J]. Hum Pathol, 1992; 23(10): 1 095-1 097.
11. ［8］Schnitt SJ, Connolly JL, Tavassoli FA, Fechner RE, Kempson RL, Gelman R, Page DL. inter-observer reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria[J]. Am J Surg Pathol, 1992; 16(12): 1 133-1 143.
12. ［9］Rosai J. Borderline epithelial lesions of the breast[J]. Am J Surg Pathol, 1991; 15(3): 209-221.
13. ［10］Rosai J. The continuing role of morphology in the molecular age[J]. Mod Pathol, 2001; 14(3): 258-260.
14. ［11］Tavassoli FA,Hoefler H,Rosai J. Intraductal proliferaive lesions.In: Tavassoli FA,eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs[M], Lyron: IARC Press; 2003. p.64.
15. ［12］Silverberg SG. Misconception About Mammary Intraepithelial Neoplasia (MIN)[J]. Breast J,1999; 5(1): 73-74.
16. ［13］Bu H, Wei B. Evidence-based medicine and pathological practice[J]. Chinese Journal of Pathology, 2003; 32(1): 92-94.
17. 步宏, 魏兵.循證醫(yī)學(xué)與病理學(xué)實(shí)踐.中華病理學(xué)雜志[J], 2003; 32(1): 92～94.
  1. 1. ［1］Wang JY. Diagnostic test. In: Wang JY. Evidence-based medicine and clinical practice [M]. 1st ed. Beijing: Science Publishing House; 2002.p.122141.
  2. 2. 王吉耀.診斷試驗(yàn). 見:王吉耀,主編.循證醫(yī)學(xué)與臨床實(shí)踐[M].第1版.北京:科學(xué)出版社; 2002. p.122～141.
  3. 3. ［2］Greenhalgh T. How to read a paper. Papers that report diagnostic or screening tests[J]. BMJ, 1997; 315(7107):540-543.
  4. 4. ［3］Wang JS. Research and evaluation of diagnostic test[A]. See: Wang JL. Clinical epidemiology[M]. 2st ed. Shanghai: Shanghai science and Technology Publishing House; 2001. p.258-272.
  5. 5. 王覺生.診斷性試驗(yàn)的研究與評(píng)價(jià)[A]. 見:王家良,主編.臨床流行病學(xué)[M]. 第2版.上海:上?？茖W(xué)技術(shù)出版社; 2001. p.258～272.
  6. 6. ［4］Bu H, Wei B. Reproducibility and limitation in pathological diagnosis[J]. Chinese Journal of Clinical and Experimental Pathology, 2003; 19(1): 349-350.
  7. 7. 步宏, 魏兵.病理學(xué)診斷的重復(fù)性與局限性[J]. 臨床與實(shí)驗(yàn)病理學(xué)雜志, 2003; 19(1): 349～350.
  8. 8. ［5］Creagh T, Bridger JE, Kupek E, Fish DE, Martin-Bates E, Wilkins MJ. Pathologist variation in reporting cervical borderline epithelial abnormalities and cervical intraepithelial neoplasia[J].J Clin Pathol,1995; 48(1): 59-60.
  9. 9. ［6］Bergeron C, Nogales FF, Masseroli M, Abeler V, Duvillard P, Muller-Holzner E, Pickartz H, Wells M. A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens[J]. Am J Surg Pathol,1999; 23(9): 1 102-1 108.
  10. 10. ［7］Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnoses of mammary atypical ductal hyperplasia[J]. Hum Pathol, 1992; 23(10): 1 095-1 097.
  11. 11. ［8］Schnitt SJ, Connolly JL, Tavassoli FA, Fechner RE, Kempson RL, Gelman R, Page DL. inter-observer reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria[J]. Am J Surg Pathol, 1992; 16(12): 1 133-1 143.
  12. 12. ［9］Rosai J. Borderline epithelial lesions of the breast[J]. Am J Surg Pathol, 1991; 15(3): 209-221.
  13. 13. ［10］Rosai J. The continuing role of morphology in the molecular age[J]. Mod Pathol, 2001; 14(3): 258-260.
  14. 14. ［11］Tavassoli FA,Hoefler H,Rosai J. Intraductal proliferaive lesions.In: Tavassoli FA,eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs[M], Lyron: IARC Press; 2003. p.64.
  15. 15. ［12］Silverberg SG. Misconception About Mammary Intraepithelial Neoplasia (MIN)[J]. Breast J,1999; 5(1): 73-74.
  16. 16. ［13］Bu H, Wei B. Evidence-based medicine and pathological practice[J]. Chinese Journal of Pathology, 2003; 32(1): 92-94.
  17. 17. 步宏, 魏兵.循證醫(yī)學(xué)與病理學(xué)實(shí)踐.中華病理學(xué)雜志[J], 2003; 32(1): 92～94.