摘要
目的 通过肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)病理诊断现状的调查研究,了解中国GLM病理诊断现状.方法 邀请全国病理医师以线上方式参与问卷调查,包括GLM诊断例数、病理报告模式和病因探讨工作的开展等热点问题.采用x2检验或Fisher确切概率法对数据进行分析.结果 共有702位病理医师参与调研,主任医师、副主任医师、主治医师和住院医师占比分别为 26.9％(189/702)、43.3％(304/702)、26.1％(183/702)和 3.7％(26/702);77.6％(545/702)的病理医师来自综合性医院、7.7％(54/702)的病理医师来自中医类医院、6.1％(43/702)的病理医师来自妇幼专科医院和4.0％(28/702)的病理医师来自肿瘤专科医院.2023年1月1日～2023年12月31日,乳腺炎诊断总例数大于45 000例.60.8％(115/189)主任医师和52.6％(160/304)副主任医师能诊断出具体乳腺炎病理类型,比例显著高于主治医师和住院医师(x2=23.537,P＜0.001),其中GLM最常见(55.1％,81/147).在诊断工作中,78.06％(548/702)病理医师会关注患者临床信息,19.2％(135/702)病理医师对标本进行病原微生物筛查,其中病理特殊染色是最常选用的手段;仅有6.0％(42/702)的病理医师所在医院常规开展组织病原体培养,其中棒状杆菌最常见;11.4％(80/702)的病理医师所在医院常规检测患者血清性激素水平,以催乳素升高最常见;7.1％(50/702)的病理医师所在医院会关注患者自身免疫状态,血清自身免疫抗体阳性但无相关临床表现者多见.在病因认识程度分析,主任医师对GLM病因的了解程度明显优于其他级别的医师(x2=11.969,P=0.003;P=0.007).大部分病理医师表示无可参考的GLM病理诊断流程(49.4％,347/702)和病理报告规范(76.4％,536/702).97.4％病理医师认同制定GLM病理诊断共识的必要性.结论 目前GLM病理诊断缺乏规范性、统一性,行业内迫切需要能指导病理医师的GLM病理诊断共识.
Abstract
Purpose To examine the contemporary state of pathological diagnosis for granulomatous lobular mastitis(GLM)in China.Methods Pathologists from across the nation were invited to engage in an online questionnaire survey,which ad-dressed pertinent topics such as the frequency of GLM diagnosis cases,the modalities of pathology reporting,and advancements in etiological research.The collected data were analyzed utili-zing the x2 test or Fisher's exact test.Results A survey of 702 pathologists included 26.9％(189/702)chief physicians,43.3％(304/702)deputy chief physician,26.1％(183/702)attending physicians,and 3.7％(26/702)residents.Partici-pants were from tertiary general hospitals(77.6％,545/702),traditional Chinese medicine hospitals(7.7％,54/702),ma-ternal and child specialty hospitals(6.1％,43/702),and on-cology specialty hospitals(4.0％,28/702).In 2023,there were over 45,000 mastitis diagnoses.A significantly higher per-centage of chief physicians(60.8％,115/189)and deputy chief physicians(52.6％,160/304)could diagnose specific mastitis types compared to attending and resident physicians(x2=23.537,P＜0.001),with"GLM"being the most common diagnosis(55.1％,81/147).In diagnostic work,78.06％(548/702)of pathologists consider patient clinical information,19.2％(135/702)screen specimens for pathogens using special staining,only 6.0％(42/702)of pathologists indicated that their hospitals routinely perform tissue culture for pathogens,with corynebacterium being the most common.Additionally,11.4％(80/702)reported that clinicians regularly test serum sex hormones,most frequently for elevated prolactin,while 7.1％(50/702)check autoimmune status,frequently detecting antibodies without clinical symptoms.Chief physicians had a significantly better understanding of the etiology of GLM com-pared to other physicians(x2=11.969,P=0.003;P=0.007).A majority of pathologists indicated a lack of guidelines for GLM pathology diagnosis(49.4％,347/702)and report standards(76.4％,536/702).Nearly all(97.4％)agreed on the need to establish a consensus for GLM diagnosis.Conclu-sion GLM pathological diagnosis is currently inconsistent and lacks standardization,highlighting the urgent need for a guiding consensus for pathologists.
维普
万方数据