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中国肉芽肿性小叶性乳腺炎病理诊断现状调查研究

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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.
Investigation and study on pathological diagnosis of granulomatous lobular mastitis in China
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.

granulomatous lobular mastitispathological diag-nosisquestionnaire survey

毕嘉欣、赵萌、水若鸿、张璋、刘月平、杨文涛、步宏、邵牧民

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深圳市中医院/广州中医药大学第四临床医学院病理科,深圳 518033

河北医科大学第四医院病理科,石家庄 050011

复旦大学附属肿瘤医院病理科,上海 200032

四川大学华西医院病理科,成都 610041

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肉芽肿性小叶性乳腺炎 病理诊断 调查问卷

2024

临床与实验病理学杂志
安徽医科大学,中华医学会安徽分会

临床与实验病理学杂志

CSTPCD北大核心
影响因子:0.776
ISSN:1001-7399
年,卷(期):2024.40(11)