摘要
目的：探讨肾穿刺活检病理切片远程诊断的正确率和影响因素以评估其可行性。方法：选择40例已有病理诊断的肾穿刺活检标本的病理切片,肾脏病医师和病理医师分别对20例进行选样。通过3种方法获取数字化病理图像,随后将其从浙江青田传输至上海,由另一位病理医师根据这些图像和提供的病史进行诊断(采用盲法)并对画面质量进行评估和对影响诊断正确率的因素进行分析。结果：40例中28例诊断完全正确,2例基本正确,4例有差异正确,4例诊断错误,2例延迟诊断。当场诊断的38例病例的严格诊断正确率为73.7%,而临床重要性诊断正确率为89.5%。由不同医师选样的两组的诊断正确率相等(严格诊断正确率为73.7%,而临床重要诊断正确率为89.5%)。不常见疾病的诊断正确率明显低于常见疾病(前后两者的严格诊断正确率分别为14.3%、87.1%,临床重要诊断正确率分别为42.9%、100%,P＜0.001)。病例图像中包含的肾小球数目与诊断结果分(完全正确诊断3分、基本正确诊断2分、差异性正确诊断1分、错误诊断0分)呈正相关(P＜0.05)。结论：肾穿刺活检病理切片远程病理诊断方法易行,本研究的远程病理诊断正确率基本符合临床要求。普通方法采集图像、压缩、传输、显示和诊断方式不影响诊断正确率。通过提高肾脏病理的肾小球采样数可以提高诊断正确率。
Objective.- The accuracy and its affect fahors were studied to evaluate the feasibility of telepathology （TP） diagnosis for renal needle biopsy. Methods： 40 cases of renal needle biopsy were included based on the microscopy results. A nephrology doctor and a pathology doctor selected 20 cases each. Digital images were obtained from 3 paths. Then digital images are transmitted from Qingtian, Zhejiang to Shanghai. Another pathology doctor rnase diagnosis blindly for each case based on the images and the clinical histories, also evaluating the quality of the pathological images. And the affect factors were discussed. Results： 28 diagnosis of those of the 40 cases were absolutely correct, 2 essentially correct, 4 partially correct, 4 wrong and 2 delayed. Of the 38 cases diagnosed on the spot, the strict accuracy and clinically important one were 73.7% and 89. 5% respectively. The diagnostic accuracy of the 2 groups whose images were selected by different doctors was identical （strict accuracy73.7% and clinically important one89.5G）. The accuracy of uncommon diseases was obviously lower than that of common diseases （strict one were14. 3G ,87. 1G respectively and clinically important one were 42. 9%,100% respectively, P〈0. 001 ）. The number of glomeruli selected was positively correlatied with the digitized results of diagnosis （if diagnosis is absolutely correct it gets 3, essentially correct gets 2, partial correct gets 1 and wrong gets 0, P〈0.05）. Conclusion： TP disgnosis for renal needle biopsy is feasible and easy. The accuracy of is in our trial can essentially meet the clinical demand. General methods to capture, compress, transmit, display images and diagresis do not influence the diagnostic accuracy. Selecting more renal glomeruli may improve the diagnostic accuracy.
出处
《中国临床医学》
北大核心
2006年第3期465-467,共3页
Chinese Journal of Clinical Medicine
关键词
远程病理
肾穿刺活检
Telepathology
Renal needle biopsy
