中国远程病理会诊与质量控制：实践与结果分析
A nationwide telepathology consultation and quality control program in China: implementation and result analysis
中国远程病理会诊与质量控制：
实践与结果分析
Je Chen1, Yahui Jiao2, Chaohui Lu1, Jun Zhou2, Zongjiu Zhang2 Chen Zhou3*
陈杰1焦雅辉2，卢朝辉1，周军2，张宗久2，周倩3
From 12th European Congress on Digital Pathology
Paris,France.18-21 June 2014
摘自《2014年6月18-21日法国巴黎第12次欧洲数字病理会议报道》
Abstract摘要
Telepathology may play an important role in pathology consultation and quality control for cancer diagnosis in China, as the country has the largest population of cancer patients worldwide. In 2011, the Pathology Quality Control Center of China and Ministry of Health developed and implemented a nationwide telepathology consultation and quality control program for cancer diagnosis in China. We here report the results of the two-year implementation and experiences.
背景
中国的癌症人群数量庞大，因而远程病理在中国肿瘤诊断的会诊咨询和诊断水平的质量控制中发挥重要的作用。2011年，中国病理质控中心和卫生部为肿瘤诊断推出远程病理会诊和质量控制项目。本文旨在报告两年来相关实践和应用的结果。
Methods
the program built an Internet based telepathology platform to connect participating hospitals and expert consultants. The hardware and software used for the platform were validated in previous validation studies in China. The program had three regional centers consisting of Peking Union Medical College, Huasi Medical College of Sichuan and. and 2nd affiliated hospital of Zhejiang University. It also had 20 provincial consultation centers based in the provincial referral hospitals. 80 provincial or national pathologists served as expert consultants for the program, providing telepathology consultation for cancer diagnosis for more than 60 participating hospitals.
方法
本项目基于互联网建立了远程病理平台，用于联系相关医院和专家顾问。平台的软硬件测试工作在之前的研究中已完成。项目由三个区域中心构成，分别是北京协和医院、四川大学华西医院和浙江大学医学院第二附属医院。在此基础上，尚有20家省级咨询中心参与项目。80位省级或国家级的病理专家为平台提供咨询服务，为60多家申请咨询的医院提供肿瘤诊断的远程病理会诊。
Results
from 2011 to July 2013, 16,247 pathology cases were submitted to the platform for consultation. Among them, 84% were due to diagnostic difficulty and 16% were due to request by patients. The preliminary diagnosis provided by submitting pathologists were in agreement with expert opinion in 59.8% of cases but was in disagreement with expert opinion in 24.2% of cases. 16.0% of cases were not provided with preliminary diagnosis. The distribution of pathology cases by system or organ were: digestive system, 17.3%; gynecologic system, 16.7%; head and neck, 15.7%; bone and soft tissue, 10.4%; lung and mediastinum, 8.6%; breast, 7.6%; urinary system, 7.5%; hematopathology, 6.4%; skin, 5.2%; neuropathology, 2.5% and cytopathology, 1.3%. Expert consultants also provided assessment of quality of slide preparation and staining, online lectures and guidance for pathology quality control.
结果
从2011年至2013年7月，共计16247例病理病例提交至平台会诊咨询。申请原因中，84%为疑难诊断，16%为病人请求。由病理医生提供的初步诊断和专家意见一致率为59.8%,24.2%初诊与专家意见不同。16.0%的病例无初步诊断。病例按系统和器官区分：消化系统17.3%；妇科系统16.7%；头颈部15.7%；骨和软组织10.4%；肺和纵隔8.6%；乳腺7.6%；泌尿系统7.5%；血液病理学6.4%；皮肤5.2%；神经系统2.5%；细胞学标本1.3%。同时，专家顾问还为病理诊断质量控制提供染色质量评估、在线讲座和指导等。
