The “gold standard” for disease diagnosis is the pathology report – Interview with Zhuo Shichao, Director of the Department of Pathology, Xuzhou Central Hospital (Hospital IV) Zhuo Shichao, Director of the Department of Pathology, Xuzhou Central Hospital There is such a group of doctors in the hospital, whose words can save a patient’s organ or tissue from being removed in minor cases, or save a living life in major cases. They can save an organ or tissue from being removed, or save a living life. Some people call them the “judge of life”, these people are the pathology department medical workers who deal with pathology slices all day long, the pathology department and its staff because unlike clinical departments often deal with patients and families, little known to the outside world. Recently, the reporter interviewed Zhuo Shichao, director of pathology department of Xuzhou Central Hospital (four hospitals), and asked him to introduce pathological examination and how to read pathological examination reports and other related topics. Zhuo Shichao, Director of the Department of Pathology, Xuzhou Central Hospital (Fourth Hospital), introduced that with the continuous improvement of medical services, the importance of pathology has been gradually reflected. As the “gold standard” of disease diagnosis, pathology diagnosis has an important value that cannot be replaced by other clinical examinations. What is the significance of pathological examination? Zhuo Shichao, director of the Department of Pathology of Xuzhou Central Hospital (four hospitals), said that pathology is a bridge between basic medicine and clinical medicine, which mainly proposes a clear pathological diagnosis of certain diseases from the morphological changes of pathological specimens, combined with changes at the molecular level, and suggests possible causes and possible factors affecting treatment and prognosis. Zhuo Shichao said that the pathological diagnosis is directly related to the clinician’s choice of treatment plan and the prognosis of the disease. In a multidisciplinary clinical pathology symposium, the pathologist usually makes the final call at the end of the symposium, announcing the pathological diagnosis and unveiling the mystery of the disease manifestation, thus, the medical profession believes that “the last word is to be said by the pathologist”, and the pathological diagnosis is also called the “final diagnosis “The pathologist is called the “doctor’s doctor”. For example, in a patient with enlarged lymph nodes, the lymph nodes are removed and pathological examination is performed. If the pathological diagnosis is “chronic lymphadenitis”, the clinician can take internal anti-inflammatory treatment; if the pathological diagnosis is “Hodgkin’s lymphoma”, chemotherapy and radiotherapy are necessary immediately; and if the pathological diagnosis is “metastatic adenocarcinoma If the pathological diagnosis is “Hodgkin’s lymphoma”, chemotherapy and radiotherapy are necessary immediately; if the pathological diagnosis is “metastatic adenocarcinoma”, systemic examination of the whole body is needed to find the primary lesion and remove it surgically if possible. Under what circumstances is pathological examination necessary? Zhuo Shichao, director of the Department of Pathology of Xuzhou Central Hospital (Hospital IV), introduced that a specimen is cut off from the operating table and sent to the Department of Pathology for production, in the middle of which it has to go through professional procedures such as fixation of tissues, dehydration, transparency, embedding, making wax blocks, slicing, staining and then observation under the microscope. There are many steps to make a pathology slice, most of which need to be done manually. Most of the time, the pathologist’s job is to make sections of the lesions taken from the patient, then put them under a microscope at 2 to 100 times depending on their specific conditions, commonly known as “looking at the film”, and then making a diagnosis and issuing a diagnostic report. The clinician will determine whether the patient needs pathological examination according to the specific condition of each patient and choose the way to obtain the tissue specimen, such as surgical excision, needle core puncture, scraping, clamping, etc. Usually the purpose of pathological examination is to clarify the diagnosis and is used to determine whether the nature of the lesion is inflammatory or tumor, and if it is a tumor, whether it is a benign or malignant tumor, etc. For patients who need pathological examination, the pathological diagnosis report is the medical “verdict” of the nature of the patient’s lesion. How to read the pathological examination report initially? For ordinary patients, how to understand the case examination report is their most concerned topic. Zhuo Shichao, director of the Department of Pathology at Xuzhou Central Hospital (Hospital IV), said that, in general, there are four basic types of pathology report statements. The first type is the positive diagnosis: the diagnosis of the nature of the lesion is clear, and a positive pathological diagnosis is given directly. The second type is the diagnosis that is not completely certain: depending on the degree of intention, the name of the proposed lesion is preceded by such words as “considered to be”, “consistent with”, “tends to be”, “suggestive of”, “suggestive of”, “suggestive of”, “suggestive of” and “suggestive of”. “suggestive”, “probable”, “suspected”, “cannot be ruled out (except)”, etc. meaning that there are reservations about the pathological diagnosis. The third category is the diagnosis of insufficient lesion basis: the lesion shown in the section is not sufficient to make the diagnosis of category 1 or 2 above, and only the morphological points of the lesion can be described in the report, i.e., descriptive report, without diagnostic opinion. Category 4 is unable to make a diagnosis: the pathology report states that the specimen cannot be diagnosed and the reasons why it cannot be diagnosed, such as the specimen sent for examination is autolysed, dried up, too small, severely distorted by extrusion, denatured by cautery or unable to be made into a section for some reasons. Zhuo Shichao, director of the Department of Pathology at Xuzhou Central Hospital (Hospital IV), reminded that no type of pathology report should be separated from clinical practice, especially for category 2 and 3 diagnostic reports, clinicians need to combine various examination data to choose the appropriate treatment plan. In addition, the pathologist can only observe the specimens sent for examination, and when the results of the pathology report differ greatly from the clinical manifestations, it may be because the tissue sent for examination is not representative of the disease, and the clinician can consider performing multiple biopsies as needed. Dr. Zhuo graduated from Yangzhou University School of Medicine in 1992 and has been engaged in clinical pathology for 23 years, and studied at the General Hospital of the Chinese People’s Liberation Army (301 Hospital) in 1997. Dr. Zhuo is the chief physician of the Department of Pathology of Xuzhou Chinese Hospital (Hospital IV), a member of the Jiangsu Provincial Pathology Committee, a member of the Chinese Anti-Cancer Association, and a vice chairman of the Xuzhou City Pathology Committee, as well as a member of the executive editorial board of several journals. His specialties include lymphoma, soft tissue tumors, prostate and other difficult pathological diagnoses. Department Introduction Xuzhou Central Hospital (Four Hospitals) Department of Pathology Xuzhou Central Hospital is the largest, most technically advanced and most mature pathology department in Huaihai Economic Zone, with 23 professional medical and technical personnel, 3 with senior titles above associate chief physician, 7 with master’s degree and 7 with bachelor’s degree. It undertakes the task of scientific research and teaching, accepts a large number of advanced training and internship doctors every year, and undertakes more than ten research projects within the department and sister departments within the hospital. The Department of Pathology was founded in 1952 and moved to the fifth floor of the new outpatient building in 2003, with a working room area of about 700 square meters, all professionally designed and professionally maintained, and all laboratories have advanced automatic exhaust systems. At present, the Department of Pathology of Xuzhou Central Hospital is one of the limited hospitals in China that have passed the Pathology Quality Control (PQCC) of the Ministry of Health and Planning and obtained the certificate, and is now participating in UK Pathology Quality Control, including routine pathology, immunohistochemistry and molecular pathology. The Department of Pathology has diagnostic room, immunohistochemistry room, molecular pathology room, tumor drug sensitivity room, TCT room, DNA ploidy detection room, tumor abnormal protein detection room, rapid pathology room, anatomy room, quality control room and cell room; molecular pathology currently carries out projects: tumor targeted drug gene detection, tumor chemotherapy drug sensitivity gene detection, tumor susceptible population gene detection, cardiology, neurology, gastroenterology, etc. Clinical drug genetic testing. The department not only undertakes all the pathology diagnosis of Xuzhou Central Hospital, but also undertakes difficult pathology consultation in Xuzhou and surrounding areas, and the counterpart hospitals include Suining County People’s Hospital, Jiawang District People’s Hospital, Feng County People’s Hospital, Feng County Hospital of Traditional Chinese Medicine, Dangshan County People’s Hospital. The department is responsible for the diagnosis of pathology by three levels of physicians, and ensures timely and accurate diagnosis, with the accuracy rate of routine diagnostic reports ≥ 99%; the accuracy rate of intraoperative rapid pathology diagnosis ≥ 95%; and the excellent rate of routine sections ≥ 98%. Technical features of the department A. Advanced pathology imaging graphic workstation (system) Xuzhou City is the first to introduce pathology image graphic workstation (system), using computerized pathology graphic reporting system (the first to introduce high-definition digital camera) to issue computerized graphic pathology report, graphic and text, real and reliable, to improve the credibility of the pathology report. Second, fast and accurate frozen section diagnosis. The two imported frozen section machines can carry out intraoperative rapid diagnosis within thirty minutes, which is specially used to help clinicians judge the nature of lesions during surgery and directly guide the clinical operation mode and scope of surgery, so as to save patients from the pain of secondary surgery. Rapid cytological screening technology. The introduction of membrane liquid-based cytology (TCT) testing program, patients can get the cytology diagnosis report in 1 hour. BenchMark series fully automatic multi-functional immunohistochemical detection system. V. Individualized treatment — tumor chemotherapy drug sensitivity gene detection, tumor targeted drug gene detection and clinical drug gene detection. New technology of tumor pathology diagnosis – “abnormal glycoprotein (TAP) detection” technology. Automatic DNA quantitative analysis system. Rapid paraffin filming equipment to produce report within 4 hours. Nine, tumor chemotherapy drug sensitivity testing