Causes of Missed Diagnosis and Misdiagnosis of Abdominal Organ Lesions in Preoperative Transabdominal Ultrasound
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摘要:
目的 评估腹腔脏器病变患者术前经腹超声检查报告并分析超声漏诊及误诊的原因。 方法 通过病理工作站导出2013年3月1日至8月31日因腹腔脏器(肝脏、胆囊、胆管、胰腺、脾脏、肾脏、肾上腺和阑尾)病变于北京协和医院进行手术治疗的住院患者病理资料, 评估相应超声报告, 记录漏、误诊报告信息, 分析漏、误诊原因。 结果 共评估超声报告1081份, 漏、误诊报告58份(5.37%, 58/1081), 其中肝脏病变6例(5.77%, 6/104), 均为误诊; 胆囊和胆管病变6例(1.30%, 6/462), 漏诊5例、误诊1例; 胰腺病变14例(19.72%, 14/71), 均为漏诊; 肾脏和肾上腺病变20例(6.47%, 20/309), 漏诊11例、误诊9例; 阑尾病变12例(16.00%, 12/75), 漏诊11例、误诊1例。漏诊结节样病变最大径平均值显著低于误诊病变(P=0.001)。 结论 不同腹腔脏器病变因性质、部位、体积以及超声本身的局限性等原因导致超声漏诊或误诊, 超声医师在临床工作中应做到全面、仔细、谨慎, 了解各腹腔脏器病变的自身特点以及超声显像的局限性, 不断积累经验, 尽可能避免不必要的错误。 Abstract:Objective To analyze the causes of missed diagnosis and misdiagnosis of abdominal organ lesions through reviewing preoperative transabdominal ultrasound reports. Methods Data of the patients who received abdominal operation for abdominal organ lesions (including liver, gallbladder, biliary tract, pancreas, spleen, kidney, adrenal gland, and appendix) in Peking Union Medical College Hospital within the period from March 1 to August 31 in 2013 were exported from pathological workstation. The preoperative ultrasound reports of these patients were reviewed. The missed diagnosis and misdiagnosis cases were recorded, and causes of the mistakes were analyzed. Results Altogether 58 cases of missed diagnosis or misdiagnosis were identified from 1081 ultrasound reports (5.37%, 58/1081), including 6 liver lesions (5.77%, 6/104, all misdiagnosed), 6 gall-bladder and biliary tract lesions (1.30%, 6/462, 5 missed and 1 misdiagnosed), 14 pancreatic lesions (19.72%, 14/71, all missed), 20 kidney and adrenal lesions (6.47%, 20/309, 11 missed and 9 misdiagnosed), and 12 appendical lesions (16.00%, 12/75, 11 missed and 1 misdiagnosed). The average maximum diameter of the missed nodular lesions was significantly smaller than that of the misdiagnosed lesions (P=0.001). Conclusions Missed diagnosis and misdiagnosis of ultrasound are attributable to various causes, including the nature, location, and size of abdominal organ lesions and the limitation of transabdominal ultrasound technology. The clinical ultrasound examination should be carried out very carefully and thoroughly. Ultrasound radiologists should have a thorough understanding of characteristics of different organ lesions and the limitation of ultrasound technique, in order to avoid missed diagnosis and misdiagnosis in clinical practice. -
Key words:
- ultrasound diagnosis /
- quality control /
- missed diagnosis /
- misdiagnosis
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表 1 住院手术患者中肝脏病变超声误诊病例的病理诊断和超声诊断
病 例 病变特征及病理诊断 超声诊断 最大径(cm) 病理诊断 超声提示 错误类型 医生年资(年) 1 7 肝脓肿,累及胆囊 胆囊实性占位,肝癌可能性大 高估 4 2 18 黏液性囊腺瘤 肝巨大囊肿 同级误诊 4 3 9 局灶性结节性增生 肝癌可能 高估 4 4 8 高-中分化肝细胞性肝癌 肝右叶实性包块,血管瘤不除外,建议增强CT扫描 低估 4 5 5 肝组织内见低分化腺癌,部分呈肉瘤样癌伴
大片坏死,不除外胆管细胞来源或转移性,
需结合临床肝右叶中低回声结节,血管瘤不除外 低估 5 6 7 肝转移性胰腺实性假乳头瘤 肝内多发中高回声,血管瘤不除外 低估 3 表 2 住院手术患者中胆囊和胆管病变超声误诊及漏诊病例的病理诊断和超声诊断
病 例 病变特征及病理诊断 超声诊断 部位 径线(cm) 病理诊断 超声提示 错误类型 医生年资(年) 1 胆囊颈 3×2 胆囊颈高-中分化腺癌 胆囊增大、胆泥、胆囊结石 漏诊 9 2 肝总管
胆囊管3×1 胆管中分化腺癌,侵及管壁全层 胆总管支架术后;胆囊增大;肝内胆管扩张 漏诊 4 3 胆囊管 3×2 胆囊管中-低分化腺癌 肝内胆管及胆总管上段扩张,考虑中下段梗阻,建议进一步检查 漏诊 1 4 胆总管 1×1 高-中分化腺癌,侵透胆总管全层达周围脂肪 肝内外胆管增宽,胆囊形态饱满 漏诊 2 5 胆管 4×1 胆管高-中分化腺癌,侵透胆管壁全层 胆总管内中低回声,可能为胆泥堆积,建议进一步检查 漏诊 2 6 胆囊 1×1 胆囊腺管状腺瘤 胆囊息肉待除外 低估 3 表 3 住院手术患者中胰腺病变(除胰腺神经内分泌肿瘤外)超声漏诊病例的病理诊断和超声诊断
病 例 病变特征及病理诊断 超声诊断 部 位 最大径(cm) 病理诊断 超声提示 错误类型 医生年资(年) 1 胰尾 2 胰腺高分化黏液腺癌 胰腺未见明显异常回声,请结合其他检查 漏诊 5 2 胰头 2 胰腺高-中分化腺癌 胆囊壁毛糙 漏诊 13 3 胰头 1 胰腺高-中分化腺癌,侵及胆管壁全层 胆总管扩张、胰管轻度扩张,建议进一步检查 漏诊 12 4 胰体 3 胰腺浆液性囊腺瘤 胰腺未见异常 漏诊 13 5 胰尾 3 IPMN(囊实性) 胰腺未见异常 漏诊 12 6 胰腺 1 伴有高度异型增生的IPMN或高分化导管腺癌 胰腺受肠气干扰显示不清 漏诊 1 IPMN:胰腺导管内乳头状黏液性腺瘤 表 4 住院手术患者中肾脏病变超声误诊病例的病理诊断和超声诊断
病 例 病变特征及病理诊断 超声诊断 部 位 最大径(cm) 病理诊断 超声提示 错误类型 医生年资(年) 1 左肾 2 肾透明细胞癌 左肾中高回声,错构瘤可能,建议进一步检查 低估 2 2 右肾 2 肾致密纤维组织囊壁,囊壁见灶性肾细胞癌浸润 肾囊肿 低估 3 3 右肾 2 肾嗜酸细胞腺瘤 右肾实性占位,肾癌不除外 高估 15 4 右肾 5 肾嗜酸细胞腺瘤 右肾上极实性占位,肾癌可能性大 高估 3 5 右肾 4 肾血管平滑肌脂肪瘤 右肾中下部实质占位,考虑肾癌 高估 8 6 左肾 5 肾血管平滑肌脂肪瘤 左肾下极背侧囊实性包块,肾癌可能性大 高估 5 7 右肾 5 上皮样血管平滑肌脂肪瘤 右肾集合系统内低回声占位,考虑肾癌 高估 12 8 左肾 3 肾组织,内见小囊肿 左肾占位性病变 高估 15 9 左肾 - 结核,累及肾盂及输尿管 左肾轻度积水,结石可能 同级 1 -