Ungawufunda kanjani umbiko wakho we-pathology

NguJason Wasserman MD PhD FRCPC
November 9, 2023

Umbiko we-pathology idokhumenti yezokwelapha echaza ukuhlolwa kwezicubu, amaseli, noma uketshezi lomzimba olukhishwe emzimbeni ngesikhathi senqubo yezokwelapha efana ne-biopsy, i-Pap test, noma ukuhlinzwa. Inikeza isifinyezo sanoma yikuphi ukuhlola okwenziwe futhi noma nini lapho kungenzeka khona ukuxilongwa (ekuhlonzweni kwemithi kusho ukuhlonza uhlobo lwesifo noma isimo nokusihlukanisa nezimo ezifanayo). Umbiko udalelwe wena udokotela wezifo, udokotela ogxile ekuxilongeni isifo ngokuhlolwa kwezicubu, amaseli, noma uketshezi lomzimba.

Mayelana nalesi sihloko

Lesi sihloko sabhalwa ngu odokotela ukukusiza ufunde futhi uqonde umbiko wakho we-pathology. Ichaza izigaba ezijwayelekile ezitholakala ezinhlotsheni eziningi zemibiko yokugula kanye nohlobo lolwazi olutholakala esigabeni ngasinye. Xhumana nathi uma unombuzo mayelana nalesi sihloko noma umbiko wakho we-pathology.

Yiluphi ulwazi olutholakala embikweni we-pathology?

Yonke imibiko ye-pathology ihlukile, futhi uhlobo nenani lolwazi elitholakala embikweni wakho lizoncika ohlotsheni lwenqubo eyenziwe. Kubalulekile ukuqaphela ukuthi amagama asetshenziswe embikweni we-pathology kanye nokuhleleka kwezigaba kuzohluka kakhulu esibhedlela ngesibhedlela.

Yonke imibiko ye-pathology kufanele ifake imininingwane elandelayo:

Ukuhlonza isiguli

Ulwazi lwakho lomuntu siqu kufanele lutholakale eduze kwaphezulu kombiko. Lolu lwazi luhlanganisa igama lakho eliphelele, usuku lokuzalwa, nobulili. Eminye imibiko izofaka nekheli lakho lasekhaya.

Inombolo yesibhedlela noma yaselabhorethri

Lena inombolo eyingqayizivele eyabelwe wena esibhedlela noma ilabhorethri. Eminye imibiko ingase isebenzise inombolo ekhishwe uhulumeni. Le nombolo isetshenziselwa ukugcina lonke ulwazi lwakho luhlangene.

Udokotela oqondisayo

Igama likadokotela owa-oda ukuhlolwa kufanele libhalwe embikweni wakho. Lokhu kungaba udokotela wakho womndeni, udokotela ohlinzayo, noma i-oncologist. Kwezinye izimo, igama le-radiologist uma inqubo yenziwa kusetshenziswa isiqondiso se-ultrasound, CT, noma i-MRI.

Umlando wezempilo

Lena incazelo emfushane yokuthi kungani inqubo yenziwa. Lapha futhi udokotela wakho angase acele udokotela wezifo ukuthi abheke izinguquko ezithile noma izimo. Isibonelo, uma ubulokhu uzwa ubuhlungu besisu nokuqunjelwa ngemva kokudla izinyanga ezimbalwa, udokotela wakho angase anqume ukwenza biopsies esiswini sakho namathumbu amancane ukuze ubheke izinguquko ezingase zidale lezi zimpawu. Kulokhu, umlando womtholampilo ohlinzekwa ngama-biopsies ungase uthi “Ubuhlungu besisu nokuqunjelwa x izinyanga. Sicela uhlole i-gastritis noma i-H. pylori”. Kulesi sibonelo, udokotela utshele udokotela mayelana nezimpawu eziholele ekutheni akhishwe futhi wacela udokotela ukuthi abheke isimo esibizwa ngokuthi. i-gastritis (ukuvuvukala esiswini) kanye ne-bacteria ebizwa ngokuthi Helicobacter pylori okuvamise ukuthelela isisu.

Umthombo wesifanekiso

Ku-pathology, igama isifanekiso isetshenziselwa ukuchaza zonke izinhlobo zezicubu, amaseli, noketshezi olukhishwa emzimbeni ukuze luhlolwe udokotela wezifo. Umthombo wesifanekiso (noma isayithi) kufanele uchaze indawo yomzimba lapho isicubu sithathwe khona. Lesi sigaba singase futhi sisho uhlobo lwenqubo eyenziwe, isibonelo, singasho i-fine needle aspiration biopsy (FNAB), ukuziqhenya, noma ukukhishwa kabusha. Lapho kuthathwa amasampula ezicubu eziningi, ngalinye kufanele lifakwe ohlwini ngokwehlukana.

Sifo

Lena ingxenye ebaluleke kakhulu yombiko wakho we-pathology. Isigaba sokuxilonga sinikeza isifinyezo noma incazelo yezinguquko ezibonwa kusampula yethishu. Igama elithi ukuxilongwa lichazwa njengenqubo yokunquma uhlobo lwesifo nokusihlukanisa kwezinye izimo. Kodwa-ke, isigaba sokuxilongwa ngeke sihlale sichaza isifo noma sinikeze igama lesimo esithile. Kwezinye izimo, isigaba sokuxilonga sisetshenziselwa ukubika ukuthi isampula yethishu ijwayelekile noma ukuthi azikho izinguquko ezibonwa kusampula ezichaza izimpawu. Kwezinye izimo, isigaba sokuxilonga sisetshenziselwa ukubika izinguquko ezihlobene nokwelashwa kwangaphambilini okufana nokwelashwa ngamakhemikhali, ukwelapha ngemisebe, noma eminye imithi. Ngezikhathi ezithile, izinguquko zizobonakala kusampula yethishu ezingajwayelekile kodwa ezingaqondile kusifo esisodwa noma isimo. Kulesi simo, udokotela wakho wezifo angase asebenzise isigaba sokuxilongwa ukuchaza izinguquko ezibonwayo ngaphandle kokunikeza ukuxilongwa kokugcina. Uma ezingaphezu kweyodwa isifanekiso yahanjiswa ukuze ihlolwe, isigaba sokuxilonga singabhala zonke izibonelo ezihloliwe futhi sinikeze ukuxilongwa ngakunye.

Vakashela wethu umtapo wokuxilongwa ukuze ufunde kabanzi mayelana nokuxilongwa kwakho.

Olunye ulwazi olungase lutholakale embikweni wakho we-pathology

Incazelo eyisamba

Ku-pathology 'gross' ibhekisela endleleni izicubu ezibukeka ngayo ngaphandle kwe-microscope noma ngeso lenyama. Uma isampula yethishu yamukelwe ilabhorethri, ihlolwa ngaphambi kokuba ezinye (noma zonke) zethishu zithunyelwe kudokotela wezifo ukuze zihlolwe ngaphansi kwesibonakhulu. Ukuhlolwa okuphelele kwezicubu kuyingxenye ebaluleke kakhulu yenqubo yokuxilonga futhi kwezinye izimo, udokotela wezifo angenza ukuxilongwa ngokubheka izicubu noma ngokufunda incazelo eyingqikithi.

Ezibhedlela eziningi, ukuhlolwa okuphelele kwesampula yethishu kwenziwa umsizi we-pathologist (PA), uchwepheshe wezokwelapha oqeqeshelwe ukuhlola izicubu zomuntu. I-PA ibhala lokho abakutholile engxenyeni yencazelo ephelele yombiko we-pathology.

Incazelo eyingqikithi kufanele ihlanganise ulwazi olufana nohlobo lwesicubu esitholiwe, usayizi wesicubu (ngokuvamile silinganiswa ngezinhlangothi ezintathu), kanye nokuba khona kwanoma yiziphi izimpawu (ngokuvamile ama-sutures noma uyinki) ezishiywe udokotela ohlinzayo ukuze asize ukuqondiswa kwezicubu. Noma yisiphi isicubu esingavamile njenge-a isisu kufanele futhi ichazwe ngokucacile. Le ncazelo ingase ihlanganise usayizi, umbala, nokuma kwesicubu esingavamile, kanye nobudlelwano baso nezicubu ezivamile ezizungezile. Ibanga phakathi kwezicubu ezingavamile kanye nonqenqema olusikiwe lwethishu noma wekhasi kufanele futhi ikalwe.

Ekupheleni kokuhlolwa okuphelele, izicubu zithunyelwa ukuze zihlolwe nge-microscopic. “Ku-toto” kusho ukuthi zonke izicubu ezitholiwe zihanjiswe ukuze zihlolwe nge-microscope. Okukhudlwana izibonelo, izingxenye ezimele noma izindawo ezikhethiwe zezicubu ziyathathwa futhi zithunyelwe ukuze zihlolwe nge-microscopic. Zonke izicubu eziyisampula zifakwa kumabhulokhi anelebuli noma amakhasethi asiza udokotela wakho ukuthi azibone ngokuhamba kwesikhathi. Ibhulokhi ngalinye liba yi-slide esibuye sihlolwe ngaphansi kwesibonakhulu ngudokotela wezifo. Wonke amabhulokhi ezicubu kufanele afakwe ohlwini ekugcineni kombiko wakho we-pathology.

Ukubonisana kwangaphakathi (okwaziwa nangokuthi isigaba esiqandisiwe noma isigaba esisheshayo)

Ukubonana nodokotela ohlinzayo ukuhlola izicubu ngokushesha, ngokuvamile kuyilapho kwenziwa inqubo yezokwelapha efana nokuhlinzwa. Inhloso yokubonisana ngokuhlinza iwukuhlinzeka udokotela wakho ngolwazi oluzosiza ekuthathweni kwezinqumo phakathi nenqubo. Elinye igama lokubonisana phakathi kokuhlinzwa yisigaba esiqandisiwe ngoba ukuhlola kuvame ukuhilela ukuqhwaza kwezicubu ezisuke zihlolwe ngesibonakhulu.

Ukuhlolwa kwe-Microscopic

Incazelo ye-microscopic isifinyezo salokho udokotela wakho wezifo akubonile lapho izicubu zakho zihlolwa ngaphansi kwe-microscope. Inhloso yalesi sigaba ukuchaza izinguquko ezibonwa esicutshini sakho kwabanye odokotela abangase bafunde umbiko wakho esikhathini esizayo. Lesi sigaba sivamise ukufaka amagama angajwayelekile kunoma ubani ongeyena udokotela (ukuthola usizo ngalawa magama siphakamisa ukuthi uhlole isichazamazwi pathology iziguli). Lesi sigaba singase futhi sifake imiphumela yokuhlolwa efana amabala akhethekile futhi i-immunohistochemistry. Akuyona yonke imibiko ye-pathology ezofaka incazelo ye-microscopic.

Amazwana

Lesi sigaba singase sisetshenziselwe ukunikeza incazelo enemininingwane eminingi yezinguquko ezibonwe kusampula yethishu noma ukuchaza ukuthi yiziphi izici eziholele ekuxilongweni. Ezimweni eziyinselele, isigaba sokuphawula singase futhi sisetshenziselwe ukuchaza ukuthi kungani ukuxilongwa kungafinyelelwanga noma kungani izifo eziningi noma izimo zidinga ukubhekwa njengento engenzeka. I-pathologist yakho ingase futhi isebenzise lesi sigaba ukwenza izincomo ezifana nokwenza esinye i-biopsy noma ukuthatha isampula yethishu enkudlwana. Uma izivivinyo ezengeziwe zi-odwe, nazo zizochazwa lapha.

Umbiko we-Synoptic

Umbiko we-synoptic yisigaba esikhethekile esizofakwa embikweni wakho we-pathology kuphela uma kutholakala ukuthi unomdlavuza. Umbiko we-synoptic uklanyelwe ukunikeza isifinyezo solwazi udokotela wakho azoludinga ukuze ahlele ukwelashwa kwakho. Ezimweni eziningi, ingxenye yombiko we-synoptic ifakwa kuphela embikweni wakho we-pathology ngemva kokuba iningi noma sonke isimila sikhishiwe emzimbeni wakho. Ngaleso sizathu, isigaba sombiko we-synoptic ngokuvamile asifakwa emibikweni yezinqubo ezincane ezifana nalezi biopsies.

Isigaba sombiko we-synoptic ngokuvamile sihlanganisa izinhlobo ezilandelayo zolwazi:

• Igama nohlobo lomdlavuza olutholakala kusampula yethishu.
• Indawo yesimila.
• Ubukhulu besimila.
• Isimila grade.
• Ukuhlolwa kwe imishado.
• Ukuhlolwa kwe ama-lymph node ngoba i-metastatic izifo.
• Isigaba se-pathological of the disease (pTNM).
• Imiphumela yanoma iyiphi i-immunohistochemical noma izifundo zamangqamuzana okungenzeka zenziwe.

eyongeziwe

Isigaba sesengezo sihlanganisa noma yiluphi ulwazi olwengeziwe olungezwe embikweni wakho ngemva kokuba usuqediwe futhi wathunyelwa udokotela wakho wezifo kuwe nakwabanye odokotela abasethimbeni lakho lokunakekelwa kwezempilo. Lesi sigaba sivame ukusetshenziselwa ukwengeza imiphumela yokuhlolwa okwengeziwe okwenziwe njengokuthi i-immunohistochemistry, I-fluorescence in situ hybridization (INHLANZI), noma ukulandelana kwesizukulwane esilandelayo (NGS). Imiphumela yokubonisana kwangaphakathi noma kwangaphandle noma ukubuyekezwa kwecala lakho nakho kungase kufakwe kulesi sigaba. Isengezo kufanele sisetshenziswe kuphela ukuchaza ulwazi olwengeziwe olusekela ukuxilongwa kwasekuqaleni. Ulwazi olusha oluholela ekushintsheni kokuxilongwa kufanele kubikwe njengento ebizwa ngokuthi Ukuchitshiyelwa.

Iyiphi ingxenye ebaluleke kakhulu yombiko wami we-pathology?

Isigaba sokuxilonga siyingxenye ebaluleke kakhulu yombiko wakho we-pathology ngoba iqukethe incazelo noma isifinyezo sezinguquko ezibonwa kusampula yakho yethishu. Isigaba sokuxilongwa sizosho ukuthi isifo noma isimo sitholakele noma isampula yethishu yayijwayelekile. Khuluma nodokotela wakho mayelana nolwazi olutholakala esigabeni sokuxilonga sombiko wakho. Ukuze uthole usizo lokuqonda ukuxilongwa kwakho, hlola yethu umtapo wokuxilongwa.

Yini okufanele ngiyenze uma ngithola iphutha embikweni wami we-pathology?

Uma uthola iphutha embikweni wakho we-pathology, isibonelo, uma igama lakho lipelwe ngokungalungile noma uma umlando womtholampilo onikeziwe ungalungile, kufanele uxhumane nodokotela wakho ukuze umbiko ulungiswe. Kungenjalo, ungathinta udokotela wezifo okhiphe umbiko.

Ezinye izinsiza eziwusizo

I-American Cancer Society

ICanada Cancer Society