Umbiko wakho we-pathology: Izimpendulo zemibuzo evame ukubuzwa

nguJason Wasserman MD PhD FRCPC
June 18, 2022


Lesi sihloko sidalwe odokotela ukuze banikeze izimpendulo zeminye yemibuzo evame ukubuzwa mayelana nemibiko yokugula. Ukuze uthole ulwazi olwengeziwe mayelana nombiko wakho we-pathology, sesha ukuxilongwa kwakho noma upheqa yethu isichazamazwi se-pathology. Xhumana nathi uma kunombuzo ongathanda ukuwubona uphendulwe kuleli khasi.

Uyini umbiko we-pathology?

Umbiko we-pathology idokhumenti yezokwelapha echaza ukuhlolwa kwezicubu ngudokotela wezifo. I-pathologist ingudokotela onguchwepheshe osebenza eduze nabanye odokotela abasethimbeni lakho lokunakekelwa kwezempilo.

Ngingathola ikhophi yombiko wami we-pathology?

Yebo, ungathola ikhophi yombiko wakho we-pathology. Izibhedlela eziningi manje zinikeza iziguli ukufinyelela embikweni wazo we-pathology namanye amarekhodi ezokwelapha ngokusebenzisa ingosi yesiguli eku-inthanethi. Uma isibhedlela noma ilabhorethri elungise umbiko wakho wokugula ingenayo iphothali yesiguli eku-inthanethi, ungacela noma nini ukuthola ikhophi yombiko wakho esibhedlela, ilabhorethri, noma udokotela wakho.

Ingabe zikhona izinhlobo ezahlukene zemibiko ye-pathology?

Yebo, kunezinhlobo ezingaphezu kolunye zombiko we-pathology futhi uhlobo lombiko we-pathology olungiselelwe luncike ohlotsheni lwesicubu esithunyelwe ukuze sihlolwe kanye nendlela isicubu esikhishwe ngayo. Izinhlobo ezijwayelekile zemibiko yokugula zifaka i-pathology yokuhlinzwa, i-hematopathology, i-neuropathology, i-cytopathology, i-autopsy pathology, kanye ne-forensic pathology. A umbiko we-pathology yokuhlinzwa isetshenziselwa izinhlobo eziningi zezicubu ezihlanganisa ezincane biopsies, ezinkulu izinqumo futhi ukuhlinzwa, kanye nokuhlolwa kwesitho sonke. Umbiko we-hematopathology usetshenziselwa ukuchaza ukuhlolwa kwegazi, umkantsha, Futhi ama-lymph node. Umbiko we-neuropathy usetshenziselwa ukuchaza ukuhlolwa kwezicubu ezivela ohlelweni lwezinzwa okuhlanganisa ubuchopho nomgogodla. Ezibhedlela eziningi, umbiko we-neuropathy usetshenziselwa ukuchaza ukuhlolwa kwamasampula emisipha. Umbiko we-cytopathology usetshenziselwa ukuchaza ukuhlolwa kwamasampula ezicubu ezincane kakhulu akhishwe phakathi ne-fine-needle aspiration noma pap smear. Okokugcina, imibiko ye-autopsy kanye ne-forensic pathology isetshenziselwa ukuchaza ukuhlolwa kwesidumbu ngemva kokushona komuntu. Ukuthi umbiko we-autopsy noma we-forensic pathology uyalungiswa yini kuncike ezimeni zezokwelapha nezomthetho ezihambisana nokufa.

Yiluphi ulwazi olufakwe embikweni we-pathology?

Yonke imibiko ye-pathology ihlanganisa izigaba zolwazi lwesiguli, isifanekiso umthombo, umlando womtholampilo, kanye ukuxilongwa. Imibiko yokugula kokuhlinzwa (leyo echaza ukuhlolwa kwamasampula amathishu amakhudlwana njenge biopsies, izinqumo, Futhi ukuhlinzwa) ngokuvamile izofaka nezigaba ze okuncane kakhulu futhi okwedlulele izincazelo kanye imibono nge-pathologist. Imibiko yomdlavuza ingase ihlanganise nesigaba esibizwa ngokuthi umbiko we-synoptic okuhlanganisa ulwazi olubalulekile njengohlobo lomdlavuza, ubukhulu besimila, wekhasi isimo, kanye nesigaba se-pathologic. Eminye imibiko izofaka nesigaba esibizwa ngokuthi i-intraoperative consultation noma isigaba esiqandisiwe uma udokotela wezifo ehlola izicubu ngesikhathi sokuhlinzwa.

Kuthatha isikhathi esingakanani ukuthola umphumela we-pathology?

Kungathatha noma yikuphi ukusuka osukwini olungu-1 kuye emavikini ambalwa ukuthola umphumela we-pathology futhi isikhathi sincike ezintweni eziningi ezihlanganisa uhlobo lwethishu, usayizi wesampula yethishu, kanye nesidingo sokwenza izivivinyo ezengeziwe. Ngaphambi kokuba noma yiluphi uhlobo lwesicubu luhlolwe udokotela wezifo, ludinga kuqala lubekwe kusilayidi engilazi futhi lufakwe amabala ukuze lubonakale ngaphansi kwesibonakhulu. Okwamasampula ezicubu ezincane njengalawo akhishwe ku-finele-needle aspiration noma i-biopsy inqubo, lokhu kungaqedwa phakathi 1 kuya 2 izinsuku. Ukuze uthole izicubu ezinkulu, ezibonakalayo noma ukuhlolwa okuphelele kufanele kwenziwe kuqala ukuze kukhethwe izindawo zezicubu ukuze kuhlolwe kabanzi ngaphansi kwesibonakhulu. Le nqubo ingathatha ezinye izinsuku ezi-3 kuya kwezi-4. Uma udokotela wezifo ethola amaslayidi engilazi, ukuhlola ngesibonakhulu ngokuvamile kungaqedwa osukwini olungu-1. Kodwa-ke, ama-pathologists avame uku-oda ukuhlolwa okwengeziwe okufana i-immunohistochemistry futhi amabala akhethekile okudingeka ukuthi ihlolwe ngaphambi kokuphothula icala. Lezi zivivinyo ezengeziwe zingathatha usuku olu-1 kuya kwezi-5 ukuqeda.

Uyini umbiko we-biopsy ojwayelekile?

Izazi ze-pathologists zisebenzisa amagama ahlukahlukene ukusho ukuthi isampula yethishu ijwayelekile. Lawa magama ahlanganisa 'akukho ukungahambi kahle okuphawulekayo kwe-pathologic', 'akukho ukugula okungavamile', 'okungaphawuleki', 'akukho ukungavamile kwe-microscopic', kanye 'nokuvamile'.

Usho ukuthini umbiko we-biopsy ongemuhle?

Izazi ze-pathology zisebenzisa igama elithi 'negative' ukusho ukuthi kukhona okwakukhona hhayi kubonakala kusampula yethishu. Ngokwesibonelo, a i-biopsy umbiko othi 'i-negative for malignancy' kusho ukuthi awekho amaseli omdlavuza abonwe ngemva kokuhlolwa kwesampula yethishu ngaphansi kwesibonakhulu. Izazi ze-pathology nazo zisebenzisa igama elithi negative ukuchaza izici ezihlukahlukene ze-pathological ezihlanganisa imishado, ukuhlasela kwe-lymphovascular, Futhi ukuhlasela kwe-perineural. Okuphambene negama eliphikisayo lithi 'positive' okusho ukuthi okuthile kwaba kubonakala kusampula yethishu.

Ingabe ukulunga kusho okujwayelekile?

UBenign ngezinye izikhathi ingasho evamile kodwa hhayi njalo. Izazi zezifo zivame ukusebenzisa igama elithi benign ukusho ukuthi into ethile akuwona umdlavuza. Nokho, izinto eziningi ezingenawo umdlavuza azikajwayelekile. Isibonelo, umuntu ongenawo umdlavuza isisu ilungile kodwa isewukukhula okungavamile kwamaseli. Okubalulekile, kwezinye izindawo zomzimba ezifana nobuchopho, ngisho nezimila eziyingozi zingadala umonakalo omkhulu njengoba zikhula futhi zilimaze izicubu ezizungezile.

Ingabe umbiko we-pathology ungaba yiphutha?

Nakuba kuyivelakancane, umbiko we-pathology njenganoma yiluphi olunye uhlobo lokuhlolwa kwezokwelapha ungaba iphutha. Kodwa-ke, ucwaningo luye lwabonisa ukuthi izinga lamaphutha ku-pathology liphansi kakhulu (ngaphansi kuka-2%) ngakho-ke imibiko eminingi izobe ilungile.

Ingabe i-dysplasia isho umdlavuza?

Cha I-Dysplasia akusho umdlavuza. I-Dysplasia yigama izazi zezifo ezisetshenziselwa ukuchaza iqembu lamaseli abonisa iphethini yokuvuthwa engavamile. Nakuba i-dysplasia ingasho umdlavuza, ezingxenyeni eziningi zomzimba kubhekwa njengesimo esiyingozi ngoba singaholela ekuthuthukiseni umdlavuza ngokuhamba kwesikhathi. Izazi ze-pathologists zivame ukuhlukanisa i-dysplasia zibe izigaba ezimbili, ebangeni eliphansi kanye nebanga eliphezulu, kanti izinga eliphezulu lihlotshaniswa nengozi enkulu yokuba nomdlavuza.

Ingabe i-cytological atypia isho umdlavuza?

Cha. Cytological i-atypia akusho umdlavuza. I-Cytologic atypia igama elithi pathologists elisetshenziswa ukuchaza amangqamuzana abukeka engajwayelekile lapho ehlolwa ngesibonakhulu. I-Cytological atypia ingabonakala kumdlavuza izimila kanye nezimo ezihlukahlukene ezingenawo umdlavuza ezifana nokutheleleka, ukuvuvukala, noma ngemva kokwelashwa ngemisebe. Izazi ze-pathologists zisebenzisa ulwazi olufana nomlando wezokwelapha wesiguli kanye nemiphumela yokuhlolwa eyengeziwe ukuze kutholakale imbangela ye-cytological atypia.

Ingabe i-atypia isho umdlavuza?

Cha I-Atypia akusho umdlavuza. I-Atypia igama elithi pathologists elisetshenziswa ukuchaza amangqamuzana abukeka engajwayelekile lapho ehlolwa ngesibonakhulu. I-Atypia ingabonakala kumdlavuza izimila kanye nezimo ezihlukahlukene ezingenawo umdlavuza ezifana nokutheleleka, ukuvuvukala, noma ngemva kokwelashwa ngemisebe. Izazi ze-pathologists zisebenzisa ulwazi olufana nomlando wezokwelapha wesiguli kanye nemiphumela yokuhlolwa eyengeziwe ukuze bathole imbangela ye-atypia.

Ingabe amaseli e-atypical angaba nempilo?

Yebo. Atypical amaseli angaba benign (abanganawo umdlavuza). I-Atypical igama elithi pathologists elisetshenziswa ukuchaza amangqamuzana abukeka engajwayelekile lapho ehlolwa ngesibonakhulu. Amaseli e-Atypical angabonakala kumdlavuza izimila kanye nezimo ezihlukahlukene ezingenawo umdlavuza ezifana nokutheleleka, ukuvuvukala, noma ngemva kokwelashwa ngemisebe.

Ingabe i-atypia iyafana ne-dysplasia?

Cha I-Atypia akufani ne-dysplasia. I-Atypia igama elithi pathologists elilisebenzisa ukuchaza noma yimaphi amaseli abukeka engajwayelekile lapho ehlolwa ngesibonakhulu. Ngokungqubuzanayo, umabhebhana isetshenziselwa ukuchaza iqembu lamaseli abonisa iphethini yokukhula engavamile. Nakuba izindawo ze-dysplasia ngokuvamile zibonisa i-atypia, akuwona wonke ama-atypia ahlotshaniswa ne-dysplasia. Ngaphezu kwalokho, ezingxenyeni eziningi zomzimba i-dysplasia ibhekwa njengesimo esiyingozi ngoba singaholela ekuthuthukiseni umdlavuza ngokuhamba kwesikhathi. Ngokuphambene, i-atypia ingabonakala inomdlavuza izimila nasezimeni ezihlukahlukene ezingenawo umdlavuza.

Ingabe i-metaplasia iwuhlobo lomdlavuza?

i-metaplasia akulona uhlobo lomdlavuza kodwa ezinye izinhlobo ze-metaplasia zingandisa ingozi yokuba nomdlavuza ngokuhamba kwesikhathi. Ngokwesibonelo, Isisu sikaBarrett kuhlotshaniswa nengozi eyengeziwe yokuthola uhlobo lomdlavuza womminzo olubizwa i-adenocarcinoma.

Ingabe wonke ama-cancer carcinomas?

Cha I-Carcinoma wuhlobo lomdlavuza kodwa akusiyo yonke imidlavuza ewumdlavuza. Ezinye izinhlobo zomdlavuza zihlanganisa i-lymphoma, melanoma, Futhi i-sarcoma.

Isho ukuthini imajini ephozithivu?

A positive wekhasi kusho ukuthi amaseli wesimila abonwe onqenqemeni olusikiwe lwesampula yethishu. Umkhawulo omuhle ubalulekile ngoba uphakamisa ukuthi amaseli e-tumor kungenzeka ukuthi ashiywe emzimbeni wakho ngesikhathi sokuhlinzwa ukuze kukhishwe isisu.

Isho ukuthini imajini eyinegethivu?

Igethivu wekhasi kusho ukuthi awekho amaseli e-tumor abonwe onqenqemeni olusikiwe lwesampula yethishu. Umkhawulo ongemuhle ubalulekile ngoba kusho ukuthi awekho amaseli e-tumor ashiywe kuleyo ndawo yomzimba wakho ngenkathi kwenziwa ukuhlinzwa ukuze kukhishwe isisu.

Ingabe i-pathologist ingudokotela?

Yebo. I-pathologist ingudokotela onokuqeqeshwa okwengeziwe kwe-subspecialty endaweni ye-pathology. Izinhlobo zama-pathologists zifaka izazi ze-anatomical pathologists, i-hematopathologists, i-neuropathologists, kanye ne-forensic pathologists. Ukuze ube udokotela wezifo umuntu kufanele aqedele isikole sezokwelapha esilandelwa ukuqeqeshwa kokuhlala. Iningi lama-pathologists libuye liqedele unyaka owengeziwe ongu-1 kuye kwemi-2 wokuqeqeshwa kobudlelwane ngemva kokuhlala.

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