请大家讨论一下，哪些病例才需要做冰冻切片？

冰冻切片是否需要是临床说了算还是病理说了算？

皮样囊肿也需要做冰冻切片吗？

如何与临床医生做良好的沟通？

What is "蓝皮书"

Can anyone post the " 蓝皮书的标准" for frozen?

Thanks in advance!

 哪些病例才需要做冰冻切片？

- Very big question! The simple answer would be: any 病例 that frozen section diagnosis can help with intraoperative decision (and there is no alternative better way for diagnosis).

 冰冻切片是否需要是临床说了算还是病理说了算？

- Should be evidence-based and decision should be made with a consensus, ideally together by both surgeon and pathologist. The final decision should be for the benefit of the patient.

 皮样囊肿也需要做冰冻切片吗？

- If the diagnosis is helpful and guide the surgeon for the intraoperative management, it is not a contra-indication for frozen section request.  It is not necessary, if request by the surgeon, I would do a frozen diagnosis and leave some specimen for permanent paraffin section. It is a common practice that we should avoid doing frozen section diagnosis for a "pigmented lesion".

如何与临床医生做良好的沟通？

It is a very critical for a good pathologist 与临床医生做良好的沟通. The most important is still being a good pathologist. How? Mutural respect + being a good pathologist + knowing the clinical problem and management...

• Explain to them (surgeon or patient) that frozen section slides quality are not as good as permanent paraffin sections and show them some examples.
• Ask them "do you want a quick inaccurate or uncertain frozen diagnosis or wait for a more accurate final diagnosis"
• Inappropriate frozen section diagnosis actually will result in a "no diagnosis"

 我认为做不做冰冻,是临床医生如何向病理医生做良好沟通的问题，也是向病理医生请教的问题。不是病理医生找他们勾通的问题。在良恶性的认知方面，我是主，他是宾。在确定手术范围前他有求于我。

无奈

 第一按规范

第二结合自己实际

第三结合医院实际