Some standard content:
National Standard of the People's Republic of China
Patholagic diagnostic criteria of pneumoconioses
Patholagic diagnostic criteria of pneumoconioses Pneumoconiosis refers to a disease characterized by pulmonary fibrosis caused by inhalation of dust during production activities. 1Diagnosis Original purchase
UDC 616-057 1 616
-07/-081 616
GB 878388
Pathological diagnosis of pneumoconiosis can only be made based on the detailed and reliable occupational history and the pathological examination results obtained by standardized examination methods. The patient's previous chest X-rays, case summaries or death records and on-site labor hygiene data are necessary reference conditions for diagnosis. 2 Diagnostic staging criteria
2.1 No pneumoconiosis
Only dust reaction is seen in the lungs and the lymph nodes in the lung drainage area, or pneumoconiosis lesions are seen in the lungs and the lymph nodes in the lung drainage area, and the scope and severity are not enough to be diagnosed as stage 2 pneumoconiosis,
2.2 Stage 1 pneumoconiosis
Fibrosis.
The total number of pneumoconiosis nodules observed visually and microscopically in all sections of the lungs is more than 20; or more than 10, accompanied by near-grade 1/1 transitional pneumoconiosis, inverse pulmonary fibrosis, grade 1/1 2.3ⅡI pneumoconiosis
fibrosis.
The total number of pneumoconiosis nodules observed visually and microscopically in all lung sections is more than 50, or more than 20, accompanied by diffuse pulmonary fibrosis of grade 1/1 degree or more and grade 2/2 degree or more. The area of pneumoconiosis-emphysema in the whole lung accounts for more than 5%. 2.4II Stage pneumoconiosis
Dust-like massive fibrosis appears in the lungs, accompanied by the foundation of pneumoconiosis of stage 1 or above. Dust-like diffuse pulmonary fibrosis of stage 3/3 degrees or above. The lesions that meet the above stages a, b or c can be diagnosed by stage. Approved by the Ministry of Health of the People's Republic of China on February 22, 1988, and implemented on September 1, 1988
A.1 Name of pneumoconiosis
Named according to the pneumoconiosis names stipulated by the state.
A, 2 Pathological types of pneumoconiosis
GB8783--88
Appendix A bZxz.net
Annotations on pneumoconiosis pathology standards
(Supplement)
A.2.1 Nodular pneumoconiosis lesions are mainly characterized by pneumoconiosis collagen fiber nodules, accompanied by other pneumoconiosis lesions. A.2.2 Diffuse fibrosis pneumoconiosis lesions are mainly characterized by pneumoconiosis diffuse collagen fiber hyperplasia, accompanied by other pneumoconiosis lesions. A.2.3 Oligoplaque pneumoconiosis lesions are mainly characterized by pneumoconiosis with perifocal emphysematous changes, and other pneumoconiosis lesions. A.3 Pneumoconiosis lesions
A, 3.1 Visual observation of pneumoconiosis nodules: Lesions are round, with blurred borders and color Gray and solid to the touch. Microscopic examination: It may be a silicic nodule, i.e. a dusty lesion with a collagen fiber core, or a mixed dust nodule, i.e. a lesion with collagen fibers and dust intermixed, with the collagen fiber component exceeding 50%; or a silicotuberculous nodule, i.e. a nodule that is a mixture of silicic nodules or mixed dust nodules and tuberculous lesions. A.3.2 Dust-induced diffuse fibrosis is a diffuse collagen fiber hyperplasia caused by dust deposition around the respiratory bronchioles, alveoli, interlobular septa, small bronchi and small blood vessels, and the subpleural area. A.3.3 Macular observation: The lesions are dark, Soft texture, unclear boundaries, and enlarged air cavities with a diameter of more than 1.5 mm around the lesion (perifocal emphysema). Microscopic examination: reticular fibers, collagen fibers and dust are intermixed in the lesion, and the collagen fiber component is less than 50%. The lesion and fibrotic lung interstitium are in a lotus-like pattern, accompanied by focal emphysema.
A.3.4 Dust-like mass fibrosis Visual observation: The lesion is a gray-black or black, tough fibrous mass of more than 2×2×2cm. Microscopic examination: It may be a fusion of pneumoconiosis nodules or a patchwork of pneumoconiosis collagen fibrosis or a mixture of various pneumoconiosis lesions. A.3.5 Dust reaction refers to dust deposition in the pleura, lymph nodes in the pulmonary drainage area, macrophage reaction, and slight erythrocyte hyperplasia. Determination of the scope and severity of pneumoconiosis lesions A.4
A. 4.1 Nodule count
Nodules with a diameter less than 2 mm are counted as 0.6 (based on microscopic counts). a.
Nodules with a diameter greater than 2 mm are counted as 1 (visually counted and determined under a microscope). h.
Nodules with a diameter greater than 5 mm are counted as 2 (visually counted and determined under a microscope). d.
Nodules with a diameter greater than 1 mm are counted as 3 (visually counted and determined under a microscope). A.4.2
Pneumoconiosis diffuse fibrosis (grade/degree) Determination Grade 1 Lesions occupy more than 26% of the total lung area.
Lesions occupy more than 50% of the total lung area.
Lesions occupy more than 75% of the total lung area.
Grade 1 fibrosis is confined to the pulmonary lobules, or to the septa of the lobules, small bronchi and small blood vessels. e.
Grade 2 is based on grade 1, with fibrosis interconnected to form a grid or patchy shape, which may be accompanied by localized honeycomb changes. Grade 3 fibrosis destroys part of the lung tissue or forms fibrous masses. The severity of the lesion is determined by the average severity of 20 sections. If the severity is higher than grade 1, it is grade 2. When diagnosing asbestosis, asbestos bodies must be found. When the total area of pleural plaques complicated by asbestosis exceeds 200 cm, the pneumoconiosis lesions are close to stage I or between stage I and stage II, and can be diagnosed as stage I or stage II respectively.
Dust plaque measurement
GB8783
The area of dust plaques is more than 25% of the total lung area.
The area of dust plaques is more than 50% of the total lung area.
The area of dust spots accounts for more than 75% of the remaining lung area.
The area of pneumoconiosis is determined by visual observation of each section of the lung, and the dust spots on the pleural surface are not included. Pneumoconiosis complications
The following diseases are listed as complications of pneumoconiosis pathological diagnosis. A.5.1 Pulmonary tuberculosis includes active pulmonary tuberculosis, namely caseous necrosis, caseous pneumonia, cavitary tuberculosis, miliary tuberculosis, endobronchial tuberculosis, hilar lymph node tuberculosis and exudative tuberculous pleurisy. To diagnose stage IIIII silicosis tuberculosis, it is necessary to have a pneumoconiosis lesion foundation of stage I or above, and at the same time, there must be fibrous masses composed of pneumoconiosis tuberculosis lesions. A.5.2 Non-specific lung infection focuses on bacterial, viral and fungal bronchial charcoal, pneumonia and lung abscess, bronchiectasis, etc. When distinguishing fibrosis caused by inflammation from fibrosis caused by dust, it can be used as dust diffuse fibrosis for diagnosis and staging. A.5.3 Pulmonary heart disease, non-pneumothorax emphysema, pneumothorax. A.5.4 Lung tumor, malignant pleural mesothelioma.
B.1 Fixation of lung specimens
GB 8783-88
Appendix B
Examination method of pneumoconiosis specimens
(Supplement)
The body is dissected within 24 hours after death. If refrigerated, its storage period can be appropriately extended. Remove the lungs, heart and mediastinum according to the standard inspection method, and immediately perfuse 10% formalin solution through the tracheal crus to make the lungs expand and fix under the physiological deep inspiration state. Before perfusion, gently press each lobe of both lungs to expel the gas in the lungs and eliminate the secretions in the trachea to facilitate the entry of the fixative into the lungs. During perfusion, the formalin column is about 40 cm away and dripped slowly. The perfusion gauge varies according to the lung capacity, generally 1000~1500ml. The liquid outflow outlet should be moved at any time so that all five lobes of the lung can be properly expanded. At the same time, the lung should be placed in a wide container filled with 10% formalin, and the surface of the lung should be covered with double layers of wet gauze to prevent air drying. After all five lobes of the lung are fully expanded, the air arm is tied to allow the dry position of each lobe of the lung to stretch freely. After five days of fixation, cut and inspect according to regulations. B.2 Visual inspection
The fixed lung specimen is placed on a cutting lung board, with the dorsal side of the lung close to the board surface. The lung is fixed to board 1 with the left hand, and the lung is evenly pressed to make the lung stick to the board surface as much as possible. Use a long knife to cut the lung into continuous coronal sections with a thickness of 1 cm each. The section at the descending process of the trachea is defined as section 0, and the lung is cut into multiple sections toward the ventral (anterior) side and dorsal (posterior) side, numbered in sequence as anterior 3, anterior 2, anterior 1, 0, posterior 1, posterior 2, and posterior 3. Observe the pneumoconiosis lesions of each section, such as dust spots, perifocal emphysema, nodules, diffuse fibrosis, massive fibrosis, lymph nodes, and pleural lesions, and register them on the specified record paper. Whole lung large section specimens can provide useful information for the pathological diagnosis and staging of pneumoconiosis, pathological X-ray comparison analysis, and the preservation of lung pathology archives and scientific research. It is recommended that units with conditions use it as an inspection guide. B.3 Histological sampling
10 pieces of tissue should be collected from each lung, including all lobes. Each piece should be 3~4mm thick and about 2cm×2cm in area. The tissue blocks should include various pneumoconiosis lesions and suspected pneumoconiosis lesions, including deep tumour tissue and foot membrane. The number of tissue blocks should be consistent with the number of the record sheet. The number of lymph nodes collected is not limited. The number of tissue blocks collected for the diagnosis of complications is not within the prescribed 20 pieces. Histological sections are routinely paraffin sections and stained with hematoxylin and eosin. When necessary, staining of reticulum, collagen fibres, elastic fibres, tuberculosis bacteria, calcium, iron, etc. should be performed to identify the nature of the lesions. B. 4 Intra-abdominal dust analysis
Dust analysis should be performed according to the microscopic ashing method.
GB 8783—88
Appendix ℃
Application form, record form, report form
(Supplement)
The formats of the application form, three record forms and report form for pneumoconiosis pathology examination are unified nationwide. c.1
Anyone who applies for pneumoconiosis pathology examination must fill in the application form specified in this standard item by item, and the diagnosis unit must complete the diagnosis work according to the format and requirements of the record form and report form. Main
Application form for pneumoconiosis pathology examination
Record form for pneumoconiosis pathology examination
Record form for visual observation of pneumoconiosis specimens:
Copy of pneumoconiosis visual lesion,
Record form for pneumoconiosis specimens.
C.4 Pneumoconiosis Pathology Diagnosis Report
GB 878388
Standard photos for pneumoconiosis pathology diagnosis
(Supplement)
A set of 40 photos for pneumoconiosis pathology diagnosis. The photos show typical pneumoconiosis lesions and serve as auxiliary explanations for the provisions of the pneumoconiosis pathology diagnosis standard.
GB 8783—88
Appendix E
Instructions for the correct use of the standard
(reference)
E.1 This standard is only applicable to the diagnosis of inorganic pneumoconiosis specified by the state, and is not applicable to the diagnosis of lung diseases caused by organic dust; it is only applicable to autopsy and surgical lobectomy specimens, and is not applicable to the pneumoconiosis pathological diagnosis of small tumor tissue biopsy, lung drainage lymph node biopsy, lung puncture, lung lavage fluid and other specimens.
E.2 According to the provisions of Article 7 of Chapter 2 of the Ministry of Health of the People's Republic of China (84) Weifangzi No. 16, pathological professionals have the right to diagnose pneumoconiosis pathology.
E.3 Pathological professionals with the right to diagnose should immediately conduct an examination and submit a diagnosis report after the "Small Lung Pathology Examination Application Form" and the information provided by the inspection unit are complete. The content of the small lung pathology diagnosis report includes the name of the pneumoconiosis, stage, pathological type and comorbidities. The pneumoconiosis pathological diagnosis report shall be prepared in duplicate, one copy shall be filed and the other shall be submitted to the pneumoconiosis diagnosis group of the same level of the inspection unit for processing. The pneumoconiosis pathological diagnosis can be used as the basis for occupational disease treatment.
Additional notes:
This standard was proposed by the Occupational Disease Diagnosis Subcommittee of the National Health Standard Promotion Technical Committee. This standard was drafted by the Institute of Labor Health and Occupational Diseases of the Chinese Academy of Preventive Medicine and the School of Public Health of West China Medical University, the Anshan Iron and Steel Institute of Labor Health, the Jiangxi Institute of Labor Health and Occupational Disease Prevention and Control, and the Shanghai Institute of Labor Health and Occupational Disease Prevention and Control. This standard shall be interpreted by the Institute of Labor Health and Occupational Diseases of the Chinese Academy of Preventive Medicine under the Ministry of Health. From the date of implementation of this standard, the Trial Scheme of the Standard for Pathological Diagnosis of Silicosis (Pneumoconiosis) (Trial Scheme for Staging of Pathological Diagnosis of Silicosis (Pneumoconiosis)) jointly issued by the Ministry of Health and the State Administration of Labor on May 21, 1978 shall be invalid.
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