Dr. Wen of the Department of Pathology is still very efficient, and the postoperative pathology report of Nong Tiesheng was quickly issued, and a total of 12 tissues were taken from the surgical area on both sides of the neck for pathological examination, and no tumor tissue was found in the 12 specimens.

This pathological examination is only intended to guide postoperative treatment and does not affect the diagnosis at that time.

In this way, there is no need to treat the tumor after surgery, and the imaging examinations done by Nong Tiesheng throughout the treatment process, including PETCT, did not show any signs of metastasis of the tumor, and it can be considered that Nong Tiesheng's tumor has been cured.

Yang Ping recalled Nong Tiesheng's medical record again, and there was only one color ultrasound of the thyroid gland in the entire medical record, indicating that thyroid adenocarcinoma was considered, but later in the attached four, he did not do color ultrasound, but did CT, CT enhancement, PETCT and other examinations, the most important color ultrasound was not, and the most important pathology report was missing, which was really strange.

This color ultrasound considering thyroid adenocarcinoma was not taken with four shots, but was taken by Nong Tiesheng in the county hospital, but when he saw that it was cancer, he immediately came to the provincial capital to see a doctor.

Yang Ping asked Li Guodong to go to the Department of General Surgery to bring over all the imaging examination materials of Nong Tiesheng, and Yang Ping slowly read the films again in the office, reading them one by one.

Because some of the images have been seriously dissolved and blurred, Yang Ping instructed Nong Zhiwen to go to the fourth place to copy all the image examinations into a CD, although it is more troublesome, but the matter of treating the disease is originally a troublesome matter, in order to do this matter well, a little trouble is nothing.

Nong Zhiwen was very active in cooperating, and immediately followed Yang Ping's instructions to attach four, and copy all the image data into a CD-ROM and bring it over, which was originally much more convenient for the USB flash drive, but the USB flash drive socket in many hospitals is closed, which is to avoid viruses in the computer, once the hospital system is poisoned, it is not a trivial matter.

Yang Ping knows that many patients' image data are CD-ROMs, so his computer is not only connected to a dedicated image display, but also has an optical drive.

After looking at the pictures one by one, Yang Ping took a long breath, from the most primitive preoperative pictures at the beginning, to the pictures after two surgeries, and then to the latest pictures, Yang Ping judged from the image that this thyroid tumor should be a benign tumor, with his own experience in reading films, Yang Ping is very confident.

However, pathological diagnosis is the gold standard for tumors, and without the original pathology report, what the tumor is in the end can only be a mystery.

Even if Yang Ping is absolutely sure, it cannot be said that this tumor must be benign, Yang Ping read the medical records again and again, from the two admission records, discharge records, and surgical records, the diagnosis has always been thyroid cancer, but what kind of classification and grading and staging are not mentioned, from beginning to end is thyroid cancer, which is very contradictory.

It stands to reason that as a tertiary teaching hospital, such medical records are unqualified, especially in a large tertiary teaching hospital like Attached Four, it should not be, is the medical record of Attached Fourth so rough now? So loosely managed?

If it is a benign tumor, radical thyroidectomy is performed, and then various chemoradiotherapy and targeted therapy are also performed around the tumor?

Yang Ping didn't dare to think so, but he had to think so.

It shouldn't be possible, there must be some misunderstanding in it, Yang Ping told himself.

Because from graduating from university to now, working for all the years, among all the doctors I have come into contact with, although there are a few doctors with improper heart, these very few doctors with improper heart skills are at most just playing for profit, and the vast majority of doctors are principled, bottom line and professional ethics, and will never do anything that violates the basic principles.

At least I have the impression that no doctor would treat a patient with a benign tumor as malignant so exaggeratedly, and then treat it with a lot of treatment.

At most, for active treatment, the benign tumor is completely removed, which is completely in line with medical principles.

For example, there is a lot of controversy in the treatment of lung nodules, some doctors think that they should be surgically removed to prevent future problems, and some doctors think that they should not be so aggressive, and in the case of many evidence that they are benign, they can be observed and rechecked regularly, because most lung nodules are benign.

Even around lung nodules, there are doctors who specialize in pulmonary nodules, and some hospitals have specialized pulmonary nodule clinics.

This is an academic controversy, and it is also something that is inconclusive, and it is completely normal for everyone to have different opinions and different ways of dealing with it.

However, for the treatment of malignant tumors, two surgeries have been performed, and no matter what the judgment is at that time, postoperative pathological examination should be a mandatory rule, and it is also the consensus of the whole world, and there is no controversy.

If it is really not thyroid cancer, if a benign tumor is misdiagnosed as thyroid cancer, what an impact will it have on the patient?

No matter how rich Yang Ping's experience in reading films is, it can't replace the pathology report, so out of rigor, Yang Ping hopes to find the pathology report.

Following this line of thought, Yang Ping told Director Fang his thoughts, and asked Director Fang to find a way to find a way to ask the patient clearly, if he could contact the relevant doctors of the county hospital at that time, it would be the best, he could help check the medical records, whether he had done a needle biopsy or something like that, and if so, bring the pathology report and pathological slides.

In addition, Yang Ping told Director Fang to contact an acquaintance on the side of Attached 4 to help someone check whether they had not done a pathological examination or the report was lost, which are completely different things.

This case, Yang Ping plans to make sure it is clear.

For what Yang Ping explained, Director Fang was resolute, he called the fourth side to ask, and his friend helped check it, saying that there was indeed no pathology report in the medical record, and there was no pathology report of this patient in the computer database of the pathology department.

Two surgeries with no pathology report? Combined with Director Qian's resounding reputation, Director Fang began to have an ominous premonition.

Since there is no pathology report attached to the fourth, then go to the county hospital to find it, Director Fang's peers in the province have a good relationship, after all, Sanbo Hospital is also a provincial hospital, and there are many doctors who study every year, he found Dr. Gu of the General Surgery Department of Zhongqiao County People's Hospital, the hospital where Nong Tiesheng was first diagnosed, Dr. Gu used to study in Director Fang's department, and Director Fang was often invited by him to do surgery.

Dr. Gu helped to find the hospital's computer system, and then borrowed the patient's electronic medical records, this patient had previously done a thyroid color ultrasound and a thyroid needle biopsy, Director Fang immediately asked Dr. Gu to make a copy of the pathology report, and then help take out the pathology sections, these two things to send to Sanbo Hospital.

Dr. Gu was very helpful, not only got the pathology report and the pathological slides at that time, but also copied the entire medical record, and immediately drove to the provincial capital and handed it over to Director Fang.

After getting the pathology slides, pathology report and the entire medical record, Yang Ping was very happy, because there were too many contradictory things in this medical record, which made Yang Ping have to suspect some things that should not be suspected.

After reading the entire medical record of Zhongqiao County People's Hospital, Yang Ping probably sorted out the context of Nong Tiesheng's medical treatment.

At that time, the judgment of the color ultrasound report of the county hospital was to consider thyroid adenocarcinoma, and it was recommended to combine clinical and pathology, and the reason of the color ultrasound doctor was very sufficient: the height of this thyroid nodule was greater than the width, and it had the characteristics of microcalcification and low blood supply.

The pathology report of Zhongqiao County People's Hospital reads: Thyroid adenocarcinoma is considered, because the sample is not satisfied, a large amount of blood and serous components are seen, and it is recommended to take a new sample.

These two examination reports are described in the medical records attached to Appendix 4, and there are relevant descriptions in the admission record of present medical history and auxiliary examinations, including the time of examination, the results and the number of the examination list, which is very standardized.

In this way, the diagnosis of thyroid cancer in Appendix 4 is based on these two reports, but as a higher-level hospital, shouldn't the specimen be re-taken for review, and after two surgeries, shouldn't the tumor removed during the operation be sent for examination? Could it be that they were diagnosed with thyroid cancer based on this report, and finally underwent surgery and extensive treatment for thyroid cancer?

"I'm going to see the pathology slides myself."

Yang Ping told Director Fang that he immediately called Wen Ruzheng from the pathology department, so he took Director Fang, Dr. Gu and pathology slides to the pathology department.

Dr. Gu was waiting to bring back the pathology section, so he also followed.

After borrowing the microscope of the pathology department to look at the pathological section, Yang Ping thought for a while, the material of the pathological section is indeed unqualified and cannot meet the requirements of judgment, but there are still a small number of cells on the section for observation, and it may be difficult for other doctors to make a judgment, but for Yang Ping, these are enough to make a judgment, this is not thyroid adenocarcinoma, but a rare thyroid zombie nodule that is easily confused with thyroid cancer.

Now there is no original color ultrasound map at hand, if there is a color ultrasound original picture, Yang Ping can make a very certain judgment, I don't know if the color ultrasound doctor in the county hospital at that time left a picture.

Now the pictures printed out of the ultrasound report are extremely blurry, and this kind of picture has no practical meaning, but is only a symbol.

"Can you find the color ultrasound pictures in Zhongqiao County at that time?" Yang Ping asked Director Fang beside him.

Without full certainty and sufficient evidence, Yang Ping is not able to speak now, because his statement will overturn all previous diagnoses and treatments, which is an extremely serious matter and must be cautious.

"I can ask." Dr. Gu, who sent the information, said.

However, Dr. Gu looked at the signature on the color ultrasound report, this color ultrasound doctor had already left his job and had come to work in a private hospital in the provincial capital, so Dr. Gu had to ask another doctor in the color ultrasound department to help check the color ultrasound image of this patient at that time.

Fortunately, soon, other doctors found the color ultrasound image of Nong Tiesheng and promised to find a way to transmit it.

Because the hospital does not allow the insertion of a USB flash drive, the color ultrasound doctor can only engrave the disc, and then find a place to process the image on the disc, and then upload it to the network disk.

Director Fang didn't go to surgery either, so he came to deal with this matter, taking Dr. Gu to eat lunch near the hospital, and waiting for the other party to transmit images while eating, the whole process was very troublesome, but to figure it out, it had to be done, which was related to the patient's life.

If it weren't for cancer, it would be conceivable that you would be carrying a mountain of cancer for the rest of your life.

At around three o'clock in the afternoon, the ultrasound doctor finally found a young doctor to help complete the conversion and transmission of the image format, stored the image in a network disk, gave Dr. Gu a username and password, and let Dr. Gu see it by himself.

At this time, Yang Ping happened to have another operation, he didn't even take off his hand clothes, and put on a white coat and went directly out of the operating room.

At the Institute of Surgery, Yang Ping's office has two computers, one connected to the Internet and the other not.

Using the computer connected to the external network, Yang Ping called up the color ultrasound images that he had worked so hard to get, and after carefully reading each frame of the image, Yang Ping breathed a sigh of relief.

But he didn't express his opinion on the spot, because Dr. Gu from Zhongqiao County was present, this matter was very small, no matter how powerful he was, after all, it was now a family word, and he didn't want his remarks to spread out for the time being, because there were still many things that had not been figured out, such as the pathological examination that was not done in the attached four at that time.

Dr. Gu's task was completed, he had to go to work tomorrow, so he hurried back with the pathological slides, Director Fang returned the pathological slides to him and asked him to take them back for archiving.

The aura of more than a dozen CNS articles shrouded Yang Ping really like a god-like existence in the minds of these doctors.

After Dr. Gu left, there were only two people in Yang Ping's office, himself and Director Fang, Yang Ping said with a serious expression.

"This is not thyroid adenocarcinoma, there are bilateral signs on the color ultrasound image, that is, a hypoechoic ring is put on the outside of the hyperechoic mass, which is typical of zombie nodules; Combined with the description of several medical records, the whole process of the onset of Nong Tiesheng, the thyroid nodule has experienced the process of unchanged, sudden enlargement, and sudden smallening, which is often seen in the cystic change or bleeding of thyroid nodules, and the glandular tissue of the thyroid gland is generally loose, if there is cystic change or bleeding inside, after a period of time, the cyst wall or solid tissue is prone to collapse, and the internal fluid is absorbed by the gland, and the solid tissue will collapse, and finally form an irregular, hypoechoic, solid nodule. The height of some nodules is greater than the width, and the concentrated glia inside is easily misdiagnosed as microcalcification, so that the absorbed color ultrasound image is easily confused with papillary thyroid carcinoma. ”

''So at that time, color ultrasound considered papillary thyroid cancer!'' ”

"This kind of thyroid zombie nodule is relatively rare, and it is easy to misdiagnose."

This is the most primitive data, and based on these primitive objective examination data, the truth is now revealed, this patient is not thyroid cancer, but a zombie nodule.

Thus, it is reasonable to link these primary data to all the tests that were done later in Annex IV as to why all the tests in Annex IV did not point to thyroid cancer.

''I see!'' ”

Director Fang took a deep breath.

But why didn't the doctor at that time review it, why did there be no pathology report after surgery, or just based on this diagnosis, he was diagnosed with thyroid adenocarcinoma, and then he was subjected to radical surgery, followed by radiotherapy, chemotherapy, and targeted therapy?

It's not like the style of a superior hospital, unless—

it!

Director Fang thought of this and cursed a foul word.