探讨病例随访在超声科质量控制中的作用。

对南方医科大学附属东莞医院2018年至2019年有病理报告的超声检查病例进行随访，将超声诊断结论和病理报告相匹配，根据其符合情况分为如下3种：完全符合、基本符合、不符合，统计不同季度和年度、不同亚专业、不同职称医师的超声诊断符合率并采用Pearson χ²检验比较2018年和2019年超声诊断符合率的差异。在超声诊断符合率数据基础上引入乳腺病例的PDCA循环管理，提高诊断质量。

病例随访结果显示，2019年度的超声诊断总符合率（完全+基本符合率）较2018年度有明显提升（95.1% vs 91.4%，χ²=71.3，P＜0.001）。与2018年相比，2019年度浅表小器官亚专业组的超声诊断总符合率有明显提升（95.4% vs 93.3%，χ²=6.3，P=0.013），妇产科亚专业组的诊断质量有显著提高（94.4% vs 89.7%，χ²=44.5，P＜0.001），腹部亚专业组的诊断质量也有改善（90.0% vs 87.3%，χ²=3.0，P=0.089）。2019年与2018年相比，高级职称医师的诊断质量保持稳定，完全符合率、基本符合率、不符合率比较，差异均无统计学意义（P均＞0.05）；中级职称的完全符合率比较（69.2% vs 69.7%），差异无统计学意义（χ²=0.6，P=0.447），基本符合率有明显提升（25.6% vs 21.2%），差异具有统计学意义（χ²=13.8，P＜0.001）；初级职称的完全符合率则有明显提升（69.0% vs 67.5%），差异具有统计学意义（χ²=10.0，P=0.002）。病例随访指导乳腺肿块PDCA循环管理，乳腺4b类肿块的恶性比例从2018年第一季度的72.7%逐渐降低至50%以下。

定期进行病例随访可以直接获得超声诊断质量数据，通过分析和总结，不断改进并提升超声诊断水平，是做好超声质量控制的重要方法之一。

To explore the role of case follow-up in quality control of ultrasound department.

The ultrasound examination cases with pathology reports at Affiliated Dongguan Hospital of Southern Medical University from 2018 to 2019 were followed. The ultrasound diagnosis was compared with the pathology report, and the cases were then divided into the following three types according to the consistency between the ultrasound diagnosis and pathology report: absolutely consistent, basically consistent, and inconsistent. Statistics on the consistent rate were compared among different quarters and years, different sub-specialties, and different titles. Pearson χ² test was used to compare the consistent rate between groups. Then, the PDCA cycle management of breast cases was introduced on the basis of the consistent rate data to improve the diagnosis quality of ultrasound.

The results of case follow-up showed that the overall consistent rate (absolutely and basically consistent rate) in 2019 was significantly higher than that in 2018 (95.1% vs 91.4%, χ²=71.3, P＜0.001). Compared with the data in 2018, the overall consistent rates in the superficial organ sub-specialty group (95.4% vs 93.3%, χ²=6.3, P=0.013), the obstetrics and gynecology sub-specialty group (94.4% vs 89.7%, χ²=44.5, P＜0.001), and the abdominal sub-specialty group in 2019 (90.0% vs 87.3%, χ²=3.0, P=0.089) were significantly improved. Compared with the data in 2018, the diagnostic quality of physicians with senior professional titles remained stable, and there was no statistically significant difference in the absolutely consistent rate, basically consistent rate, or inconsistent rate (P＞0.05); the absolutely consistent rate of intermediate professional titles had no significant change (69.2% vs 69.7%, χ²=0.6, P=0.447), but the basically consistent rate was significantly improved (25.6 % vs 21.2%, χ²=13.8, P＜0.001); and the absolutely consistent rate of junior professional titles increased significantly (69.0 % vs 67.5%, χ²=10.0, P=0.002). After case follow-up was used to guide the PDCA cycle management of breast masses, the malignancy proportion of malignant breast masses in category 4b gradually decreased from 72.7% in the first quarter of 2018 to less than 50%.

Regular follow-up of cases can directly obtain ultrasound diagnostic quality data. Analysis and summary of follow-up data can improve and enhance the level of ultrasound diagnosis. Therefore, case follow-up is one of the important methods for ultrasound quality control.