Viete o čo ide pri Liquid Based Cytology? | Medicínske právo
              

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Viete o čo ide pri Liquid Based Cytology?


 | 11.11.2010 | komentárov: 299

Komora pre medicínske právo - MEDIUS v týchto dňoch začína realizovať spoločný projekt so spoločnosťou HIS- DG, s.r.o. (Biopticko- cytologické laboratórium). Ide o zavedenie novej metodiky spracovania cytologických vyšetrení Liquid Based Cytology a s tým súvisiaceho informovaného súhlasu pre pacienta. Projekt nám v rozhovore priblížil riaditeľ spoločnosti HIS-DG, s.r.o. a zároveň vedúci lekár- patológ MUDr. Jozef Bodnár.

Obrazok
Mohli by ste nám objasniť, čo znamená Liquid Based Cytology (LBC)?

Liquid Based Cytology je technologický proces spracovania steru krčka maternice, ktorý sa robí za účelom diagnostikovania predrakovinových stavov krčka maternice. Sú to stavy, ktoré ak sa včas nezachytia a neliečia, môžu viesť k vzniku rakoviny krčka maternice. Podstatou celého tohto technologického procesu je separácia buniek krčka maternice a čistý cytologický preparát. Ten  pri hodnotení vo svetelnom mikroskope znižuje riziko falošne negatívnych, ale aj falošne pozitívnych nálezov, a to vďaka tomu, že na podložnom sklíčku, ktoré patológ hodnotí a vyšetruje sa nachádzajú len bunky sliznice krčka maternice. 

Aké sú  doterajšie spôsoby vyšetrovania  cytologických sterov a v čom spočíva zásadný rozdiel medzi LBC a konvenčnou cytológiou?

Doterajší  tzv. konvenčný spôsob vyšetrovania spočíva v tom, že gynekológ odobratý ster z povrchu krčka maternice priamo natrie na podložné mikroskopické sklíčko a zafixuje ho fixačným roztokom. Avšak pri tomto procese sa na podložné sklíčko natrie aj hlien a prípadné iné bunkové súčasti ako leukocyty, baktérie, krv atď.. Tie môžu spôsobiť to, že preparát je ťažko hodnotiteľný a výsledok môže byť skreslený.  Ďalšou nevýhodou konvenčnej cytológie môže byť aj mechanické poškodenie buniek pri natieraní na podložné sklíčko. Zásadným rozdielom medzi konvenčnou cytológiou a LBC je práve to, že pri LBC sa odfiltrujú hlien a iné nežiadúce bunkové elementy. Na podložné sklíčko sa bunky nanesú šetrným spôsobom. Celý proces prebieha automaticky v špeciálnom zariadení. Ďalším významným faktorom je tiež transport cytologického materiálu, pretože po odobratí steru sa tzv. „brush“ alebo kefôčka vloží do patentom chránenej  uzatvárateľnej transportnej nádobky, v ktorej sa nachádza špeciálny roztok. Materiál je tak chránený pred náhodným poškodením a znehodnotením.

Aký má podľa Vás význam zavedenie tejto metodiky do diagnostického procesu?

Hlavný význam spočíva v tom, že táto metodika, ako som už spomínal,  eliminuje možnosť  výskytu falošne negatívnych resp. falošne pozitívnych nálezov a taktiež umožňuje realizovať  aj špeciálne nadstavbové vyšetrenia ako napr. HPV, stanovenie proliferačnej aktivity, genetické vyšetrenia, atď..

Má táto metodika aj nejaké nevýhody ? Aké sú možnosti štandardného zavedenia LBC do praxe?

Samozrejme, jej najväčšou nevýhodou je finančná náročnosť . Náklady na toto vyšetrenie sú na naše pomery veľmi vysoké a nemôžu byť  financované zo zdravotného poistenia, takže ak chceme toto vyšetrenie realizovať v praxi, musí tam byť spoluúčasť pacienta.

Akú úlohu by mohla zohrať Komora pre medicínske právo- MEDIUS pri štandardizácii tohto diagnostického procesu?

Komora pre medicínske právo ako garant poskytovania kvalitnej zdravotnej starostlivosti  a dodržiavania práv v liečebnom procese by mala predovšetkým dohliadať na to, aby pacientka bola informovaná o všetkých aspektoch tohto diagnostického procesu formou informovaného súhlasu pacienta.

Čo to znamená v praxi?

Znamená to, že pacientka by mala byť oboznámená so všetkými výhodami, ale aj nevýhodami, ktoré toto vyšetrenie v praxi ponúka, aby sa k nej informácie o vyšetrení prostredníctvom lekára objektívne dostali a aby sa sama pacientka dobrovoľne a slobodne rozhodla, či zvolí jeden, alebo druhý spôsob vyšetrenia. Na stránkach Komory pre medicínske právo  by pacientka v prípade právnych nejasností mohla hľadať oporu  v poradni. Tam  odborníci ako z oblasti práva, tak z oblasti medicíny zodpovedajú  jej prípadné otázky napr. aj ohľadne právnych aspektov financovania  aj tohto vyšetrenia.

A čo lekár? Akým spôsobom by bol chránený?

Aj keď sa to nezdá, ochrana lekára spočíva práve v pravdivej informovanosti pacientky o všetkých vyššie uvedených aspektoch, napr. tohto konkrétneho diagnostického procesu a v slobodnej voľbe pacientky. Ďalším prínosom pre lekára by malo byť aj množstvo právnych informácií z oblasti medicínskeho práva a jeho aplikácie v praxi aj s ohľadom na legálnosť, či nelegálnosť niektorých sprievodných úkonov diagnostického procesu. Tieto a mnohé iné informácie  bude môcť členstvom v komore získať.

Akou formou by členstvom v Komore získal tieto informácie?

Získal by ich formou akreditovaného vzdelávania s konkrétnym zameraním na aplikáciu medicínskeho práva v liečebnom procese. Všetci dobre vieme, že poskytovanie zdravotnej starostlivosti je vzájomný interaktívny proces medzi  lekárom a pacientom. Medzi právami a povinnosťami ako pacienta, tak lekára by mala byť vzájomná rovnováha. To aby nedošlo k narušeniu tejto rovnováhy, by mala byť hlavná úloha Komory pre medicínske právo. Čiže jednoducho povedané, úlohou Komory  je pôsobenie rovnako smerom k pacientke ako aj k lekárovi a hľadanie najoptimálnejších styčných bodov v komunikácii tak, aby boli zaistené všetky právne aspekty liečebného procesu.


zhovárala sa: Bc. Alexandra Bodnárová




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