摘要
目的 分析甲状腺术中冰冻与术后病理诊断不一致病例的临床病理特征,探讨提高冰冻确诊率的方法和措施。方法 收集2018-03—2021-12期间行冰冻切片检查且经石蜡切片确诊的甲状腺病变1761例,分析其中病理诊断不一致病例的临床特点、大体特征、组织学改变、伴随基础病变以及相关人为因素。结果 在1761例甲状腺病变中,术中冰冻总确诊率为87.7%[其中良性病变(滤泡性腺瘤除外)、乳头状癌、微小乳头状癌及滤泡性肿瘤的确诊率分别为97.0%、97.4%、81.1%及47.6%],延迟诊断率为10.5%,假阴性率为1.8%,无假阳性。延迟诊断病例中,结节性甲状腺肿14例,其中8例显著间质纤维化,7例伴有乳头结构及细胞非典型性、4例因钙化/骨化制片困难;乳头状癌14例,其中10例为滤泡亚型;微小乳头状癌50例,其中46例乳头结构及核特征不明显,19例纤维瘢痕占肿瘤主体,7例因钙化影响制片。假阴性共32例,均为冰冻取材漏检的微小乳头状癌。结论 良性病变、乳头状癌及微小乳头状癌的冰冻确诊率高,冰冻检查是术中判断甲状腺病变性质的重要手段;滤泡性肿瘤冰冻确诊率低,冰冻诊断价值有限;甲状腺病变组织学结构的复杂性和冰冻取材漏检微小病变,为造成术中冰冻与术后病理诊断不一致性的主要因素。
Objective To analyze the clinicopathological characteristics of the cases with inconsistent diagnosis between frozen section(FS) and paraffin section(PS), and to explore the method of improving the accuracy of frozen section. Methods A total of 1761 cases of thyroid lesions diagnosed by FS and PS between March 2018 and December 2021 were collected, and the cases with inconsistent diagnosis were analyzed, including their clinical features, specimen gross features, histological characteristics, concomitant disease and human factors. Results In 1761 cases of thyroid disease, the diagnostic accuracy of FS was 87.7% and that of of benign lesions, papillary thyroid carcinoma(PTC), micropapillary thyroid carcinoma and follicular thyroid tumor(FTT) were 97.0%, 97.4%, 81.1% and 47.6%, respectively;the delayed diagnosis rate was 10.5%, the false negative rate was 1.8%, and no false positive cases were found. In the delayed diagnosis group, 14 cases were nodular goitre, including 8 cases with significant interstitial fibrosis, 7 cases with papillary structure and cellular atypia, and 4 cases with difficulty in FS preparation due to calcification and ossification. There were 14 cases of PTC for delayed diagnosis, 10 of them were follicular variant. There were 50 cases of micro-PTC for delayed diagnosis, including 46 cases with no obvious papillary structure and nuclear features, 19 cases with fibrous tissue occupying the main component of the tumor, and 7 cases with obvious calcification. A total of 32 false negative cases were all micro-PTC missed by frozen sampling. Conclusion FS examination has high diagnostic accuracy in benign thyroid lesions, PTC and micro-PTC, and is an important method of intraoperative diagnosis of thyroid lesions. The FS accuracy of FTT is low and the diagnostic value is limited. The histological complexity of thyroid lesions and missed small lesions in frozen sampling are the main reasons for the inconsistency between FS and PS.
作者
崔艳梅
张洪生
王丽
李花
刘伟
高爱明
CUI Yan-mei;ZHANG Hong-sheng;WANG Li;LI Hua;LIU Wei;GAO Ai-ming(Departmentof Pathology,Affiliated People's Hospital,Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China;Department of Pathology,Fujian Medical University Cancer Hospital/Fujian Cancer Hospital,Fuzhou 350014,China)
出处
《诊断病理学杂志》
2023年第1期14-17,共4页
Chinese Journal of Diagnostic Pathology
关键词
甲状腺
甲状腺肿瘤
冰冻切片
石蜡切片
诊断
Thyroid
Thyroid neoplasm
Frozen section
Paraffin section
Diagnosis
