甲状腺微小乳头状癌术中冰冻病理诊断研究及B-raf基因检测意义

Pathological Diagnosis of Thyroid Micropapillary Carcinoma during Frozen Operation and Significance of B-raf Gene Detection

目的探讨甲状腺微小乳头状癌术中应用冰冻病理诊断的临床效果及B-raf^(V600E)基因检测的临床意义。方法选取168例甲状腺微小乳头状癌患者作为研究对象,术中采用冰冻病理诊断,并将诊断结果与石蜡切片病理结果进行对比。同时将168例患者按照基因检测结果分为突变型(n=126)与野生型(n=42),将不同类型基因检测结果患者的性别、年龄、家族史、肿瘤大小、是否伴有慢性淋巴性甲状腺炎、是否伴有淋巴结转移及临床分期进行对比。结果冰冻病理检出率(82. 1%)与石蜡切片病理确诊率(100%)存在明显差异。通过B-raf基因检测,2种基因类型患者在肿瘤大小、是否伴有慢性淋巴性甲状腺炎上存在明显差异,而在性别、年龄、是否有家族史、是否伴有淋巴结转移及临床分期上无明显差异。结论术中冰冻病理诊断应用于甲状腺微小乳头状癌检测中虽存在一定的误差,但仍有较高的检出率,且多种干预措施的应用可提高冰冻病理诊断准确率。B-raf^(V600E)基因与甲状腺乳头状癌患者的肿瘤大小及是否伴有慢性淋巴性甲状腺炎有关,因此检测B-raf^(V600E)基因可为甲状腺乳头状癌的防治提供更多参考依据。

Objective To investigate the clinical effect of frozen pathological diagnosis of thyroid micropapillary carcinoma and the clinical significance of B-rafV600Egene detection. Methods 168 patients with papillary thyroid microcarcinoma were selected as the research subjects. Frozen pathological diagnosis was performed during the operation,and the results were compared with those of paraffin sections. At the same time,168 patients were divided into mutant( n = 126) and wild-type( n = 42) patients according to the gene test results. The results of different types of gene tests included gender,age,family history,tumor size,and chronic lymphoid involvement. Thyroiditis,accompanied by lymph node metastasis,and clinical staging were compared. Results There was a significant difference between the frozen pathological detection rate of 82. 1% and the paraffin section pathological diagnosis rate of 100%. Through the B-raf gene test,there were significant differences in the tumor size and the presence of chronic lymphoid thyroiditis between the two gene types. There was no significant difference in gender,age,family history,lymph node metastasis,or clinical stage. Conclusion There are some errors in the application of intraoperative frozen pathological diagnosis in the detection of thyroid papillary microcarcinoma,the detection rate is still high,and the application of various interventions can improve the accuracy of frozen pathological diagnosis. The tumor size of B-rafV600Egene and thyroid papillary carcinoma is associated with chronic lymphoid thyroiditis. Therefore,the detection of B-rafV600Egene can provide more reference for the prevention and treatment of thyroid papillary carcinoma.