甲状腺微小乳头状癌术中冰冻病理诊断准确性分析及影响因素

Analysis on Accuracy and Influencing Factors of Intraoperative Frozen Section Pathological Diagnosis of Thyroid Papillary Micro Carcinoma

目的:分析甲状腺微小乳头状癌(PTMC)术中冰冻切片病理诊断准确性,并探讨冰冻病理诊断的影响因素。方法:选择2015年3月至2018年4月在本院行甲状腺手术的296例甲状腺病变患者作为研究对象,所有患者均进行术中冰冻切片病理诊断及术后石蜡切片病理诊断,以石蜡切片病理诊断结果为金标准,分析术中冰冻切片病理诊断的准确性。采用Logistic回归分析探讨影响术中冰冻病理诊断准确性的危险因素。结果:术后石蜡切片确诊为PTMC患者51例,检出率17.23%。术中冰冻切片确诊40例,诊断率78.43%,误诊率7.84%,延迟诊断率9.80%,漏诊率3.92%,无假阳性病例。术中冰冻切片诊断准确性在肿瘤大小、包膜侵犯、甲状腺钙化方面差异有统计学意义(P<0.05)。Logistic多因素回归分析显示,肿瘤大小、包膜侵犯是影响术中冰冻切片病理诊断准确性的独立危险因素。结论:术中冰冻切片病理诊断PTMC的准确性高,其诊断准确性受肿瘤大小和包膜侵犯的影响。

Objective: To analyze the accuracy of intraoperative frozen section pathological diagnosis of thyroid papillary micro carcinoma (PTMC), and to explore the influencing factors of frozen pathological diagnosis. Methods: 296 patients with thyroid diseases in our hospital from March 2015 to April 2018 were selected as the subjects, all the patients were diagnosed by pathological section of intraoperative frozen section and pathological diagnosis of postoperative paraffin section, the pathological diagnosis of postoperative paraffin section was the gold standard, the accuracy of pathological diagnosis of intraoperative frozen section was analyzed. Logistic regression analysis was used to explore the risk factors affecting the accuracy of intraoperative frozen pathological diagnosis. Results: 51 cases of PTMC patients were diagnosed with postoperative paraffin section, with a detection rate of 17.23%. 40 cases were diagnosed by intraoperative frozen section, the diagnostic rate was 78.43%, the misdiagnosis rate was 7.84%, the delayed diagnosis rate was 9.80%, the missed diagnosis rate was 3.92%, and there were no false positive cases. The diagnostic accuracy of intraoperative frozen section was significantly different in tumor size, capsular invasion and thyroid calcification (P<0.05). Logistic multivariate regression analysis showed that tumor size and capsular invasion were independent risk factors affecting the accuracy of intraoperative frozen section pathological diagnosis. Conclusion: Intraoperative frozen section is highly accurate in diagnosing PTMC, the accuracy of diagnosis is affected by tumor size and capsule invasion.