冰冻切片对甲状腺微小癌术中病理诊断的准确性及漏诊率、误诊率分析

Analysis on the accuracy and missed diagnosis, misdiagnosis rates of intraoperative pathological diagnosis of thyroid microcarcinoma by frozen section

目的 分析在甲状腺微小癌术中病理诊断中应用冰冻切片检查的价值及误诊率、漏诊率和准确性。方法选取2018年10月至2020年10月在漳州市第三医院就诊的甲状腺微小癌患者200例,在术前实施超声引导下甲状腺细针穿刺病理诊断,对患者均开展手术治疗,在术中实施冰冻切片检查,完成手术后开展石蜡切片病理检查,诊断金标准为石蜡切片病理检查,将这两种病理诊断方法的诊断效果进行比较和分析。结果200例患者均通过石蜡切片病理诊断明确为甲状腺微小癌,准确率为100.00%,术中冰冻切片病理检查结果为明确检出甲状腺微小癌197例,准确率为98.5%,两种病理诊断方法比较,差异无统计学意义(P> 0.05);其中漏诊1例,漏诊率为0.05%;延迟诊断1例,延迟诊断率为0.05%;误诊1例,误诊率为0.05%。冰冻切片和超声引导下甲状腺细针穿刺病理诊断甲状腺滤泡状腺癌和甲状腺髓样癌检出率比较,差异有统计学意义(P <0.05)。冰冻切片病理特点为坚硬质地,囊实性、囊性,呈现结节状,取材过程中发现点状钙化灶或纤维瘢痕样组织(灰白色),边界模糊,在甲状腺实质中浸润。结论 在甲状腺微小癌术中病理诊断中应用冰冻切片检查可获得满意的病理诊断效果,诊断准确率较高,误诊率和漏诊率较低,建议推广。

Objective To analyze the value, misdiagnosis rate, missed diagnosis rate and accuracy of frozen section examination in the intraoperative pathological diagnosis of thyroid microcarcinoma. Methods A total of 200 patients with TMC who attended in the Third Hospital of Zhangzhou from October 2018 to October 2020were selected as study subjects. All patients were treated surgically, and they were subjected to preoperative ultrasound-guided fine needle aspiration of the thyroid gland for pathological diagnosis. Intraoperative frozen section examination followed by postoperative paraffin section pathological examination was performed, with the latter as the gold standard of diagnosis. The diagnostic effect of these two pathological diagnosis methods was compared and analyzed. Results All 200 patients were diagnosed as TMC by paraffin section pathological examination, with 100.00% accuracy rate, and 197 patients were clearly detected as TMC by intraoperative frozen section pathological examination, with 98.5% accuracy rate, with no statistically significant difference between the two pathological diagnosis methods in the diagnostic accuracy(P > 0.05). Of the 200 patients planned to be diagnosed by intraoperative frozen section pathological examination, 1 patient was missed, with missed diagnosis rate of 0.05%, 1 patient was delayed in diagnosis, with delayed diagnosis of 0.05%, and 1 patient was misdiagnosed, with the misdiagnosis rate of 0.05%. There were statistically significant differences between the frozen section and ultrasound-guided fine needle aspiration of the thyroid gland in the detection rates of thyroid follicular adenocarcinoma and medullary thyroid carcinoma(P < 0.05). The frozen section was pathologically characterized by firm textured, cystic-solid or cystic nodules, and punctate calcification foci or fibrous scarlike tissues(grayish-white) with blurred border and infiltration in the thyroid parenchyma were found during the sampling. Conclusion Satisfactory pathological diagnosis can be obtained by applying frozen section examination in the intraoperative pathological diagnosis of TMC, and this diagnostic method has high diagnostic accuracy and low misdiagnosis and missed diagnosis rates, and therefore, it is recommended to be promoted.