细胞学涂片在肺结节术中的快速病理诊断价值

The rapid pathological diagnostic value of cytological smear in pulmonary nodule during operation

目的探讨细胞学涂片在肺结节术中的快速病理诊断价值。方法对胸腔镜手术术中送检的40例肺结节标本进行细胞学涂片,迪夫快速染色,光镜下观察,即时报告结果;与术中冷冻切片和术后石蜡切片结果进行对照。以术后石蜡切片诊断结果作为金标准,细胞学涂片和冷冻切片诊断结果分为确诊、误诊和延迟诊断,计算诊断准确度。结果在40例肺结节标本中,石蜡切片诊断腺癌28例,鳞癌2例,肺错构瘤1例,硬化性肺细胞瘤1例,肉芽肿病变3例,机化性病变或炎性病变5例;细胞学涂片确诊38例,准确率95.0%,1例误诊,1例延迟诊断;冷冻切片确诊39例,准确率97.5%,1例延迟诊断;细胞学涂片与冷冻切片检查对术中肺结节的诊断准确度差异无统计学意义(χ^(2)=0.000,P=1.000)。结论细胞学涂片检查在肺结节的术中快速病理诊断中有较高的准确率,具有临床实用价值。

Objective To explore the rapid pathological diagnostic value of cytological smear in pulmonary nodule during surgery.Methods A total of 40 lung nodule specimens collected during thoracoscopic surgery were performed cytological smears,Diff rapid staining was used to observe under light microscopy.Real-time report was given results.The results of intraoperative frozen section and postoperative paraffin section were compared.The result of postoperative paraffin section was used as the gold standard for the diagnosis.Results of cytological smear and frozen section diagnosis were divided into the confirmed,misdiagnosed and delayed diagnose groups.The diagnostic accuracy was calculated.Results In 40 lung nodule specimens,28 cases were diagnosed with adenocarcinoma,2 cases were diagnosed with squamous cell carcinoma,1 case with pulmonary hamartoma,1 case with sclerosing pneumocytoma,3 cases with granulomatous lesions and 5 cases with organizing or inflammatory lesions by paraffin sections.Thirty-eight cases were diagnosed by cytological smears,with an accuracy rate of 95.0%.One case was misdiagnosed and one case was delayed in diagnosis.Thirty-nine cases were diagnosed by frozen sections,with an accuracy rate of 97.5%,and 1 case was delayed in diagnosis.There was no significant difference in the diagnostic accuracy between cytological smear and frozen section examination for intraoperative pulmonary nodules(χ^(2)=0.000,P=1.000).Conclusion Cytological smear examination has high accuracy in rapid pathological diagnosis of pulmonary nodules during surgery and has clinical practical value.