提高中小医院冷冻切片病理诊断质量的方法(附300例分析)

Ways to Improve Quality of Pathological Diagnosis on Frozen Sections at Medium and Small Sized Hospitals

目的:探讨提高中小医院冷冻切片病理诊断准确率的方法。方法:分析300例冷冻切片快速病理诊断结果的确诊率、误诊率,并分析误诊及不能确诊的原因。结果:本组确定性诊断285例,占95%,其中误诊9例,误诊率3%,全部为假阴性诊断;不能确诊者15例,占5%。误诊的主要原因系取材不当,不能确诊的主要原因为诊断人员对误诊过度担心,保留性意见表达过度。结论:影响中小医院冷冻切片诊断确诊率的因素,除读片水平外,标本取材、临床资料的采集、对疾病的总体分析和估计、诊断中对疑难病例准确适当的表达等也都是十分重要;另外,如冷冻切片在手术室进行有利于提高诊断的准确率及确诊率。

Objective:To explore the ways of improving pathological diagnosis rate and diagnostic correct rate on frozen sections at medium and small sized hospitals.Methods:Diagnosis rate,misdiagnosis rate,and causes for misdiagnosis and non-diagnosis rate were analyzed in 300 patients who underwent pathological procedures on frozen sections.Results:A confirmative diagnosis was achieved in 285 samples through frozen section,accounting for 95% of total cases;misdiagnosis was made in 9 samples,occupying 3% of the total patients.All of the 9 misdiagnosed cases were diagnosed with pseudo-negative results.15 samples could not be diagnosed,accounting for 5% of the total samples.The main reason for misdiagnosis lied in samples selection process rather than in observing sections;non-diagnosis in 9 cases occurred mainly because the pathologists were excessively worried about misdiagnosis,therefore,they expressed an over-conservative opinion. Conclusions:Factors influencing the diagnosis rate of frozen sections at medium and small sized hospitals included sample collection,clinical data collection and overall understanding of a disease,besides the pathological knowledge and skills on frozen sections.An accurate and appropriate expression in dealing with difficult cases was also very important.If the process of frozen sectioning and diagnosis were performed in operating room,it would be much beneficial to improvement of diagnosis rate and correct diagnosis rate.