135例神经系统病变术中冰冻诊断结果分析

Diagnostic Analysis on 135 Intraoperative Frozen Section Examination of Nervous System Lesions

背景与目的:中枢神经系统疾病冰冻切片诊断的误诊率较其他脏器相对较高,文献报导误诊率在1.6-13.2%,误诊率较高的肿瘤包括脑膜间叶性肿瘤,血管母细胞瘤,淋巴瘤及少枝胶质细胞瘤。本文总结和探讨神经系统病变术中诊断存在的问题,以提高神经系统病变术中诊断的质量。方法:我们回顾性地研究了4年中所进行的135例神经外科术中送检冰冻标本的诊断,并对照相应石蜡标本的诊断结果进行了分析比较。结果:发现冰冻切片诊断错误9例,误诊率为6.67%。误诊病例包括:星形细胞瘤1/73例(误诊率1.4%),室管膜瘤3/4例(误诊率75%),小脑髓母细胞瘤1/5例(误诊率20%),嗅神经母细胞瘤1/2例(误诊率50%),中枢神经细胞瘤1/2例(误诊率50%),脉络丛肿瘤1/2例(误诊率50%),非肿瘤性病变1/9例(误诊率11.1%)。结论:发生在脑室外的室管膜瘤易发生误诊;小脑髓母细胞瘤、嗅神经母细胞瘤等出现滤泡样结构或表现出结节样的结构时可能与转移性低分化癌混淆;脑组织中血管畸形伴血肿形成,由于常并发出现显著的胶质细胞反应而导致肿瘤的诊断。

BACKGROUND ＆ OBJECTIVE： Intraoperative frozen section examination （FSE） for brain lesions provided relatively high rate of misdiagnoses than other organs of the body. It was reported that the rate of misdiagnoses is between 1.6% and 13.2%. The entities that are most easily misinterpretated are meningeal mesenehymal tumors, haemangioblastomas, malignant lymphomas and oligodendrogliomas. This paper is to review what type of misdiagnoses were found and to explore methods to improve the accuracy of intraoperafive FSE of nervous system lesions. METHODS： A retrospective review of 135 intraoperation consultation eases of neural system lesion was performed, and these eases were also compared to the diagnoses of the corresponding paraffin sections. RESULTS： Paraffin section examination confirmed the intraoperative diagnosis in 126 （93.3%） of 135 eases were accurate, and the misdiagnosis rate （MR） was 6.67 %. The eases misdiagnosed were as follows： astrocytoma 1 （MR 1.4%）, ependymoma 3（MR 75%） medulloblastoma of cerebellum 1 （MR 20%）,olfactory neuroblastoma 1 （MR 50%）;central neurocytoma 1（ MR 50%）,ehoroid plexus tumors 1（MR 50%）, non-neoplastic lesions 1 （MR 11.1%）, respectively. CONCLUSION： It is subject to be misdiagnosed when the ependymomas occurred outside ventricle. It is prone to confusion among the metastatic poorly differentiated carcinoma with medulloblastoma of cerebellum and olfactory neuroblastoma which possess the predominant follicular or nodular morphology. In addition, it is also possibly considered as a neoplastic lesion when vascular malformation is accompanied by haematoma and marked gliocyte reaction.