触诊阴性乳腺病灶术中冰冻诊断的可行性分析

Feasibility of Intraoperative Frozen Section Diagnosis in the Nonpalpable Breast Lesions

目的探讨触诊阴性乳腺病灶活检术中冰冻诊断的准确性与可行性。方法由钼靶发现的触诊阴性乳腺病灶158例,采用金属线定位技术切除活检,术中进行冰冻切片与诊断,以石蜡组织学诊断为准,评价冰冻诊断的准确性。结果158例标本中,病理巨检时仅80例(50.6%)发现肉眼可见的异常病灶,平均长径1.2cm。石蜡组织学诊断乳腺浸润癌15例,微小浸润导管癌15例,原位癌12例,导管上皮不典型增生5例,占29.7%(47/158)。术中冰冻对乳腺浸润癌诊断的准确率为93.3%,对微小浸润癌、原位癌、导管上皮不典型增生诊断的准确率分别为60%、58.3%与60%,误诊均为假阴性与低估诊断,无假阳性与过度诊断,原因主要为切片误差与解释错误。结论冰冻切片对浸润性乳腺癌诊断的准确率高,可用于指导触诊阴性乳腺病灶活检术中手术方案的选择,而对微小浸润癌、原位癌及导管上皮不典型增生常出现假阴性与低估诊断,应待石蜡组织学诊断后再决定手术方案。

Objective To evaluate the accuracy and feasibility of intraoperative frozen section diagnosis in nonpalpable breast lesions （NPBLs）. Methods Diagnoses on frozen sections were performed on 158 consecutive wire-localized breast biopsies with mammographically detected nonpalpable breast lesions. Every specimen was diagnosed by introperative frozen resection. The initial frozen section diagnoses were compared with the diagnoses obtained on permanent paraffin sections to estimate its accuracy. Results On the surgical specimen examination of the 158 NPBLs, macroscopically abnormal lesions could be found only in 80（50. 6%）cases, with a mean diameter of 1.2cm. There were 15 invasive breast cancers, 15 microinvasive carcinomas, 12 carcinoma in situ and 5 atypical ductal hyperplasia altogether, which was 29. 7%（47/158） of the all NPBLs, according to the permanent paraffin sections. The accuracy of frozen section diagnoses on invasive breast cancer, microinvasive carcinoma, carcinoma in situ and atypical ductal hyperplasia were 93. 3%, 60%, 58. 3% and 60%, respectively. The errors of frozen sections were false negative diagnosis and underestimation, while no false positive diagnosis and overestimation were found. Errors in frozen slicing and interpretation were main reasons of the false negative diagnosis and underestimation. Conclusion Frozen section is feasible in aiding decision-making for operation in the invasive breast cancer due to its high accuracy. But the operation selection for microinvasive carcinoma, carcinoma in situ and atypical ductal hyperplasia should delay to the permanent paraffin sections diagnosis because of the frequent false negative and underestimation in the frozen sections diagnosis.