甲状腺肿块手术中冷冻切片诊断118例结果分析

Clinical pathological analysis for 118 cases of thyroid gland tumor treated by frozen section during operation

目的探讨甲状腺肿物手术中冷冻切片(frozen section,FS)诊断在临床与病理工作中的实际意义。方法分析118例甲状腺手术中FS的临床和病理资料,将其分为癌症组和非癌组进行多指标对比及淋巴结转移等情况分析。甲状腺癌按WHO(2004)新标准分类。结果118例FS中诊断癌症(癌症组)32例(27.1%)。非癌组86例(72.9%)。癌分类:乳头状癌26例(81.3%),滤泡癌2例(6.3%),髓样癌1例(3.1%),转移鳞癌3例(9.3%)。FS与石蜡切片(paraffinsection,PS)对照,甲状腺癌的定性准确率100%。甲状腺癌组与非癌组对比:钙化,尤其沙砾体更常见;囊性变更少见(P均<0.01),其他指标无统计学意义(P>0.05)。实施颈淋巴结清扫22例,有转移18例(81.8%),淋巴结癌转移率(138/508个)27.2%。结论采用甲状腺术中FS诊断癌有非常高的准确率和非常大的外科实用价值。

Objective To study the practical significance of thyroid gland＇ s frozen section during operation at clinical pathology. Methods The clinical and pathological data of 118 cases of frozen sections of thyroid gland were analyzed. The data were divided into carcinoma group（ n = 32） and no-carcinoma group（ n = 86）, and which were analyzed according to multi-criteria and lymph node metastases. Thyroid carcinoma was classified according to the new criteria of WHO （2004）. Results 32 of 118 cases frozen sections of thyroid gland were carcinoma（27.1% ）, including 10 cases male （31.3 % ） and 22 cases female （68.7 % ）. No- carcinoma was 86 cases （ 72.9 % ）, including 25 cases male （29.1% ） and 61 cases female （70.9%）. 26 of 32 cases were papillary carcinomas （81.3%）, two were follicular carcinoma （6.3%）, one was medullary carcinoma （3. 1% ）, and three were metastatic squamous cell carcinoma （9.3%）. Compared with paraffin sections, the accuracy of qualitative diagnoses was 100%. Calcification especially psammoma bodies frequently appeared in thyroid carcinoma, and contrary to cystic change. There was no significant difference in other pmmneters. 22 cases dissected the jugular lymph node. Lymph node metastases were found in 18 cases （81.8%）,and the positive rate was 27.2% （138/508）. Conclusion The diagnosis of thyroid carcinoma by frozen section is extraordinary accuracy and practicability in surgery.