子宫内膜癌术中冰冻和术后石蜡病理诊断符合率及其影响因素

Study on Clinical Factors Affecting Concordance between Frozen Section and Paraffin Pathology in Endometrial Cancer

目的:研究影响子宫内膜癌患者术中冰冻病理与术后石蜡病理诊断符合率的临床因素。方法:回顾分析1996年7月—2008年1月在上海交通大学医学院附属仁济医院和2008年9月—2011年9月在同济大学附属第一妇婴保健院收治的共389例子宫内膜癌患者的临床治疗资料。观察术中冰冻病理与术后病理在诊断肿瘤细胞级别、肿瘤肌层浸润深度方面的符合率及影响符合率的因素。结果:①术中冰冻与术后石蜡病理的细胞级别的总体符合率为78.6%(147/187),其中G1,G2和G3的符合率分别为88.6%,60.6%和95.2%。随着石蜡病理诊断细胞级别的升高和肌层浸润深度的加深,细胞级别诊断符合率逐渐升高(P=0.008,P=0.002)。②肌层浸润深度的总体符合率为97.8%(178/182)。石蜡病理诊断细胞级别提高,肌层浸润的符合率逐步下降(P=0.027)。结论:冰冻病理在诊断子宫内膜癌肌层浸润深度上符合率较高,在细胞级别的诊断上有一定局限。

Objective：To investigate clinical factors affecting the concordance of intraoperative frozen section （FS） pathology and postoperative paraffin section （PS） findings in endometrial cancer. Methods：From Jul 1996 to Sep 2011,389 endometiral cancer patients undergoing treatment in Department of Gynecology, Renji Hospital, Shanghai Jiao Tong University and Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University were enrolled in this retrospective study. The results of intraoperative FS and postoperative PS findings were compared and clinical factors affecting concordance of tumor grade and tumor invasion were studied. Results： ①According to the PS results,the overall concordance rate of tumor grade was 78.6% （ 147/182 ）. The concordance of G 1, G2, G3 was 88.6%, 60.6%, 95.2% and respectively. With increasing tumor grade and deeper tumor invasion by PS diagnosis,the higher concordance of grade were observed （P=0.008 ,P=0.002）. ②The overall concordance rate of depth of myometrial invasion was 97.8% （178/182）. It was observed that the increasing grade of tumor cell by PS would result in decreased concordance rate in myometrial invasion between FS and PS （P=0.027）. Conclusion_s： The diagnosis depth of myometrial invasion by FS is relatively accurate. However,the clinical accuracy in tumor grade of FS might not be so satisfied.