术中冰冻对甲状腺微小乳头状癌的病理诊断分析

Intraoperative frozen-section analysis for papillary thyroid microcarcinoma

目的探讨术中冰冻在甲状腺微小乳头状癌(PTMC)病理诊断的临床应用,分析PTMC在术中冰冻的诊断标准及漏诊、误诊的因素。方法对36例经免疫组化确诊的PTMC患者,观察术中冰冻切片、术后常规石蜡切片的形态特征。结果 PTMC术中冰冻确诊28例,其中85.7%(24/28)见间质硬化,92.8%(26/28)见浸润行为,均见核异型、核沟及核内包涵体。PTMC术中冰冻未确诊8例,其中PTMC冰冻取材阴性2例,可疑、漏诊、误诊6例,以滤泡亚型及包裹亚型为主。结论术中冰冻是PTMC的快速诊断方法之一,PTMC在术中冰冻的主要诊断标准:间质硬化、浸润行为、核异型、核内包涵体;细致、规范的冰冻取材方法及熟知滤泡型及包裹型的形态学特征,可降低术中冰冻对PTMC的漏诊、误诊率,提高术中冰冻对PTMC诊断的准确性。

Objective To investigate the utilization and diagnostic criteria of intraoperative frozen-section analysis in the pathological diagnosis of papillary thyroid microcarcinoma （ PTMC ） , and identify the leading cause of misdiagnosis and missed diagnosis of PTMC. Methods For 36 patients with PTMC confirmed by immunohistochemical technology, the util- ity of intraoperative frozen section examination was compared with the postoperative routine paraffin section results. Re- suits 28 cases of PTMC were diagnosed by intraoperative frozen section examination, in which 24 （85.7%） cases were with sclerotic stroma,26（92.8% ） cases with infiltration, all cases with nuclear atypia,nuclear grooves or intranuclear in- clusions. 8 cases were unable to be made a definitive diagnosis ,in which 2 cases were negative samples,6 cases were sus- picious, misdiagnosis or missed diagnosis, and these cases were mainly the ncapsulated or follicular variant. Conclusion The intraoperative frozen section examination is one of rapid diagnostic methods for PTMC, the main diagnostic criteria in- clude ： sclerotic stroma, infiltration, nuclear atypia, nuclear grooves and intranuclear inclusions. The meticulous and norma- tive sampling method and the ability of pathologist to identify the morphological characteristics of ncapsulated and follicu- lar variant can decrease the rate of misdiagnosis and missed diagnosis, and imps＇ore the accuracy of intraoperative frozen section examination.