快速冰冻病理检查在子宫内膜癌术中的诊断价值

Diagnostic value of endometrial cancer surgery in quick frozen biopsy

目的:探讨快速冰冻病理检查在子宫内膜癌术中诊断的价值,为术中手术治疗方案的制定提供客观依据。方法:对2006年1月-2010年12月我院妇科诊断及手术治疗的182例子宫内膜癌患者的临床病理资料进行回顾性分析。所有患者术前均采用分段诊断性刮宫诊断方法诊断为子宫内膜癌,接受手术治疗并常规术中行快速冷冻病理切片检查。以术后石蜡病理检查结果为标准,比较患者术中快速冰冻病理检查结果在判断肿瘤分级和肌层浸润方面与其的符合率。结果:182例子宫癌患者浆液性癌、透明细胞癌、子宫内膜样腺癌所占比例分别为10.44%、2.74%、87.36%;术前肿瘤细胞分级确诊为G1级,依据FIGO分期,Ⅰa期、Ⅰb期、Ⅰc期、Ⅱa期、Ⅱb期、Ⅲc期所占比例分别为57.69%、13.19%、10.44%、7.69%、5.49%、5.49%。182例子宫内膜癌患者肿瘤细胞分级诊断,差异有统计学意义(P<0.05)。快速冰冻病理检查和石蜡切片病理检查,差异有统计学意义(P<0.05)。结论:快速冰冻病理检查在子宫内膜癌术中对组织学分级的诊断准确率不高,但对肌层浸润深度尤其≥1/2肌层浸润深度的诊断较为准确。在子宫内膜癌术中应用快速冰冻病理检查具有一定的指导意义,可作为肌层浸润深度评估的常规检查之一,为术中制定手术范围及淋巴结切除提供客观依据。

Objective： To investigate the value of quick frozen biopsy in the diagnosis of endometrial cancer surgery. Methods： Data of 182 patients with endometrial cancer were retrospectively analyzed comparing patients with intraoperative frozen section biopsy results to determine tumor grade and myometrial invasion. Results： In 182 cases of uterine cancer,serous carcinoma,clear cell carcinoma,endometrial adenocarcinoma proportion was 10. 44%,2. 74%,87. 36%. Preoperative diagnosis of tumor cells was G1 grade level. Ⅰaperiod,Ⅰbperiod,Ⅰcperiod,Ⅱaperiod,Ⅱb period,Ⅲcperiod was 57. 69%,13. 19%,10. 44%,7. 69%,5. 49%,5. 49%. 182 cases of endometrial cancer in diagnostic classification,quick frozen biopsy and pathological examination of paraffin G1 level consistent with the diagnosis was 68. 18%（ 90/132）,G2 level consistent with the diagnosis was 42. 86%（ 9/21）,G3 level consistent with the diagnosis was 100. 00%（ 3/3）,the results of other diagnostic 42. 31%（ 11/26）,which the difference was statistically significant（ P 0. 05）. Quick frozen biopsy and pathological examination of paraffin in class I,the coincidence rate was 31. 71%（ 26/82）,II level diagnostic coincidence rate 89. 25%（ 83/93）,III level diagnostic coincidence rate100. 00%（ 7/7）,which the difference was statistically significant（ P 0. 05）. Conclusion： Quick frozen biopsy in endometrial cancer surgery for histological grade diagnostic accuracy rate is not high,but the depth of myometrial invasion especially ≥1/2 myometrial invasion was more accurate. In endometrial cancer surgery application,quick frozen biopsy had certain significance.