670例甲状腺冰冻切片病理诊断分析

Thyroid frozen section:a clinicopathological study of 670 cases

目的探讨术中冰冻切片对甲状腺病变的诊断价值及误诊原因。方法回顾性分析670例甲状腺病变术中冰冻切片诊断结果,并与石蜡切片比较,分析甲状腺冰冻切片病理形态特征及误诊和延迟诊断情况。结果 670例甲状腺冰冻切片病例中,确诊647例(准确率96.58%),误诊15例(误诊率2.24%),延迟诊断8例(延迟率1.19%);误诊病例中假阳性1例(0.15%),假阴性14例(2.09%)。结论直径小于0.2cm的微小癌和不确定包膜侵犯的滤泡性肿瘤是甲状腺冰冻切片的主要诊断陷阱,准确取材、精心制片及熟练掌握冰冻切片甲状腺病变形态特征可提高冰冻切片诊断准确率并降低误诊率。

Objective To explore the misdiagnosis reasons of thyroid lesions by intraoperative frozen section and assess its diagnosis value. Methods Six hundred and seventy cases of thyroid lesions were analyzed by intraoperative frozen section and paraffin section retrospectively, and the reasons of misdiagnosis and delayed diagnosis in frozen section were elucidated. Results In frozen section of 670 thyroid lesions, 647 cases （96.58%） were diagnosed for exactly, 15 cases （2.24%） were misdiagnosed, 8 cases （1.19%） were deferred for diagnosis. In misdiagnosed cases, 1 case was false positive （0.15%）, and 14 cases were false negative （2.09%）. Conclusion Minimum cancers with the diameter less than 0.2 cm and thyroid follicular tumors with minimal capsule invasive were the predominant pitfall for thyroid lesions in frozen section diagnosis. Therefore, definite diagnosis of thyroid lesions in frozen section should he based on the histopathological features, perfect sections and accurate materials drew from lesions tissues.