甲状腺微小乳头状癌的术中冰冻病理诊断研究

Intraoperative Frozen Pathological Diagnosis of Thyroid Micropapillary Carcinoma

目的探讨甲状腺微小乳头状癌诊断中术中冰冻病理的应用价值,为临床治疗提供理论依据。方法回顾性分析该院2017年7月—2018年7月进行手术治疗的甲状腺结节患者36例的临床资料。所有均接受术中冰冻切片病理检查以及术后石蜡切片病理检查,以石蜡标本诊断结果为标准,分析术中冰冻病理检查对甲状腺微小乳头状癌的诊断灵敏度、特异度及准确率,对比不同检查方式的诊断结果,一致性采用Kappa值进行检验。结果术后石蜡切片及免疫组化病理诊断显示,确诊为甲状腺微小乳头状癌的有22例,确诊为非甲状腺微小乳头状癌的有14例。术中冰冻病理诊断阳性22例,阴性14例,以术后石蜡切片及免疫组化病理诊断结果为参照,22例阳性病例中21例为真阳性,1例为假阳性;14例阴性病例中,14例均为真阴性。术中冰冻切片病理用于检查甲状腺微小乳头状癌的诊断灵敏度为100.00%、特异度为93.33%、准确率为97.22%(χ^2=1.008、2.047、1.267,P=0.103、0.445、0.364),Kappa值为0.805,结果显示两种病理诊断结果对比一致性良好,差异无统计学意义(P>0.05)。结论术中冰冻切片病理用于检查甲状腺微小乳头状癌的临床准确率较高,与术后石蜡切片及免疫组化病理诊断结果基本相一致,可作为手术方案制定及调整的可靠参考。

Objective To explore the application value of intraoperative frozen pathology in the diagnosis of thyroid micropapillary carcinoma,and to provide theoretical basis for clinical treatment.Methods The clinical data of 36 patients with thyroid nodules who underwent surgery from July 2017 to July 2018 in our hospital were retrospectively analyzed.All patients underwent intraoperative frozen section pathological examination and postoperative paraffin section pathological examination.The diagnostic sensitivity,specificity and accuracy of intraoperative frozen pathological examination for thyroid micropapillary carcinoma were analyzed according to the diagnostic results of paraffin specimens.The diagnostic results of the method were tested using Kappa values.Results Postoperative paraffin sections and immunohistochemical pathology showed that 22 cases were diagnosed as thyroid micropapillary carcinoma,and 14 cases were diagnosed as non-thyroid micropapillary carcinoma,22 cases were positive for frozen pathological diagnosis and 14 cases were negative.The results of postoperative paraffin section and immunohistochemical pathological diagnosis were used as reference.Among the 22 positive cases,21 cases were true positive,1 case was false positive;14 cases were negative.14 cases were all true negative.Intraoperative frozen section pathology for the diagnosis of thyroid micropapillary carcinoma has a diagnostic sensitivity of 100.00%,a specificity of 93.33%,and an accuracy of 97.22%(χ^2=1.008,2.047,1.267,P=0.103,0.445,0.364).the Kappa value was 0.805,The results of pathological diagnosis were consistent and the difference was not statistically significant(P>0.05).Conclusion The clinical accuracy of intraoperative frozen section pathology for the examination of thyroid micropapillary carcinoma is high.It is consistent with postoperative paraffin section and immunohistochemical pathological diagnosis.It can be used as a reliable reference for the development and adjustment of surgical plans.