术中冰冻切片法诊断甲状腺微小乳头状癌的准确率及其影响因素

Accuracy rate of intraoperative frozen section in diagnosis of papillary thyroid microcarcinoma and its influencing factors

目的分析术中冰冻切片法诊断甲状腺微小乳头状癌的准确率及其影响因素。方法选取30例甲状腺微小乳头状癌患者,均接受手术治疗。手术过程中行冰冻切片病理检查,手术完成后行常规石蜡切片检查。将石蜡切片诊断结果作为疾病诊断"“金标准”,分析术中冰冻切片结果与金标准结果的相符性,探讨影响冰冻切片病理诊断准确性的相关因素。结果本组30例患者经术后石蜡切片诊断均确诊为甲状腺微小乳头状癌,确诊率为100.00%。冰冻切片病理诊断结果显示,有23例患者诊断为甲状腺微小乳头状癌,确诊率为76.67%;3例患者因冰冻切片未切取到病变组织而漏诊,漏诊率为10.00%;3例患者延迟诊断,延迟诊断率为10.00%;1例患者误诊为桥本甲状腺炎和滤泡型腺瘤,误诊率为3.33%。影响冰冻切片准确性的单因素包括肿瘤直径、甲状腺钙化分型、包膜侵犯情况等(P<0.05或P<0.01);多因素回归分析结果显示,包膜侵犯(浸润性生长)、肿瘤直径等均是影响冰冻切片病理诊断准确性的独立危险因素(P<0.01)。结论术中冰冻病理切片诊断法在甲状腺微小乳头状癌的诊断中具有较高准确性,但是也受到多种因素影响,应采取相关措施以避免给患者造成二次手术创伤。

Objective To analyze accuracy rate of intraoperative frozen section in diagnosis of papillary thyroid microcarcinoma and its influencing factors.Methods A total of 30 patients with papillary thyroid microcarcinoma were selected and treated with operation.The pathological examination of frozen section was performed during the operation,and the routine paraffin section was performed after the operation.The results of paraffin section were considered as the gold standard for disease diagnosis.The consistency between the results of intraoperative frozen section and gold standard was analyzed,and the relevant factors affecting the accuracy rate of pathological diagnosis of frozen section were explored.Results All the 30 patients were diagnosed as papillary thyroid microcarcinoma by paraffin section,and the diagnosis rate was 100.00%.The pathological diagnosis of frozen section showed that 23 patients were diagnosed as papillary thyroid microcarcinoma,with a diagnosis rate of 76.67%;3 patients were missed because the frozen section was not cut with the pathological tissue,with a diagnosis rate of 10.00%;3 patients were delayed in diagnosis,with a diagnosis rate of 10.00%;1 patient was misdiagnosed as Hashimoto′s thyroiditis and follicular adenoma,with a misdiagnosis rate of 3.33%.The single factors affecting the accuracy rate of pathological diagnosis of frozen section included tumor diameter,classification of thyroid calcification and condition of capsule invasion(P<0.05 or P<0.01).The results of multivariate regression analysis showed that capsule invasion(invasive growth)and tumor diameter were independent risk factors affecting the accuracy rate of pathological diagnosis of frozen section(P<0.01).Conclusion The method of intraoperative pathological frozen section has a high accuracy rate in the diagnosis of papillary thyroid microcarcinoma,but it is also affected by many factors,so relevant measures should be taken to avoid secondary surgical trauma to patients.