提高甲状腺乳头状癌在术中冰冻病理诊断中准确性的临床研究

Clinical research on improving the accuracy of intraoperative frozen pathological diagnosis of papillary thyroid carcinoma

目的研究如何提高甲状腺乳头状癌在术中冰冻病理诊断中的准确性,同时降低微小乳头状癌的漏诊率。方法选取2015年6月~2019年12月我院收治的65例甲状腺乳头状癌患者作为研究对象,将其分为两组,2015年6月~2017年12月的23例患者为改进前组,2018年1月~2019年12月改进取材方法后的42例患者为改进后组;同时将两组病例分别进行术中冰冻切片与常规石蜡切片(这些病例均经免疫组化证实为甲状腺乳头状癌)。对两组的结果进行观察,分析术中冰冻病理诊断在甲状腺乳头状癌中的应用价值,并比较改进方法前后术中冰冻的准确率、漏诊率等的差别,从而更好地提高甲状腺乳头状癌术中冰冻的诊断准确率,同时避免微小乳头状癌的漏诊。结果改进前组中23例患者的冰冻切片病理诊断的确诊率为78.26%,漏诊率为8.7%,延迟诊断率为13.04%。改进后组中42例患者的冰冻切片病理诊断的确诊率达到95.23%,较改进前组有了明显提高,差异有统计学意义(P <0.05);漏诊率和延迟诊断率分别降至0和4.76%,均较改进前组有了明显降低。结论术中冰冻病理诊断在甲状腺乳头状癌中发挥着非常重要的作用,但也存在一定的漏诊率,尤其是微小乳头状癌;通过改进取材方法,不断提高诊断水平,使其准确率明显升高,从而更好地发挥了术中冰冻在诊断甲状腺乳头状癌方面的作用。

Objective To research on improving the accuracy of intraoperative frozen pathological diagnosis of papillary thyroid carcinoma and to reduce the missed diagnosis rate of papillary thyroid carcinoma.Methods A total of 65 patients with papillary thyroid carcinoma admitted to our hospital from June 2015 to December 2019 were selected as the research objects and divided into two groups.Patients from June 2015 to December 2017 were selected as the pre-improved group(n=23),while patients from January 2018,in which the sampling method was improved,to December 2019 were selected as the improved group(n=42).At the same time,cases of the two groups were treated with intraoperative frozen section and routine paraffin section respectively(these cases were confirmed as papillary thyroid carcinoma by immunohistochemistry).The results of the two groups were observed,the application value of intraoperative frozen pathological diagnosis in papillary thyroid carcinoma was analyzed,and the differences of intraoperative frozen accuracy rates and missed diagnosis rates before and after the improved method were compared,in order to increase the accuracy rates of intraoperative frozen diagnosis in papillary thyroid carcinoma and avoid missed diagnosis of papillary thyroid microcarcinoma.Results In the pre-improved group,the diagnosis rate of frozen section pathology was 78.26%,the missed diagnosis rate was 8.7%,and the delayed diagnosis rate was 13.04%.The diagnosis rate of frozen section pathology in 42 patients in the improved group reached 95.23%,which was significantly higher than that in the pre-improved group and the difference was statistically significant(P<0.05).The missed diagnosis rate and delayed diagnosis rate decreased to 0 and 4.76%respectively,which were significantly lower than those in the pre-improved group.Conclusion Intraoperative frozen pathological diagnosis plays a very important role in papillary thyroid carcinoma,but there is also a certain missed diagnosis rate,especially in papillary thyroid microcarcinoma.The role of intraoperative frozen section in the diagnosis of papillary thyroid carcinoma can be better played through improving the sampling method,continuously improving the diagnostic level and increasing the accuracy rate.