印片细胞DNA定量分析联合冰冻切片在术中快速诊断中的应用

Application of Quantitative DNA Analysis of Imprint Cytology Combined with Frozen Section in Rapid Intraoperative Diagnosis

目的探讨印片细胞DNA定量分析联合冰冻切片在术中快速诊断中的应用价值。方法选取术中需行快速病理诊断的标本237例,均行印片细胞DNA定量分析、冰冻切片检测,以常规石蜡切片诊断结果为对照标准。结果常规石蜡切片结果显示,237例标本中69例为恶性肿瘤;与常规石蜡切片比较,DNA定量分析、冰冻切片及二者联合检测的敏感度分别为73.91%、95.65%和73.91%,特异度分别为92.86%、89.29%和76.79%,误诊度分别为7.14%、10.71%和1.79%;联合检测的误诊度显著低于DNA定量分析和冰冻切片(χ^(2)=5.17,P<0.05;χ^(2)=10.10,P<0.01)。在头颈部病变恶性肿瘤诊断中,与常规石蜡切片比较,DNA定量分析、冰冻切片及二者联合检测的敏感度分别为40.00%、90.00%和83.33%,特异度分别为85.00%、85.00%和85.00%,误诊度分别为15.00%、15.00%和15.00%;DNA定量分析的敏感度显著低于联合检测(χ^(2)=8.58,P<0.01)。结论印片细胞DNA定量分析联合冰冻切片可提高术中快速诊断的准确性,但在头颈部病变诊断中的作用有限。

Objective To investigate the value of quantitative DNA analysis of imprint cytology combined with frozen section in rapid intraoperative diagnosis.Methods Quantitative DNA analysis of imprint cytology and frozen sections were conducted in 237 specimens requiring rapid pathological diagnosis during operation.The results of conventional paraffin sections were used as the standard.Results Conventional paraffin sections showed 69 cases of malignant tumors among the 237 specimens.The sensitivity,specificity and misdiagnosis rate were respectively 73.91%,92.86%and 7.14%for quantitative DNA analysis,95.65%,89.29%and 10.71%for frozen section,and 73.91%,76.79%and 1.79%for their combination.The misdiagnosis rate of combined quantitative DNA analysis and frozen section was lower than that of quantitative DNA analysis alone(χ^(2)=5.17,P<0.05)or frozen section alone(χ^(2)=10.10,P<0.01).In the diagnosis of head and neck malignant tumors,the sensitivity,specificity and misdiagnosis rate were respectively 40.00%,85.00%and 15.00%for quantitative DNA analysis,90.00%,85.00%and 15.00%for frozen section,and 83.33%,85.00%and 15.00%for their combination.The sensitivity of quantitative DNA analysis alone was lower than that of combined quantitative DNA analysis and frozen section(χ^(2)=8.58,P<0.01).Conclusion Quantitative DNA analysis of imprint cytology combined with frozen section can improve the accuracy of rapid intraoperative diagnosis of malignant tumors,but has limited role in the diagnosis of head and neck lesions.