冰冻病理切片技术在评估乳腺癌保乳手术中切缘状态的应用价值

Application Value of Frozen Pathological Section Technique in Assessing the Status of Margins in Breast-conserving Surgery for Breast Cancer

目的:在乳腺癌保乳手术中应用冰冻病理切片技术,并分析其对切缘状态的评估价值。方法:选取2017年6月-2020年10月在本院行乳腺癌保乳手术治疗的146例患者,所有患者均接受乳腺癌保乳手术治疗,术中应用冰冻病理切片的方式评估切缘状态。根据石蜡病理结果将患者分为切缘阴性组、切缘阳性组,分析切缘阳性的影响因素,对比两组患者的相关手术指标,评价术中冰冻切片病理检查的准确性以及患者发生并发症的情况。结果:石蜡病理结果显示,切缘阳性36例(24.66%),切缘阴性110例(75.34%)。根据术中首次冰冻病理切片切缘评估结果,切缘阴性114例(78.08%),切缘阳性32例(21.92%),冰冻病理切片诊断符合率为94.52%。切缘阴性及阳性组患者的年龄、组织类型、肿瘤分期比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄≥40岁、浸润性小叶癌、肿瘤分期T3期为切缘阳性的危险因素(P<0.05)。与切缘阴性组患者相比,切缘阳性组患者的手术时间更长,手术费用更高(P<0.05)。结论:应用冰冻病理切片技术可快速、准确地对乳腺癌保乳手术后组织切缘状态进行评估,应注意把握影响切缘状态的相关因素,提高对存在高危因素患者的重视程度。

Objective:To apply frozen pathological section technology in breast-conserving surgery for breast cancer and analyze its value in evaluating the status of resection margins.Method:A total of 146 patients who underwent breast-conserving surgery for breast cancer in our hospital from June 2017 to October 2020 were selected.All patients received breast-conserving surgery for breast cancer,and intraoperative frozen pathological sections were used to evaluate the status of surgical margins.According to the results of paraffin pathology,the patients were divided into the negative surgical margin group and the positive surgical margin group.The influencing factors of the positive surgical margin were analyzed,the relevant surgical indicators of the two groups were compared,and the accuracy of intraoperative pathological examination of frozen sections and the occurrence of complications of patients were evaluated.Result:The results of paraffin pathology showed that 36 cases (24.66%) had positive margins and 110 cases (75.34%) had negative margins.According to the results of the first frozen pathological section margin evaluation during the operation,114 cases (78.08%) had negative margins,32 cases (21.92%) had positive margins,and the diagnostic coincidence rate of frozen pathological sections was 94.52%.There were statistically significant differences in the age,tissue type,and tumor stage of patients in the negative and positive resection margin group (P<0.05).Multivariate logistic regression analysis showed that age ≥40 years,invasive lobular carcinoma,and tumor stage T3 were risk factors for positive margins (P<0.05).Compared with the patients in the negative margin group,the patients in the positive margin group had longer operation time and higher surgical cost (P<0.05).Conclusion:The application of frozen pathological section technique can quickly and accurately evaluate the condition of tissue resection margins after breast cancer breast-conserving surgery,attention should be paid to the relevant factors affecting the condition of resection margins and the degree of attention to patients with high risk factors should be improved.