肺结节的术中冰冻病理诊断研究

Study on pathological diagnosis of pulmonary nodules in frozen operation

目的:分析术中冰冻病理检查对肺结节诊断的准确率,为临床治疗提供理论依据。方法:以2017年1月至2021年6月,在北京安贞医院接受手术治疗,并行术中冰冻切片病理检查的肺结节患者为研究对象,对术中冰冻切片病理诊断结果与术后石蜡切片及免疫组化病理诊断结果进行对比分析。结果:术中冰冻病理检查鉴别诊断肺结节良、恶性的准确率为99.2%,767例肺结节患者中,6例未做出明确诊断,术后经石蜡病理诊断,2例为硬化性肺细胞瘤,4例为肺腺癌。术中冰冻病理检查对肺恶性肿瘤分型准确率为85.3%,其中肺腺癌诊断准确率较高,为87.1%(440/505);神经内分泌肿瘤诊断准确率较低,为70.6%(12/17);4例转移癌均未做出明确分型诊断,对其准确诊断难度较大。结论:术中冰冻切片病理检查可对绝大部分肺结节的良、恶性予以准确诊断,少部分冰冻诊断困难病例通过复习病史、结合快速免疫组化技术等,可望提高术中冰冻病理诊断能力,为手术方案的调整提供可靠依据。

Objective:Analyze the accuracy of intraoperative frozen pathological examination for the diagnosis of pulmonary nodules,and provide theoretical basis for clinical treatment.Methods:Patients with pulmonary nodules who underwent surgical treatment in Beijing Anzhen Hospital from January 2017 to June 2021,and intraoperative frozen section pathological examinations were taken as the research objects.The intraoperative frozen section pathological diagnosis results and postoperative paraffin sections pathological diagnosis were compared and analyzed.Results:The accuracy of intraoperative frozen pathological examination to differentiate between benign and malignant pulmonary nodules was 99.2%.Among 767 patients with pulmonary nodules,6 patients had no clear diagnosis.These 6 cases were diagnosed by paraffin pathology,2 cases were sclerosing lung cell tumor,4 cases were lung adenocarcinoma.The accuracy rate of intraoperative frozen pathological examination for the classification of lung malignant tumors was 85.3%.Among them,the accuracy rate of lung adenocarcinoma was 87.1%(440/505);The accuracy rate of neuroendocrine tumors was low,70.6%(12/17);None of the 4 cases of metastatic cancer had a clear type diagnosis,and it was difficult to diagnose accurately.Conclusions:Intraoperative frozen section pathological examination can accurately diagnose most of the benign and malignant lung nodules.A small number of frozen diagnosis difficult cases can be expected to improve the ability of intraoperative frozen pathology through review of medical history and rapid immunohistochemistry techniques.Provide a reliable basis for the adjustment of the surgical plan.