术中冰冻切片与术后石蜡切片对PTMC病理诊断的效果分析

Efficacy comparison of intraoperative frozen section and postoperative paraffin section in pathological diagnosis of P TMC

目的对比分析术中冰冻切片与术后石蜡切片对甲状腺微小乳头状癌(PTMC)患者病理诊断符合率。方法选取我院收治的疑似PTMC患者147例,均进行术中冰冻切片、术后石蜡切片,以石蜡标本病理诊断为金标准,统计术后石蜡切片诊断结果,对比术中冰冻切片、术后石蜡切片诊断PTMC诊断效能(准确度、灵敏度、特异度)及符合率,分析影响术中冰冻切片诊断符合率的因素。结果术后石蜡切片诊断显示,147例疑似PTMC患者检出65例,其中双侧癌变24例,单侧癌变41例;术中冰冻切片诊断显示:65例PTMC患者,确诊57例(87.69%),误诊2例(3.08%),漏诊8例(12.31%),术中冰冻切片准确度、灵敏度、符合率低于术后石蜡切片(P<0.05);术中冰冻切片诊断PTMC患者肿瘤直径>5 mm符合率高于肿瘤直径≤5 mm,浸润性生长诊断符合率高于非浸润性生长,甲状腺钙化微钙化诊断符合率高于粗钙化、周边钙化(P<0.05);采用Logistic多因素回归分析显示浸润性生长、肿瘤直径是影响术中冰冻切片诊断符合率的独立危险因素(P<0.05)。结论术中冰冻切片诊断PTMC患者病理符合率较高,但受浸润性生长、肿瘤直径等因素影响,诊断符合率略低于术后石蜡切片,对临床手术方案的制定具有参考价值。

Objective To compare and analyze the coincidence rate of intraoperative frozen section and postoperative paraffin section in the pathological diagnosis of papillary thyroid microcarcinoma(PTMC).Methods A total of 147 suspected PTMC patients wereselected for intraoperative frozen section and postoperative paraffin section.With the pathological diagnosis of paraffin section as gold standard,the diagnostic results of postoperative paraffin section were counted and the diagnostic efficiency(accuracy,sensitivity,specificity)and coincidence rate of intraoperative frozen section and postoperative paraffin section were compared.The single factors and multiple factors that affected the coincidence rate of intraoperative frozen section diagnosis were compared.Results The postoperative paraffin section diagnosis showed that 65 cases of PTMC were detected in 147 suspected PTMC patients,including 24 cases of bilateral cancer and 41 cases of unilateral cancer.The intraoperative frozen section diagnosis showed that in 65 cases of PTMC patients 57 cases were confirmed(87.69%),2 cases were misdiagnosed(3.08%),8 cases were missed diagnosis(12.31%).The accuracy,sensitivity and coincidence rate of intraoperative frozen section were lower than those of postoperative paraffin section(P<0.05).As for intraoperative frozen section,the diagnostic coincidence rate of PTMC patients with tumor diameter>5 mm is higher than that of tumor diameter≤5 mm;the diagnostic coincidence rate of invasive growth is higher than that of non-invasive growth;the diagnostic coincidence rate of thyroid calcification and microcalcification is higher than that of coarse calcification and peripheral calcification(P<0.05).Logistic multivariate regression analysis showed that invasive growth and tumor diameter were independent risk factors affecting the diagnostic coincidence rate of intraoperative frozen section(P<0.05).Conclusion Intraoperative frozen section has a higher pathological coincidence rate in diagnosis of PTMC.However,affected by factors such as invasive growth and tumor diameter,the diagnostic coincidence rate is slightly lower than that of postoperative paraffin section,which has reference value for the formulation of clinical surgical procedures.