術中冰凍切片與術後病理診斷分析

Analysis of intraoperative frozen section and subsequent paraffin section pathological diagnosis

目的總結和分析術中冰凍切片與術後病理診斷的誤差及其原因,從而提高術中冰凍診斷的水平。方法應用解剖和外科病理主任協會和中華醫學會的評核標準,對本院病理科2012~2013年間502例術中冰凍切片與術後病理診斷進行回顧性分析和統計,分析冰凍切片診斷誤差的原因,尋求提高術中冰凍切片診斷水平的方法。結果術中冰凍切片與術後病理診斷結果對照,診斷一致的有443例,佔88.2%。診斷不同的共有3例,佔0.6%。其中診斷較大不同2例,佔0.4%,延遲報告14例,佔2.8%,均屬合理延遲報告。不宜應用冰凍佔42例,約8.4%。在30min內報告發出的佔87.3%。結論結果符合外科病理主任協會和中華醫學會的評核標準。術中冰凍切片診斷質量的控制需要臨床、病理醫生及病理技術人員三方面的配合,科內亦要建立一個術中冰凍切片規範系統,設定一套持續質量改善的管理制度,並進行質控監測,才能不斷提高術中冰凍切片診斷水平。

Objective To analyze the intraoperative frozen section and final paraffin pathological diagnosis’s discrepancy and their causes,inorder to improve the level of diagnosis in intraoperative frozen section.Methods Total 502 cases of frozen section from 2012 to 2013 were retrospectively compared with final paraffin diagnosis.The results and cause of discrepancy between both diagnoses were analyzed by using the standard of Association of Directors of Anatomic and Surgical Pathology and the manipulation guide of clinical techniques of Chinese Medical Society.Results The diagnostic results of frozen section during operation were compared with the subsequent paraffin section,the concordance rate was 88.2%(443/502),total 3 cases(0.6%)had different diagnosis,in which 2 cases(0.4%)had the major discordance.Total 14 cases(2.8%)were delayed reported and were resonable.Inappropriate forzen section application were in 42cases(8.4%).The reports signed out within 30 minutes accounts 87.3%.Conclusion The diagnostic result of frozen section during operation was consistent with the standard of Association ofDirectors of Anatomic and Surgical Pathology and Chinese Medical Society.A high level of quality control of frozen section should be based on good co-operation of clinician,pathologist and technician.Establishment of a system for continuing management and quality control of frozen section is also important,in order tocontinually promote the diagnosis quality of frozen section.