影响术中冷冻诊断小体积肺腺癌准确性的临床病理因素分析

Factors affecting the accuracy of intraoperative frozen section pathological diagnosis of small-sized lung adenocarcinoma

目的 探讨术中冷冻切片诊断小体积肺腺癌的临床价值及影响准确性的临床病理因素。方法 回顾性分析2019-09—2021-10内蒙古自治区人民医院200例肺腺癌患者的临床病理资料,以石蜡切片诊断结果为“金标准”,分析冷冻切片检查的准确性,探讨影响准确性的临床病理因素。结果 冷冻切片与石蜡切片总体符合率为88.5%,其中冷冻切片诊断非典型腺瘤性增生符合率为100%、原位腺癌(AIS)符合率为88.9%、微浸润性腺癌(MIA)符合率为81.0%、浸润性腺癌符合率为90.7%。分析发现肿瘤大小≥1 cm、不吸烟、存在高级别组织学形态的患者符合率高,差异有统计学意义(P<0.05)。结论 小体积肺腺癌术中冷冻切片病理诊断具有较高的准确性,是术中手术治疗方案选择的重要依据,当冷冻切片诊断为AIS、MIA时,需结合肿瘤大小、是否存在高级别组织学亚型等因素考虑。

Objective To investigate the clinical value of intraoperative frozen section in the diagnosis of small-sized lung adenocarcinoma and the clinicopathological factors affecting the accuracy. Methods The clinicopathological data of 200 patients with lung adenocarcinoma in the People’s Hospital of Inner Mongolia Autonomous Region from 2019-09 to 2021-10 were retrospectively analyzed, and the diagnostic results of paraffin section were used as the “gold standard” to analyze the accuracy of frozen section examination, and to explore the clinicopathological factors that affected the accuracy. Results The overall coincidence rate of frozen section and paraffin section was 88.5%, among which the coincidence rate of frozen section diagnosis of atypical adenomatous hyperplasia was 100%, that of adenocarcinoma in situ(AIS) was 88.9%, and that of minimally invasive adenocarcinoma(MIA) was 81.0%, and that of invasive adenocarcinoma was 90.7%. The analysis showed that the patients with tumor size ≥1 cm, non-smokers, and high-grade histological morphology had a high coincidence rate, and the difference was statistically significant(P<0.05). Conclusion Intraoperative frozen section pathological diagnosis of small-sized lung adenocarcinoma has high accuracy and is an important basis for the selection of intraoperative surgical treatment. When frozen section is diagnosed as AIS or MIA, it is necessary to formulate a surgical plan based on tumor size, presence of high-grade histological subtypes, and smoking factors to avoid insufficient surgical treatment.