术中冰冻病理检查对肺部占位性病变的诊断结果及误诊原因分析

Diagnosis of pulmonary space occupying lesions by intraoperative frozen pathological examination and analysis of the causes of misdiagnosis

目的探讨术中冰冻病理检查对肺部占位性病变的诊断结果及误诊原因。方法回顾性分析2015年7月至2022年5月在解放军第九六〇医院淄博医疗区行手术治疗且实施术中冰冻病理检查的121例肺部占位性病变患者的病历资料,以石蜡切片诊断结果为“金标准”,分析冰冻诊断的准确率以及其误诊率的原因。结果121例肺部占位性病变手术标本经石蜡切片诊断肿瘤性病变84例(69.42%),其中原位腺癌9例(0.74%),浸润性腺癌58例(47.93%),微浸润性腺癌7例(5.79%),小细胞癌1例(0.83%),鳞状细胞癌4例(3.31%),其他5例(4.13%);非肿瘤性病变37例(30.58%),其中非典型腺瘤样增生1例(0.83%),结核9例(7.44%),炎性假瘤1例(0.83%),硬化性非细胞瘤1例(0.83%),错构瘤5例(4.13%),其他20例(6.14%);以石蜡切片的诊断结果为金标准,121例肺部占位性病变冰冻病理切片诊断准确率为90.91%(110/121),误诊率为9.09%(11/121);冰冻病理检查误诊的11例患者中主要为诊断不足5例(45.45%),其次为诊断错误2例(18.18%),取材不充分4例(36.36%)。结论术中冰冻病理检查对肺部占位性病变诊断准确率较高,能够为手术方案制定提供参考,而误诊的主要原因为诊断不足、诊断错误、取材不充分,临床须加以重视。

Objective To explore the diagnostic results of intraoperative frozen pathological examination for pulmonary space occupying lesions and the causes of misdiagnosis.Methods The medical records of 121 patients with pulmonary space occupying lesions who underwent surgery and underwent intraoperative frozen pathological examination in Zibo Medical District,the 960th Hospital of the People's Liberation Army from July 2015 to may 2022 were retrospectively analyzed.Based on the diagnostic results of paraffin sections as the"gold standard",the accuracy of frozen diagnosis and the reasons for its misdiagnosis rate were analyzed.Results Among 121 cases of lung space occupying lesions,84 cases(69.42%)were diagnosed as neoplastic lesions by paraffin section,including 9 cases of adenocarcinoma in situ(0.74%),58 cases of invasive adenocarcinoma(47.93%),7 cases of microinvasive adenocarcinoma(5.79%),1 case of small cell carcinoma(0.83%),4 cases of squamous cell carcinoma(3.31%),and 5 other cases(4.13%);37 cases(30.58%)were non neoplastic lesions,including 1 cases(0.83%)of atypical adenomatous hyperplasia,9 cases(7.44%)of tuberculosis,1 case(0.83%)of inflammatory pseudotumor,1 case(0.83%)of sclerosing noncellular tumor,5 cases(4.13%)of hamartoma,and 20 other cases(6.14%).Taking the diagnostic results of paraffin sections as the gold standard,the diagnostic accuracy of frozen pathological sections in 121 cases of lung space occupying lesions was 90.91%(110/121),and the misdiagnosis rate was 9.09%(11/121).Among the 11 patients misdiagnosed by frozen pathological examination,the underdiagnosis was 5 cases(45.45%),followed by 2 cases of wrong diagnosis(18.18%),and 4 cases of insufficient materials(36.36%).Conclusion Intraoperative frozen pathological examination has a high accuracy in the diagnosis of pulmonary space occupying lesions,which can provide reference for the formulation of surgical plans.The main causes of misdiagnosis are insufficient diagnosis,wrong diagnosis and insufficient materials,which should be paid attention to clinically.