术中冰冻病理检查对甲状腺微小乳头状癌诊断的准确率分析

Analysis of the Accuracy of Intraoperative Frozen Pathology Examination on the Diagnosis of Micro Papillary Carcinoma of the Thyroid Gland

目的分析术中冰冻病理检查对甲状腺微小乳头状癌诊断的准确率。方法选取2018年3月—2019年6月于江苏省常熟市第一人民医院入院检查的149例疑似甲状腺微小乳头状癌患者作为研究对象,所有患者均进行术中冰冻病理检查和常规切片病理检查,并以常规切片病理检查为金标准,比较两种检查方式的诊断结果。结果149例患者中经过金标准确诊的患者有141例,8例为阴性,术中冰冻病理检查诊断140例,有1例误诊,2例漏诊;术中冰冻病理检查的灵敏度、特异性、阳性预测值、阴性预测值以及准确率分别为98.58%、87.50%、99.29%、77.78%、97.99%,且与金标准的一致性较高,Kappa值为0.813;除外1例误诊病例,经术中冰冻病理检查确诊为甲状腺微小乳头状癌患者有139例,病灶直径≤0.3 cm有23例(92.00%),0.3~0.7 cm之间的有64例(100.00%),≥0.7 cm的有52例(100.00%)。结论采用术中冰冻病理检查是诊断甲状腺微小乳头状癌的重要依据,但是有一定的误诊、漏诊率,需要通过术后病理切片进行补充诊断。

Objective To analyze the accuracy of intraoperative frozen pathologic examination in the diagnosis of thyroid micropapillary carcinoma.Methods A total of 149 suspected patients with thyroid micropapillary carcinoma admitted to the First People's Hospital of Changshu City,Jiangsu Province from March 2018 to June 2019 were selected as the research objects.All patients underwent intraoperatively frozen pathological examination and routine pathological examination,and the routine pathological examination was used as the gold standard to compare the diagnostic results of the two examination methods.Results Among 149 patients,141 were confirmed by gold standard,8 were negative,140 were confirmed by intraoperative frozen pathological examination,1 was misdiagnosed and 2 were missed.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of intraoperatively frozen pathological examination were 98.58%,87.50%,99.29%,77.78%and 97.99%,respectively,and the consistency with gold standard was high,Kappa value was 0.813.Excluding one misdiagnosed case,there were 139 cases of thyroid micropapillary carcinoma confirmed by intraoperative frozen pathological examination,of which 23 cases(92.00%)had focal diameter≤0.3 cm,64 cases(100.00%)had focal diameter between 0.3-0.7 cm,and 52 cases(100.00%)had focal diameter≥0.7 cm.Conclusion Intraoperative frozen pathological examination is an important basis for the diagnosis of thyroid micropapillary carcinoma,but there is a certain rate of misdiagnosis and missed diagnosis,so it is necessary to supplement the diagnosis through postoperative pathological sections.