1263例肺部结节术中冰冻病理诊断分析

Analysis of intraoperative frozen section diagnosis of 1263 pulmonary nodules

目的探讨肺部结节术中冰冻切片诊断的要点及难点。方法收集首都医科大学附属北京朝阳医院2021年1月—2022年1月肺部结节病例的术中冰冻及术后石蜡病理诊断结果,以术后石蜡诊断为最终诊断,分析冰冻诊断中误诊病例的主要原因,总结容易误诊病例的诊断及鉴别诊断要点。结果共纳入1178例患者的1263例冰冻病理结果,其中男475例、女703例,平均年龄58.7(23~86)岁。1263例冰冻切片的病理诊断正确率为95.65%,误诊率为4.35%。误诊病例55例,分别为浸润性腺癌18例(3.44%)、原位腺癌17例(5.82%)、黏液腺癌7例(35.00%)、微浸润性腺癌4例(2.09%)、IgG4相关性疾病3例(100.00%)、黏液型原位腺癌2例(66.67%)、非典型腺瘤样增生1例(16.67%)、硬化性肺细胞瘤1例(14.29%)、细支气管腺瘤1例(33.33%)、乳头状腺瘤1例(100.00%)。结论术中冰冻诊断仍具有其局限性,临床医生需结合影像学检查及临床经验综合判断。

Objective To explore the key points and difficulties of intraoperative frozen section diagnosis of pulmonary diseases.Methods The intraoperative frozen section and postoperative paraffin section results of pulmonary nodule patients in Beijing Chaoyang Hospital,Capital Medical University from January 2021 to January 2022 were collected.The main causes of misdiagnosis in frozen section diagnosis were analyzed,and the main points of diagnosis and differential diagnosis were summarized.Results According to the inclusion criteria,a total of 1263 frozen section diagnosis results of 1178 patients were included in the study,including 475 males and 703 females,with an average age of 58.7(23-86)years.In 1263 frozen section diagnosis results,the correct diagnosis rate was 95.65%,and the misdiagnosis rate was 4.35%.There were 55 misdiagnoses,including 18(3.44%)invasive adenocarcinoma,17(5.82%)adenocarcinoma in situ,7(35.00%)mucinous adenocarcinoma,4(2.09%)minimally invasive adenocarcinoma,3(100.00%)IgG4 related diseases,2(66.67%)mucinous adenocarcinoma in situ,1(16.67%)atypical adenomatous hyperplasia,1(14.29%)sclerosing pulmonary cell tumor,1(33.33%)bronchiolar adenoma,and 1(100.00%)papillary adenoma.Conclusion Intraoperative frozen section diagnosis still has its limitations.Clinicians need to make a comprehensive judgment based on imaging examination and clinical experience.