术中冰冻病理诊断对眼睑肿物切除的价值探讨及病理类型分析

Exploration of the value of intraoperative frozen sections for excision of eyelid masses and analysis of pathological types

目的 探讨送检术中冰冻病理诊断(frozen sections, FS)的眼睑肿物病理类型及其对眼睑肿物和切缘的诊断准确率,分析FS与石蜡病理诊断不一致的常见原因。方法 选取2016年12月至2021年12月首都医科大学附属北京同仁医院送检FS眼睑肿物标本561份,分析眼睑肿物的病理类型,并以石蜡病理诊断为金标准,分析FS对眼睑肿物和切缘的诊断准确率。结果 561份标本中,左眼280份,右眼281份;上睑225份,下睑311份,内眦18份,外眦7份;肿物最大直径1~35 mm,平均(15.1±9.4)mm。其中良性病变165份(29.4%),位居前三位的分别为炎性病变、色素痣和脂溢性角化病;恶性病变396份(70.6%),位居前三位的分别为基底细胞癌、皮脂腺癌和鳞状细胞癌。FS对肿瘤和切缘的诊断准确率分别为97.1%、99.3%,肿瘤延迟诊断率为6.2%。肿瘤诊断不一致类型为误分类(60.0%,9/15)、假阴性(26.7%,4/15)及假阳性(13.3%,2/15)。诊断不一致的原因为解读失误(73.3%,11/15)、制片失误(26.7%,4/15)。结论 送检FS的眼睑肿物以恶性病变为主,并以基底细胞癌和皮脂腺癌多见;FS对眼睑肿物及切缘均具有较高的诊断准确率,能很好地指导手术开展,皮脂腺癌和恶性肿瘤的特殊亚型是与石蜡病理诊断不一致的主要因素,切片深度不够是导致漏诊和诊断不充分的主要原因,日常工作中对于可疑复发及较小的肿瘤应给予充分评估。

Objective To explore the pathological types of eyelid tumors and their diagnostic accuracy in frozen sections(FS)during inspection,and to analyze the reasons for inconsistencies between FS and paraffin pathology diagnosis.Methods A total of 561 specimens of intraoperative FS eyelid tumor resection in Beijing Tongren Hospital,Capital Medical University from December 2016 to December 2021 were selected.The pathological types of eyelid tumors were analyzed,and the diagnostic accuracy of FS for eyelid tumors and margins was compared with paraffin pathology diagnosis.Results Among the 561 specimens,there were 280 left eyes and 281 right eyes;225 upper lids,311 lower lids,18 medial canthi,and seven lateral canthi.The maximum diameter of the tumors ranged from 1 to 35 mm,with an average of(15.1±9.4)mm.Among them,there were 165 cases of benign lesions(29.4%),with the top three being inflammatory lesions,pigmented nevus and seborrheic keratosis,and 396 cases of malignant lesions(70.6%),with the top three being basal cell carcinoma,sebaceous gland carcinoma and squamous cell carcinoma.The diagnostic accuracy rates of FS for tumor and margin were 97.1%and 99.3%,respectively,and the delayed diagnosis rate of tumor was 6.2%.The types of inconsistent diagnoses included misclassification(60%,9/15),false negative(26.7%,4/15),and false positive(13.3%,2/15).The reasons for inconsistent diagnoses were interpretation errors(73.3%,11/15)and slide preparation errors(26.7%,4/15).Conclusions The majority of FS for eyelid tumors are malignant lesions,most of which are basal cell carcinoma and sebaceous gland carcinoma.FS has a high diagnostic accuracy for eyelid tumor and margins,and can guide the operation well.Special subtypes of malignant tumors and sebaceous gland carcinoma are the main factors of inconsistence with paraffin pathological diagnosis,and insufficient section depth is the main reason for missed diagnosis and inadequate diagnosis.Suspicious recurrence and small tumors should be fully evaluated in daily work.