子宫内膜癌术中冷冻切片病理检查的准确性

Accuracy of frozen section examination in the surgery for endometrial cancer

目的探讨子宫内膜癌术中冷冻切片病理检查的准确性。方法选取2015年1月至2018年1月间宝鸡市第二人民医院妇产科收治的65例子宫内膜癌患者进行回顾性分析,所有患者均取术中冷冻切片,以患者术后石蜡包埋切片结果为金标准,比较两种检查方法在诊断宫颈累及、肌层浸润深度、肿瘤细胞级别以及组织学类型等方面的准确度。结果冷冻切片诊断子宫内膜癌肿瘤细胞级别的准确度为80. 0%,特异度为100. 0%,敏感度为79. 0%。冷冻切片诊断子宫内膜癌肿瘤组织学类型的检查准确度为84. 6%,特异度为100. 0%,敏感度为83. 9%。冷冻切片诊断子宫内膜癌肿瘤肌层浸润程度的准确度为83. 1%,特异度为100. 0%,敏感度为82. 3%。冷冻切片诊断子宫内膜癌肿瘤细胞宫颈累及的准确度为90. 8%,特异度为33. 3%,敏感度为100. 0%。结论依靠术中冷冻切片判断子宫内膜癌宫颈累及、组织学类型、肌层浸润深度和肿瘤细胞级别等方面存在不足,因此,不能完全依赖其作为判断子宫内膜癌手术范围的依据。

Objective To investigate the accuracy of frozen section examination in the surgery for endometrial cancer. Methods From January 2015 to January 2018,65 patients with endometrial cancer admitted to Baoji Second People’s Hospital were retrospectively analyzed. Intraoperative frozen section procedure was performed on all the patients. Postoperative paraffin embedding section results were considered as the gold standard. The accuracy of the two examination methods in the diagnosis of cervical involvement,muscular infiltration depth,level of tumor cells,and the histological type were compared. Results The accuracy,specificity and the sensitivity of frozen section examination was 80. 0%,100. 0% and 79. 0%,respectively for the level of tumor cells. In terms of tumor histological type,the accuracy,specificity and the sensitivity of frozen section examination was 84. 6%,100. 0% and 83. 9%,respectively. In terms of the infiltration degree of tumor muscle layer,the accuracy,specificity and the sensitivity of frozen section examination was 83. 1%,100. 0% and 82. 3%,respectively. In terms of cervical involvement of tumor cells,the detection accuracy,specificity and the sensitivity of frozen section examination was 90. 8%,33. 33%,and 100. 0%. Conclusion Intraoperative frozen section shows defects in judging the cervical involvement,histological type,muscular infiltration depth and level of tumor cells,as well as insufficient. Therefore,it cannot be completely relied on as the basae to judge the scope of surgery for endometrial cancer.