基于冷冻切片的直接免疫组化染色法在甲状腺乳头状癌中的诊断价值

目的 探讨基于冷冻切片的直接免疫组化染色法在甲状腺乳头状癌中的诊断价值.方法 收集手术中送检的甲状腺良性病变组织、乳头状癌组织各30例,采用直接免疫组化染色法、石蜡切片免疫组化染色法检测CK19、Galectin-3的表达,对比两种染色法的时间、质量、阳性率及诊断准确率.结果 直接免疫组化染色法耗时15 min,石蜡切...     

753例甲状腺疾病快速冷冻切片的病理诊断分析与探讨

目的探讨甲状腺疾病快速冷冻切片的诊断及鉴别诊断并分析导致漏诊的原因。方法对753例甲状腺疾病进行分析,其中结节性甲状腺肿622例,乔本病及其他甲状腺炎共58例,甲亢32例,甲状腺癌共41例(其中甲状腺乳头状癌32例,髓样癌5例,滤泡癌2例,未分化癌2例)。结果甲状腺疾病快速冷冻切片的总符合率为98.9%,漏诊率为1.1%。术后诊断良性符合率为100%,术后诊断为恶性的符合率为80.48%,漏诊率为19.52%。甲状腺乳头状癌快速诊断符合率为84.38%,漏诊率为15.62%。滤泡癌2例在术中均未作出诊断,漏诊率为100%。未分化癌2例均作出明确诊断。髓样癌5例,其中1例漏诊。结论甲状腺癌在快速冷冻病理诊断中有较高的漏诊率,尤其是甲状腺乳头状癌和滤泡癌,提高诊断率需要不断总结经验教训,把大体取材、组织学特点及临床沟通有机结合起来,同时加强与技术人员的合作。     

提高病理冰冻切片质量的体会

目的通过自身的工作体会,探讨提高冰冻切片质量的技巧及方法.方法对乳腺、子宫、甲状腺、胃肠等几种不同组织进行冰冻切片比较、观察.结果切片完整,厚薄均匀,染色核浆对比鲜明,细胞形态及组织结构清晰,符合术中快速冰冻诊断要求.结论一张优质的冰冻切片需要技术员对不同的组织区别对待,从取材、冷冻、切片、固定、染色等环节认真做起.     

甲状腺肿块术中冰冻切片诊断的初探

1983年12月～1991年12月间我科共计有392例甲状腺肿块病人接受术中冰冻切片检查,其中15例冰冻切片与术后石蜡切片结果不符,占3.8％;3例术中冰冻切片未得结果,占0.8％,作者分析了术中冰冻切片与术后石蜡切片结果不符的可能因素,对甲状腺肿块术中冰冻切片的应用价值及注意事项提出了自己的看法。     

93例卵巢肿瘤冰冻切片病理诊断分析

冰冻切片病理诊断有利于手术医师在术中获得正确及时的诊断，选择下一步适宜的手术方案。但由于这项工作是在短时间内完成，受取材制片因素影响较大，常给诊断带来困难，为了提高冰冻切片病理诊断的正确率，对９３例卵巢肿瘤术中冰冻片进行回顾性分析，以期总结经验，提高...     

CK19、CK20在甲状腺乳头状癌诊断中的应用价值

目的：探讨甲状腺癌中CK19、CK20蛋白的表达，提高甲状腺的诊断与鉴别诊断水平。方法：应用免疫组化染色对70例甲状腺癌（15例经典型乳头状癌、34例滤泡型乳头状癌、3例Warthin乳头状癌、2例透明细胞型乳头状癌、例柱状细胞型乳头癌、15例滤泡性癌），10例甲状腺腺瘤、10例结节性甲状腺肿和5例标本甲状腺炎中CK19、CK20的表达进行观察。结果:CK19在甲状腺疾病中的表达：55例乳头状癌中，53例为中、强阳性，2例为弱阳性；15例滤泡性癌中，13例为阴性、弱阳性，2例为中、强阳性，两者之间差异存在显著性（P＜0．05）。各癌旁滤泡、10例滤泡性腺瘤、10例结节性甲状腺肿的滤泡、5例桥本甲状腺炎也主要为阴性、弱阳性，个别为中等阳性。对CK20的表达，各型甲状腺乳头状癌、滤泡性癌、癌旁滤泡及滤泡状癌和乳头状增生、多灶性分布的甲状腺泡型乳头状癌和各种滤泡性病变有帮助，可提高甲状腺良恶性病变诊断的准确率及鉴别诊断水平。CK20对鉴别诊断的帮助不大。     

针吸细胞学对甲状腺乳头状癌的诊断价值

目的探讨甲状腺乳头状癌的细针细胞学核的特征,提高甲状腺乳头状癌的诊断准确性。方法回顾性分析121例经组织学证实为甲状腺乳头状癌的细针穿刺细胞学标本。结果 121例中,细胞学诊断无法诊断或标本不满意3例,良性病变2例,非典型病变2例,滤泡性肿瘤2例,可疑乳头状癌12例,乳头状癌100例。核沟在甲状腺乳头状癌细胞学中阳性率最高,但其特异性不足。核内假包涵体、砂砾体在甲状腺乳头状癌的阳性率低于核沟,但特异性很高。结论超声引导下细针穿刺细胞学检查对甲状腺乳头状癌的诊断有较高的敏感性,核沟、核内假包涵体、砂砾体是诊断甲状腺乳头状癌的重要指标。     

手术中冰冻切片诊断卵巢肿瘤859例分析

目的：总结部冻切片诊断卵巢肿瘤的体会。方法：回顾性分析８５９例卵巢肿瘤冰冻切片诊断资料．结果：利用冰冻切片诊断卵巢肿瘤，确诊率９４．８８％，未能确诊率０．５８％，误诊率４．５４％。误诊３９例，多见于交界性粘液囊腺瘤，分化好粘液囊腺癌和转移性粘液腺癌；４例冰冻切片误诊的良性肿瘤包括２例卵巢甲状腺种和２例粘液囊腺瘤。误诊原因中，取材不当占５３．８８％，读片错误３５．９０％，制片不良１０．２８％。结论：     

CD26/DPPⅣ、galectin-3在甲状腺乳头状癌的表达及意义

目的 探讨二肽基肽酶Ⅳ（CD26/DPPⅣ）及半乳糖凝集素3（galectin-3）在甲状腺乳头状癌的表达及其意义。方法 用免疫组织化学EnVision二步法,分别检测68例乳头状癌及36例腺瘤组织中CD26/DPPⅣ及galectin-3的表达。结果 CD26/DDPⅣ及galectin-3在甲状腺腺瘤中不表达或低水平的表达,在大多数乳头状癌中高水平的表达;诊断乳头状癌的敏感性、特异性及诊断准确率,CD26/DDPⅣ分别为86.8%、97.2%及90.4%,galectin-3分别为97.1%、91.7%及95.2%。乳头状癌中CD26/DPPⅣ及galectin-3的表达,腺内型与腺外型、无淋巴结转移者与有淋巴结转移者、预后低危者与高危者均无显著性差异。结论 CD26/DDPⅣ与galectin-3是较有希望的甲状腺乳头状癌的标志物,其免疫组化染色可以辅助常规的病理检查进行乳头状癌与腺瘤的鉴别诊断,但对于甲状腺乳头状癌侵袭、淋巴结转移及预后的判断可能无明显价值。     

甲状腺乳头状癌术中冷冻切片诊断及延迟原因分析

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理特征、诊断及鉴别诊断。方法收集165例PTC的病理资料,光镜下观察术中冷冻切片及常规石蜡切片,并对其中12例行免疫组化染色,检测CK19、Galectin-3、MC、CK (34βE12)、CD56及Ki-67的表达,同时行BRAF基因突变检测。结果 165例患者中女性134例,男性31例,经术中冷冻诊断确诊141例,准确率为85. 5%。延迟诊断21例(12. 7%),假阴性诊断3例(1. 8%)。CK19和Galectin-3在PTC中呈强阳性。BRAF基因V600E突变7例。结论 PTC女性多见,术中冷冻切片对PTC的诊断具有重要应用价值,病理医师需掌握冷冻切片中组织结构及细胞形态的变异,以提高诊断的准确性。CK19和Galectin-3有助于PTC的诊断,BRAF基因突变检测可作为临床评估患者预后的重要参考指标。     

Thyroid follicular neoplasm: Analysis by fine needle aspiration cytology,frozen section,and histopathology

We performed a retrospective analysis of follicular neoplasm data obtained from frozen section examinations of thyroid nodules. A total of 5,660 patients underwent preoperative neck ultrasonography and fine‐needle aspiration cytology (FNAC), surgical treatment, and follow‐up at a medical institute. Patients with papillary thyroid microcarcinoma were excluded from this study. In 971 cases, frozen section examination was performed during the surgical treatment of follicular neoplasm that was diagnosed via FNAC. Thyroid malignancies were histologically confirmed in 25.1% of cases (244/971). Among the patients with papillary thyroid carcinoma, 45 were diagnosed with the follicular variant of papillary thyroid carcinomas (27.4%). The diagnostic sensitivity of frozen section for the nonfollicular variant of papillary thyroid carcinoma was better than that for the follicular variant of papillary thyroid carcinoma (89.1% versus 78.9%; P = 0.1023). For 12 cases the diagnosis was atypical follicular adenomas. The diagnostic accuracy of frozen section in cases of follicular neoplasm was 76.9% with a sensitivity of 84.8% and a specificity of 98.9%. In conclusion, our analysis revealed high rates of accuracy when using frozen tissue sections for early diagnosis and treatment of follicular neoplasm; thus, an early decision to extent of surgery prevents a risky follow‐up surgery. Diagn. Cytopathol. 2010;38:801‐805. © 2009 Wiley‐Liss, Inc.     

Frozen section diagnosis and the thyroid

The diagnostic problems arising from frozen section evaluation of thyroid lesions are complex and beclouded in controversy. Prime examples include follicular and Hurthle cell neoplasms, both of which lack standardization in classification and management. The seemingly straightforward identification of papillary carcinoma is often complicated by the frequent absence of its distinguishing features, some of which are reportedly restricted to formalin-fixed paraffin embedded material. Thyroiditides and thyroidal ectopias present unique and separate differential diagnostic considerations that at the time of frozen section may pose problems for surgeon and pathologist alike. These issues and their controversial aspects are addressed, and potential diagnostic pitfalls related to frozen section diagnosis of thyroid lesions in general are outlined. An analysis of 300 thyroid frozen sections over a 5-year period and the histologic frozen section features of 40 papillary thyroid carcinomas are also presented. The presence of optically clear nuclei was identified in frozen sections from 15 cases, and was extensive in one. Thirty-eight of 40 cases displayed optically clear nuclei within permanent sections. It is suggested that this cytologic feature is not the exclusive domain of permanent section, and when present in the frozen section may be helpful in identifying papillary carcinoma, especially when an obvious papillary component is lacking.     

Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules.

AIMS: To evaluate the correlation of fine needle aspiration (FNA) cytology and frozen section biopsy in the diagnosis of thyroid nodules. METHODS: The medical records of 662 patients who underwent FNA cytology of the thyroid and thyroid surgery were analysed. Frozen section biopsies were taken from 586 of the 662 patients. The diagnostic correlations of FNA cytology, frozen section, and both FNA cytology and frozen section with definitive histological assessment were evaluated. RESULTS: Among the 662 patients who received FNA cytology, there were 356 cases (53.8%) diagnosed as benign, 114 cases (17.2%) as malignant, 148 cases (22.4%) as indeterminate, and 44 cases (6.6%) as unsatisfactory. The positive predictive value for the detection of malignancy by FNA cytology was 92.1% and the negative predictive value was 95.2%. The incidence of malignancy in the indeterminate cytological diagnosis was 23%. The diagnosis from frozen sections was benign in 445 cases (75.9%), malignant in 134 cases (22.9%), and deferred in 7 cases (1.2%). By frozen section, the positive and negative predictive values were 97% and 95.5%, respectively. Diagnostic accuracy up to 98% was achieved when FNA cytology and frozen section diagnoses were in agreement. No false positives were observed when FNA cytology and frozen sections were both positive for malignancy. When FNA cytology and frozen section diagnoses were discordant, frozen section showed a higher accuracy (78.9%) than FNA cytology (21.1%). In the face of an indeterminate or unsatisfactory cytological diagnosis, the diagnostic accuracy of frozen sections reached 92.6%. CONCLUSIONS: The results confirm that FNA cytology is a useful tool in the initial evaluation of thyroid nodules. Intraoperative frozen section is a valuable procedure to confirm the cytological diagnosis and identify malignancy in patients with indeterminate or unsatisfactory cytological diagnosis. With reliance on frozen sections as an intraoperative guide of thyroid surgery, the possibility of unnecessary extensive surgery and the need for the second operation are considerably lower.     

Use and abuse of frozen section in the diagnosis of follicular thyroid lesions

The role of intraoperative frozen section in certain organ systems such as the thyroid continues to be problematic. In many cases, diagnoses are deferred or nonhelpful—“follicular lesion.” In the modern era, the widespread use of preoperative aspiration biopsy has allowed for more careful selection of patients who undergo thyroid surgery. In many cases, the fine-needle-aspiration (FNA) biopsy diagnosis can be definitive or can guide the specific surgical procedure. The literature supports our approach, which is summarized as follows: Intraoperative consultation is not needed on the intrathyroidal nodule if a preoperative FNA was definitive for papillary carcinoma. Frozen section is of no value in the intraoperative diagnosis of lesions diagnosed on FNA as “follicular neoplasm” or “Hürthle cell neoplasm” because the characterization of these lesions requires detailed analysis of the tumor capsule for the demonstration of capsular and/or vascular invasion—an analysis that is not practical in the intraoperative setting. Finally, intraoperative consultation including frozen section and intraoperative cytologic examination is most useful in those cases that are diagnosed as suspicious for papillary carcinoma by FNA, because the assessment of nuclear features needed for the definitive diagnosis is possible with intraoperative techniques in a significant number of cases.     

Current practices in performing frozen sections for thyroid and parathyroid pathology

In this review article, current trends in thyroid and parathyroid frozen sections are discussed. In Japan and other countries, the numbers of thyroid frozen sections have been dramatically decreasing over the past decade. The decline in the number of thyroid frozen sections has been attributed to two major factors: highly diagnostic preoperative fine needle aspiration for papillary carcinomas, the most frequent type of thyroid cancers, and the acknowledgment in the literature of the disadvantageous frozen sections for follicular tumors. Several authors have argued that the frozen section of thyroid nodules should be limited only to cases that have a preoperative cytology diagnosis as "atypical" or "suspicious". In contrast, frozen sections for parathyroid glands have been increasing in numbers. This increase is thought to be largely due to the high number of parathyroidectomies for secondary hyperplasia in dialysis patients. Frozen sections are usually performed to confirm the removal of parathyroid tissue for either cyropreservation or auto-transplantation. It is concluded that thyroid and parathyroid frozen section examination is restricted to selected situations.     

乳腺癌术中前哨淋巴结169枚印片细胞学诊断分析

目的探讨印片细胞学检查在乳腺癌术中前哨淋巴结诊断的价值,提高术中快速诊断的准确率。方法对67例乳腺癌患者的169枚前哨淋巴结同时进行术中冷冻切片检查及印片细胞学检查,与术后石蜡切片诊断对比分析。结果以淋巴结枚数为单位,169例术中前哨淋巴结冷冻切片确诊163例,确诊率96.45%;印片细胞学确诊162例,确诊率95.86%;两者联合诊断,共同确诊166例,确诊率98.22%。结论乳腺癌术中前哨淋巴结印片细胞学检查与冷冻切片检查相结合有互补作用,联合应用可提高术中前哨淋巴结诊断准确率。     

Quality assessment of intraoperative frozen sections in a teaching hospital: an analysis of 847 consecutive cases

We evaluated the accuracy of 847 consecutive frozen section diagnoses in order to develop a quality control. We also evaluated the time needed to perform them. Frozen sections and final diagnoses agreed in 92.6% and disagreed in 1.7% (14 cases). 5.8% of the cases were deferred. The only case of false-positive frozen sections (0.1%) was due to a pathologist's misinterpretation. False-negative frozen sections were due to sampling errors: in 5 cases, diagnostic tissue was present only in permanent sections of the frozen block and in 8 cases diagnostic tissue was present only in the portion of the specimen not sampled by the frozen section. One hundred and ninety two frozen sections concerned thyroid neoplasms. Thirteen cancers were diagnosed on frozen sections, 2 cancers were considered as benign and 9 cancers had a differed diagnosis. The mean duration to perform the frozen sections was 21 minutes. In conclusion, intra operative frozen section diagnosis is rapid and reliable. Discrepancies are more often false negatives due to sampling errors. Although a high rate of differed diagnosis was observed in thyroid neoplasms, frozen sections remain useful for these lesions. Imprint cytology of thyroid nodules is advisable.     

Pathologic analyses of peritoneal nodules in gastric cancer patients during surgery—A single cancer center experience with diagnostic pitfalls

Background: Gastric carcinoma (GC) is the second most common cause of cancer-related deaths worldwide. During operations, nodular lesions of the peritoneum are often sent for frozen section (FS). For pathologists, FS of the peritoneum is challenging due to sparse and discohesive tumor cells in a fibrotic background.Methods: To explore diagnostic accuracy and diagnostic pitfalls of FS in this setting, we retrospectively collected 252 peritoneal biopsies in cases with GC from January 2006 to May 2017 and compared corresponding permanent sections and patient prognosis. After review, 6 cases (2.4%) were discrepant: positive conversion was identified in 5 cases due to scarce tumor cells associated with severe fibrosis and inflammation; negative conversion was identified in one case due to papillary mesothelial cell proliferation masquerading as carcinoma.Results: Two hundred cases were finally confirmed as positive for tumor cells. Of these, 185 (92.5%) patients died of GC, with survival times ranging from 7 to 3574 (mean 415) days after operation. Fifty-two (20.6%) cases were negative for tumor, and pathologic findings included chronic inflammation with fibrosis (N?=?25: associated with previous operation, 10; idiopathic, 15) and papillary mesothelial cell proliferation (N?=?9). All 5 patients with frozen diagnosis converted to positive results died of GC during follow up. A total of 19 patients with peritoneal nodules diagnosed as benign on FS died with GC (79.0%), and their survival times ranged from 87 to 3649 (mean 833) days.Conclusions: Peritoneal biopsies in patients with GC were mostly carcinoma, followed by chronic inflammation with fibrosis and papillary mesothelial cell proliferation. Deeper sections or intradepartmental consultations were helpful to reduce false negative diagnosis on FS.     

367例甲状腺疾病临床病理诊断分析

目的：总结甲状腺腺瘤和单结节性甲状腺肿的鉴别诊断,细针穿刺诊断在甲状腺疾病中的应用经验和价值,旨在提高甲状腺疾病的诊断和鉴别诊断水平。方法：对367例甲状腺病变进行病理形态学为主的复验和结果分析。结果：甲状腺疾病中女性患者占82．6％;各类疾病中甲状腺腺瘤占首位（50．1％）;术中冷冻切片对甲状腺良恶性疾病诊断（定性）的符合率为100％,具体类型诊断（定类）符合率为88．2％;细针穿刺诊断准确率为77．8％。结论：应重视甲状腺腺瘤与单结节性甲状腺肿的鉴别诊断;甲状腺疾病,尤其是甲状腺恶性疾病的细针穿刺诊断准确率低,无法取代传统的冷冻切片诊断。     

Role of cytology and frozen sections in the intraoperative examination of the thyroid: comparison of two experiences

Two experiences of peroperative diagnosis in thyroid surgery are reported. In Bordeaux (France), frozen sections are supplemented by touch smears. Imprints alone give results similar to frozen but are not suitable in differentiating follicular adenoma from carcinoma; they appear more accurate for recognising the follicular presentation of papillary carcinoma. Touch smear is a rapid cost-effective alternative to frozen section. In Brussels (Belgium), a more conventional attitude results in 185 frozen. A false negative ends in a follicular carcinoma. Eleven follicular proliferations will be signed out adenoma (8 cases) or carcinoma (3 cases) and three papillary carcinomas will only be detected after embedding. Six false negative derive from frozen section, no false positive is noted. An immediate change in the surgical procedure is justified twice. These observations argue for the free choice by the pathologist of the best technical procedure in peroperative diagnosis.