3000例中枢神经系统病变冰冻诊断分析

目的:重新研究3000例神经系统占位性病变的冰冻切片;分析误诊病例之病理特点;归纳以脑肿瘤为主的中枢神经系统疾病冰冻诊断的要点、难点.方法:分析经术后石蜡切片诊断证实的3000例术中冰冻切片诊断结果.结果:冰冻诊断准确率95.87%(2876/3000),误诊率4.13%.误诊率最高的肿瘤是脑膜间叶性肿瘤、血管母细胞瘤、淋巴瘤、少突胶质细胞瘤等.结论:正确的冰冻诊断需要全面的临床资料和足够的病变组织;病理医师要有雄厚的病理基础和冰冻切片诊断的丰富经验及较全面的临床、影像学知识才能保证诊断的可靠性.     

41例甲状腺癌冰冻切片诊断分析

目的探讨甲状腺癌术中冰冻切片的诊断要点,提高术中冰冻切片的诊断水平。方法对我院206例甲状腺疾病中冰冻切片并经石蜡切片证实的41例甲状腺癌的病理资料进行回顾分析。结果41例甲状腺癌冰冻切片38例术中确诊,1例误诊为甲状腺不典型腺瘤,1例高度疑为乳头状癌而延迟诊断,1例因肿物钙化明显无法冰冻制片而漏诊。结论甲状腺癌术中冰冻切片诊断漏诊和过诊都可能导致严重的后果,术前了解病史,取材全面细致,掌握各型甲状腺癌的镜下特征,并由两位经验丰富的病理医师共同诊断是提高甲状腺癌冰冻切片病理诊断准确性的关键。     

309例肺部肿物冰冻切片诊断分析

目的:分析309例肺部占位性病变的冰冻切片误诊病例之病理特点,归纳以肺癌为主的肺部病变冰冻诊断的要点、难点.方法:回顾性分析我院经手术治疗的309例肺部病变冰冻切片资料与手术后石蜡切片,对证实为误(未)诊的19例进行综合分析.结果:冰冻诊断准确率93.85%,误诊率6.15%(19/309).误诊率最高的肿瘤是硬化性血管瘤和炎性假瘤.结论:由于硬化性血管瘤和炎性假瘤组织学形态多样,在冰冻诊断中容易漏诊或过诊,需要病理医生特别关注,在全面取材、观察的基础上,加强与临床医生的沟通,可以有助于作出的正确诊断.     

776例甲状腺肿块术中冰冻切片诊断分析

目的:探讨甲状腺肿块冰冻切片诊断的临床意义及其误诊原因。方法:分析1995年12月至2003年7月术中776例甲状腺肿块冰冻切片与术后石蜡切片的诊断结果。结果:776例中,确诊758例,确诊率为97.7%;误诊15例,误诊率为1.9%;甲状腺癌131例,其中假阴性漏诊14例,漏诊率10.7%。结论:术中冰冻切片对甲状腺占位病变有定性诊断意义,但取材的局限性,病变形态的多样性,隐匿性和冰冻切片的质量是造成漏诊和延迟诊断的主要原因。     

左前胸壁肿物合并胸腔积液的多发性骨髓瘤一例并文献复习

 目的　分析以胸壁肿物合并胸腔积液为首发症状的多发性骨髓瘤（MM）患者肺部浸润的临床病理特征。方法　分析1例MM肺部浸润患者的全部临床资料,同时复习相关文献。结果　根据临床症状、体征、各项理化和影像学检查及胸壁肿物细针穿刺的病理学特征,明确诊断为MM（IgG型 ,ISS分期Ⅲ期）。结论　胸壁肿物合并大量胸腔积液为首发表现的MM非常少见,在临床上极易被误诊,全面观察病情及各项检查结果对诊断及临床治疗有重要意义。     

临床误诊乳腺癌13例原因分析及预防

目的　对临床误诊乳腺癌原因分析 ,提高对乳腺癌的诊断率 ,减少误诊。方法　采用详细询问病史 ,X线钼靶摄影等方法。共诊断Ⅱ、Ⅲ期乳腺癌 135例。结果　 135例临床诊断为乳腺癌 ,术中冰冻切片及术后病理证实非乳腺癌 13例 ,误诊率 (13/135 )9 6 %。结论　通过 13例非乳腺癌的误诊原因分析及结合多种方法检查 ,可提高乳腺癌的临床诊断水平。     

高级别宫颈上皮内瘤变行子宫切除术患者术前病理确诊方式的回顾性分析

目的:通过对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理（paraffin section examination,PSE）的一致性,对高级别宫颈上皮内瘤变行子宫切除术的术前病理确诊方式进行研究。方法:选取2010年1月至2015年12月阴道镜活检病理为宫颈上皮内瘤变Ⅱ级(CINⅡ)和Ⅲ级(CINⅢ、原位癌)在我院行宫颈锥切术患者共454例,其中依宫颈锥切术中冰冻病理即刻行子宫切除手术治疗患者238例,另外216例为待宫颈锥切术后石蜡病理回报后再次子宫切除手术治疗的患者,对比阴道镜下活检病理、宫颈锥切术中冰冻病理与术后石蜡病理的一致性,以及对比锥切术后石蜡病理与再次子宫切除术后病理的一致性。结果:阴道镜活检与术中冰冻病理诊断的符合率为89.11%（270/303）,CINⅡ为63.33％（38/60）,22例升级为CINⅢ;CINⅢ为95.47%（232/243）,11例升级（9例升级为宫颈癌Ⅰa1期,2例升级为Ⅰb1期）。阴道镜活检与术后石蜡病理诊断的符合率为77.53%(352/454)。CINⅡ为22.99%(20/87),67例升级（57例升级为CINⅢ,8例升级为宫颈癌Ⅰa1期,2例升级为Ⅰa2期）;CINⅢ为 90.46%（332/367）,35例升级（26例升级为宫颈癌Ⅰa1期,7例升级为Ⅰb1期,2例升级为Ⅱa期）。阴道镜活检对宫颈癌的漏诊率总体为9.91％(45／454)。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术中冰冻病理与术后石蜡病理诊断的符合率为88.12%(267/303)。CINⅡ为60.00%(36/60),24例升级（18例升级为CINⅢ,5例升级为宫颈癌Ⅰa1期,1例升级为Ⅰa2期）;CINⅢ为95.06%(231/243),12例升级（9例升级为宫颈癌Ⅰa1期,2例升级为Ⅰb1期,1例升级为Ⅱa期）。宫颈锥切术中冰冻病理对宫颈癌的漏诊率总体为5.94%（18/303）。宫颈锥切术中同时送冰冻病理患者303例,宫颈锥切术术中冰冻病理比阴道镜活检病理诊断的符合率高,差异有统计学意义（χ2= 27.68,P﹤0.05）。待宫颈锥切术后石蜡病理回报后再次手术治疗的216例患者中,宫颈锥切术后石蜡病理对高级别宫颈上皮内瘤变及浸润癌诊断的准确率可达99.07％（214/216）。结论:阴道镜活检是初步诊断高级别宫颈上皮内瘤变的一种方法;宫颈锥切术具有诊断与治疗的作用,术中冰冻病理（frozen section examination,FSE）能够提早发现部分微小浸润癌及浸润癌,但是存在一定的误诊和漏诊率。因此,建议对所有无生育要求的高级别宫颈上皮内瘤变患者,应先行宫颈锥切术,待术后石蜡病理回报后再行子宫切除术,以达到规范治疗。     

甲状腺乳头状微小癌临床病理分析及术中中央区淋巴结清扫的探讨

 目的
分析甲状腺乳头状微小癌（PTMC）的临床病理因素,探讨术中中央区淋巴结清扫的病理诊断方法。
方法
复习存档病理资料125例PTMC（2010年）,详细描述其组织学诊断标准,并与近3年来PTMC病理资料作比较。
结果
微小乳头状癌以女性患者居多,共107例,占85.6%（男女比例为1∶6）;≤45岁58例（46.4%）,＞45岁64例
（51.2%）,差异无统计学意义;左侧49例（39.38%）,右侧63例（50.4%）,双侧12例（9.6%）,峡部1例。
术中冰冻切片检查121例,未做4例,确诊113例（88.43%）,冰冻切片漏诊8例（6.6%）。确诊病例中92例做了同侧中央区淋巴结清扫,淋巴结出现转移28例（30.44%）,无转移64例（69.7%）。其中原发灶≥0.5 cm者中央区淋巴结转移率为34.0% （18/53）,＜0.5 cm者转移率为25.6% （10/39）,两者比例为1.71∶1,但差异无统计学意义（P=0.391）。
结论
术中冰冻切片确诊为PTMC者应行预防性中央区淋巴结清扫。     

142例乳腺肿瘤冰冻切片病理诊断分析

目的 对142例乳腺肿瘤的临床诊断及术中冰冻切片诊断(FS)与石蜡切片诊断进行对比，探讨术中冰冻在乳腺肿瘤诊断中的价值。方法 石蜡切片诊断良性肿瘤81例，恶性肿瘤61例。术中冰冻切片诊断为良性肿瘤81例。恶性肿瘤57例，未明确良恶性待常规病检4例。结果冰冻切片诊断与石蜡切片诊断总符合率为97．2％(138/142)，其中良性肿瘤符合率为100％(81/81)，恶性肿瘤符合率93.6％(57/61)。对良性肿瘤阳性预测值为95％(77/81)。对恶性肿瘤阳性预测值为100％(57/57)。结论 通过对冰冻切片诊断与石蜡切片诊断符合率及阳性预测值的分析，冰冻切片诊断是术中确定乳腺肿瘤性质和决定手术方案，减少临床误差的一种较准确，快捷和可靠的方法。     

甲状腺微小癌的早期诊断和治疗(附34例临床分析)

目的:探讨B超、FNA、术中冰冻切片在甲状腺微小癌TMC的早期诊断和治疗中的意义.方法:分析1992年～1998年经手术和病理证实的甲状腺微小癌34例的临床资料.结果:术前拟诊32例,B超诊断阳性率94.4%(32/34),FNA诊断阳性率81.1%,冰冻切片诊断阳性率90%,术后病理检查确诊微小癌34例,其中术中冰冻切片未发现3例,4例作患侧甲状腺叶加对侧甲状腺次全切除和双侧甲状腺次全切除术,28例行患侧甲状腺叶切除术:2例患侧甲状腺叶切除加改良性颈淋巴结清扫术,随访率88%(30/34),随访时间5～10年;1例对侧复发,无一例死亡.结论:B超结合FNA、术中冰冻检查能提高甲状腺微小癌的临床诊断率,有临床价值.甲状腺叶或次全切除治疗微小癌具有较好的疗效.     

硬化性肺泡细胞瘤术中冰冻误诊分析及文献回顾

目的:分析硬化性肺泡细胞瘤术中冰冻切片形态特征，总结其误诊原因和鉴别要点。方法:收集2011年1月至2017年12月硬化性肺泡细胞瘤术中冰冻误诊病例4例，光学显微镜下观察冰冻切片形态特点并与术后石蜡切片对照。结果:硬化性肺泡细胞瘤冰冻切片以乳头区、实性区为主者，形态结构与细胞特点易于误诊为腺癌，血管瘤样区域易于与血管源性肿瘤混淆。结论:硬化性肺泡细胞瘤是术中冰冻误诊率较高的肿瘤，乳头样区域和实性区域尤应与乳头状腺癌和实性腺癌鉴别，结合影像学及临床特点综合分析、多处取材并应用术中细胞印片是避免误诊的有效手段。     

The Evaluation of Intra-Operative Frozen Section Diagnosis Accuracy of Ovarian Tumors; Old Fashioned Not Out of Fashion

Background: The accuracy of intra-operative decision in confirming ovarian tumor malignancy during the operation is vital. Frozen sections are an important intra-operative tool to determine the provisional diagnosis and appropriate treatment of a tumor. Study design: All records of diagnosed ovarian tumor patients who underwent exploratory laparotomy with intra-operative frozen sections request at Bhumibol Adulyadej Hospital (BAH) between January 2016 and June 2018 were reviewed. Main outcome measures: Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of intra-operative frozen and permanent sections were evaluated. Result: A total of 150 cases were recruited in this study. The mean age was 45.4 years. The number of benign, borderline and malignant ovarian tumors in this study were 97, 9 and 44 cases, respectively. The overall accuracy was 93.3%. Percentage of accuracy, sensitivity, specificity, PPV and NPV for benign, borderline and malignancy were 98.0/94.7/94.0, 100/88.9/79.6, 94.3/95.0/100, 97.0/55.3/100 and 100/99.3/92.2, respectively. Conclusion: The frozen section results yielded accurate diagnosis for rapid intraoperative evaluation of ovarian tumors. Its high accuracy allows for an appropriate surgical plan to be made in a timely manner. Large sizes and suspected mucinous borderline ovarian tumors reduced accuracy factors of frozen sections.     

Intra-Operative Frozen Sections for Ovarian Tumors – A Tertiary Center Experience

Background: Accuracy of diagnosis with intra-operative frozen sections is extremely important in the evaluation of ovarian tumors so that appropriate surgical procedures can be selected. Study design: All patients who with intra-operative frozen sections for ovarian masses in a tertiary center over nine years from June 2008 until April 2017 were reviewed. Frozen section diagnosis and final histopathological reports were compared. Main outcome measures: Sensitivity, specificity, positive and negative predictive values of intra-operative frozen section as compared to final histopathological results for ovarian tumors. Results: A total of 92 cases were recruited for final evaluation. The frozen section diagnoses were comparable with the final histopathological reports in 83.7% of cases. The sensitivity, specificity, positive predictive value and negative predictive value for benign and malignant ovarian tumors were 95.6%, 85.1%, 86.0% and 95.2% and 69.2%, 100%, 100% and 89.2% respectively. For borderline ovarian tumors, the sensitivity and specificity were 76.2% and 88.7%, respectively; the positive predictive value was 66.7% and the negative predictive value was 92.7%. Conclusion: The accuracy of intra-operative frozen section diagnoses for ovarian tumors is high and this approach remains a reliable option in assessing ovarian masses intra-operatively.     

Intra-Operative Frozen Sections: Experience at A Tertiary Care Centre

The present study was conducted to assess error rates with diagnosis using intra-operative frozen sections, and to indicate ways to increase overall performance. Over a period of two years, 227 cases were biopsied intra-operatively. Errors were observed in 14 cases. Four of these were sampling errors, one by a pathologist and three by surgeons. In seven cases incorrect interpretations were made. Epithelial dysplasia was observed on definitive histology in two cases which was not reported intra-operatively. One case was of ectopic thyroid. In cases of oral cancer where sentinel lymph nodes were sampled, immunohistochemistry for cytokeratin was performed to facilitate identification of micrometastasis. Only single case displayed tumor deposits which was not evident morphologically. Resection margins were reported in seventy eight cases. Some 18% (14/50) benefited from revision of margins; overall sensitivity of intra-operative frozen sections for marginal status was 71.4%, with a specificity of 90.3%. Overall sensitivity was 75% and specificity was 97.5%. Careful observation, pathologist experience and knowledge of limitations help in improving the overall diagnostic outcome.     

卵巢肿瘤快速冰冻切片与石蜡切片病理诊断的对比分析

目的 探讨卵巢肿瘤快速冰冻切片与石蜡切片病理诊断的对比效果.方法 以卵巢肿瘤患者126例作为研究对象,选择新鲜样本进行快速冰冻切片与石蜡切片病理诊断,对比诊断效果.结果 冰冻切片检查的平均时间为(34.52±4.19)min,石蜡切片检查的平均时间为(4.59±1.11)h,冰冻切片检查的时间明显短于石蜡切片检查(t=34.294,P<0.05).卵巢肿瘤患者126例石蜡切片诊断为良性卵巢肿瘤76例,恶性卵巢肿瘤50例,良性与恶性卵巢肿瘤的年龄、病变位置、病程、体重指数等对比无统计学意义(P>0.05).快速冰冻切片诊断为良性卵巢肿瘤73例,恶性卵巢肿瘤53例,快速冰冻切片诊断卵巢肿瘤的敏感性与特异性分别为96.1%和100.0%.恶性卵巢肿瘤3例患者分别被误诊为浆液性囊腺瘤、未成熟畸胎瘤、交界性粘液性囊腺瘤.结论 相对于石蜡切片病理诊断,快速冰冻切片对卵巢肿瘤的诊断周期比较短,诊断敏感性与特异性比较高,但是也存在一定的误诊情况,需要提高医师的操作技能,尽量减少误诊的发生.     

555例乳腺病变冷冻切片病理诊断分析

目的:探讨乳腺病变冷冻切片诊断的准确性,进一步提高临床与病理对冷冻切片的认识,从而降低误诊率。方法:回顾分析我院2005年-2009年555例乳腺病变冷冻切片与石蜡切片对比诊断结果。结果:555例冷冻切片报告中,确诊546例,确诊率为98.38%,7例延迟诊断,2例假阴性误诊,假阴性率为0.59%。结论:术中冷冻切片诊断技术是乳腺病变的重要诊断手段之一,全面深入了解其病变特点及局限性,才能减少误诊。     

Impact of Using Intra-Operative Ultrasound Guided Breast- Conserving Surgery on Positive Margin and Re-Excision Rates in Breast Cancer Cases with Current SSO/ASTRO Guidelines

Purpose: To review the impact of using intra-operative ultrasound guided breast conserving surgery with frozen sections on nal pathological margin outcome with the current guidelines set forth by the Society of Surgical Oncology (SSO) and the American Society of Surgical Oncology (ASTRO). Materials and Methods: A retrospective review including all cases of intra-operative ultrasound guided breast conserving surgery was performed at the National Cancer Institute Thailand between 2013 and 2016. Patient demographics, tumor variables, intraoperative frozen section and nal pathological margin outcomes were collected. Factors for positive or close margins were analyzed. Results: A total of 86 patients aged between 27 and 75 years with intra- operative ultrasound guided breast conserving surgery were included. Three cases (3.5%) of positive margin were detected by intra-operative frozen section and 4 cases (4.7%) by final pathology reports. There were 18 cases (20.9%) with a close margin (     

Accuracy of Intra-operative Frozen Sections in the Diagnosis of Ovarian Masses

The accuracy of frozen section diagnosis in the intraoperative evaluation of ovarian masses is very importantwith regard to surgeon selection of appropriated operating procedures. For evaluation in our institute, therecords of 127 patients with ovarian masses submitted for intraoperative frozen sections between January 2001and December 2005 were reviewed. After exclusion of 4 completely infarcted masses and 11 cases with deferredfrozen section diagnoses, 112 were analyzed for diagnostic accuracy by comparing with the final histologicresults. We found sensitivity in the diagnosis of benign, borderline and malignant tumors to be 100%, 84%, and92 %, respectively, with specificities of 92.7%, 97.9%, and 100%, respectively. The overall accuracy with frozensections was 94 %. Among 18 patients with deferred or discordant diagnoses, mucinous tumors accounted for72 % of cases. No over-diagnosis of malignancy or misdiagnosis of metastatic lesions as primary ovarian cancerby frozen sections was observed. In conclusion, the accuracy of intraoperative frozen section for the diagnosisof ovarian masses is high. Frozen sections also help in the evaluation of metastatic tumors to the ovary. Mucinoustumors constitute an important group causing diagnostic discrepancies.     

甲状腺肿瘤手术中冰冻切片诊断的应用

目的：探讨冰冻切片在甲状腺手术中的临床应用，提高甲状腺冰冻切片诊断的准确率，减少甲状腺恶性肿瘤的漏诊。方法：回顾性分析356例甲状腺冰冻切片和石蜡切片资料。结果：冰冻切片诊断良性病变309例，恶性肿瘤36例，延迟诊断11例；45蜡切片良性病变314例，恶性肿瘤42例，其中冰冻切片假阴性诊断5例（1．4％），冰冻切片确诊率为98．5％。结论：提高切片质量，掌握正确的取材方法，提高对甲状腺良恶性肿瘤的鉴别能力，可提高甲状腺手术中冰冻切片诊断的准确率。