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。     

Pitfalls in frozen section interpretation: a retrospective study of palpable breast tumors

AIMS AND BACKGROUND: The use of frozen sections for purposes of diagnosis is recognized to involve a degree of uncertainty. A retrospective study of breast specimen frozen section diagnoses was undertaken in order to analyse the major pitfalls. METHODS: Hard copy files from our archives relating to symptomatic (palpable) breast specimens obtained between 1983 and 1996 were reviewed. RESULTS: The review revealed 23 errors among the diagnoses on 2110 frozen specimens. Twenty-two of them were false-negative and 1 (a case of multiple intraductal papillomatosis with atypical ductal hyperplasia) was false-positive for malignancy. The factors contributing to the pitfalls were: 1) misinterpretation; 2) poor quality of the frozen sections (artifacts making the diagnosis difficult); 3) sampling errors during sectioning; 4) ignorance of the macroscopic features; 5) lesions difficult to interpret; 6) ductal carcinoma in situ as the only lesion in the specimen; and 7) sections not deep enough. Several of the factors sometimes occurred simultaneously. CONCLUSIONS: Although the number of errors is relatively low, more stress should be placed on the preoperative diagnosis of breast lesions. Breast surgery frozen section should be used as rarely as possible for diagnostic purposes, despite the generally good diagnostic accuracy. However, it is reasonable to use frozen sections widely until the given preoperative diagnostic tools allow an appropriate preoperative workup, because it is the only way to keep histopathologists trained to interpret frozen sections.     

Evaluation of intraoperative frozen section diagnosis of sentinel lymph nodes in breast cancer

BACKGROUND: Intraoperative frozen sections (FS) of sentinel lymph nodes (SLNs) can be used to detect metastatic disease, allowing immediate axillary lymph node dissection (ALND). However, pathological inconsistency in the SLNs diagnosis is sometimes encountered when the results of FS and permanent sections are compared. The purpose of this study was to reveal the usefulness and limitations of FS for the diagnosis of SLNs in patients with breast cancer. METHODS: We reviewed the results for 569 patients with breast cancer at stage 0-II who underwent a sentinel node biopsy between February 1998 and December 2002. SLNs were analyzed using standard FS procedures and a single section stained with hematoxylin and eosin was examined. Patients determined to have positive SLNs based on the results of the FS diagnosis immediately underwent ALND. Permanent sections were later prepared from the remaining frozen tissues and examined using hematoxylin and eosin staining without additional immunohistochemical staining. RESULTS: Seven cases (1%) with atypical cells were found in the FS diagnosis intraoperatively, which were counted as "negative" by the following analysis. The final pathology results showed metastasis in the SLN sections in 159 patients (28%), of whom 26 were diagnosed as negative by the FS diagnosis. Accuracy, specificity and the false-negative rate were 95, 100 and 16%, respectively. The mean size of the nodal metastases in the false-negative cases was significantly smaller than that in the true-positive cases (n = 72) (P < 0.01). False-negative rates for T1b, T1c and T2 were 33, 19 and 14%, respectively. The rate of micrometastasis in T1 (43%) was significantly higher than that of T2 (13%) (P < 0.01). CONCLUSIONS: FS diagnosis for SLNs is reliable. Patients with negative SLNs by the FS diagnosis can avoid reoperation for ALND. However, FS may fail to detect micrometastases, especially in cases with small tumors.     

Practical issues of intraoperative frozen section diagnosis of bone and soft tissue lesions.

BACKGROUND: Intraoperative pathologic diagnosis of bone and soft tissue lesions is an important yet challenging tool in clinical musculoskeletal oncology practice. There is limited information in the literature addressing the practical issues commonly encountered regarding intraoperative frozen section of musculoskeletal lesions. METHODS: A literature review and retrospective review of practical experience in intraoperative pathology consultation at our institute's sarcoma program were conducted to investigate the pitfalls and limitations of frozen section and potential solutions to overcome these problems. RESULTS: Frozen section evaluation is an essential and reliable procedure for guiding intraoperative decisions. Intraoperative cytology as an adjunct to frozen section enhances the accuracy of diagnosis of bone and soft tissue lesions. Cytology can accurately diagnose certain entities alone and is superior to frozen section for certain tumor types and for evaluating bone marrow margins. It is also invaluable in triaging cases for ancillary studies and for tumor banking. Practical working protocols can be developed to optimize the usefulness of intraoperative pathologic consultation. CONCLUSIONS: Intraoperative pathology consultation should be done in an interdisciplinary approach by correlating clinical, radiologic, and pathologic information. As an adjunct to frozen section, cytology and gross examination enhance the accuracy of diagnosis of musculoskeletal lesions.     

Accuracy of preoperative endometrial biopsy and intraoperative frozen section in predicting the final pathological diagnosis of endometrial cancer

BackgroundHistotype and grade of endometrial cancer (EC) are prognostic factors of nodal involvement and thus of survival. Preoperative biopsy (PB) and intraoperative frozen section (FS) are usually used to guide surgical staging on which the choice of adjuvant therapy will be based successively.ObjectiveThe aim of this study was to assess the agreement rate between PB and FS with final diagnosis (FD) in a series of surgically resected EC.MaterialsAll patients submitted to hysterectomy for EC or atypical endometrial hyperplasia in the Reggio Emilia Province hospitals from 2007 to 2018 were included. Concordance rate differences in histotype, grading, myoinvasion, risk of recurrence between PB, FS and FD were assessed with Fisher's exact test and Mc Nemar contingency test.ResultsA total of 352 patients were identified. For 345 patients it was possible to compare PB and FD results. FS examination was performed in 201/352 (57%) cases, while for 21/352 (6%) patients only an intraoperative macroscopic evaluation was done; in the remaining women, FS-exam was omitted. In 14/201 (7%) cases the tumor wasn't grossly identifiable and the random FS-sampling wasn't able to find the tumor site.High diagnostic concordance of tumor type between PB and FD was observed: no significant differences were registered in type 1 and type 2-endometrial cancer identification (83%, 73%, p = 0.121). Significant differences (p = 0.005) were observed comparing FS and FD results: 95% of type 1-ECs were correctly diagnosed by FS, while only 76% of type 2-ECs received a correct diagnosis on FS. PB showed a concordance with FD among tumor grading close to 55% whilst concordance achieved 71% grouping low grade (G1-G2) EC. No significant differences in FS and FD concordance rate were observed between tumor grades. Concordance for low grade was significantly higher than for high grade ECs (89% vs 50%, respectively, p value = 0.014).The concordance rate in evaluating the myoinvasion status between FS and FD was 80% (n: 199 patients), reaching 99% after combining the first 2 groups (0–49% vs ≥ 50%). Twenty-two cases underwent only intraoperative macroscopic evaluation of the myoinvasion, with an accuracy of 91%: only in 1 case the invasion of the cervical stroma was not detected (Stage II), and 1 case the patient was overstaged as Ib.Discrepancies were observed in FS capacity to correctly predict the final ESMO risk group in stage I patients: FS resulted particularly reliable in predicting a low-risk (concordance with FD: 91%) while the accuracy sharply decreased for intermediate- and high-risk patients (62% and 40%, respectively).To investigate the usefulness of FS in EC management, we compared patients who underwent FS (FS-group) or not (no–FS–group). Especially for low risk patients, the FS significantly increased the adequacy of surgical treatment from 53% (no–FS–group) to 72% (FS-group) (p = 0.016).ConclusionsFS remains a useful tool to tailor surgery in EC-patients, avoiding secondary surgery to complete staging particularly in patients with AH + AHBA, low and intermediate risk ECs that could benefit from adjuvant therapy.     

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。     

Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia

Objective: The purpose of this study was to correlate the histological diagnosis made during intraoperativefrozen section (FS) examination of hysterectomy samples with complex atypical endometrial hyperplasia (CAEH)diagnosed with definitive paraffin block histology. Methods: FS pathology results of 125 patients with a preoperativebiopsy showing CAEH were compared retrospectively with paraffin block pathology findings. Results:Paraffin block results were consistent with FS in 78 of 125 patients (62.4%). The FS sensitivity and specificityof detecting cancer were 81.1% and 97.9%, with negative and positive predictive values of 76.7%, and 98.4%,respectively. Paraffin block results were reported as endometrial cancer in 77 of 125 (61.6%) patients. Finalpathology was endometrial cancer in 45.3% patients diagnosed at our center and 76.9% for patients who hadtheir diagnosis at other clinics (p=0.018). Paraffin block results were consistent with FS in 62.4% of all casesConsistence was 98.4% in patients who had endometrial cancer in FS. Conclusion: FS does not exclude thepossibility of endometrial cancer in patients with the preoperative diagnosis of CAEH. In addition, sufficientendometrial sampling is important for an accurate diagnosis     

印片细胞学联合冷冻切片术中诊断乳腺癌前哨淋巴结的研究

目的对乳腺癌前哨淋巴结活组织检查（SLNB）术中诊断常用的方法印片细胞学（TIC）及冷冻切片（FS）术中联合应用的价值进行评估。方法150例患者的400枚前哨淋巴结（SLN），将其中352枚SLN沿长轴对分，两切面分别印片，行术中TIC及FS诊断，其余48枚较小的SLN仅行FS诊断，结果与术后病理进行比较。结果55例患者的89枚SLN为阳性。TIC及FS特异度均为100％。按SLN数目统计，TIC和FS术中诊断的敏感度分别为71．9％（64／89）和83．1％（74／89）（P〉0．05）；两者联合诊断的敏感度为96．6％（86／89），显著高于FS和TIC单独诊断的敏感度（均P〈0．001）。按患者数目统计，TIC及FS术中诊断的敏感度分别为80．0％（44／55）及81．8％（45／55）（P〉0．05），两者联合诊断的敏感度为94．5％（52／55），显著高于FS和TIC单独诊断的敏感度（均P〈0．001）。结论联合应用FS及TIC进行SLN术中诊断具有较高的敏感度和特异度，能够满足临床需求，可以有效地避免二次手术。     

The value of intraoperative frozen section examination of sentinel lymph nodes in breast cancer

Background

Sentinel node biopsy is a standard diagnostic component for the treatment of patients with a primary mammary carcinoma. By concomitantly performing intraoperative lymph node biopsy and primary tumor resection, patients with a positive sentinel node (SN) are not subjected to the inconvenience and risks of second surgical intervention. The aim of this retrospective study was to determine the sensitivity, accuracy and long-term consequences of the frozen section (FS) examination of the SN in breast cancer patients.

Methods

Sentinel lymph node biopsy was performed in 615 patients with an invasive tumor of the breast. Frozen sections of the SN were taken from the optimal cross-sectional surface. Serial sections were made from the remaining SN and stained using hematoxylin–eosin and immunohistochemistry.

Results

Sentinel node frozen biopsy accurately predicted the state of the axilla in 559 (90.7%) patients. There were 50 false-negative findings in patients with sentinel node metastases. The sensitivity and specificity of the intraoperative frozen section examination were 71.6% and 100%, respectively. Follow-up (mean 36.3 months) of all false-negative cases showed no development of local axillary recurrence. The results demonstrated no significant relation between tumor size and frozen section sensitivity. Frozen section investigation was less sensitive in ascertaining micrometastases (sensitivity 61.1%) than macrometastases (sensitivity 84.0%, p < 0.001).

Conclusion

Intraoperative frozen section examination of the sentinel node is a useful predictor of axillary lymph node status in breast cancer patients. Seventy-two percent of the patients with metastatic disease were correctly diagnosed and spared a second surgical procedure.     

False-positive and false-negative cases of fine-needle aspiration cytology for palpable breast lesions

Background  Fine-needle aspiration cytology (FNA) is less traumatic and technically easy to apply to small breast tumors. Methods  A total of 382 cases of palpable breast lesions that had undergone fine needle aspiration and histopathologic diagnosis were reviewed with an emphasis on the rate of false positive diagnoses in benign breast lesions. Results  A diagnosis of“malignant”was made in 98 of the 382 specimens (25.6%). The predictive value for malignancy was 97.9%. The sensitivity, specificity, and accuracy of FNA were 86.3%, 98.2%, and 93.2%, respectively, when the“suspicious”group was considered positive for malignancy. The histologic subtypes of the 4 false-positive cases were epithelial proliferative lesions, ductal or lobular hyperplasia. None of these 4 cases were definitely diagnosed as“malignant”by radiological studies. Four false-negative cases by FNA were suspicious for malignancy radiologically. There was no specific pathological subtype associated with false-negative status on FNA in this study. Conclusion  Palpable breast tumors can be definitively diagnosed based on a combination of physical examination, radiological studies and FNA, when the radiological studies concur with the diagnosis by FNA.     

快速免疫组织化学技术在甲状腺肿瘤术中冷冻诊断中的应用

 目的　探讨快速免疫组化（IHC）新方法及其在甲状腺肿瘤术中冷冻诊断中的应用价值。方法　采用MaxVision快速免疫组化一步法检测CK19、HBME-1、Gla-3在甲状腺乳头状癌（PTC）及甲状腺良性病变组织冷冻切片中的表达,以冰剩组织MaxVision常规IHC作对照。结果　MaxVision快速IHC一步法在20 min内完成,三种标记阳性定位与常规IHC基本对应一致,表达部位CK19位于细胞质和细胞膜,Gla-3、HBME-1以滤泡腔缘或（和）乳头表面为主,表达强度强于常规IHC。冷冻切片快速IHC CK19、HBME-1、Gla-3阳性表达率：良性病变（结节性甲状腺肿、慢性淋巴细胞性甲状腺炎、腺瘤）为0、10.7 %（3／28）、0,PTC为94.9 %（37／39）、92.3 %（36／39）、92.3 %（36／39）,三种标记在甲状腺良性病变与PTC间表达差异均有统计学意义（χ2值分别为59.326、55.861、44.605,均P＜0.05）;同一病例两种以上标记阳性在良性病变为0,PTC为100 %,差异有统计学意义（χ2＝67.000,P＜0.05）。结论　MaxVision快速IHC一步法可以应用于术中冷冻诊断,联合检测CK19、HBME-1、Gla-3对PTC术中冷冻诊断具有较高辅助诊断价值。     

False-positive and false-negative cases of fine-needle aspiration cytology for palpable breast lesions.

BACKGROUND: Fine-needle aspiration cytology (FNA) is less traumatic and technically easy to apply to small breast tumors. METHODS: A total of 382 cases of palpable breast lesions that had undergone fine needle aspiration and histopathologic diagnosis were reviewed with an emphasis on the rate of false positive diagnoses in benign breast lesions. RESULTS: A diagnosis of " malignant " was made in 98 of the 382 specimens (25.6%). The predictive value for malignancy was 97.9%. The sensitivity, specificity, and accuracy of FNA were 86.3%, 98.2%, and 93.2%, respectively, when the " suspicious " group was considered positive for malignancy. The histologic subtypes of the 4 false-positive cases were epithelial proliferative lesions, ductal or lobular hyperplasia. None of these 4 cases were definitely diagnosed as " malignant " by radiological studies. Four false-negative cases by FNA were suspicious for malignancy radiologically. There was no specific pathological subtype associated with false-negative status on FNA in this study. CONCLUSION: Palpable breast tumors can be definitively diagnosed based on a combination of physical examination, radiological studies and FNA, when the radiological studies concur with the diagnosis by FNA.     

空芯针活检快速冰冻病理检查在乳腺癌诊断中的应用

随着乳腺癌发病率的上升，如何对怀疑为恶性肿瘤的患者进行快速确诊，及时制定治疗方案，无论对患者还是对医师均是十分重要的。本院自2006年4月起对怀疑为乳腺癌的住院患者术前均行空芯针组织活检（Tru-Cut needle biopsy，TCNB）快速冰冻诊断，并根据诊断结果及时选择最佳的治疗方案，取得了满意的治疗效果，现报告如下。     

超声引导下空芯针穿刺快速冰冻病理检查在乳腺肿块诊断中的应用价值

目的探讨超声引导下空芯针穿刺快速冰冻病理检查在乳腺肿块诊断中的应用价值。 方法选取2017年9月至2018年2月在解放军福州总医院普通外科确诊为乳腺肿块需行空芯针穿刺活组织检查(CNB)的51例患者进行前瞻性研究。以术后病理组织学诊断结果为金标准,采用Kappa一致性检验评价CNB快速冰冻病理诊断的准确性。 结果CNB快速冰冻病理检查到癌细胞者35例,术后病理诊断均为恶性;未见癌细胞者16例,术后病理诊断：4例为恶性,12例为良性。CNB快速冰冻病理诊断的假阴性率为10.3%(4/39),准确率为92.2%(47/51),敏感度为89.7%(35/39),特异度为12/12,假阳性率为0(0/12),阳性预测值为100%(35/35),阴性预测值为12/16,阴性似然比为0.103,Youden指数为0.897。CNB快速冰冻病理诊断与术后病理诊断差别无统计学意义(χ²＝2.250,P＝0.125)。进一步行Kappa一致性检验,结果显示CNB快速冰冻病理诊断与术后病理诊断之间具有很好的一致性(Kappa＝0.805,P<0.001)。年龄分组、肿块位置、X线检查及肿块直径对CNB快速冰冻病理诊断准确率没有影响(P均>0.050;χ²＝3.074,P＝0.266);弹性成像≥4分者,其CNB快速冰冻病理诊断准确率明显高于<4分者[100%(37/37)比10/14,P＝0.004];彩色超声BI-RADS分级对CNB快速冰冻病理诊断准确率有影响(χ²＝15.432,P<0.001),其中,BI-RADS分级≥4级者CNB快速冰冻病理诊断准确率明显高于无法分级者[100%(36/36)比1/4,P<0.017]。弹性成像评分≥4分者CNB快速冰冻病理诊断准确率是<4分者的10.57倍;彩色超声可明确BI-RADS分级者,其CNB快速冰冻病理诊断准确率是无法分级患者的35.25倍。 结论CNB快速冰冻病理检查可以作为诊断乳腺肿块性质的方法,具有微创、快速的优点,但存在一定的假阴性错误,且阴性预测值也不高,如结果为阴性,需进一步行肿块活组织检查确诊其性质。弹性成像评分及彩色超声BI-RADS分级结果是CNB快速冰冻病理诊断准确率的影响因素。     

肿瘤多预后因素术中冷冻切片联合检测的临床意义

目的探讨在手术中进行肿瘤多预后因素联合检测的方法。方法选择临床高度可疑恶性肿瘤患者,检测指标组合如肿瘤性质、类型、分化、侵犯范围及手术切缘等,在术中选取相应的组织块拼接制作一张冷冻切片进行多指标联合检测,根据检测结果采取相应的临床对策后进行常规石蜡切片检测,前后结果进行对照。结果检测114例,术中病理确诊为恶性肿瘤95例,肿瘤周围浸润瘤细胞残留24例,手术断端残留7例。与常规石蜡切片各项目检测结果相比较,肿瘤性质、分类、分化检测结果基本一致,手术断端瘤细胞残留冷冻切片检测阳性例数(7/95)较石蜡切片(2/95)稍高,但差异无统计学意义,P=0·088,而周围浸润瘤细胞残留冷冻切片检测阳性率25·26%(24/95)显著高于临床扩大清除后常规石蜡切片检测结果3·2%(3/95),P=0·000。结论冷冻切片多项目联合检测可以在术中较全面地反映肿瘤状态和手术清除的程度,提高手术治疗的准确性和针对性,具有重要的临床应用价值。     

肿瘤多预后因素术中冷冻切片联合检测的临床意义

目的：探讨在手术中进行肿瘤多预后因素联合检测的方法。方法：选择临床高度可疑恶性肿瘤患者，检测指标组合如肿瘤性质、类型、分化、侵犯范围及手术切缘等，在术中选取相应的组织块拼接制作一张冷冻切片进行多指标联合检测，根据检测结果采取相应的临床对策后进行常规石蜡切片检测，前后结果进行对照。结果：检测114例，术中病理确诊为恶性肿瘤95例，肿瘤周围浸润瘤细胞残留24例，手术断端残留7例。与常规石蜡切片各项目检测结果相比较，肿瘤性质、分类、分化检测结果基本一致，手术断端瘤细胞残留冷冻切片检测阳性例数（7／95）较石蜡切片（2／95）稍高，但差异无统计学意义，P=0．088，而周围浸润瘤细胞残留冷冻切片检测阳性率25．26%（24／95）显著高于临床扩大清除后常规石蜡切片检测结果3．2％（3／95），P=0．000。结论：冷冻切片多项目联合检测可以在术中较全面地反映肿瘤状态和手术清除的程度，提高手术治疗的准确性和针对性，具有重要的临床应用价值。     

The accuracy of frozen section analysis in ultrasound- guided core needle biopsy of breast lesions

Background  

Limited data are available to evaluate the accuracy of frozen section analysis and ultrasound- guided core needle biopsy of the breast.     

Ultrasonographic evaluation of palpable breast masses: analysis of 134 cases

Sonography has become a helpful adjunct to mammography mainly for a differential diagnosis between simple cysts and solid masses. The authors examined by ultrasound 134 palpable masses in the breast which had been previously evaluated by clinical examination and mammography and then submitted to biopsy or fine needle aspiration. The exact diagnosis of a simple cyst was made in 94.1% of the cases, whereas the diagnosis of fibroadenoma was made in 80% of the cases. Ultrasound examination proved to be useful in patients with dense breasts: in this group, 82.1% of the patients with a histologic diagnosis of benign status had a correct ultrasound diagnosis. In agreement with other authors, we believe that breast sonography has no part in screening programs.     

Clinicopathological characteristics of non palpable breast cancer presenting as an axillary Mass

We present the clinical and pathological findings of non-palpable breast cancer presenting an axillary mass in 8 patients at the National Cencer Center Hospital and in 89 cases previously reported in Japan. Mammography and ultrasonography were positive in 26.4% and 26.8% of cases, respectively. 82(94.3%) of 87 patients underwent mastectomy as a local control. In 19(30.6%) of 62 patients, the pathological size of the lesion was less than 5 mm. In 15 patients primary tumors could not be identified pathologically. The number of nodes involved ranged from 1-55 with a median of 5. There was no significant correlation between the number of involved nodes and the size of the axillary mass, nor between the number of involved nodes and the pathological size of the primary breast lesion. The 5-year survival rate was 59.4%. There was no statistically significant difference in 5-year survival rates between occult breast cancer and palpable breast cancer in each nodal category. Only the number of involved nodes was a reliable prognostic factor. Unlike palpable breast cancer, the pathological size of the primary tumor was not a predictor of prognosis. In this respect, the biological behavior of occult breast cancer is quite different from that of palpable breast cancer.