590例乳腺肿块术中冷冻切片诊断分析

目的探讨乳腺肿块冷冻切片的准确性及提高准确率的方法，进一步密切临床与病理的联系，以提高对冷冻切片的认识，降低误诊率。方法回顾对比分析近8．5年来术中590例乳腺肿块冷冻切片与术后石蜡切片的诊断结果。结果590例冷冻切片报告中，确诊586例，确诊率为99.32％；误诊4例，均为假阴性，误诊率为0．68％，其中2例是制片质量问题导致浸润性导管癌误诊为良性病变，另2例是因取材局限导致叶状囊肉瘤误诊为纤维腺瘤。结论冷冻取材的局限，病变形态的多样以及冷冻切片的质量是造成误诊和延期诊断的主要原因。只要熟悉乳腺病变诊断和鉴别诊断要点，加强外科与病理医师间的联系，乳腺肿块冷冻切片是一种准确性比较高，可靠性比较强的检查手段。

Diagnostic value of intraoperative frozen section in breast neoplasms: analysis of 590 cases

Objective To evaluate the diagnostic accuracy of intraoperative frozen section in breast neoplasms and to improve the diagnostic accuracy rate,to promote closer communication betwen clinicians and ~pathologists ,mutually increase an understanding of frozen sections, and thus decrease the rate of misdiagnosis. Methods The diagnostic reports of intraoperative frozen sections and paraffin sections of 590 cases with breast neoplasms taken in the recent 8 and a half years were analyzed retrospectively. Results 586 cases (~99.32 %) of intraoperative frozen sections were diagnosed correctly and 4(0.68%) were misdiagnosed. In the 4 misdiagnosed cases,2 cases of infiltrating ductal carcinoma were misdiagnosed as benign lesions,due to questionable quality of the slides,and 2 cases of lobular cystic sarcoma were misdiagnosed as fibroadeuoma,due to removal of insufficient specimen.Conclusions The chief causes of misdiagnosis and delayed diagnosis of frozen sections are specimen limitations,varied morphology of the lesions,and quality of the frozen sections.When there is familiarity with the main aspects of diagnosis and differential diagnosis of breast pathology and enhancement of communication between the surgeon and pathologist,then frozen section of breast masses is an accurate and reliable method of investigation.