术中冰冻病理对肺结节胸腔镜手术切除范围的指导意义

目的探讨肺结节术中冰冻病理与术后病理判断浸润范围上的一致性,明确术中冰冻病理是否可以协助术者确定肺结节手术切除的范围。方法2017年1月~2018年6月电视辅助胸腔镜手术切除肺结节156例,分析术中冰冻病理与术后病理的诊断符合率。结果术中冰冻病理诊断非典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)、原位腺癌(adenocarcinoma in situ,AIS)及微浸润腺癌(minimally invasive adenocarcinoma,MIA)103例,浸润性腺癌(invasive adenocarcinoma,IA)53例;术后病理证实AAH、AIS及MIA 106例,IA 50例。根据病灶侵袭性、复发及转移的风险程度将AAH、AIS、MIA定义为低风险病灶,IA定义位为高风险病灶。术中冰冻病理诊断高风险病灶敏感性98.0%(49/50),特异性96.2%(102/106),准确率96.8%(151/156)。术中冰冻病理诊断低风险病灶预测值99.0%(102/103),高风险病灶预测值92.5%(49/53)。结论术中冰冻病理在判断IA方面具有较高的诊断符合率,在准确区别AAH与AIS和AIS与MIA存在不确定性。在肺结节手术切除范围的制定上,术中冰冻病理可以作为重要的指导依据。

The Significance of Intraoperative Frozen Pathology for Video-assisted Thorocoscopic Resection Range for Lung Nodules

Objective To explore the consistency of frozen pathology in pulmonary nodule operation and the extent of infiltration judged by pathology after operation,and to determine whether intraoperative frozen pathology can help surgeons to determine the extent of pulmonary nodule resection.Methods We chose 156 patients with lung nodules from January 2017 to June 2018 in our hospital,all of which were given video-assisted thoracoscopic surgery.And the coincidence rate between intraoperative frozen pathology and postoperative pathological diagnosis was analyzed.Results Intraoperative frozen pathological diagnosis showed 103 cases of atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS)and minimally invasive adenocarcinoma(MIA),and 53 cases of invasive adenocarcinoma(IA).And finally 106 cases of AAH,AIS and MIA,50 cases of IA were confirmed by postoperative pathology.According to the risk of lesion invasion,recurrence and metastasis,we defined the AAH,AIS and MIA as the low risk lesions,and IA as the high risk lesions.The sensitivity,specificity and accuracy of intraoperative frozen pathological diagnosis were 98.0%(49/50),96.2%(102/106),and 96.8%(151/156),respectively.The predictive value of intraoperative frozen pathology was 99.0%(102/103)for low-risk lesions and 92.5%(49/53)for high risk lesions.Conclusions Intraoperative frozen pathology has a high diagnostic coincidence rate in the judgment of IA,while it is uncertain to distinguish the AHH with AIS,and AIS with MIA.For determination of lung nodule resection range,intraoperative frozen pathology can be used as an important basis and guidance.