术中快速病理检查在肾脏占位性病变手术中的应用价值

目的 探讨术中快速冷冻切片病理检查对肾脏占位性病变性质的诊断价值以及在术中确定相应手术方式中的作用. 方法 2006年1月至2010年12月行术中快速冷冻切片病理检查的肾脏占位性病变患者195例.男114例,女81例.年龄17 ～78岁,平均52岁.病变位于右肾104例,左肾89例,双肾2例.体检发现129例,有临床症状66例.占位病变长径≤4.0 cm者128例,4.1 ～7.0 cm者49例,＞7.0 cm者18例.比较术中快速病理和术后常规石蜡切片病理的诊断结果.肾肿瘤患者行肾切除术或肾部分切除术,比较两组患者术中快速病理诊断结果. 结果 术中快速病理诊断结果为透明细胞癌115例,乳头状细胞癌2例,嫌色细胞癌2例,肾腺癌12例,恶性肾肿瘤1例,未分化癌1例,良性肾肿瘤47例,肾囊肿8例,尿路上皮癌7例.术后石蜡切片病理诊断结果为透明细胞癌122例,乳头状细胞癌8例,嫌色细胞癌6例,肉瘤样癌2例,肾母细胞瘤1例,良性肾肿瘤41例,肾囊肿8例,尿路上皮癌7例.术中快速病理检查诊断肾脏恶性病变的敏感性为96.6％,特异性100.0％,良恶性诊断准确率为97.4％.病理亚型诊断符合率分别为透明细胞癌94.3％,乳头状细胞癌25.0％,嫌色细胞癌16.7％,肉瘤样癌和肾母细胞瘤0,良性肿瘤97.6％,尿路上皮癌100.0％.180例肾肿瘤患者中57例行肾部分切除术,123例行肾切除术.两组肿瘤最长径≤4.0 cm患者分别占80.7％ (46/57)和62.6％(77/123),差异有统计学意义(P=0.015);两组快速病理诊断为恶性病变患者分别占31.6％(18/57)和93.5％(115/123),差异有统计学意义(P＜0.001). 结论 术中快速冷冻切片病理检查诊断肾脏恶性病变的敏感性、特异性和准确率高;病理亚型中,肾脏透明细胞癌和尿路上皮癌的诊断符合率高.手术方式的选择与肾脏肿瘤大小和术中快速冷冻切片病理结果有关.

Value of intraoperative frozen section examination in the diagnosis and surgical procedures selection of renal occupying lesions

Objective To evaluate the value of intraoperative frozen section examination (IFS) in the diagnosis and surgical procedures selection for renal occupying lesions. Methods From January 2006 to December 2010,IFS was used in 114 men and 81 women with renal occupying lesions.The mean age was 52 years (range 17 -78).In 104,89,and 2 patients,lesions were in the right,left and bilateral kidneys,respectively.All patients underwent physical examination,129 were asymptomatic at presentation while clinical symptoms were observed in 66.The largest dimension of the tumors were 4 cm or less in 128 patients,4- 7 cm in 49,and larger than 7 cm in 18,respectively.The outcomes between IFS and postoperative routine paraffin section examination were compared.In cases with renal tumors nephrectomy or partial nephrectomy was performed.The results of IFS were compared between the 2 groups. Results The sensitivity and specificity of IFS for renal malignant lesions was 96.6％ and 100％,respectively.The total accuracy rate of IFS for renal occupying lesions was 97.4％.By subgroup analysis,the accuracy rate of clear cell carcinoma,papillary cell carcinoma,chromophobe cell carcinoma,sarcomatoid cancer,nephroblastoma,benign tumor and urothelial cancer was 94.3％,25.0％,16.7％,0,0,97.6％ and 100.0％,respectively.Partial nephrectomy and nephrectomy were performed in 57 and 123 patients with renal tumors,respectively.The surgical procedures selection was significantly associated with the lesion size (4 cm or less for 80.7％ vs 62.6％,P =0.015) and the malignant lesion diagnosed by IFS (31.6％ vs 93.5％,P＜0.001). Conclusion The accuracy of frozen section analysis for renal malignant lesions during surgery is reliable and significantly high,and the results can exert an important impact on surgical procedures selection.