卵巢交界性肿瘤术中冷冻切片诊断的准确性分析

目的 评价卵巢交界性肿瘤(BTO)冷冻诊断的准确性和阳性预测值.方法 回顾性分析1995年3月至2008年5月广东省人民医院病理科诊断的BTO病例,单因素和多因素回归分析方法 用于评价患者及肿瘤特征对于不当诊断(低诊断和过诊断)的影响.结果 共有73例BTO患者入组,其中39例(53.42%)为浆液性肿瘤,32例(43.84%)为黏液性肿瘤,2例(2.74%)为宫内膜样肿瘤.冷冻诊断与石蜡诊断一致者为55/73(75.34%),冷冻诊断BTO的敏感性为87.30%,阳性预测值为85.94%.冷冻过诊断率为0,低诊断率为24.66%(18/73).在单因素分析中,肿瘤直径和肿瘤组织学类型与冷冻低诊断有关;在多因素回归分析中,肿瘤直径是预测低诊断的惟一自变量.而患者年龄、肿瘤分期、双侧卵巢肿瘤、血清CA-125和子宫内膜异位与冷冻低诊断无关.结论 术中冷冻诊断BTO的敏感性和阳性预测值较低,低诊断常常发生,外科医师应对BTO的冷冻诊断持谨慎态度.

Analysis of diagnosis accuracy by frozen sections in 73 cases of borderline tumor of ovary

Objective To assess the sensitivity and positive predictive value(PPV) of intraoperative frozen section diagnosis of the borderline tumor of ovary(BTO).Methods A retrospective analysis and comparison were done respectively between the accuracies of diagnoses made by using frozen and paraffin sections from the satne tissue blocks for BTO from March 1995 to Mav 2008 achieved in the Department of Pathology,Guangdong General Hospital Univariate and multivariate regression models were used to assess the influence of patient and tumor characteristics on the likelihood of underdiagnosis and overdiagnosis.Results Of the 73 patients analyzed,39 cases(53.42%)were histologically serous tumors. 32(43.84%)were mucinous and 2(2.74%)were endometrioid tumors.Diagnoses identical in those made by using either frozen or routine paraffin sections were 55/73(75.34%).The sensitivity and positive predictive value of frozen section diagnosis were 87.30%and 85.94%.respectively.Underdiagnosis of frozen section were 18/73(24.66%).There Was no overdiagnosis cases obtained Univariate analysis showed that tumor diameter and tumor histology were the predictors of underdiagnosis in frozen section analysis.And in multivariate analysis,only tumor diameter,rather than patient age,tumor histology and stage,bilateral side tumor,serum CA-125 and concurrent presence of endometriesis was a predictor of underdiagnosis.Conclusions Intraoperative frozen section diagnosis of BTO has a low sensitivity and PPV. Underdiagnosis is not uncommon.Surgical management based on intranperative frozen section diagnosis should be used with caution.