2021 年第 10 期 第 16 卷

甲状腺微小乳头状癌术中快速冷冻诊断质量控制分析及临床病理意义

Analysis of quality control and clinicopathological significance of intraoperative frozen section diagnosis for papillary thyroid microcarcinoma

作者：张哲陈东付稳方微商建峰 于玮石凤茹

英文作者：Zhang Zhe Chen Dong Fu Wen Fang Wei Shang Jianfeng Yu Wei Shi Fengru

单位：首都医科大学附属北京安贞医院病理科北京市病理质量控制和改进中心100029

英文单位：Department of Pathology Beijing Anzhen Hospital Capital Medical University Beijing Pathology Quality Control and Improvement Center Beijing 100029 China

关键词：甲状腺微小乳头状癌；术中快速冷冻诊断；质量控制

英文关键词：Papillarythyroidmicrocarcinoma;Intraoperativefrozensectiondiagnosis;Qualitycontrol

• 摘要：

• 目的  探讨甲状腺微小乳头状癌（PTMC）术中快速冷冻诊断与石蜡诊断符合率及影响诊断符合率的因素，探究PTMC术中快速冷冻诊断的临床应用价值及规范质量控制方法。方法 收集2007年1月至2019年12月首都医科大学附属北京安贞医院冷冻与石蜡对照诊断的228例PTMC患者的临床资料进行回顾性分析。分析术中冷冻诊断符合率、漏诊率、误诊率等以及影响冷冻符合率的因素，并观察其临床病理特点。结果 228例患者术中诊断符合203例，诊断符合率89.0%；漏诊25例，漏诊率为11.0%。25例冷冻漏诊患者中，2例为取材漏诊；2例因肿瘤偏小；17例为诊断漏诊；2例组织有钙化，脱钙组织出现病变；2例冷冻切片制作出现问题。228例患者男女之比为1∶3.75，女性明显多于男性。PTMC合并甲状腺疾病者156例，占68.4%，且均发生于女性。结论 病理诊断医师需掌握PTMC的临床病理特点，强化冷冻取材、掌握诊断标准，病理技师提高切片制作技术，是提高术中快速冷冻诊断与石蜡诊断符合率的关键。

• Objective To analyze the coincidence rate of intraoperative frozen section diagnosis and paraffin section in papillary thyroid microcarcinoma(PTMC) and the factors affecting the coincidence rate, so as to explore the clinical application value of intraoperative frozen section in PTMC and to standardize the quality control method. Methods The clinical data of 228 patients with PTMC diagnosed by freezing and paraffin in Beijing Anzhen Hospital, Capital Medical University from January 2007 to December 2019 were collected and analyzed retrospectively. The intraoperative frozen section diagnosis coincidence rate, missed diagnosis rate, misdiagnosis rate and the factors affecting the intraoperative frozen section diagnosis compliance rate were analyzed. The clinicopathological features of PTMC were analyzed. Results Among 228 cases, the intraoperative diagnosis was consistent in 203 cases, and the coincidence rate was 89.0%; missed diagnosis in 25 cases, the missed diagnosis rate was 11.0%. Among 25 cases of frozen section missed diagnosis, the tumor was not taken in 2 cases, tumor were small in 2 cases, 17 cases was missed diagnosis, 2 cases had calcification with decalcified tissue lesions, and 2 cases of frozen section were not well prepared. The ratio of male to female in 228 patients was 1∶3.75, and the female was significantly more than the male. There were 156 cases of PTMC with thyroid diseases, accounting for 68.4%, and all of them were female. Conclusions  The key to improve the coincidence rate of intraoperative frozen section diagnosis and paraffin section is that pathologists need to master clinicopathological characteristics of PTMC, strengthen taking the frozen specimen and master the diagnostic criteria, and the pathology technicians improve the level of preparation of frozen sections.