甲状腺微小乳头状癌术中快速病理形态学特点及临床分析  

Pathological and Clinical Characteristics of Papillary Thyroid Microcarcinoma in Intraoperative Quick Diagnosis

作　　者：郭芳[1] 谭雨萌 冯曦[1] 方娜[1] 杨小玲[1] 

机构地区：[1]湖北省肿瘤医院病理科,武汉430079 [2]湖北中医药大学基础医学院,武汉430079

出　　处：《肿瘤防治研究》2016年第1期67-71,共5页Cancer Research on Prevention and Treatment

摘　　要：目的总结甲状腺微小乳头状癌术中快速大体标本及显微镜下的形态学特点,提高确诊率。方法收集129例甲状腺术中快速及常规病理诊断为甲状腺微小乳头状癌的患者资料,包括术中肉眼观察标本大体描述、冰冻切片及术后常规病理诊断等,进行统计学分析。结果 (1)甲状腺微小乳头状癌病理诊断技术成熟术中快速诊断和常规石蜡切片诊断的符合率为97.67%;(2)大体标本观察肿瘤在左、右侧或双侧的发生率差异无统计学意义(34.9%vs.38.0%vs.27.1%,P=0.1630);单个肿瘤直径≤0.5 cm组,明显多于直径>0.5 cm组(63.6%vs.36.4%,P=0.0000)差异有统计学意义;肿瘤发生1灶组、2灶组和2灶以上组比较,差异有统计学意义(84.5%vs.8.5%vs.7.0%,P=0.0000);肿瘤质硬组明显多于质软组,差异有统计学意义(85.3%vs.14.7%,P=0.0000);切面白色组明显多于淡红组,差异有统计学意义(94.6%vs.5.4%,P=0.0000);伴随星形外观组明显多于不伴随星形外观组,差异有统计学意义(60.5%vs.39.5%,P=0.0008);基础病变为:结节性甲状腺肿组、桥本氏甲状腺炎组、其他病变组和腺瘤囊性变组的发生率呈依次递减的趋势,差异有统计学意义(48.1%vs.22.5%vs.15.4%vs.14.0%,P=0.0000);(3)显微镜下术中快速切片中显著的纤维间质反应、硬化的背景上出现张力大扩张的腺体为诊断的重要线索,细胞核内假包涵体、砂粒体及钙化的存在可以辅助诊断。结论术中快速切片为甲状腺微小乳头状癌诊断的重要技术手段,正确辨认肿瘤组织的大体及显微镜下特点,有利于提高诊断的准确性。Objective To generalize the characteristics of papillary thyroid microcarcinoma（PTMC） in gross view and microscopic observation,to improve the accuracy of diagnosis.Methods We collected and analyzed statistically the data of 129 patients diagnosed as PTMC by conventional and quick pathological diagnosis,including descriptions in gross view,frozen section and routinely paraffin-embedded section.Results（1） The diagnostic technology of PTMC was mature;the coincidence rate of diagnosis based on frozen section and routinely paraffi n-embedded section was 97.67%;（2） PTMC could happen only on the left,right or both sides,but there was no statistically signifi cant difference（34.9% vs.38.0% vs.27.1%,P=0.1630）.And the number of patients with single tumor diameter ≤0.5cm was obviously more than that 0.5cm（63.6% vs.36.4%,P=0.0000）.There were statistically signifi cant difference among groups with 1,2 and 2 lesions（84.5% vs.8.5% vs.7.0%,P=0.0000）,hard and soft tumor（85.3% vs.14.7%,P=0.0000）,white and light red section of tumors（94.6% vs.5.4%,P=0.0000）,with and without star-like-scar appearance（60.5% vs.39.5%,P=0.0008）.There was a general decrease in the incidence of basic lesions：nodular goiter,hashimoto thyroiditis,other lesions and adenoma with cystic degeneration（48.1% vs.22.5% vs.15.4% vs.14.0%,P=0.0000）.（3） In the frozen section＇s microscopic observation,the key clues of diagnosis were the higher tensive and expansive glands invaded in the fibrous and sclerotic background.Intranuclear inclusions and psammoma bodies or calcifi cation were helpful for diagnosis.Conclusion Quick pathological diagnostic technology in operation is the most important method to diagnose PTMC.Correctly identifying the typical characteristics in gross and microscopic view is effective to improve the diagnostic accuracy.

关 键 词：甲状腺 微小 乳头状癌 术中快速切片 病理诊断 

分 类 号：R736.1[医药卫生—肿瘤]