子宫内膜癌术中冷冻切片病理检查的诊断准确性及其影响因素  

Diagnostic accuracy and influencing factors of intraoperative frozen section pathological examination in endometrial carcinoma

作　　者：王利丽[1] 王心[1] 吴楠[1] 尚丽新[1] 顾玉婵 赵谦谦 

机构地区：[1]北京军区总医院妇产科,100010 [2]大连医科大学,辽宁116044

出　　处：《中华妇幼临床医学杂志（电子版）》2016年第1期40-46,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家卫计委科研基金(W2014GJ03)~~

摘　　要：目的探讨子宫内膜癌(EC)术中冷冻切片病理检查的诊断准确性及其影响因素。方法选择2006年1月至2014年12月,北京军区总医院妇产科诊治的170例EC患者为研究对象。以术后石蜡包埋切片病理检查结果为诊断金标准,比较所有EC患者术中冷冻切片病理检查在诊断肿瘤细胞级别、组织学类型、肌层浸润深度及宫颈累及方面的敏感度和特异度差异,及影响术中冷冻切片病理检查粗符合率的临床因素。本研究遵循的程序符合北京军区总医院人体试验委员会制定的伦理学标准,得到该委员会批准,并与患者签署临床研究知情同意书。结果 1在肿瘤细胞级别的诊断上,术中冷冻切片病理检查诊断低分化的敏感度(87.5%)分别较诊断高分化、中分化的敏感度(74.7%、56.1%)高,且差异有统计学意义(χ2=4.28、23.97,P=0.028、0.000);诊断低分化的特异度(98.4%)较诊断高分化的特异度(75.4%)高,且差异有统计学意义(χ2=22.65,P=0.000)。2在肿瘤组织学类型的诊断上,术中冷冻切片病理检查诊断为Ⅰ型的敏感度(88.5%)较诊断为Ⅱ型的敏感度(33.3%)高,诊断为Ⅰ型的特异度(45.5%)较诊断为Ⅱ型的特异度(88.8%)低,且差异均有统计学意义(χ2=63.99、43.03,P=0.000、0.000)。3在诊断肿瘤肌层浸润深度上,术中冷冻切片病理检查诊断深肌层浸润的敏感度(95.0%)较诊断浅肌层浸润的敏感度(86.5%)高,且差异有统计学意义(χ2=4.61,P=0.032);诊断深肌层浸润的特异度(99.2%)与浅肌层浸润的特异度(95.5%)比较,差异则无统计学意义(χ2=1.52,P=0.218)。4在诊断宫颈累及方面,术中冷冻切片病理检查诊断宫颈累及的敏感度(20.0%)较诊断无宫颈累及的敏感度(100.0%)低,诊断宫颈累及的特异度(100.0%)较无宫颈累及的特异度(20.0%)高,且差异均有统计学意义(χ2=133.33、133.33,P=0.000、0.000)。5研究的10项临床因素中,肥胖、组织学类型为Ⅰ型及低分化EC患者术中冷冻Objective To investigate the diagnostic accuracy and influencing factors of intraoperative frozen section pathological examination in endometrial carcinoma（EC）.Methods From January 2006 to December 2014,170 patients with EC who were hospitalized in the department of Gynecology and Obstetrics,Military General Hospital of Beijing,were chosen as study objects.The diagnostic gold standard was postoperative paraffin embedded biopsy results.The sensitivity and specificity differences of intraoperative frozen biopsy in the diagnosis of tumor cell level,tumor histological type,depth of myometrial infiltration and cervical involvement of all EC patients,and clinical influencing factors of rough coincidence rate of intraoperative frozen section pathological examination were analyzed.The procedures of this study accord with the ethical standards established by the Human Testing Committee of Military General Hospital of Beijing,and get the approval of the committee,and the patients signed the informed consent.Results 1For intraoperative frozen section pathological examination in the diagnosis of tumor cell level,the sensitivity of poorly differentiated（87.5%）was higher than that of well or moderately differentiated（74.7%,56.1%）,respectively,and the differences were statistically significant（χ2=4.28,23.97;P=0.028,0.000）.The specificity of poorly differentiated（98.4%）was higher than that of well-differentiated（75.4%）,and the difference was statistically significant（χ2=22.65,P=0.000）.2For intraoperative frozen section pathological examination in the diagnosis of tumor histological type,the sensitivity of typeⅠ（88.5%）was higher than that of type Ⅱ（33.3%）,the specificity of typeⅠ（45.5%）was lower than that of typeⅡ（88.8%）,and the differences were statistically significant（χ2=63.99,43.03;P=0.000,0.000）.3For intraoperative frozen section pathological examination in the diagnosis of depth of myometrial infiltration,the sensitivity of deep myometrial infiltration（95.0%）was

关 键 词：子宫内膜肿瘤 冷冻切片 石蜡包埋 活组织检查 女性 

分 类 号：R737.33[医药卫生—肿瘤]