子宫内膜不典型增生术中冰冻病理检查的价值评估  

The Value of Intraoperative Rapid Frozen Section in the Diagnosis in Atypical Endometrial Hyperplasia

作　　者：邱黎倪 陈秀娟[1] 黄凌娜[1] 连成瑛[1] 倪翊华[1] 缪庚运 QIU Lini;CHEN Xiujuan;HUANG Lingna;LIAN Chengying;NI Yihua;MIAOGengyun(Department of Obstetrics and Gynecology,Fujian Maternity and Child Health Hospital/Affiliated Hospital of Fujian Medical University,Fuzhou Fujian 350001,China)

机构地区：[1]福建省妇幼保健院/福建医科大学附属医院妇产科,福建福州350001

出　　处：《中国卫生标准管理》2020年第9期108-110,共3页China Health Standard Management

摘　　要：目的评价术中快速冰冻病理检查在评估子宫内膜不典型增生患者漏诊子宫内膜癌的临床价值。方法回顾性分析自2012年1月1日-2018年12月31日因子宫内膜不典型增生于我院行子宫切除手术的179例患者的临床病理资料,将术中快速病理检查结果与术后病理石蜡检查结果进行对比分析,分析两者总体符合率,以及在组织类型和肿瘤细胞分级、肌层浸润、宫颈累及方面的一致性情况。结果子宫内膜不典型增生患者术中冰冻病理检查与术后石蜡病理检查结果总体符合率为89.51%。冰冻病理检查与石蜡病理检查在组织类型、肿瘤细胞分级、肌层浸润具有较强强度一致性,其Cohen’s Kappa(K)系数分别为0.777、0.676、0.647;子宫内膜不典型增生漏诊子宫内膜癌的宫颈浸润具有中等强度一致性,其Cohen’s Kappa(K)系数为0.474。结论术中冰冻病理检查与石蜡病理检查在子宫内膜不典型增生漏诊子宫内膜癌的组织类型、肿瘤细胞分级以及肌层浸润方面具有较强的一致性,但是在宫颈累及方面诊断的一致性仅为中等。术中冰冻病理对子宫内膜不典型漏诊子宫内膜癌的诊断具有一定的价值。Objective To investigate the clinical value of intraoperative rapid frozen section in the diagnosis of missed endometrial cancer in patients with atypical endometrial hyperplasia.Methods A retrospective analysis of 179 patients with atypical endometrial hyperplasia who underwent hysterectomy in our hospital from January 1,2012 to December 31,2018,,make a comparative analysis of intraoperative rapid frozen section(FS)results and paraffin-embedded permanent section(PS)results to analyze overall coincidence rate,the agreement of tissue type,tumor grade,myometrial invasion and cervical involvement.Results The overall coincidence rate of intraoperative rapid frozen section results and paraffin-embedded permanent section results was 89.51%.There was good agreement between FS and PS in detecting tissue type,detecting tumor grade,and evaluation of myometrial invasion,the Cohen’s kappa(k)coefficients were 0.777,0.676 and 0.647,respectively.There was moderate agreement in evaluation of cervical involvement,the Cohen’s kappa(k)coefficients was 0.474.Conclusion There was good agreement between FS and PS in detecting tissue type,detecting tumor grade,and evaluation of myometrial invasion of endometrial carcinoma missed by AEH,but there was only moderate agreement in the evaluation of cervical involvement.intraoperative rapid frozen section has certain value in the diagnosis of missed endometrial cancer of atypical endometrial hyperplasia.

关 键 词：子宫内膜不典型增生 子宫内膜癌 子宫切除 冰冻病理检查 石蜡病理检查 Cohen’s Kappa(K)系数 

分 类 号：R361[医药卫生—病理学]