术中冰冻切片检查在Ⅰ型子宫内膜癌中的临床应用价值  

Clinical application value of intraoperative frozen section in typeⅠendometrial carcinoma

作　　者：熊旺 毛熙光 Xiong Wang;Mao Xiguang(Department of Obstetrics and Gynecology,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院妇产科,四川泸州646000

出　　处：《遵义医科大学学报》2020年第5期635-640,共6页Journal of Zunyi Medical University

摘　　要：目的探讨Ⅰ型子宫内膜癌术中快速冰冻切片病理检查(FS,Frozen section)的临床应用价值。方法在2018年11月~2019年11月于西南医科大学附属医院妇产科就诊的103例子宫内膜癌患者中筛选出术后证实为Ⅰ型子宫内膜癌并且符合纳入标准的64例患者为研究对象。将64例患者手术中FS与手术后石蜡切片病理检查(PS,Paraffin section)(金标准)相对比,从而获得术中FS在判断Ⅰ型子宫内膜癌肿瘤细胞等级、癌灶浸润子宫肌层深度及宫颈间质受累的符合率。结果①术中FS在判断肿瘤细胞等级方面总体符合率达71.88%(46/64),其中G1级符合率为60.87%(14/23),G2级、G3级符合率分别为50%(7/14)、92.59%(25/27)。②在判断癌灶浸润子宫肌层深度方面的总体符合率为92.19%(59/64),其中癌灶浸润子宫肌层深度<1/2的符合率为96.23%(51/53),癌灶浸润子宫肌层深度≥1/2的符合率为72.73%(8/11)。③在判断宫颈间质受累方面总体符合率为89.06%(57/64),其中癌灶未累及宫颈间质的符合率为94.12%(48/51),累及宫颈间质的符合率为69.23%(9/13)。结论①术中FS判断Ⅰ型子宫内膜癌G3级符合率较G2、G1符合率均高。②在判断癌灶浸润子宫肌层深度方面尤其是癌灶浸润子宫肌层深度<1/2有较高的符合率。③判断宫颈间质受累总体符合率比较理想。Ⅰ型子宫内膜癌手术中能够联合FS结果从而个体化手术方式。但术中FS在判断肿瘤细胞等级的总体符合率有待提升。Objective To study the clinical application value of intraoperative frozen section(FS)in typeⅠendometrial carcinoma.Methods Among the 103 patients with endometrial cancer who were treated in the Department of Obstetrics and Gynecology of the Affiliated Hospital of Southwest Medical University from November,2018 to November,2019,a total of 64 patients who were confirmed to be typeⅠendometrial carcinoma after the operation were selected as the research objects.To compare the intraoperative FS results with the postoperative Paraffin section(PS)results(gold standard),the coincidence rate of intraoperative FS was obtained to diagnose the tumor grade,depth of myometrial invasion and tumor invading the stromal connective tissue of the cervix.Results(1)According to the intraoperative FS,the overall diagnostic coincidence rate of tumor grade reached 71.88%(46/64),while the respective diagnostic coincidence rate of G1,G2 and G3 was 60.87%(14/23),50%(7/14)and 92.59%(25/27);(2)The intraoperative FS showed an overall diagnostic coincidence rate of 92.19%(59/64)in the depth of myometrial invasion,the tumor limited to the endometrium or invading less than half the myometrium was 96.23%(51/53),the invading no less than half of the myometrium was 72.72%(8/11);(3)The intraoperative FS showed an overall diagnostic coincidence rate of 89.06%(57/64)in the tumor invading the stromal connective tissue of the cervix,without invading the stromal connective tissue of the cervix was 94.12%(48/51),and invading the stromal connective tissue of the cervix was 69.23%(9/13).Conclusion(1)The intraoperative FS could be used to determine the typeⅠendometrial carcinoma G3 with higher diagnostic coincidence rate than G1 and G2;(2)Intraoperative FS was performed to determine the depth of myometrial invasion with a high coincidence rate,especially in the tumor limited to the endometrium or invading less than half of the myometrium;(3)Judging the overall diagnostic coincidence rate of invading the stromal connective tissue of the cervix was ideal

关 键 词：子宫内膜肿瘤 病理学 冰冻切片 石蜡切片 手术分期 

分 类 号：R737.33[医药卫生—肿瘤]