甲状腺癌颈部淋巴结冷冻切片与术后病理不符原因分析  

Reasons for the inconsistency between frozen sections of cervical lymph nodes and postoperativepathology in thyroid cancer

作　　者：李秀萍 陈燕[1] LI Xiu-ping;CHEN Yan(Department of Pathology,Xi'an Central Hospital,Xi'an 710004,China)

机构地区：[1]西安市中心医院病理科,西安710004

出　　处：《诊断病理学杂志》2024年第8期715-718,745,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨分析甲状腺癌(TC)颈部淋巴结术中冷冻切片(FS)与石蜡制片不符的原因及如何提高两者符合率。方法收集临床资料,筛选出FS与石蜡制片不符的患者30例,重新在显微镜下阅片,以石蜡制片为金标准,分析FS与石蜡制片不符原因。结果30例患者延迟诊断18例,假阴性10例,假阳性2例;术后病理甲状腺乳头状癌转移19例,甲状腺髓样癌1例,良性未见转移10例;延迟诊断18例中,术后病理甲状腺乳头状癌转移8例,甲状腺异位5例,未见肿瘤3例,未见肿瘤但见砂粒体2例。假阴性10例,包括取材漏取2例,FS未切出2例,显微镜下未识别6例。术后病理类型甲状腺乳头状癌转移8例,甲状腺髓样癌转移1例,异位胸腺组织旁淋巴结甲状腺癌转移1例。30例患者FS切片质量,丙级片14例,乙级片12例;20例患者转移灶≤2 mm的19例,>2 mm的1例;肿瘤位于淋巴结被膜下窦12例,未位于被膜下窦8例。结论FS与石蜡制片的不符的原因多种多样且贯穿在整个FS及阅片的全过程,包括取材不足漏诊、切片未切出深部病变,制片质量欠佳,转移灶极小镜下漏诊或者异型性不够,无法识别等。Objective To explore and analyze the reasons why frozen section(FS)is inconsistent with paraffin section(PS)in cervical lymph node surgery of thyroid cancer to improve the coincidence rate between them.Methods After collecting clinical data,5 patients with FS inconsistent with paraffin section were screened out,and the sections were re-read under the microscope.Taking paraffin section as the gold standard,the reasons of FS inconsistent with paraffin section were analyzed.Results Of the 30 patients,18 were delayed in diagnosis,10 were false negative and 2 were false positive.Postoperative pathological thyroid papillary carcinoma metastasized in 19 cases,medullary thyroid carcinoma was detected in 1 case,and benign without metastasis in 10 cases.Among the 18 cases of delayed diagnosis,8 cases were pathological papillary thyroid carcinoma metastasis,5 cases were ectopic thyroid,3 cases were not found tumor,and 2 cases were found in psammoma bodies.10 cases were false negative,including 2 cases of missing samples,2 cases of FS were not cut out,and 6 cases were not recognized under microscope.Postoperative pathological types included 8 cases of papillary thyroid carcinoma,1 case of medullary thyroid carcinoma and 1 case of ectopic thymic lymph node thyroid carcinoma.The quality of FS section of 30 patients included 14 cases of grade C and 12 cases of grade B;Of the 20 patients,19 cases had metastases less than 2 mm,and 1 case was more than 2 mm;The tumor was located in the subcapsular sinus of lymph nodes in 12 cases and not in the subcapsular sinus in 8 cases.Conclusion The reasons for the inconsistency between FS and paraffin sections are diverse and run through the entire process of FS and section review,including insufficient sampling and missed diagnosis,failure to cut deep lesions in the section,poor section quality,minimal metastasis,missed diagnosis under endoscope,or insufficient atypia,making it difficult to identify.

关 键 词：术中冷冻制片 石蜡制片 淋巴结 甲状腺乳头状癌 甲状腺癌 

分 类 号：R736.1[医药卫生—肿瘤]