术中冰冻病理在乳腺肿瘤诊断中的应用及常见诊断陷阱  

Application of Intraoperative Frozen Pathology in the Diagnosis of Breast Tumors and Common Diagnostic Pitfalls

作　　者：徐庆梅 王晓红 徐国新 XU Qingmei;WANG Xiaohong;XU Guoxin(Department of Pathology,Xinyi People’s Hospital,Xuzhou,Jiangsu 221400,China)

机构地区：[1]新沂市人民医院病理科,江苏徐州221400

出　　处：《中国医药指南》2025年第5期109-111,共3页Guide of China Medicine

摘　　要：目的分析术中冰冻病理在乳腺肿瘤诊断中的应用及常见诊断陷阱。方法选取2021年1月至2024年2月新沂市人民医院收治的784例乳腺肿瘤患者为对象,所有患者均接受术中冰冻切片检查,依据石蜡切片诊断结果将患者分成良性组和恶性组,对比两组患者的病理特征,分析病理诊断过程中的常见诊断陷阱。结果784例乳腺肿瘤患者中,经术后石蜡切片诊断为恶性183例,良性601例,术中冰冻切片确诊为恶性177例,良性607例;术中冰冻切片在乳腺肿瘤诊断中的特异性、灵敏度、阴性预测值、阳性预测值、准确度分别为98.71%、95.63%、98.71%、98.87%、98.72%,与石蜡切片具有极好的一致性(Kappa=0.964);石蜡切片诊断良性乳腺肿瘤病理诊断结果:纤维腺瘤505例,导管内乳头状瘤58例,腺病瘤23例,良性叶状肿瘤6例、硬化性腺病6例,放射状瘢痕3例,恶性乳腺肿瘤病理诊断结果分为:导管原位癌18例,浸润性导管癌162例,髓样癌1例,大汗腺导管内癌1例,其他少见1例;术中冰冻切片对乳腺良、恶性肿瘤分型诊断符合率分别为99.67%、95.63%;其中硬化性腺病为乳腺肿瘤的常见诊断陷阱。结论术中冰冻切片的病理诊断结果具有较高的临床诊断符合率,可作为术中确诊乳腺肿瘤性质与进一步治疗方案制订的依据,但有少量误诊病例,硬化性腺病为常见诊断陷阱,在病理诊断中注意识别、区分。Objective To analyze the application and common diagnostic pitfalls of intraoperative frozen pathology in the diagnosis of breast tumors.Methods A total of 784 cases of breast tumor patients admitted to Xinyi City People’s Hospital from January 2021 to February 2024 were included.All patients underwent intraoperative frozen section examination.Based on the paraffin section diagnosis,patients were divided into benign and malignant groups.The pathological characteristics of the two groups were compared,and common diagnostic pitfalls in the pathological diagnosis process were analyzed.Results In a study of 784 breast tumor patients,postoperative paraffin section diagnosis identified 183 malignant and 601 benign cases.Intraoperative frozen section diagnosed 177 malignant and 607 benign cases.The diagnostic performance of intraoperative frozen section was:specificity 98.71%,sensitivity 95.63%,negative predictive value 98.71%,positive predictive value 98.87%,accuracy 98.72%,with high consistency to paraffin section(Kappa=0.964).Paraffin section diagnosed benign tumors as:505fibroadenomas,58 intraductal papillomas,23 adenosis tumors,6 benign phyllodes tumors,6 sclerosing adenosis,3 radial scars.Malignant tumors were diagnosed as:18 ductal carcinoma in situ,162 invasive ductal carcinomas,1 medullary carcinoma,1 apocrine ductal carcinoma in situ,1 other rare type.Intraoperative frozen section’s conformity rate for benign and malignant tumor classification was 99.67%and 95.63%respectively.Sclerosing adenosis is a common diagnostic pitfall.Conclusions The pathological diagnosis results of intraoperative frozen sections have a high clinical diagnostic accuracy and can be used as a basis for confirming the nature of breast tumors during surgery and formulating further treatment plans.However,there is a small misdiagnosis rate,and sclerosing adenosis is a common diagnostic trap.Attention should be paid to identification and differentiation in pathological diagnosis.

关 键 词：乳腺肿瘤 术中冰冻病理诊断 术后石蜡切片 诊断效能 诊断陷阱 

分 类 号：R737.9[医药卫生—肿瘤]