The Accuracy of Frozen Section Diagnosis of Pulmonary Nodules Evaluation of Inflation Method during Intraoperative Pathology Consultation with Cryosection
The Accuracy of Frozen Section Diagnosis of Pulmonary Nodules Evaluation of Inflation Method during Intraoperative Pathology Consultation with Cryosection
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DOI：
10.1097/jto.0b013e3181c09f9c
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发表时间：
2010-01-01
影响因子：
20.4
通讯作者：
Choe, Gheeyoung
中科院分区：
文献类型：
--
作者：
Xu, Xianhua;Chung, Jin-Haeng;Choe, Gheeyoung
简介：术中冰冻切片诊断（FSD）是一项非常重要的病理检查，可以确定后续手术的范围。然而，FSD是特别困难的小肺结节，由于严重的建筑变形在冷冻切片。本研究旨在确定肺结节FSD的准确性，并评估冷冻切片过程中的充气方法。方法：我们回顾性分析了229个连续肺结节的FSD，并评估冷冻切片过程中充气方法的诊断准确性和有效性。自2006年8月以来，所有冷冻切片（165张，72.1%）都是在用最佳稀释的包埋液充气后制作的。结果：FSD如下：非肿瘤性病变（29张，12.7%）、良性肿瘤（28张，12.2%）和恶性肿瘤（172张，75.1%）。小于2cm的病灶占60.3%（138/229）。肺组织经稀释包埋液充气后冰冻切片质量良好。膨胀的肺标本含有微小的病变，表现出明显的肉眼外观，无法触及。组织学上，开放的空气空间和正常的实质结构保存良好。微小的癌前病变，如不典型腺瘤样增生和细支气管肺泡癌，可以很容易地确定。结论：冷冻切片中使用膨胀法后，FSD的敏感性和特异性均达到100%，术中病理会诊率明显提高，尤其是小的不可触及的癌前病变。病理学家可以自信地指导外科医生计划手术治疗。
Introduction: Intraoperative frozen section diagnosis (FSD) is a very important pathologic examination that can determine the extent of the subsequent surgical procedure. However, FSD is especially difficult in small pulmonary nodules due to severe architectural distortion during cryosection. This study was undertaken to determine the accuracy of FSD of pulmonary nodules and to evaluate the inflation method during cryosection.Methods: We retrospectively reviewed FSD of 229 consecutive pulmonary nodules and evaluated the diagnostic accuracy and efficacy of inflation method during cryosection. Since August 2006, all frozen sections (165, 72.1%) were made after inflation with optimally diluted embedding medium.Results: The FSD were as follows: nonneoplastic lesions (29, 12.7%), benign neoplasms (28, 12.2%), and malignant neoplasms (172, 75.1%). The proportion of the lesions smaller than 2 cm was 60.3% (138 of 229). The frozen section quality of lung tissue was excellent after inflation with diluted embedding medium. Inflated lung specimens harboring minute lesion displayed distinct gross appearance, which could not be palpated. Histologically, open air spaces and normal parenchymal architectures were well preserved. Minute precancerous foci such as atypical adenomatous hyperplasia and bronchioloalveolar carcinoma could be readily identified. After using inflation method during cryosection, both the sensitivity and specificity reached 100%, and the incidence of intraoperative pathology consultation increased markedly, especially small impalpable lesions.Conclusions: The accuracy of FSD and histologic qualities were excellent by using inflation method, especially in cases of impalpable small precancerous lesions. The pathologist could guide with confidence the surgeon in planning the surgical management.