乳腺肿瘤术中冰冻切片病理诊断分析

乳腺肿瘤术中冰冻切片病理诊断分析

发表时间：2020-03-27T08:54:20.957Z 来源：《航空军医》2020年1期作者：杨娜[导读] 对乳腺肿瘤术中冰冻切片病理诊断进行临床分析研究，以期提高临床诊断率。

（泰来县人民医院 162400）摘要：目的对乳腺肿瘤术中冰冻切片病理诊断进行临床分析研究，以期提高临床诊断率。方法选择2018年1月-2019年12月在我院接受治疗的乳腺肿瘤患者86例作为研究对象，回顾性分析所有患者的临床资料，对比分析患者术中冰冻切片和术后石蜡切片病理诊断的结

果和报告。结果经术中冰冻切片病理诊断，86例乳腺肿瘤患者中，79例患者确诊，确诊率为91.86%，其中完全符合76例，占88.38%，基本符合3例，占3.49%；5例患者延迟诊断，延迟诊断率为5.81%，其中4例诊断为乳腺增生（后经石蜡切片结合免疫组化检查诊断2例为浸润性小叶癌，2例为乳腺增生症纤维硬化期），1例为不典型导管增生，切片使细胞异形，可能是导管原位癌；2例患者误诊且均误诊为假阴性，误诊率为2.33%。结论术中冰冻切片病理诊断率高，具有十分重要的临床指导意义。要使冰冻切片的诊断率和准确率、判别能力进一步提高，必须要在前期取材过程中掌握正确的方式，并在中期注意切片的质量，这样可以在后期提高对诊断的认识，避免不必要的失误。

关键词：乳腺肿瘤；冰冻切片；病理诊断 [Abstract] Objective：to analyze and study the pathological diagnosis of frozen section during the operation of breast tumor，in order to improve the clinical diagnosis rate.Methods：86 patients with breast cancer who were treated in our hospital from January 2018 to December 2019 were selected as the research objects.The clinical data of all patients were analyzed retrospectively，and the results and reports of pathological diagnosis of frozen section and paraffin section were compared and analyzed.Results：of the 86 cases of breast cancer，79 cases were diagnosed by frozen section，the rate of diagnosis was 91.86%，among which 76 cases were completely diagnosed，accounting for 88.38%，3 cases were basically diagnosed，accounting for 3.49%；5 cases were delayed diagnosis，the rate of delayed diagnosis was 5.81%，among which 4 cases were diagnosed as hyperplasia of breast（2 cases were diagnosed as invasive lobular cancer by paraffin section combined with immunohistochemistry，2 cases were diagnosed as invasive lobular cancer One case was atypical ductal hyperplasia with abnormal cells，which may be ductal carcinoma in situ.Two cases were misdiagnosed as false negative，the misdiagnosis rate was 2.33%.Conclusion：the pathological diagnosis rate of frozen section in operation is high，which has very important clinical significance.In order to improve the diagnosis rate，accuracy rate and discrimination ability of frozen section，it is necessary to master the correct way in the early sampling process，and pay attention to the quality of section in the middle stage，so as to improve the understanding of diagnosis in the later stage and avoid unnecessary mistakes. [Key words] breast tumor；frozen section；pathological diagnosis

近年来，乳腺肿瘤的发病率呈现上升趋势，大部分恶性肿瘤患者不得不行切除术。虽然保乳术的出现可保证乳房完整，但由于难以确定乳腺肿瘤的病理特征和性质，难以制定手术方案，而冰冻切片诊断技术解决了这一难题[1]。乳腺肿瘤的术中冰冻切片的病理诊断和检查属于临床上病理工作难点，其检查方法主要是让组织在低温下冰冻，进而对组织行切片和固定及染色和封片，最后将组织置于显微镜下，快速地诊断肿瘤是恶性还是良性[2]。乳腺肿瘤术中冰冻切片的病理诊断为临床手术范围以及治疗方案的确定提供了确切依据。本文主要对2018年1月-2019年12月86例乳腺肿瘤患者的术中冰冻切片病理诊断进行临床分析研究，探讨病理诊断的误诊情况和延迟诊断原因，现报告如下。

1 资料与方法

1.1 一般资料

随机选择2018年1月-2019年12月在我院接受治疗的乳腺肿瘤患者86例作为研究对象，均为女性患者，年龄24～61岁，平均（38±4.5）岁。按乳腺肿块位置分为：左侧乳腺41例，右侧乳腺44例，双侧1例；良性肿瘤46例，恶性肿瘤40例。对所有患者行术中冰冻切片病理诊断和检查，并与石蜡切片的病理检查进行对照，所有检查标本均于术中立即送检，均为新鲜的组织。

1.2 检查与诊断方法

于手术过程中将肿块切除后认真检查并送检新鲜的组织：资深医师进行冰冻切片的病理检查，取材根据病理医师的具体需要来定，取材之后使用恒冷冰冻切片机进行制作。具体操作步骤为：将选取组织放置在冻头上（涂有甲基纤维素包埋剂），将温度控制在-25 ℃左右进行快速冷冻，适宜的冷冻时间为2～3 min，之后进行切片（切片的厚度为5μm），使用95%的酒精或是福尔马林（10%）对切片进行固定，固定时间为1 min，之后水洗和HE进行染色，并进行加温速染，染色完成用酒精进行逐级脱水，继而封片。在光学显微镜之下进行切片判读，将诊断的结果传到送检科室。

完成冰冻切片的病理检查后，将剩余的冰冻组织进行常规的石蜡切片病理检查和诊断复核，对于比较难以进行确诊的患者，可以与免疫组化结合进行检查和诊断。检查完毕后将冰冻切片和石蜡切片两项病理检查的结果进行比较，最终的诊断结果将石蜡切片诊断结果作为标准。