西藏甲状腺病变术中冰冻切片检查结果分析

摘要(中文译文)

目的 分析西藏地区甲状腺病变术中冷冻切片诊断的准确性，探讨提高诊断准确性的方法和措施。方法 收集西藏地区四家医院2020年1月至2024年12月手术切除的371例甲状腺病变患者的临床病理资料，以术后石蜡切片诊断为金标准，分析冷冻切片诊断的准确率、漏诊率、误诊率及延迟诊断率。结果 371例甲状腺病变术中冷冻切片诊断准确率为95.42%（354/371），漏诊率为0.27%（1/371），误诊率为0.54%（2/371），延迟诊断率为3.77%（14/371）。漏诊1例，为甲状腺乳头状癌。误诊2例，其中1例术中诊断为恶性肿瘤，术后诊断为结节性甲状腺肿伴滤泡上皮非典型增生；另1例术中诊断为髓样癌，术后诊断为亚急性甲状腺炎。结论 冷冻切片诊断是术中判断甲状腺病变良恶性的重要方法，滤泡性肿瘤及小病灶的术中诊断率较低。规范取材、提高冷冻切片质量、掌握甲状腺病变术中冷冻切片的显微形态学特点及诊断标准，可提高术中冷冻切片诊断的准确性。

Abstract

Objective To analyze the accuracy of intraoperative frozen section diagnosis of thyroid lesions in Xizang and explore the methods and measures to improve the diagnosis accuracy. Methods The clinicopathological data of 371 patients with thyroid lesions surgically resected by four hospitals in Xizang from January 2020 to December 2024 were collected.With the paraffin section diagnosis after surgery as the standard,the accuracy,missed diagnosis rate,misdiagnosis rate,and delayed diagnosis rate of frozen section diagnosis were analyzed. Results The intraoperative frozen section diagnosis in 371 cases of thyroid lesions showed the accuracy of 95.42% (354/371),the missed diagnosis rate of 0.27% (1/371),the misdiagnosis rate of 0.54% (2/371),and the delayed diagnosis rate of 3.77% (14/371).One case was subjected to missed diagnosis,which was a papillary carcinoma of the thyroid gland.Two cases were misdiagnosed.One of them was diagnosed as malignant tumor during surgery but nodular goiter with atypical hyperplasia of follicular epithelium after surgery.The other case was diagnosed as medullary carcinoma during surgery but subacute thyroiditis after surgery. Conclusions Frozen section diagnosis is an important method for determining the benign or malignant nature of thyroid lesions during surgery.The diagnosis rates of follicular tumors and small lesions are low during surgery.Standardized sampling,improving the quality of frozen sections,and mastering the microscopic morphological characteristics and diagnostic criteria of frozen sections of thyroid lesions during surgery can improve the accuracy of intraoperative frozen section diagnosis.

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