Melancon C Claire, Clinger John D
1 Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
Otolaryngol Head Neck Surg. 2017 Aug;157(2):314-319. doi: 10.1177/0194599817697279. Epub 2017 Mar 28.
Objectives Acute invasive fungal sinusitis (AIFS) remains a significant cause of morbidity and mortality in the immunocompromised patient population. Early diagnosis is key to improving patient outcomes. Frozen section biopsies have been shown to decrease time to diagnosis when compared with permanent pathology. However, its accuracy has not been adequately described in the literature, specifically in regard to AIFS. The aim of this study is to evaluate the statistical diagnostic accuracy of frozen sections and to review the etiology, clinical presentation, and current diagnostic protocols in management of AIFS. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Retrospective review included 67 pathologic records in Co-Path, with search criteria including invasive fungal, clinical history, frozen section, and final diagnosis between the dates of 2006 and 2015. Results Sixty-seven cases were reviewed per the search criteria in Co-Path. Of these, 31 met further criteria of having had frozen section analysis. Variables such as sensitivity, specificity, positive predictive value, and negative predictive value were assessed. All 21 positive frozen sections correlated with positive permanent pathology, giving a positive predictive value of 100%. Frozen section biopsies were 87.5% sensitive and 100% specific. Conclusion Early diagnosis of AIFS has been shown to decrease morbidity and mortality. Frozen section biopsies remain key in obtaining an early diagnosis among patients with a high clinical suspicion for invasive fungal sinusitis. Frozen section biopsies positive for invasive fungal pathology were universally consistent with definitive diagnosis.
目的 急性侵袭性真菌性鼻窦炎（AIFS）仍是免疫功能低下患者发病和死亡的重要原因。早期诊断是改善患者预后的关键。与常规病理检查相比，冰冻切片活检已被证明可缩短诊断时间。然而，其准确性在文献中尚未得到充分描述，特别是关于AIFS的准确性。本研究的目的是评估冰冻切片的统计学诊断准确性，并回顾AIFS管理中的病因、临床表现和当前诊断方案。
研究设计 病例系列并进行病历回顾。
研究地点 三级转诊中心。
研究对象和方法 回顾性研究包括Co-Path中的67份病理记录，检索标准包括侵袭性真菌、临床病史、冰冻切片和2006年至2015年期间的最终诊断。
结果 根据Co-Path中的检索标准，共回顾了67例病例。其中，31例符合进行冰冻切片分析的进一步标准。评估了敏感性、特异性、阳性预测值和阴性预测值等变量。所有21份冰冻切片阳性结果均与常规病理检查阳性结果相关，阳性预测值为100%。冰冻切片活检的敏感性为87.5%，特异性为100%。
结论 已证明AIFS的早期诊断可降低发病率和死亡率。对于临床高度怀疑侵袭性真菌性鼻窦炎的患者，冰冻切片活检仍是获得早期诊断的关键。侵袭性真菌病理阳性的冰冻切片活检结果与最终诊断普遍一致。
