Amraei Razie, Moradi Afshin, Zham Hanieh, Ahadi Mahsa, Baikpour Maryam, Rakhshan Azadeh
Department of Pathology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email:
Asian Pac J Cancer Prev. 2017 Mar 1;18(3):659-666. doi: 10.22034/APJCP.2017.18.3.659.
Objective: Using diagnostic pathological methods during surgery is a valuable means of determining the appropriate management for patients. Application of Frozen Section in CNS surgeries might face challenges due to friability of brain tissue and its relative inaccessibility. Various studies have evaluated the diagnostic acuity of frozen section compared to gold standard but results have been quite inconsistent. We conducted the present study to evaluate the accuracy of cryostat in diagnosing central nervous system tumors compared to the Gold Standard method. Methods: In this descriptive retrospective study, patients with definite diagnosis of central nervous system tumors made through histopathological evaluations were identified by reviewing the archives of pathology reports during 1996-2013. Demographic data, clinical history, radiologic findings and results of pathologic evaluations were extracted from the medical records and entered into SPSS statistical software v.22 for analysis. Results: A total of 405 patients diagnosed with CNS tumors were identified, of which 16 patients were not eligible and eventually 389 patients were included in the study. Regarding tumor category, subtype and grade, the results of the two methods were totally compatible in 303 patients (77.9%) and discrepant in 22.1% of cases. The tumors located in the middle fossa (p=0.031; OR=2.27; 95% CI: 1.08-4.79) and the posterior fossa (p=0.021; OR=2.46; 95% CI: 1.15-5.26) and the tumors biopsied using the stereotactic method (p=0.050; OR=2.42; 95% CI: 1.001-5.83) were associated with an increased chance of discrepant results between the two methods. Conclusion: Frozen section can correctly diagnose and affect the management of CNS lesions in 77.9% of cases. Finding ways to increase the sensitivity and specificity of this method and providing surgeons with more definite and exact intra-operative diagnosis can improve management of central nervous system lesions to a considerable degree.
手术过程中使用诊断性病理方法是确定患者适当治疗方案的重要手段。由于脑组织质地脆且相对难以获取，冷冻切片在中枢神经系统手术中的应用可能面临挑战。与金标准相比，已有多项研究评估了冷冻切片的诊断敏锐度，但结果差异很大。我们开展本研究以评估冷冻切片诊断中枢神经系统肿瘤与金标准方法相比的准确性。方法：在这项描述性回顾性研究中，通过查阅1996 - 2013年病理报告档案，确定经组织病理学评估确诊为中枢神经系统肿瘤的患者。从病历中提取人口统计学数据、临床病史、影像学检查结果和病理评估结果，并录入SPSS统计软件v.22进行分析。结果：共确定405例诊断为中枢神经系统肿瘤的患者，其中16例不符合条件，最终389例患者纳入研究。在肿瘤类别、亚型和分级方面，两种方法的结果在303例患者（77.9%）中完全相符，在22.1%的病例中存在差异。位于中颅窝（p = 0.031；OR = 2.27；95% CI：1.08 - 4.79）和后颅窝（p = 0.021；OR = 2.46；95% CI：1.15 - 5.26）的肿瘤以及采用立体定向方法活检的肿瘤（p = 0.050；OR = 2.42；95% CI：1.001 - 5.83）与两种方法结果存在差异的可能性增加有关。结论：冷冻切片可在77.9%的病例中正确诊断并影响中枢神经系统病变的治疗。找到提高该方法敏感性和特异性的方法，并为外科医生提供更明确和准确的术中诊断，可在很大程度上改善中枢神经系统病变的治疗。
