Künzel J, Raftis F, Hagemann J, Bahr K, Zimmer S, Koutsimpelas D, Matthias C
Hals‑, Nasen‑, Ohrenklinik, Plastische Operationen, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
Institut für Pathologie, Universitätsmedizin Mainz, Mainz, Deutschland.
HNO. 2019 Jan;67(1):30-35. doi: 10.1007/s00106-018-0523-4.
In the course of restoration of the middle ear, routine histological examinations are initiated in many cases, although a middle ear cholesteatoma can be clinically diagnosed in a normal case.
To determine the correlation between the surgeons' diagnosis and that of the pathologist and comparison with literature data. To check the rate of unexpected diagnoses. Analysis of the costs and survey of German ENT clinics with regard to handling of the histological examination in suspected cholesteatoma.
Retrospective evaluation of cholesteatoma cases of the ENT Department of the University Medical Center of Mainz from 2010-2015. Germany-wide postal survey of ENT clinics.
In all, 449 operations for the rehabilitation of a middle ear cholesteatoma, of which there were 312 (69.5%) first diagnoses and 137 (30.5%) recurrences. A histological examination was conducted in 78.6%. For first diagnoses, the sensitivity of the clinical assessment was 97.9%, specificity 10%, positive predictive value 96.3%, and negative predictive value 16.7%. Recurrences showed values of 100%, 40%, 97.1% and 100%. Unexpected malignant findings did not occur. This routine histological examination was performed by 58.6% of German ENT hospitals. A total of 80% of those questioned this to be useful. A histological examination cost an average of 14.06 €.
Intraoperatively, there is a high degree of accuracy in diagnosing cholesteatoma. The cost factor of the histological examination is low and should not be the basis for the decision. The ear microscopy and the experience of the ear surgeon should be decisive for the decision for histological examination.
在中耳修复过程中，尽管在正常情况下中耳胆脂瘤可通过临床诊断，但许多病例仍会进行常规组织学检查。
确定外科医生的诊断与病理学家的诊断之间的相关性，并与文献数据进行比较。检查意外诊断的发生率。分析成本，并就疑似胆脂瘤组织学检查的处理情况对德国耳鼻喉科诊所进行调查。
对美因茨大学医学中心耳鼻喉科2010年至2015年的胆脂瘤病例进行回顾性评估。对德国各地的耳鼻喉科诊所进行邮政调查。
总共进行了449例中耳胆脂瘤修复手术，其中312例（69.5%）为首次诊断，137例（30.5%）为复发。78.6%的病例进行了组织学检查。对于首次诊断，临床评估的敏感性为97.9%，特异性为10%，阳性预测值为96.3%，阴性预测值为16.7%。复发病例的相应值分别为100%、40%、97.1%和100%。未出现意外的恶性发现。德国58.6%的耳鼻喉科医院进行了这种常规组织学检查。总共80%的受访者认为这是有用的。组织学检查平均费用为14.06欧元。
术中诊断胆脂瘤具有高度准确性。组织学检查的成本因素较低，不应作为决策依据。耳显微镜检查和耳外科医生的经验应是决定是否进行组织学检查的决定性因素。
