Prayson Richard A
Department of Anatomic Pathology, Cleveland Clinic, United States.
Ann Diagn Pathol. 2018 Aug;35:7-10. doi: 10.1016/j.anndiagpath.2018.02.001. Epub 2018 Feb 10.
Frozen section intraoperative consultation is a well-established means of evaluating brain tumors at the time of surgery. Limitations to the procedure are also well recognized resulting in less than perfect specificity of diagnosis. This study retrospectively reviewed 424 consecutive meningioma cases (N = 310 females; mean age 57.3 years) to examine concordance between frozen section evaluation of meningioma subtype and grade as compared with the final diagnosis subtype and grade. A discrepancy between frozen section diagnosis and final diagnosis was observed in 114 (26.9%) of cases. Of the WHO grade I subtypes, the most common discrepancy involved transitional meningiomas (N = 31) which were most commonly diagnosed at frozen section as either fibrous (N = 18) or meningothelial (N = 13) meningiomas. None of the grade I tumors were diagnosed as higher grade lesions. Of the higher grade meningiomas (WHO grade II and III) (N = 145) reviewed, concordance between tumor type and grade was seen in only 26.2% of cases; most commonly, 73/98 atypical meningiomas were under-graded as some subtype of WHO grade I meningioma (71/73 cases). In conclusion, discrepancies at frozen section with respect to accurately identifying higher grade meningiomas and higher grade meningioma subtypes are common and are generally due to tumor sampling and heterogeneity.
术中冰冻切片会诊是手术时评估脑肿瘤的一种成熟方法。该方法的局限性也已得到充分认识，导致诊断特异性不尽完美。本研究回顾性分析了424例连续的脑膜瘤病例（310例女性；平均年龄57.3岁），以检验脑膜瘤亚型和分级的冰冻切片评估结果与最终诊断的亚型和分级之间的一致性。114例（26.9%）病例的冰冻切片诊断与最终诊断存在差异。在世界卫生组织（WHO）I级亚型中，最常见的差异涉及过渡型脑膜瘤（31例），冰冻切片时最常诊断为纤维型（18例）或脑膜内皮型（13例）脑膜瘤。I级肿瘤均未被诊断为高级别病变。在回顾的高级别脑膜瘤（WHO II级和III级）（145例）中，肿瘤类型和分级的一致性仅见于26.2%的病例；最常见的情况是，73/98例非典型脑膜瘤被低估为WHO I级脑膜瘤的某种亚型（71/73例）。总之，冰冻切片在准确识别高级别脑膜瘤及其亚型方面存在差异很常见，且通常是由于肿瘤取样和异质性所致。
