Department of Neurosurgery, Shanghai Institute of Neurological Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China.
Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
Endocr Pathol. 2019 Sep;30(3):180-188. doi: 10.1007/s12022-019-09582-5.
Cushing's disease (CD) is most commonly caused by a microadenoma, which at surgical exploration may not provide adequate tissue for pathologic diagnosis using standard techniques. We wished to determine the accuracy of intraoperative pathologic examination and whether the addition of intraoperative cytology increased the diagnostic yield. We reviewed the pathology reports from 403 operations on 341 patients with CD microadenomas from a single institution. The concordance rates of intraoperative diagnoses (cytology and frozen) with the final (paraffin section) pathological diagnosis were calculated. The overall pathologic confirmation of an adenoma (by either cytology, frozen, or paraffin section) was compared with the result from a historical cohort (using only standard frozen section analysis but not intraoperative cytology) and the pooled result from a meta-analysis of previously published data. The concordance rate between frozen section diagnosis and paraffin section histology was 390/403 (96.8%). The concordance rate between cytological smear and paraffin section histology was 213/246 (86.6%). In 54 cases (13.4%) with ultimate remission, pathologic confirmation was obtained only on intraoperative pathology (frozen section or cytology). Overall, pathologic confirmation was obtained in 326 operations (80.9%) by at least one pathological modality. The overall pathological confirmation of an adenoma was greater after the introduction of intraoperative cytology when compared with the historical control (67.1%, p = 0.015), and compared with the pooled rate of published data from the meta-analysis (72.1%, p < 0.001). Our findings suggest that addition of intraoperative cytological analyses during surgery for CD is an additional useful diagnostic tool for both neurosurgeons and pathologists.
库欣病（CD）最常见的原因是微腺瘤，在外科探查时，使用标准技术可能无法提供足够的组织进行病理诊断。我们希望确定术中病理检查的准确性，以及是否增加术中细胞学检查可以提高诊断率。我们回顾了一家机构的 341 名 CD 微腺瘤患者的 403 次手术的病理报告。计算了术中诊断（细胞学和冷冻切片）与最终（石蜡切片）病理诊断的一致性率。通过对比历史队列（仅使用标准冷冻切片分析，而不使用术中细胞学）和之前发表数据的荟萃分析的汇总结果，比较了通过任何一种方法（细胞学、冷冻切片或石蜡切片）病理证实为腺瘤的比例。冷冻切片诊断与石蜡切片组织学的一致性率为 390/403（96.8%）。细胞学涂片与石蜡切片组织学的一致性率为 213/246（86.6%）。在 54 例（13.4%）最终缓解的患者中，仅通过术中病理（冷冻切片或细胞学）获得病理证实。总体而言，通过至少一种病理方法获得了 326 次手术（80.9%）的病理证实。与历史对照组相比（67.1%，p = 0.015），以及与荟萃分析中发表数据的汇总率相比（72.1%，p < 0.001），引入术中细胞学分析后，腺瘤的总体病理证实率更高。我们的研究结果表明，在 CD 手术中添加术中细胞学分析是神经外科医生和病理学家的另一种有用的诊断工具。
