Sawady J, Berner J J, Siegler E E
Department of Laboratories, Mt Sinai Medical Center, Cleveland, OH 44106.
Hum Pathol. 1988 Sep;19(9):1019-23. doi: 10.1016/s0046-8177(88)80080-7.
Previous studies on the accuracy of frozen sections (FS) were not based on the reasons for which the FS was performed. By omitting this important information, those studies reported FS accuracy of 94% to 97.4%. The current study analyzes the accuracy of FS diagnoses based on the reasons for which they were conducted. Of 482 specimens examined by FS in 1986, 41 were performed for evaluation of section margins of tumors, 29 for identification of unknown tissue, and 43 for detection of lymph node metastases. All 113 of these examinations proved to be 100% accurate. The remaining 369 FS were performed for diagnosis of an unknown pathologic process. Of these, 83.47% were precisely diagnosed; in 10.30%, the pathologic process was correctly, but not precisely, diagnosed; in 3.79%, the diagnosis was deferred; and the remaining 2.44% were incorrectly diagnosed (with no harmful consequences to the patients). By eliminating the cases of deferred diagnoses, the accuracy rate increased to 86.76%. Therefore, we suggest that the pathologist and the surgeon should not draw any conclusion from an inconclusive interpretation of FS and should proceed as though an FS had not been performed. When combining results of "precise diagnoses" with those of "correct pathologic process," the overall accuracy rate increased to 97%. The investigators conclude that FS should be used for a general diagnosis of a pathologic process rather than for an exact or precise diagnosis. Finally, we suggest that a similar survey of FS be periodically performed in every pathology department as part of its quality assurance program.
以往关于冰冻切片（FS）准确性的研究并非基于进行冰冻切片的原因。由于忽略了这一重要信息，那些研究报告的冰冻切片准确率为94%至97.4%。本研究根据冰冻切片的实施原因分析其诊断准确性。1986年对482个标本进行了冰冻切片检查，其中41个用于评估肿瘤切缘，29个用于识别未知组织，43个用于检测淋巴结转移。所有这113项检查结果均被证明100%准确。其余369次冰冻切片用于诊断未知病理过程。其中，83.47%得到了准确诊断；10.30%的病理过程诊断正确但不准确；3.79%的诊断被推迟；其余2.44%诊断错误（对患者无不良后果）。排除诊断推迟的病例后，准确率提高到86.76%。因此，我们建议病理学家和外科医生不应从冰冻切片的不确定解读中得出任何结论，而应像未进行冰冻切片一样继续操作。将“准确诊断”结果与“正确病理过程”结果相结合时，总体准确率提高到97%。研究者得出结论，冰冻切片应用于病理过程的一般诊断，而非精确诊断。最后，我们建议每个病理科定期进行类似的冰冻切片调查，作为其质量保证计划的一部分。
