理解鼻窦和前颅底恶性肿瘤的冰冻切片组织病理学及提出的报告指南。
Understanding frozen section histopathology in Sinonasal and anterior skull base malignancy and proposed reporting guidelines.
机构信息
Division of Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
出版信息
J Surg Oncol. 2023 Dec;128(8):1243-1250. doi: 10.1002/jso.27429. Epub 2023 Aug 31.
BACKGROUND
Intraoperative frozen section histopathology (IFSH) in sinonasal and skull base surgery although widely used is not well studied.
METHODS
We reviewed a database of sinonasal and anterior skull base tumors, between 1973 and 2019, and identified 312 suitable operative cases. Clinicopathologic data was collected and analyzed, in addition to descriptive data for histopathological reports classified as "ambiguous," or "limited/insufficient-quality/quantity."
RESULTS
Overall, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for IFSH were 90.2%, 97.5%, 94.2%, 95.6%, and 95.2%, respectively. IFSH for adenocarcinoma, salivary carcinoma, and SCC all demonstrated a better clinical utility with a sensitivity of 90% or greater, while it was less than 90% for esthesioneuroblastoma, melanoma, and sarcoma. Other factors such as unclear reporting, poor quality specimens, or limited quality specimens were shown to lower diagnostic performance. Based on limitations identified, we proposed a novel IFSH reporting algorithm to improve IFSH in sinonasal and skull base surgery.
CONCLUSIONS
IFSH is an accurate and clinically useful technique in sinonasal and skull base surgery patients; however, limitations exist.
背景
尽管术中冰冻切片组织病理学（IFSH）在鼻-鼻窦和颅底外科中被广泛应用，但研究并不充分。
方法
我们回顾了 1973 年至 2019 年间鼻-鼻窦和前颅底肿瘤的数据库，确定了 312 例适合手术的病例。收集并分析了临床病理数据，以及将组织病理学报告分类为“模糊”或“有限/不足质量/数量”的描述性数据。
结果
总体而言，IFSH 的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 90.2%、97.5%、94.2%、95.6%和 95.2%。IFSH 对腺癌、涎腺癌和 SCC 的临床实用性较好，敏感性均为 90%或更高，而嗅神经母细胞瘤、黑色素瘤和肉瘤的敏感性则低于 90%。其他因素，如报告不明确、标本质量差或标本有限，都会降低诊断性能。根据确定的局限性，我们提出了一种新的 IFSH 报告算法，以改善鼻-鼻窦和颅底外科中的 IFSH。
结论
IFSH 是鼻-鼻窦和颅底外科患者中一种准确且具有临床应用价值的技术；然而，仍存在局限性。
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