Dankwa E K, Davies J D
J Clin Pathol. 1985 Nov;38(11):1235-40. doi: 10.1136/jcp.38.11.1235.
A consecutive series of 1000 operative frozen section diagnoses was reviewed. Correct diagnosis was made at the time in 96.5% of the cases. Clinically relevant errors were found in 1.3% of the cases and unimportant errors in 0.9%. Diagnosis was deferred, to await subsequent paraffin sections, in a further 1.3%. All the errors and provisional diagnoses in the deferred cases were conservative false negative results; no false positive diagnosis of malignancy was made. The cases of incorrect or deferred diagnosis were analysed to ascertain the origin of the difficulties, which comprised: technical imperfection (three cases); the focal nature of the lesion (14); and pathological misinterpretation (28). More than one of these factors played a part in eight cases. Further retrospective assessment indicated that the factors leading to error or deferred diagnosis were avoidable in 57% and potentially avoidable in 43% of cases. Misinterpretation was the single factor responsible for all avoidable misdiagnoses or deferred diagnosis. None the less, unavoidable factors led to erroneous or deferred diagnosis in about 2% of operative frozen section requests. Using present methods this seems to be the irreducible minimum of failures to make the correct diagnosis when frozen sections are assessed.
回顾了连续1000例手术冰冻切片诊断病例。96.5%的病例在当时做出了正确诊断。1.3%的病例发现了临床相关错误，0.9%为不重要错误。另有1.3%的病例诊断延迟，等待后续石蜡切片结果。延迟病例中的所有错误和临时诊断均为保守性假阴性结果；未出现恶性肿瘤的假阳性诊断。对诊断错误或延迟的病例进行分析以确定困难的根源，包括：技术不完善（3例）；病变的局灶性（14例）；以及病理误判（28例）。其中不止一个因素在8例病例中起作用。进一步的回顾性评估表明，导致错误或延迟诊断的因素在57%的病例中是可避免的，在43%的病例中是潜在可避免的。误判是所有可避免的误诊或延迟诊断的唯一因素。尽管如此，不可避免的因素在约2%的手术冰冻切片申请中导致了错误或延迟诊断。使用目前的方法，这似乎是评估冰冻切片时无法正确诊断的最低不可减少的比例。
