Michael C W, Lawrence W D, Bedrossian C W
Department of Pathology, University of South Alabama, Mobile, USA.
Diagn Cytopathol. 1996 Dec;15(5):387-94. doi: 10.1002/(SICI)1097-0339(199612)15:5<387::AID-DC6>3.0.CO;2-9.
Little information is available on the relative value of intraoperative cytology (IOC) and frozen section (FS) in evaluation of ovarian lesions. We compared the two methods in 63 histologically proven cases of resected ovaries studied by imprints (40 cases), FNAs (38 cases), and scrapes (5 cases). Diagnoses were: 10 nonneoplastic cysts, 46 neoplasms (benign, 19; borderline, 8; and malignant, 19) and 7 tumors comprised of small blue cells (SBC): granulosa cell (3), lymphoma (1), small cell carcinoma (1), and sarcoma (2). There were no false-positive diagnoses by IOC or FS among the benign and borderline conditions. Five benign lesions, however, had FS deferred because of architectural complexity, this in contrast to only one case reported as atypical by IOC. Borderline tumors were recognized as such in 3 cases examined by FS, but no such diagnosis was possible by IOC due to the inability to assess invasion. The diagnosis in borderline neoplasms of surface epithelial origin was deferred in 4 cases by FS and reported as atypical in 5 cases examined by IOC due to the spectrum of architectural and nuclear atypia in borderline tumors. Of the 19 malignant cases, five were deferred because of uncertainty of invasion by FS, whereas two were called atypical by IOC. Five of 7 SBC tumors were recognized as such by FS and 6 of 7 by IOC, but none could be unequivocally subclassified by either method. Intraoperative FNAs and scrapes were superior to imprints, which tended to be bloodier and thicker. In contrast to FNAs, scrapes were easier to direct and yielded greater cellularity, although both methods were comparable in diagnostic accuracy. Even though the diagnostic yield of IOC was only slightly better than that of FS, it provided much better cytologic detail, and afforded a more representative sampling.
关于术中细胞学检查（IOC）和冰冻切片（FS）在评估卵巢病变方面的相对价值，目前可用信息较少。我们对63例经组织学证实的切除卵巢病例进行了比较，这些病例通过印片（40例）、细针穿刺抽吸活检（FNA，38例）和刮片（5例）进行研究。诊断结果为：10例非肿瘤性囊肿、46例肿瘤（良性19例、交界性8例、恶性19例）以及7例由小蓝细胞（SBC）组成的肿瘤：颗粒细胞瘤（3例）、淋巴瘤（1例）、小细胞癌（1例）和肉瘤（2例）。在良性和交界性病变中，IOC或FS均未出现假阳性诊断。然而，有5例良性病变因结构复杂而推迟了FS检查，相比之下，IOC仅报告1例为非典型病变。在FS检查的3例交界性肿瘤中被识别为此类病变，但由于无法评估浸润情况，IOC无法做出此类诊断。表面上皮来源的交界性肿瘤中，有4例因FS检查无法确定浸润情况而推迟诊断，5例IOC检查的病例因交界性肿瘤存在结构和核异型性而报告为非典型病变。在19例恶性病例中，5例因FS检查无法确定浸润情况而推迟诊断，而2例被IOC称为非典型病变。7例SBC肿瘤中，5例被FS识别为此类肿瘤，7例中有6例被IOC识别，但两种方法均无法明确进行亚分类诊断。术中FNA和刮片优于印片，印片往往血迹更多且更厚。与FNA相比，刮片更容易操作且细胞产量更高，尽管两种方法在诊断准确性上相当。尽管IOC的诊断阳性率仅略高于FS，但它提供了更好的细胞学细节，并能提供更具代表性的样本。
