Tworek J A, Giordano T J, Michael C W
University of Michigan Hospitals, Ann Arbor 48109, USA.
Am J Clin Pathol. 1998 Oct;110(4):456-61. doi: 10.1093/ajcp/110.4.456.
We retrospectively studied the usefulness of intraoperative cytology (IOC) and frozen section (FS) in the rapid diagnosis of 68 thyroid lesions. In 14 cases of papillary thyroid carcinoma, IOC correctly diagnosed 13 cases, while FS correctly diagnosed 11 cases. There was no significant difference in sensitivities, and both methods had similar specificities. In 21 cases of colloid nodule, IOC was slightly more sensitive than FS; IOC correctly diagnosed 16 cases, while FS correctly diagnosed 15 cases. However, the specificity of IOC was only 71%, but was 98% for FS. Of 17 follicular adenomas, FS diagnosed 16 as follicular neoplasms and misdiagnosed only 1 as a colloid nodule. By contrast, IOC misdiagnosed 9 follicular adenomas as colloid nodules, most of which were macrofollicular variants with abundant colloid. Of 11 follicular carcinomas, FS diagnosed all as follicular neoplasms, while IOC misdiagnosed 3 as colloid nodules. While IOC is not as accurate as FS in the diagnosis of colloid nodules and follicular neoplasms, it is highly sensitive and specific in the diagnoses of papillary carcinoma and performance of the technique is rapid and easy. In an intraoperative setting, IOC is a useful adjunct to FS in screening thyroid nodules for the presence of papillary carcinoma.
我们回顾性研究了术中细胞学检查（IOC）和冰冻切片（FS）在68例甲状腺病变快速诊断中的实用性。在14例甲状腺乳头状癌中，IOC正确诊断了13例，而FS正确诊断了11例。两种方法的敏感性无显著差异，且特异性相似。在21例胶样结节中，IOC比FS稍敏感；IOC正确诊断了16例，而FS正确诊断了15例。然而，IOC的特异性仅为71%，而FS为98%。在17例滤泡性腺瘤中，FS将16例诊断为滤泡性肿瘤，仅将1例误诊为胶样结节。相比之下，IOC将9例滤泡性腺瘤误诊为胶样结节，其中大多数是具有丰富胶质的大滤泡变体。在11例滤泡癌中，FS均诊断为滤泡性肿瘤，而IOC将3例误诊为胶样结节。虽然IOC在诊断胶样结节和滤泡性肿瘤方面不如FS准确，但它在诊断乳头状癌方面具有高度敏感性和特异性，且该技术操作快速简便。在术中，IOC是FS筛查甲状腺结节是否存在乳头状癌的有用辅助手段。
