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[目的]探讨甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)术中冷冻切片病理诊断的要点,分析造成术中冷冻切片误诊、漏诊的原因。[方法]回顾性分析107例PTMC患者的病理学特征、冷冻切片和石蜡切片结果以及免疫组化结果。[结果]术中冷冻切片确诊97例,延迟诊断4例,误诊4例,漏诊2例。冷冻切片易出现毛玻璃样核及核内包涵体等人工假象。其中81例PTMC石蜡切片免疫组化法CK19、Galectin-3、TPO阳性率分别为93.8%、88.9%、13.6%。[结论]核增大、核轮廓不规则、核重叠、核沟是冷冻切片诊断PTMC的重要核参数改变,需结合组织结构异型性明确诊断。仔细剖检、强化取材及严格掌握诊断标准是避免误诊和漏诊,提高PTMC检出率的关键。
[Objective] To explore the main points of pathological diagnosis of frozen section of papillary thyroid microcarcinoma (PTMC) and analyze the causes of misdiagnosis and missed diagnosis of intraoperative frozen section. [Methods] The pathological features of 107 patients with PTMC were retrospectively analyzed. The frozen section, paraffin section and immunohistochemistry results were also analyzed. [Results] The intraoperative frozen sections were diagnosed in 97 cases, delayed diagnosis in 4 cases, misdiagnosis in 4 cases and missed diagnosis in 2 cases. Frozen sections prone to frosted glassy nuclei and nuclear inclusions and other artifacts. The positive rates of CK19, Galectin-3 and TPO in 81 cases of PTMC paraffin sections were 93.8%, 88.9% and 13.6%, respectively. [Conclusion] The nuclear enlargement, irregular nuclear profile and nuclear overlap are the important nuclear parameters of PTMC in the diagnosis of frozen section. It is necessary to confirm the diagnosis of PTMC. Careful dissection, enhanced material and strict diagnostic criteria to avoid misdiagnosis and missed diagnosis, improve PTMC detection rate of the key.