摘要
目的 探讨术中冰冻病理检查在立体定向脑病变活检的应用价值。方法 回顾性分析2015年6月—2021年10月收治的44例接受神经外科机器人辅助立体定向活检的脑深部病变患者临床资料。所有患者行术中冰冻病理,必要时行术中冰冻免疫组化检查。常规病理结果作为诊断金标准,判断冰冻结果的确诊率、延迟诊断率和误诊率,分析术中冰冻病理的诊断阳性率、诊断符合率及其影响因素。结果 44例患者接受46次活检手术,有9例患者首次术中冰冻结果为阴性,其中7例调整穿刺深度再次活检后取得冰冻阳性结果。23例患者通过术中免疫组化及时判断肿瘤类别。最终44例患者(96.65%)术中冰冻结果阳性,诊断符合率91.3%(35例确诊+7例延迟诊断)。穿刺活检结果为胶质瘤27例(WHOⅠ-Ⅱ级6例,WHOⅢ-Ⅳ级21例),淋巴瘤12例,生殖细胞瘤4例,淀粉样变性1例。结论 虽然术中冰冻病理会导致手术耗时增多,但能快速判断立体定向活检标本的性质,避免了过度取材,提高手术效率,减少活检损伤,可应用在神经外科机器人引导下脑病变活检手术中。
Objective To explore the application value of intraoperative frozen section analysis in stereotactic biopsy of brain lesions.Methods The clinical data of 44 patients with brain lesions from June 2015 to October 2021 were analyzed retrospectively.Intraoperative frozen pathology analysis was applied in all 46 procedures,immunohistochemical examination was applied if necessary.Regular pathological results were used as the gold standard for diagnosis,and the diagnostic rate,delayed diagnostic rate and misdiagnosis rate of frozen results were judged.The diagnostic positive rate,diagnostic coincidence rate and influencing factors of frozen pathology during operation were analyzed.Results Of the 44 patients who underwent 46 biopsies,9 patients had negative results in the first intraoperative freezing,and 7 of them had positive results after adjusting the depth of puncture and re-biopsy.23 patients were diagnosed by intraoperative immunohistochemistry.In the end,44 patients(96.65%) had positive intraoperative freezing results,and the diagnostic accuracy rate was 91.3%(35 cases were confirmed+7 cases were delayed).The results of puncture biopsy included 27 cases of glioma(6 cases of WHO grade Ⅰ-Ⅱ,21 cases of WHO grade Ⅲ-Ⅳ),12 cases of lymphoma,4 cases of germinoma,and 1 case of amyloidosis.Conclusions Although intraoperative frozen pathology leads to more operation time consuming,it can quickly uncover the pathology of biopsy specimens,avoid excessive sampling improve operation efficiency and reduce surgical complications.Intraoperative frozen pathology can be applied in robot-assisted stereotactic brain lesion biopsy.
作者
陈志杰
林涛
刘妲
邓斌
张旭标
曾永亲
邓少勇
罗似亮
李海南
成白杰
CHEN Zhi-jie;LIN Tao;LIU Da(Department 2 of Neurosurgery,Guangdong 999 Brain Hospital Affiliated to Medical College of JiNan University,Guangzhou,510510,China)
出处
《临床神经外科杂志》
2023年第2期135-140,共6页
Journal of Clinical Neurosurgery
基金
广东省医学科学技术研究基金项目(A2020505)
广东省医学科学技术研究基金项目(B2023418)。
关键词
立体定向
脑活检术
精确诊断
术中冰冻
诊断阳性率
brain biopsy
intracranial tumor
stereotactic biopsy
intraoperative frozen-section
diagnostic yield
