无染色明视野镜检法在甲状腺癌手术中判定甲状旁腺的 临床应用
| 作者: |
1万光俊,
1方大正,
1沈丰,
1吴红伟,
1周文波
1 湖北医药学院附属东风医院 普通外科，湖北 十堰 442000 |
| 通讯: |
方大正
Email: annluo150174598@sina.com |
| DOI: | 10.3978/.2018.05.005 |
| 基金: | 湖北省十堰市科技局科技基金资助项目（16Y61）。 |
摘要
目的：探讨甲状腺癌术中无染色明视野镜检法判定甲状旁腺的准确性及其临床应用价值。
方法：2016年1月—2017年6月期间共手术治疗357例甲状腺癌患者，对其中115例甲状腺癌患者术中发现的疑似下甲状旁腺组织196枚，每枚疑似下甲状旁腺组织中取出约2 mm3大小样本，分成均等的2份，1份用压片法制成玻璃压片，试行无染色明视野镜检来判定甲状旁腺，另1份行术中冷冻病理检测，以术中冷冻病理为金标准，对这两种方法的判定结果进行比较。
结果：196枚疑似下甲状旁腺组织经无染色明视野镜检法检出甲状旁腺组织142枚，脂肪组织29枚，淋巴结组织17枚，胸腺组织8枚；术中冷冻病理检测检出甲状旁腺组织146枚，脂肪组织27枚，淋巴结组织16枚，胸腺组织7枚。无染色明视野镜检法鉴定甲状旁腺组织的敏感性97.26%、特异性100.00%，脂肪组织的敏感性93.00%、特异性97.63%，淋巴结组织的敏感性88.00%、特异性98.33%，胸腺组织的敏感性83.00%、特异性98.42%。一致性检验结果显示，两种判定方法一致性高，甲状旁腺组织、脂肪组织、淋巴结组织、胸腺组织的κ值分别为0.948、0.875、0.835、0.704。
结论：无染色明视野镜检法在甲状腺癌手术中判定甲状旁腺敏感性和特异性均较高、术中能准确分辨出甲状旁腺组织与其他组织，从而减少甲状旁腺误切和错误自体移植；同时具有操作简便，耗时少、费用低，推荐临床应用。
关键词：
甲状腺肿瘤；甲状腺切除术；甲状旁腺；病理学，外科
方法：2016年1月—2017年6月期间共手术治疗357例甲状腺癌患者，对其中115例甲状腺癌患者术中发现的疑似下甲状旁腺组织196枚，每枚疑似下甲状旁腺组织中取出约2 mm3大小样本，分成均等的2份，1份用压片法制成玻璃压片，试行无染色明视野镜检来判定甲状旁腺，另1份行术中冷冻病理检测，以术中冷冻病理为金标准，对这两种方法的判定结果进行比较。
结果：196枚疑似下甲状旁腺组织经无染色明视野镜检法检出甲状旁腺组织142枚，脂肪组织29枚，淋巴结组织17枚，胸腺组织8枚；术中冷冻病理检测检出甲状旁腺组织146枚，脂肪组织27枚，淋巴结组织16枚，胸腺组织7枚。无染色明视野镜检法鉴定甲状旁腺组织的敏感性97.26%、特异性100.00%，脂肪组织的敏感性93.00%、特异性97.63%，淋巴结组织的敏感性88.00%、特异性98.33%，胸腺组织的敏感性83.00%、特异性98.42%。一致性检验结果显示，两种判定方法一致性高，甲状旁腺组织、脂肪组织、淋巴结组织、胸腺组织的κ值分别为0.948、0.875、0.835、0.704。
结论：无染色明视野镜检法在甲状腺癌手术中判定甲状旁腺敏感性和特异性均较高、术中能准确分辨出甲状旁腺组织与其他组织，从而减少甲状旁腺误切和错误自体移植；同时具有操作简便，耗时少、费用低，推荐临床应用。
Identification of parathyroid glands during thyroid cancer surgery by bright-field microscopy without staining
CorrespondingAuthor:FANG Dazheng Email: annluo150174598@sina.com
Abstract
Objective: To investigate the accuracy and clinical application value of using bright-field microscopy without any staining for identification of parathyroid glands during thyroid cancer surgery.
Methods: Among a total of 357 patients undergoing surgical treatment for thyroid cancer during January 2016 to June 2017, 196 suspected inferior parathyroid tissues were found in 115 cases. A sample about 2 mm3 in size was taken from each suspected tissue, and then evenly divided into two parts. One part was crushed on a glass slide by compression method for parathyroid gland identification using bright-field microscopy without staining, and the other one was sent for intraoperative frozen pathological examination. The results of the two methods were compared using the results of frozen pathological examination as gold standard.
Results: In 196 suspected inferior parathyroid tissues, 142 were identified as parathyroid tissue, 29 as adipose tissue, 17 as lymph node tissue and 8 as thymus tissue by bright-field microscopy without staining; 146 were diagnosed as parathyroid tissue, 27 as adipose tissue, 16 as lymph node tissue and 7 as thymus tissue by intraoperative frozen pathological examination. The sensitivity and specificity of the bright-field microscopy without staining for detecting parathyroid tissue, adipose tissue, lymph node tissue and thymus tissue were 97.26% and 100.00%, 93.00% and 97.63%, 88.00% and 98.33%, and 83.00% and 98.42%, respectively. The results of consistency test showed that there was a high consistency between the two methods, as shown by the κ value for parathyroid tissue of 0.948, adipose tissue of 0.875, lymph node tissue of 0.835 and thymus tissue of 0.835 and 0.704, respectively.
Conclusion: The sensitivity and specificity of bright-field microscopy without staining for parathyroid identification during thyroid cancer surgery are high. It can accurately distinguish parathyroid tissue and other tissues, and thereby reduce inadvertent parathyroidectomy and wrong autologous transplantation. Meanwhile, it has the advantages of simple operation, less time-consuming and low cost. So, it is recommended to be used.
Keywords：
Thyroid Neoplasms; Thyroidectomy; Parathyroid Glands; Pathology
Surgical
Methods: Among a total of 357 patients undergoing surgical treatment for thyroid cancer during January 2016 to June 2017, 196 suspected inferior parathyroid tissues were found in 115 cases. A sample about 2 mm3 in size was taken from each suspected tissue, and then evenly divided into two parts. One part was crushed on a glass slide by compression method for parathyroid gland identification using bright-field microscopy without staining, and the other one was sent for intraoperative frozen pathological examination. The results of the two methods were compared using the results of frozen pathological examination as gold standard.
Results: In 196 suspected inferior parathyroid tissues, 142 were identified as parathyroid tissue, 29 as adipose tissue, 17 as lymph node tissue and 8 as thymus tissue by bright-field microscopy without staining; 146 were diagnosed as parathyroid tissue, 27 as adipose tissue, 16 as lymph node tissue and 7 as thymus tissue by intraoperative frozen pathological examination. The sensitivity and specificity of the bright-field microscopy without staining for detecting parathyroid tissue, adipose tissue, lymph node tissue and thymus tissue were 97.26% and 100.00%, 93.00% and 97.63%, 88.00% and 98.33%, and 83.00% and 98.42%, respectively. The results of consistency test showed that there was a high consistency between the two methods, as shown by the κ value for parathyroid tissue of 0.948, adipose tissue of 0.875, lymph node tissue of 0.835 and thymus tissue of 0.835 and 0.704, respectively.
Conclusion: The sensitivity and specificity of bright-field microscopy without staining for parathyroid identification during thyroid cancer surgery are high. It can accurately distinguish parathyroid tissue and other tissues, and thereby reduce inadvertent parathyroidectomy and wrong autologous transplantation. Meanwhile, it has the advantages of simple operation, less time-consuming and low cost. So, it is recommended to be used.