【摘要】 目的研究细针吸取活检在浅表软组织肿瘤术前病理诊断及鉴别诊断中的应用。方法收集2019—2020年本院行细针吸取活检检查并术前确诊为软组织肿瘤的患者329例,与手术切除组织病理学诊断对比分析。评价细针吸取活检在软组织肿瘤术前病理诊断准确率,分析细胞与组织形态特征,将细针吸取活检与切除标本病理诊断良性和恶性的诊断符合率作为标准,针对各组用χ~2检验进行统计学比较。结果 329例细针吸取活检的诊断符合率94.53%(311/329),其他18例中有13例为无法确诊肿瘤类型和5例误诊;误诊的5例为HE诊断组术前诊断为良性肿瘤,术后诊断为黏液性脂肪肉瘤、高分化脂肪肉瘤和高分化软骨肉瘤; 148例良性肿瘤中未出现过度诊断病理。细胞和组织形态分组中,梭形细胞肿瘤组符合率最高(98.3%),而血管/脂肪组织组符合率(66.67%)较低(P<0.01);非染色组诊断符合率(95.67%)明显低于染色组符合率(74.49%)。结论细针吸取活检在软组织肿瘤术前诊断具有临床应用价值,对临床制定合理的个体化治疗方案尤其高级别肉瘤的术前化疗具有重要临床意义,而脂肪和血管源性肿瘤以及中间型软组织肿瘤的诊断符合率偏低,细针吸取活检诊断时避免误诊和过诊断。更多还原

【Abstract】 Objective To study the application of fine needle biopsy in preoperative pathological diagnosis and differential diagnosis of soft tissue tumors. Methods From 2010 to 2019,329 patients who underwent fine needle biopsy and were diagnosed as soft tissue tumors before surgery were collected from our hospital. We evaluated the accuracy of fine needle puncture cell block in the preoperative pathological diagnosis of soft tissue tumor,and analyzed the characteristics of cell and tissue morphology,the coincidence rate of fine needle puncture cell block and the pathological diagnosis of benign and malignant specimens was used as the standard,and the chi-square test was used for statistical comparison among each of groups. Results The diagnostic coincidence rate was 94. 53%( 311/329) in 329 cases of fine needle puncture cells,and 13 of the other 18 cases were of undiagnosed tumor type and 5 were misdiagnosed. Five patients with misdiagnosis were diagnosed as benign tumor before operation,and were diagnosed as mucous liposarcoma,highly differentiated liposarcoma and highly differentiated chondrosarcoma after operation. No overdiagnosis was found in 148 benign tumors. Among the cell and tissue morphology groups,the fusiform cell tumor group had the highest coincidence rate( 98. 3%),while the vascular/adipose tissue group had the lowest coincidence rate( 66. 67%)( P< 0. 01). The diagnostic coincidence rate of the non-staining group( 95. 67%) was significantly lower than that of the staining group( 74. 49%). Conclusion Fine needle puncture cells block in the preoperative diagnosis of soft tissue tumor has clinical application value,especially in clinical setting reasonable individualized treatment program of high grade sarcoma before chemotherapy. The diagnosis coincidence rate of adipose and vascular tumors and intermediate soft fissue tumors is low,and therefore fine needle puncture cell diagnosis should be avoided misdiagnosis and the diagnosis.更多还原