细胞蜡块在乳腺肿块细针穿刺细胞学中的应用

目的探讨细胞蜡块(cell block,CB)技术在乳腺肿块细胞学诊断中的应用价值。方法对327例乳腺肿块患者行细针穿刺细胞学(fine needle aspiration cytololgy,FNAC)检查,并制作CB,与术后组织学病理诊断结果进行对比分析。结果经组织病理学对照,FNAC诊断敏感度为95.96%,特异度为96.12%,假阳性率为3.88%,假阴性率为4.04%,阳性预示值为97.44%,阴性预示值为93.94%,诊断准确率为96.02%。CB联合FNAC诊断敏感度为97.98%,特异度为98.45%,假阳性率为1.55%,假阴性率为2.02%,阳性预示值为98.98%,阴性预示值为96.95%,诊断准确率为98.17%。结论 CB可以弥补FNAC的不足,CB联合FNAC检测可有效提高诊断敏感度、特异度及准确率。     

对乳腺肿物针吸细胞学诊断标准的探讨——951例细胞学与组织学的对照分析

目的：探讨乳腺肿物针吸细胞学检查（FNAC）的基本形态学要素及拟定的诊断标准的可靠性与局限性。方法：对4309例患者行FNAC检查,其中951例获得组织病理学核对。结果：413例针吸涂片中,多数性质相同的病例显示具有相对一致的形态学变化特征。732例恶性肿瘤诊断的敏感性为97．3％,219例良性病变诊断的特异性为97．7％,总准确率为97．4％;假阴性率为2．7％,潜在假阳性率为2．3％,无1例假阳性,总误诊率为2．6％。结论：（1）导管上皮细胞分化、排列方式以及良性裸核细胞的数量是分析乳腺肿物FNAC形态学变的3个基本要素。（2）拟定的乳腺肿物FNAC诊断标准检查结果可靠性很强;但仍存在一定的局限性,需要通过病理组织学诊断解决。     

两种不同针吸细胞学操作流程的诊断准确率比较

目前乳腺肿块术前细针吸取细胞学检查已在国内医院较广泛开展 ,其对乳腺肿块性质的术前诊断准确性已达70 %～ 98% ,是目前公认的最为可靠有效的诊断方法之一[1,2 ] ,但其操作技术工作流程上仍有多种方式 ,导致临床工作中诊断准确性高低不一 ,甚至发生漏误诊。我们针对人员操作技术流程环节 ,对 5 88例乳腺组织肿块应用穿刺 制片 诊断细胞学 (简称三位一体 )法和非三位一体法操作技术流程 ,将术前穿刺细胞学诊断与术后病理结果进行对照研究 ,进一步探讨针吸细胞学诊断工作的最佳模式 ,提高细胞学诊断的准确性。一、材料和方法收集本院 1996～…     

经皮细针肺穿刺108例细胞学分析

对肺部有肿块,而胸片、痰液以及支气管镜检查未能明确其性质的108例患者,行经皮细针肺穿刺之细胞学诊断分析。108例中,22例仅作单纯细胞学诊断,86例有外科手术切除标本之病理、超微结构或其它化验检查证实。肿块直径为1cm～5cm。细胞学与手术切除标本或活检的病理诊断的符合率为93.0%(80/86),假阴性3例,假阳性3例。文中对各种不同病变的细胞学特征,假阴性和假阳性的原因以及经皮细针肺穿刺的实用价值进行了分析讨论。     

罕见乳腺病变的细胞学特点

细针吸取细胞活检是良性及恶性乳腺病变手术前的主要检查方法。相对于带芯针穿组织活检 ,细针吸取细胞活检具更快速、更经济、痛楚少和基本无合并症的优点。但在另一方面 ,由于直接细胞涂片和离心细胞涂片在保持组织结构方面逊于组织活检 ,要减少假阳性和假阴性 ,诊断者的经验就成为准确诊断的关键。细胞学诊断低分化的乳腺导管癌 ,一般不难。但要正确诊断良恶交界或是罕见的乳腺病变 ,就要在熟悉常见病变细胞学特点的基础上 ,留意罕见病变独特的、有时可能是非常细微的变化。这些罕见病变都有各自的细胞学特征。认识这些细微又独特的细胞学…     

60例乳腺肿块穿刺细胞学分析

乳腺肿块针吸细胞学检查 (ＦＮＡＣ)是一种利用活检针或注射器对乳腺肿块进行细胞病理学检查的方法。目前 ,ＦＡＮＣ已成为重要的乳腺肿块辅助诊断方法。1　材料与方法1 .1　材料　所选 60例为我院病理科 2 0 0 0～ 2 0 0 1年 1 0月接受的ＦＡＮＣ的合格标本。其中 33例为女性 ,年龄 2 6～ 70岁 ,经病理组织学诊断 ,恶性肿瘤 2 3例 ,良性肿瘤 1 0例。1 .2　方法　 1 0ｍｌ注射器 (6号针头 ) ,具体操作步骤 :消毒后 ,左手固定肿物并绷紧皮肤 ,用右手将针头经皮刺入肿块 ,利用注射器持续负压 ,在肿物内不同方向进退数次 (注意把持稳器械以免损…     

乳腺黏液腺癌的细针吸取细胞学诊断价值及标准

目的 探讨细针吸取细胞学(FNAC)在诊断乳腺黏液腺癌中的价值及标准。方法 对14例乳腺黏液腺癌FNAC涂片的基本形态学要素进行回顾性比较研究,并对细胞学诊断为Ⅰ～Ⅲ级的病例进行原因分析。结果 乳腺黏液腺癌核级主为1—2级,属轻～中度异型性,诊断敏感性为71．4％,假阴性率为28．6％。14例均出现多少不等的黏液,12例出现三维结构为主以及弥散为主的细胞排列方式,11例出现中度异型的游离肿瘤细胞。乳腺纯黏液腺癌组4例出现砂粒体。结论 只要掌握乳腺黏液腺癌FNAC涂片基本形态特征,FNAC诊断乳腺黏液腺癌是可行的。     

常用检查方法对乳腺癌诊断价值的比较研究

目的 :比较电脑近红外线扫描、 B超 ,钼靶 X线摄片和针吸细胞学检查对乳腺癌的诊断价值。方法 :将 6 3位女性乳腺癌患者的电脑近红外线扫描、 B超、钼靶和针吸细胞学检查和病理诊断进行对比。结果 :电脑近红外线扫描、 B超、钼靶和针吸细胞学检查对乳腺癌的诊断准确率分别为 85 .7% ,6 3.1% ,72 .6 %和 83.3%。结论 :电脑近红外线扫描检查简便、无创伤、诊断准确率也较高 ,尤其对早期乳腺癌有较高的诊断价值。联合检查能大大提高诊断准确率。     

乳腺核芯针穿刺病理诊断的准确性

目的 提高乳腺核芯针穿刺病理诊断的准确性.方法 回顾性观察解放军总医院病理科2004年1月至2007年6月667例超声引导下乳腺核芯针穿刺连续病例,主要以先行核芯针穿刺活检,随后切除病变的患者为研究对象,对比核芯针穿刺与手术切除标本的病理形态,分析诊断差异的原因.结果 382例核芯针穿刺后行局部病变切除、保乳手术和乳房切除术,切除手术后病理诊断为恶性者281例,其中假阴性4例,假阴性率为1.4%.无假阳性病例.低估者28例,导管原位癌低估者为6/11,高估者2例.核芯针穿刺诊断的准确率为94.7%(266/281).结论 了解乳腺核芯针穿刺取材的局限性,善用免疫组织化学指标,掌握少见病变,才能减少低估和高估病例、杜绝假阳性病例.病理医师应在保证诊断准确的前提下,尽可能细化诊断.     

乳腺核芯针穿刺病理诊断的准确性

目的 提高乳腺核芯针穿刺病理诊断的准确性.方法 回顾性观察解放军总医院病理科2004年1月至2007年6月667例超声引导下乳腺核芯针穿刺连续病例,主要以先行核芯针穿刺活检,随后切除病变的患者为研究对象,对比核芯针穿刺与手术切除标本的病理形态,分析诊断差异的原因.结果 382例核芯针穿刺后行局部病变切除、保乳手术和乳房切除术,切除手术后病理诊断为恶性者281例,其中假阴性4例,假阴性率为1.4%.无假阳性病例.低估者28例,导管原位癌低估者为6/11,高估者2例.核芯针穿刺诊断的准确率为94.7%(266/281).结论 了解乳腺核芯针穿刺取材的局限性,善用免疫组织化学指标,掌握少见病变,才能减少低估和高估病例、杜绝假阳性病例.病理医师应在保证诊断准确的前提下,尽可能细化诊断.     

提高乳腺肿物针吸细胞学诊断正确率措施的探讨

目的探讨提高乳腺肿物针吸细胞学（ＦＮＡＣ）诊断正确率、降低误诊率、规范诊断报告形式及充分发挥其作用的措施。方法对１６２９例病人行ＦＮＡＣ检查，其中４４４例获病理组织学核对。结果３０７例恶性肿瘤诊断的敏感性和１３７例良性病变诊断的特异性分别为９５．８％和９８．５％，总正确率为９６．６％；假阴性率为４．２％，潜在假阳性率为１．５％，无１例假阳性，总误诊率为３．４％。结论我们认为（１）使用优良的穿刺器械及制片技术，实行“一体化”工作程序，认真进行细胞学与组织学对照，对提高乳腺肿物ＦＮＡＣ诊断正确率及降低误诊率具有重要意义。（２）Ｂｅｔｈｅｓｄａ乳腺ＦＮＡＢ统一方案中提出的诊断报告形式值得借鉴。（３）ＦＮＡＣ在乳腺肿物的诊治中能够发挥出更重要的作用。     

A comparative analysis of core needle biopsy and fine-needle aspiration cytology in the evaluation of palpable and mammographically detected suspicious breast lesions

The present study was undertaken to compare the efficacy of needle core biopsy (NCB) of the breast with fine-needle aspiration cytology (FNAC) in breast lesions (palpable and non-palpable) in the Indian set-up, along with the assessment of tumor grading with both the techniques. Fifty patients with suspicious breast lesions were subjected to simultaneous FNAC and ultrasound-guided NCB following an initial mammographic evaluation. Cases were categorized into benign, benign with atypia, suspicious and malignant groups. In cases of infiltrating duct carcinomas, grading was performed on cytological smears as well as on NCB specimens. Both the techniques were compared, and findings were correlated with radiological and excision findings. Out of 50 cases, 18 were found to be benign and 32 malignant on final pathological diagnosis. Maximum number of patients with benign diagnosis was in the fourth decade (42.11%) and malignant diagnosis in the fourth as well as fifth decade (35.48% each). Sensitivity and specificity of mammography for the diagnosis of malignancy was 84.37% and 83.33%, respectively. Sensitivity and specificity of FNAC for malignant diagnosis was 78.15% and 94.44%, respectively, and of NCB was 96.5% and 100%, respectively. But NCB had a slightly higher specimen inadequacy rate (8%). NCB improved diagnostic categorization over FNAC by 18%. Tumor grading in cases of IDC showed high concordance rate between NCB and subsequent excision biopsy (94.44%) but low concordance rate between NCB and FNAC (59.1%). NCB is superior to FNAC in the diagnosis of breast lesions in terms of sensitivity, specificity, correct histological categorization of the lesions as well as tumor grading.     

Contribution of fine needle aspiration cytology to diagnosis and management of thyroid disease.

AIMS: To determine the role of fine needle aspiration cytology (FNAC) in the diagnosis and management of thyroid disease. METHODS: Clinical histories of 144 patients who had undergone FNAC of the thyroid were analysed. Clinical presentation, non-invasive investigations including hormone assays, ultrasound, and isotope scan procedures were compared with FNAC diagnoses in all cases and with histological diagnosis in the 28 cases (19%) that had undergone surgery. Clinical management was decided upon combining all of the above investigations. The relative contribution of the FNAC was divided into: essential, additional and non-contributory, misleading. RESULTS: FNAC diagnoses included: 29 (16%) benign colloid goitre, 56 (39%) benign cystic goitre, 24 (17%) thyroiditis, and 22 (15%) neoplasms. Nineteen (13%) of the specimens were unsatisfactory. When compared with clinical diagnoses based on non-invasive diagnostic investigations FNAC represented no improvement on the diagnosis of benign colloid/cystic goitre (55% v 54% respectively). It represented an improvement on the diagnosis of thyroiditis (9% v 17% respectively). FNAC decreased clinically suspicious lesions in which 22 neoplasms were diagnosed from 37% to 15%. Eleven patients with neoplasms underwent surgery and neoplasms were confirmed histologically. Others including lymphoma, metastatic carcinoma, and analplastic carcinoma were managed conservatively. There were four false negative FNAC diagnoses (3%) in clinically suspicious lesions, found on histology to be benign follicular adenomas. CONCLUSIONS: FNAC had an essential role in the diagnosis and management of 23% of our patients, a confirmatory role in 61% of patients, a non-contributory role in 13% when specimens were inadequate, and was misleading in 3% where results were false negative. The positive identification of thyroiditis and neoplasia stands on its own as a justification for FNAC.     

Image-directed percutaneous FNAC of ovarian neoplasms

Fine needle aspiration of ovarian neoplasms is a relatively less frequented area of diagnostic aspiration cytology. Hence, an attempt has been made in the present study to evaluate the current status of Image-directed percutaneous needle aspiration in ovarian neoplasms and to assess its value and limitations in the diagnosis and management of ovarian neoplasms. The present study involves 105 cases of ovarian neoplasms, which were assessed by ultrasound-guided FNAC. Only those cases with adequate material on aspiration and availability of cellblock or biopsy material following FNAC for correlative histopathological study were included in the study. The diagnostic accuracy of ovarian neoplasms in the present study was 89.85%, with a false negative rate of 4.76%. Considering the rapidity and reliability of the procedure with its added advantages like cost-effectiveness and increased patient acceptability, it can be concluded that image-guided FNAC holds a key position in the diagnosis and management of ovarian neoplasms.     

Role of fine needle aspiration cytology in the diagnosis of goiter

Enlargement of the thyroid gland is a common occurrence in most parts of the world especially in the iodine-deficient goiter belt areas. Vast majority of these lesions are benign but they invariably lead to a series of investigations among which FNAC plays a pivotal role. Although many studies have reported diagnostic accuracy of FNAC in detecting neoplasms, there have been few studies where the role of FNAC in the diagnosis of goiter along with their diagnostic pitfalls has been evaluated. The present study was undertaken to assess the accuracy of FNAC in diagnosis of goiter and to highlight its limitations and diagnostic pitfalls. 771 cases over a five-year period were retrieved from the files of Cytopathology Laboratory, Department of Pathology at the All India Institute of Medical Sciences, New Delhi. They included 733 cases where the cytological diagnosis was goiter or suggestive of goiter along with 38 cases in which the histological diagnosis was goiter while the cytological diagnosis was cystic change or neoplasm. FNAC with minimum of two passes were performed in each case and May Grünwald Giemsa and Papanicolaou stains were done. Histology was available in 192 cases. The cytological and histological concordance was determined and the FNAC smears and histological sections in cases showing discordance were reviewed. There was cytological and histological concordance 130/168 (77.38%) cases. In 34 cases (20.23%) no diagnosis could be offered because of cystic change. A false positive cytologic diagnosis of neoplasm was made in 4 cases. Presence of hurthle cell metaplasia, hyperplastic nodules and papillary hyperplasias were responsible for the false positive diagnoses. In 24 cases neoplasms were initially missed on FNAC of which 10 cases could be detected on review while 5 cases were considered unsatisfactory. Sampling errors were mainly responsible for these false negative diagnoses. FNAC is thus an accurate and reliable diagnostic tool for management of goiters provided strict adherence to adequacy criteria are maintained.     

Fine-needle aspiration cytology of salivary glands: diagnostic pitfalls--revisited

Fine needle aspiration cytology (FNAC) of salivary gland lesions is a safe, effective diagnostic technique. Several amply illustrated reviews are available in the English literature. The reported diagnostic accuracy varies between 86% to 98%. The sensitivity ranges from 62% to 97.6% and specificity is higher from 94.3% to 100%. In this present study, we have analyzed 172 cases of salivary gland aspirates and the histopathological diagnosis was available in 45 cases. There was discordance in cytological and histopathological diagnosis in nine cases. Five cases had discrepancies in benign versus malignant diagnosis with four cases being false negative. The errors in these FNA diagnoses were due to sampling error, observational error and interpretational error. Therefore, this study illustrates high diagnostic accuracy of FNAC in salivary gland lesions and shows that FNAC offers valuable information that allows the planning of subsequent patient management.     

Should fine‐needle aspiration cytology be the first choice diagnostic modality for assessment of all nonpalpable breast lesions? The experience of a breast cancer screening center in Alexandria,Egypt

Fine‐needle aspiration cytology (FNAC) of breast masses has been replaced by ultrasound‐guided core‐needle biopsy (USG‐CNB) in many countries. However, in Egypt, breast FNAC continues to play the major role in diagnosing breast masses. In this prospective study, we evaluated the efficacy of USG‐FNACs performed at a breast cancer screening center by comparing the FNAC results with the corresponding definitive histological examination outcome. We also investigated the role that CNB can play as a complementary diagnostic tool for FNAC in selected cases. A total of 229 consecutive nonpalpable breast masses were included in this study. Each FNAC was placed into one of four categories: 3.5% nondiagnostic, 13.5% benign, 12.3% atypical/suspicious (indeterminate), and 70.7% malignant. The overall diagnostic accuracy was 98.9%, with a specificity and sensitivity of 99.3 and 96.7%, respectively. The overall positive predictive values and negative predictive values were 99.3 and 96.7%, respectively. Only 37 masses (16%) were converted to CNB, with the indeterminate cytology being the most common cause (54%) for this conversion. Two cases demonstrating the superior benefit of FNAC over CNB are illustrated. Although we started the study by reserving CNB as a first choice to assess microcalcifications without architectural distortion, we ended the study by deciding to perform combined FNAC and CNB for this type of lesions. In conclusion, aiming to maximize the preoperative diagnosis of cancer, it would be cost efficient and time saving to use FNAC as a first‐line investigation to benefit from the wealth of cytological information yielded, followed by CNB in selected cases. Diagn. Cytopathol. 2010;38:880–889. © 2010 Wiley‐Liss, Inc.     

Papillary lesions of the breast—accuracy of core biopsy

Tse G M, Tan P‐H, Lacambra M D, Jara‐Lazaro A R, Chan S‐K, Lui P C, Ma T K F, Vong J S, Ng D C H, Shi H‐J & Lam W W
(2010) Histopathology 56 , 481–488 Papillary lesions of the breast—accuracy of core biopsy Aims: To assess the accuracy of diagnosing papillary breast lesions in core needle biopsy. Methods and results: One hundred biopsy specimens of papillary breast lesions were reviewed and compared with the final excisional diagnoses. The discordant biopsy specimens were stained for oestrogen receptor (ER), cytokeratin (CK) 14 and p63, and these specimens were reclassified based on these results. The overall core biopsy accuracy, false‐positive and false‐negative rate were 79%, 5% and 16%, respectively. A benign core biopsy specimen diagnosis gave a false‐negative rate of 10%, and malignant core biopsy specimen diagnosis did not give any false‐positive results. Using homogeneous ER (epithelial), positive CK14 (epithelial) and p63 (myoepithelial) immunoreactivity as benign criteria, the discordant rate was reduced by 30% and 69% when using all three or two of these three criteria for diagnosis. However, false‐positive and ‐negative cases could not be totally eliminated. Conclusions: Immunohistochemistry is helpful in core biopsy diagnosis of papillary breast lesions, but some cases remained misdiagnosed.     

Diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in bone and soft tissue tumor: A comparative study of the image-guided and blindly performed procedure

IntroductionFine needle aspiration cytology (FNAC) and core needle biopsy (CNB) can provide tissue samples for the diagnoses of bone and soft tissue tumors. We evaluated the diagnostic accuracy of FNAC and CNB, the usefulness of the image-guided needle procedures, and assessed whether a discordance can influence the prognosis.Patients and methodsWe retrospectively examined the accuracy rates of FNAC and CNB procedures by analyzing results of 405 specimens of 389 patients. We evaluated the diagnostic accuracy of FNAC and CNB, compared the clinical effectiveness between the image-guided procedures and the blind procedures, and also compared survival rates between the true positive and the false negative cases for patients with high-grade malignant tumors.ResultsThe accuracy rates of FNAC were 86.6% and 93.8% for CNB. In cases with non-palpable masses, there were significantly low sampling error rates in the image-guided procedure. There were no significant differences in progression-free-survival and overall survival rates in patients between the false negative and true positive cases.ConclusionBoth FNAC and CNB procedures had high accuracy rates. Limited to cases with no palpable masses, the image-guided procedure had a low sampling error rate and was an effective method for obtaining tissue samples.