超声波快速石蜡细胞块切片技术在细针穿刺活检中的应用

细针穿刺(fine needle aspiration，FNA)细胞学检查可以对体表及实质器官的肿块作定性及分类诊断，但有局限性，对少见疑难病难以定性和分类，文献报道细胞块切片可一定程度地弥补细胞学诊断的局限性，因在制作细胞块切片过程中可部分恢复原组织结构，其中的微小组织碎片经切片也更清楚地显示其组织学特征，对疾病的病理诊断、分类有一定帮助。     

液基细胞学与经支气管针吸活检在肺癌诊断中应用

目的探讨液基细胞学(liquid-based cytology,LBC)与经支气管针吸活检(transbronchial needle aspiration,TBNA)在肺癌诊断中的应用价值。方法 TBNA取材共833例,其中674例常规制备传统涂片(conventional smears,CS)后制备LBC涂片,余159例仅制作CS,比较两种制片方法在TBNA细胞病理学诊断中的差异和优、缺点,并将细胞病理学诊断与组织病理学相比较。结果 CS标本不满意率为16.4%,高于LBC涂片的标本不满意率(10.2%)。TBNA标本中LBC诊断肺癌的敏感性和准确性分别为93.5%和95.3%,CS敏感性和准确性分别为93.8%、95.3%,统计学显示两种方法的敏感性及准确性均无差异。18.5%(5/27)可疑癌病例应用LBC可得以确诊。两种制片方法得出阳性病例的分型准确率无差异。鳞癌、腺癌和小细胞癌与组织病理诊断的符合率分别为93.5%、98.3%和100%。结论在TBNA标本中应用LBC诊断肺癌的敏感性和准确性高、分型准确,与组织病理诊断符合率高,且与CS合用有互补作用。此外,LBC标本不满意率低,细胞结构清楚、背景干净、涂片数量少、阅片时间明显缩短。     

颈部淋巴结针吸细胞学580例诊断分析

目的 探讨颈部淋巴结针吸细胞学诊断的准确率及误诊原因.方法 分析580例颈部淋巴结针吸细胞学检查结果.其中161例在原部位取活检,分析针吸细胞学与组织学诊断符合率及误诊原因.结果 580例中淋巴结反应性增生226例,特异性炎202例,恶性淋巴瘤45例,转移癌107例.161例针吸细胞学与组织学诊断符合率为94.4%.107例转移癌中96例经临床及病理检查确定了原发灶.细胞学与组织学对照结果显示,细胞学检查有9例误诊,针吸细胞学误诊主要原因是吸取组织量少,对病变了解不全面;误诊病例结合病史及临床表现均有考虑到其他疾病的可能性.结论 颈部淋巴结针吸细胞学诊断准确率较高,但对可疑病变及原发肿瘤的分型,针吸细胞学仅可给予提示件初步诊断,需经组织学活检,必要时免疫组织化学诊断分型.     

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～…     

浸润性乳腺癌术前FNA近似分子分型的临床意义

目的探讨浸润性乳腺癌术前细针吸取细胞学(fine needle aspiration,FNA)近似分子分型的可行性及临床意义。方法对42例女性原发性乳腺癌患者术前行细针穿刺术,涂片后进行细胞学诊断。利用免疫细胞化学技术检测ER、PR、HER2、CK5/6和EGFR表达情况,将乳腺癌近似分为腺腔A型(Luminal A)、腺腔B型(Luminal B)、纯HER2过表达型(pure HER2-overexpressing)、基底样型(basal-like)、HER2过表达基底样型(basal-HER2)及正常乳腺型(null)6个分子亚型。将其与术后对应标本的病理学及免疫组化结果进行比较。结果术前穿刺涂片诊断为"高度可疑乳腺癌"及"乳腺癌"的42例女性患者,经术后病理组织学证实均为浸润性乳腺癌,细胞学诊断准确率为100%。在42例乳腺癌细针吸取细胞涂片上利用免疫细胞化学进行术前各分子标记的检测,其中ER/PR阳性率为52.38%(22/42),HER2阳性率为42.86%(18/42),EGFR/CK5/6阳性率为19.04%(8/42)。相对应的石蜡切片经免疫组化检测,ER/PR阳性率分别为52.38%(22/42),HER2阳性率为40.48%(17/42),EGFR/CK5/6阳性率为23.81%(10/42)。其中,1例细胞涂片HER-2为阳性,而对应的石蜡切片为阴性;2例石蜡切片EGFR为阳性,而对应的细胞涂片为阴性,两种方法差异无统计学意义(P>0.05)。结论 FNA是术前诊断乳腺癌准确、易行的方法之一。浸润性乳腺癌术前FNA近似分子分型简单明了,切实可行。其有助于术前掌握乳腺癌的生物学特征,可能成为指导术前新辅助化疗、术式选择的有用指标。     

700例针吸细胞学检查诊断分析及体会

1985年～1986年,针吸细胞学检查诊断700例,经组织学证实288例,其中病理证实的65例恶性肿瘤中针吸检查有60例符合,漏诊率为7.7%,223例良性肿瘤针吸检查符合数221例,漏诊率为0.9%。认为针吸涂片能充分显示细胞形态结构,细胞新鲜,结构清晰,不但能确定肿瘤性质,并能对其进一步分类,对非肿瘤性病变也能作出明确诊断。对乳腺囊肿可达治疗和诊断的目的。且操作简便安全,诊断快速,准确可靠。可部分代替术中的冰冻切片,具有重要的临床实用价值。     

细针穿刺细胞学与小切片对照诊断分析

细针穿刺细胞学与小切片对照诊断分析殷凤泉，刘俊英利用简便、安全的细针吸取术对肿块做生物学诊断是一种直接、快速、准确、经济的方法。我们对体表或接近体表的脏器内肿块行细针穿刺，并制订了＂三步法＂。细胞学诊断为第一步。用斜面刀刃式细针穿刺吸取细胞的同时，切...     

细针吸取活检切片技术及其实用价值

细针吸取(FNA)细胞学涂片检查已广泛应用于肿瘤及其他疾病的诊断,但由于涂片不可能十分均匀,常因细胞的重叠堆积而影响观察。近期国外对于FNA切片技术屡有报道,但实践总结资料不多。本文通过121例FNA切片与相应涂片及部分术后组织切片的对照分析,对其实用价值做出初步评价。     

内镜超声引导下胰腺占位性病变细针穿刺液基细胞学诊断北大核心CSCD

目的探讨沉降式液基细胞学（LCT）制片技术在胰腺占位性病变内镜超声引导下细针穿刺（EUS-FNA）细胞学诊断中的应用价值。方法回顾性分析556例胰腺占位的EUS-FNA样本的LCT涂片,参照2014版胰胆管细胞学诊断指南进行分级诊断。其中164例依据手术切除标本或穿刺活检组织病理结合免疫组织化学获得病理诊断,以此为金标准,分析LCT诊断的准确性及影响因素,并分析细胞学诊断错误的原因。结果EUS-FNA的样本满意率96.0%（534/556）,LCT诊断的敏感性87.7%（128/146）、特异性13/16、阳性预测值97.7%（128/131）、阴性预测值41.9%（13/31）和诊断准确率87.0%（141/162）。囊性占位的细胞学诊断的准确率低于实性占位;不同组织学类型中,腺癌、淋巴瘤、神经内分泌肿瘤的细胞学敏感性明显高于囊性肿瘤及间叶源性肿瘤。假阳性病例多因炎性反应导致上皮出现不同程度的异型性而报告＂异型＂,假阴性病例多数为穿刺未取到肿瘤细胞或是肿瘤细胞少、异型性小而致漏诊。结论EUS-FNA的LCT检测是诊断胰腺占位的有效工具,统一规范的诊断术语和分类有助于提高诊断的准确性和可重复性。     

CT引导下经皮肺穿刺细胞学和组织学联合检查的诊断价值

目的探讨CT引导下经皮肺穿刺细胞学和组织病理学联合检查在肺部周围性和弥漫性病变诊断中的价值。方法回顾性分析370例CT引导下经皮肺穿刺标本,分析细胞学与组织病理学诊断方法的相关性,比较细胞学、组织病理学以及两者结合诊断的敏感性、假阴性率,分析细胞学分型的准确率。结果 370例肺穿刺标本中,组织病理学诊断为癌、恶性肿瘤、疑癌、异型和阴性的例数分别为177(47.84%)、22(5.95%)、16(4.32%)、12(3.24%)和143(38.65%),细胞学诊断相应的例数为166(44.87%)、10(2.70%)、16(4.32%)、49(13.24%)和129(34.87%),两种检测方法结果相关(P0.001)。细胞学诊断敏感性为80.00%(192/240),组织病理学诊断敏感性为89.58%(215/240),两者结合诊断敏感性为98.33%(236/240),细胞学诊断与组织病理学诊断的敏感性差异有显著性(P0.05),组织病理学与两者结合诊断敏感性差异有显著性(P0.05)。细胞学阳性病例分型准确率为66.15%(127/192)。术中及术后并发症为14.59%,其中气胸31例,针道出血或痰中带血23例,均经相应处理后好转。结论 CT引导下经皮肺穿刺对于肺部病变是安全的、高敏感性和高准确性的定性诊断方法,同时行细胞学和组织病理学检查可显著提高诊断率,临床应用价值高。     

Fine-needle aspiration of the liver. A comparison of smear and rinse preparations in the detection of cancer

Fifty-nine successive cases of fine-needle aspiration (FNA) of the liver were reviewed to determine the efficacy of various rinse and smear preparations in rendering a diagnosis of cancer. Preparations included Papanicolaou- and Diff-Quik-stained smears, Millipore filters, cytocentrifugation, and cell blocks. Of 33 of 59 cases diagnostic for cancer, 90% were positive on rinse, 78% on smear, and 69.6% on both rinse and smear. Seven cases (21.2%) were diagnostic on rinse preparation only and would otherwise have been interpreted as equivocal. Papanicolaou smears and cell block rinses were most valuable to evaluate malignancy in the liver, using the FNA technic. The authors believe rinse preparations justify their cost for assessment of cancer and are essential to establish the diagnosis in a significant number of cases.     

Evaluation of aspiration cytology of the liver space occupying lesions by simultaneous examination of smears and cell blocks

This study was undertaken to compare the efficacy of cytologic smears and histological sections from cell blocks in diagnosis of space occupying lesions (SOLs) of the liver and to classify the lesions on the basis of combined cytohistologic diagnosis. The study was conducted on 50 patients who had radiologically detected SOL/SOLs in the liver and ultrasound‐guided fine needle aspiration of liver was done. In all the cases, both smears and cell blocks were made. Forty‐seven cases were diagnosed as malignant and three as benign on both cytologic smears and cell blocks. Hepatocellular carcinoma was diagnosed in 8 (16%) cases and metastasis in 39 (78%) cases. The subtyping of malignancy could not be done on 11 (22%) cytologic smears and 8 (16%) cell block sections. However, on combined cytohistologic correlation, 17 (34%) out of these 19 (38%) cases could be subtyped. Sensitivity of cytologic smears and cell blocks in subtyping of malignancy was 72.3% and 82.9%, respectively. Combined cytohistologic diagnosis was found to be significantly better than isolated cytologic and cell block diagnosis (P ≤ 0.05). To conclude, FNA of the SOLs of the liver is an effective procedure for diagnosing malignancy. However, cytological examination alone may fail to pinpoint the type of the tumor. Concomitant examination of cell block not only confirms the malignancy but also helps in subtyping it. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Ultrasound-guided fine-needle aspiration biopsy of the thyroid: role of on-site assessment and multiple cytologic preparations

Several studies have shown that ultrasound guidance can serve as a valuable aid in improving the diagnostic yield of fine-needle aspiration (FNA) biopsy of thyroid nodules. In this study, we evaluated the combined impact of ultrasound-guidance, rapid on-site evaluation of FNA specimens, and different cytologic preparations (fresh and alcohol-fixed smears, Millipore filter) and staining methods (Diff-Quik and Papanicolaou stains) on the diagnostic yield of thyroid FNA. Ultrasound-guided FNA was performed on 282 patients (313 cases) between November 1997 and April 1999. The diagnostic categories included: benign (198 cases, 63.2%); indeterminate (42 cases, 13.4%); suspicious for follicular variant of papillary carcinoma (26 cases, 8.3%), malignant (32 cases, 10.1%); and nondiagnostic (15 cases, 5%). The nondiagnostic cases also included 6 cystic lesions without any solid component and 3 thyroid-bed aspirations. After excluding these, the nondiagnostic rate was only 2%. Histological follow-up was available in 77 (77/313) cases. The concordance rate between cytological and histological diagnosis was 100% in malignant, 67% in suspicious, and 56% in indeterminate cases. All cases with histologic follow-up were selected to evaluate the independent diagnostic efficacy of each aforementioned cytologic staining method. A definite diagnosis could be made solely on the basis of air-dried, Diff-Quik-stained preparations in 50 (65%), alcohol-fixed, Papanicolaou stained smears in 68 (88%), and Millipore filter preparations in 70 (91%) cases. We conclude that ultrasound-guided FNA combined with on-site evaluation and different cytologic preparations can significantly improve the diagnostic accuracy of thyroid FNA specimens.     

Fine-needle aspiration: Comparison of smear,cytospin, and cell block preparations in diagnostic and cost effectiveness

We compared the results of smears to those of cytospin and cell block preparations from fine-needle aspirations to determine the cost effectiveness of each and to determine which should be routinely obtained. We reviewed 844 cases, 361 of which had both smears and cytospins, and 483 of which had both smears and cell blocks. Smears alone were diagnostic in 94% of cases (796/844 cases), cytospins alone diagnostic in 43% of cases (154/361 cases), and cell blocks alone diagnostic in 57% of cases (277/483 cases). Cytospins contributed additional information beyond that obtained from smears in 2% (7/361) and cell blocks in 12% (57/483) of cases. When smears were nondiagnostic, cytospins contributed additional information in 10% (2/21) of cases and cell blocks contributed additional information in 44% (12/27) of cases. The cost of providing a diagnosis from smear alone is $212, from cytospin alone is $352, and from cell block alone is $392. The cost for additional information established by cytospin is $7,736 and by cell block the cost is $1,906. Smears are superior to either cytospins or cell blocks in providing a diagnosis. It is not cost-effective to obtain either cytospins or cell blocks in addition to smears on all cases. However, it is cost-effective to obtain cell blocks when the immediate smear evaluation is nondiagnostic. Diagn. Cytopathol. 1998;19:70–74. © 1998 Wiley-Liss, Inc.     

Cytologic diagnosis of gastrointestinal stromal tumors of the stomach by endoscopic ultrasound-guided fine-needle aspiration biopsy: cytomorphologic and immunohistochemical study of 12 cases.

Gastrointestinal stromal tumor (GIST) is an uncommon tumor, which was usually diagnosed by endoscopic biopsy or surgical resection. This study evaluated the efficacy and accuracy of endoscopic ultrasound (EUS) -guided fine-needle aspiration (FNA) biopsy in the diagnosis of GIST and reported its cytomorphologic features. Twelve patients with gastric GIST were diagnosed through EUS-guided FNA. Immediate on-site evaluation and cytologic diagnoses were given in nine cases (75.0%) with an average of three passes. Cell blocks provided diagnostic material in three cases (25.0%). Spindle cells were present in the cytologic material in all cases. Two patients had subsequent surgical resections. Immunohistochemical (IHC) studies performed in cell blocks and two surgical specimens all supported the original diagnoses. In the two cases with surgical resections, IHC results in cell blocks were similar to that in the resected specimens. This study demonstrated that when combining smears and cell blocks, EUS-guided FNA is accurate and efficient in the diagnosis of GIST. IHC reactivity in cell blocks correlated with that of the main tumors.     

Utility of millipore filter and cell block in thyroid needle aspirates: Which method is superior?

The main goal of thyroid fine-needle aspiration (FNA) is to distinguish nodules that require surgery from those that do not, thereby decreasing the number of diagnostic thyroidectomies. Several cytologic preparations are used to reach a definitive diagnosis, including smears using conventional stains, such as Diff-Quik (DQ) and Papanicolaou (Pap), millipore filters (MF), and cell blocks (CB). This study is undertaken to study the efficacy and adequacy to reach a definitive diagnosis of two cytologic preparations, MF and CB, in thyroid aspirates. All thyroid needle aspirates performed at Emory University Hospitals from January 2003 to April 2005 that had both MF and CB preparations for microscopic evaluation were studied. Conventional stains (DQ and Pap) were prepared. An initial aliquot of the specimen was divided for MF, and the remaining specimen submitted for CB preparation. All MF and CB slides were reviewed blindly. Adequacy criteria were assessed as 6-8 groups of follicular cells, with each containing 10 or more cells. Patient demographics, cytologic diagnoses, and follow-up information were retrieved. A total of 218 cases met our criteria; 21 of these cases were excluded due to lack of available diagnostic slides. Thus, a total of 197 cases were studied. Approximately two-third of the cases (57.9%) were diagnosed on DQ- and Pap-stained smears only, in which both CB and MF were inadequate. About 4.6% of the cases were diagnostic on both CB and MF; 36.0% on MF only, and 1.5% on CB preparation only. In more than half the cases (57.9%), diagnosis of thyroid FNA was rendered only on conventional stained smears. MF smears appeared to be superior for diagnostic yield (40.6%) than CB (6.1%), which is dependent on specimen cellularity. Therefore, MF rather than CB should be added to conventional stained smears (DQ and Pap) to supplement the diagnostic yield, especially in specimens of low cellularity.     

Fine Needle Aspiration cytology versus Fine Needle Sampling without aspiration. A prospective study of 200 cases

In the present prospective study of 200 patients with superficial swelling of various sites, FNS followed by FNA were performed. Fifteen cases were excluded due to inadequate material. In the 80 lymph node cases, FNS was diagnostic in 85% cases as compared to FNA in 87.5%. The diagnostic accuracy was higher for FNA (87.5%) than for FNS (81.25%). However FNS smears were much superior qualitatively than FNA smears and for the diagnosis of malignant conditions FNS was found to be much better. Regarding the 68 thyroid swellings, FNS obtained a diagnosis in 82.4% cases while FNA got it in 77.9%. The diagnostic accuracy with FNS (89%) was much better compared to FNA (75%). Of the 27 breast cases FNS yielded diagnostic material in 70.38% cases while FNA was diagnostic in 85.19%, thus establishing definite superiority. However FNS seemed to be better for diagnosing malignant lesions while FNA appeared better for diagnosing benign ones. In the 5 salivary gland lesions and 5 miscellaneous lesions both FNS and FNA fared equally well. On the whole FNS technique was much more patient friendly and gave high class "text book" quality smears while FNA smears gave quantitatively more adequate material. Both the techniques therefore would be complementary to each other.     

Pilomatrixoma: clinicopathologic study of 51 cases with emphasis on cytologic features

The clinical and pathologic features of 51 cases of pilomatrixoma found in our archives from 1990-1999 were reviewed, with emphasis on the cytopathologic features of the 22 cases that were sampled by fine-needle aspiration (FNA) biopsy prior to excision. Although uncommon, almost 20% of the pilomatrixomas in this series occurred in adults over age 30. Of the commonly reported features, the presence of basaloid cells and ghost cells in FNA smears, associated with a cutaneous location of the lesion, was sufficient for a confident cytologic diagnosis of pilomatrixoma. The presence of foreign body-type giant cells, nucleated squamous cells, and calcification, alone or in combination, was less specific, but supported a diagnosis of pilomatrixoma. Although infrequently reported, prominent nucleoli in basaloid cells and smears containing refractile keratin clumps were very useful clues in the diagnosis of pilomatrixoma. Finally, the routine use of cell blocks is recommended because in many of the cases presented ghost cells were fragmented or obscured in smears, but were more readily identified in cell block sections.     

Fine-needle aspiration of primary osteosarcoma: a cytological-histological study

This study aims to determine the diagnostic accuracy of fine-needle aspiration (FNA) evaluation of primary osteosarcoma (OS) and to review diagnostic criteria and adjunctive methods that can contribute to a confident diagnosis of OS in cytological smears. We evaluated FNA smears of OS in 59 patients for the following: cytomorphology and occurrence of osteoid, usefulness of adjunctive methods in evaluation of FNA smears and correspondence of FNA to the clinical data, and the histological features of excised tumors. Reliable cytological criteria of malignancy were found in 49 smears of high-grade OS. These criteria, correlated with radiographic studies and complemented by ancillary techniques, allowed diagnosis of OS or suspicion of OS in 44 cases. An additional four smears were diagnosed as sarcoma and one case was diagnosed erroneously as being carcinoma metastasis. There were no false positive or false negative diagnoses. We conclude that FNA smears from high-grade OS have characteristic features, which together with clinical and radiological data and ancillary studies allow correct diagnosis in most tumors.     

EUS‐FNA diagnosis of pancreatic serous cystadenoma with the aid of cell blocks and α‐inhibin immunochemistry: A case series

Serous cystadenoma (SCA) is an uncommon benign pancreatic neoplasm that is most often managed conservatively with follow‐up rather than surgical excision. Therefore, to avoid the serious complications of pancreatic surgery, SCA should be diagnosed accurately at the preoperative level. Preoperative SCA diagnosis requires a multimodal diagnostic approach that includes imaging, cystic fluid biochemical analysis and/or endoscopic ultrasound fine‐needle aspiration (EUS‐FNA). In this brief report, we describe six EUS‐FNA cases from five patients that were reported as “benign, consistent with serous cystadenoma”. Samples were hypocellular, composed of loose clusters and single cuboidal, bland‐looking cells among epithelial sheets representing gastrointestinal contamination. Cell blocks were prepared and all six FNA cases revealed cuboidal cells with a positive α‐inhibin immunophenotype, consistent with a diagnosis of SCA. As EUS‐FNAs of SCA commonly result in non‐diagnostic interpretations, cell block preparations with subsequent immunochemistry can increase their diagnostic accuracy and guide patient management.