Diagnostic sensitivity of different techniques in the diagnosis of lung tumors with the flexible fiberoptic bronchoscope. Comparison of brush biopsy, imprint cytology of forceps biopsy, and histology of forceps biopsy

Brush and forceps biopsies were done consecutively in 186 cases of pulmonary neoplasia with a flexible fiberoptic bronchoscope guided by x-ray television fluoroscopy. Imprint and histologic sections were prepared from all forceps biopsy specimens. The three techniques were compared for their diagnostic sensitivity. As a result 84.9% of all imprints, 80.6% of brush biopsy specimens, and 62.9% of histologic sections were positive for malignancy. The sensitivity of brush biopsy specimens was independent of the location and morphology of the tumors, but the sensitivity of forceps biopsy specimens was lower in neoplasms unidentified by bronchoscopy. The sensitivity of the diagnostic accuracy when all three methods were used jointly was 97.3%, and the specificity was 100%. Agreement in the final morphologic tumor type was found in 130 of 150 cases (86.7%) by positive brush biopsy specimens, in 136 of 158 cases (86.1%) by positive imprint cytology, and in 104 of 117 cases (88.9%) by positive histology from forceps biopsy specimens. For routine bronchoscopy, all three methods should be used in combination to obtain the highest diagnostic yield.     

Fine-needle-aspiration cytodiagnosis of recurrent malignant melanoma

Sixty-four patients with melanoma (28 with clinical stage I disease and 36 with clinical stages II through IV disease) were fine-needle biopsied on suspicion of recurrent melanoma. Eighty-four biopsies were aspirated percutaneously and three at exploratory laparotomy. A tumor mass was present at 81 biopsies. The remaining biopsies were taken with theguidance of liver scan or fluoroscopy. In the patients with the diagnosis of recurrent malignant melanoma the cytodiagnosis was correct in 45 patients out of 47. One patient was diagnosed as breast cancer and one as malignant mesenchymal tumor. Of 40 biopsies considered normal, three were revised to be melanoma. No false-positive diagnosis was found. The frequency of false-negative diagnosis was 6%. Fine-needle-aspiration cytology is a suitable method t o establish a correct diagnosis when there is a suspicion of recurrent disease during the follow-up of melanoma patients. The high diagnostic accuracy in patients with enlarged lymph nodes is excellent and makes the method preferable to diagnostic surgical excision biopsies.     

How much brushing is enough for the diagnosis of lung tumors?

BACKGROUND. Bronchoscopic investigations of lung tumors require high diagnostic accuracy. Sometimes the combination of brush biopsy with cytologic and histologic examination of forceps-obtained biopsy specimens fails to diagnose tumors. Techniques with a minimum risk and low cost when repeated several times could increase the efficiency of tumor diagnosis and help to avoid rebronchoscopy. METHODS. Repeated brush biopsies were done during one bronchoscopic examination in 270 patients with pulmonary neoplasias using a flexible fiberoptic bronchoscope guided by radiographic video fluoroscopy. The results of up to five brush biopsies were compared for their diagnostic sensitivity. RESULTS. Singly, 68-77% of the specimens showed malignant findings. With repeated brushing, the sensitivity of the diagnostic accuracy increased to 89.6%. In the periphery of the bronchial tree, the sensitivity of brush biopsy was slightly lower in bronchoscopically invisible tumors. In 222 of 242 (91.7%) patients with positive results of brush biopsy, there was agreement in the final typing of tumor morphology. CONCLUSION. For routine bronchoscopy, repeated brush biopsy should be done to obtain the highest diagnostic yield.     

Diagnostic Yield of Touch Imprint Cytology of Prostate Core Needle Biopsies

Touch imprint cytology may provide additional information to core needle biopsy interpretation according to previous reports. The aim of this study was to investigate the diagnostic yield of this method in the diagnosis of prostate carcinoma. For this purpose, 452 transrectal prostate needle biopsies were evaluated from 56 patients. All patients were clinically suspicious of having prostate carcinoma. Two touch imprints were prepared from each fresh biopsy cylinder. Results of the standard histology and of the touch imprint evaluation were compared. Histologically negative biopsy cylinders were further evaluated for prostate carcinoma by fine step serial sectioning. The standard histological examination showed adenocarcinoma in 27 patients. Touch imprint cytology revealed atypical cells suspicious of carcinoma in 38 patients. This group included all 27 patients with positive standard histology and further 11 patients with initially negative core biopsy. Following serial sectioning, in three out of these 11 samples, histological evidence of a carcinoma could be proven. Fine step serial sectioning of all 29 core biopsies negative for carcinoma by standard histological examination, 26 patients remained negative. All three core biopsies initially negative by standard histology but positive after serial sectioning had cytology findings suspicious of carcinoma. We conclude, that in problematic cases the additional use of touch imprint cytology and serial sectioning of prostate core needle biopsies significantly improve the diagnostic accuracy.     

Diagnostic accuracy of fine-needle aspiration cytology of the breast in Japan: Report from the Working Group on the Accuracy of Breast Fine-Needle Aspiration Cytology of the Japanese Society of Clinical Cytology

The Working Group of the Japanese Society of Clinical Cytology was assembled to assess the current status of breast cytology in Japan by conducting a large-scale survey regarding the accuracy of fine-needle aspiration biopsy (FNAB) in Japan. We collected data and investigated the status of breast cytological diagnosis at 12 different cooperating facilities in Japan, and re-evaluated their false-negative and false-positive cases. Among 30,535 individuals who underwent a breast cytological examination, analyses were conducted on 10,890 individuals (35.7%) in whom cytological diagnoses were confirmed by histology. Among these patients, the cytological diagnosis had an inadequate rate of 17.7%, an indeterminate rate of 7.8%, a positive predictive value of 'malignancy suspected' cells of 92.4%, an absolute sensitivity of 76.7%, a complete sensitivity of 96.7%, a specificity of 84.3%, a positive predictive value of 'malignant' cells of 99.5%, a false-negative value of 3.31%, a false-positive value of 0.25% and an accuracy rate of 88.0%. Subsequently, 297 false-negative and 23 false-positive cases were re-evaluated and several factors were characterized (i.e. histological type, tumor size and misread points). This survey collected data from a large number of cases for breast FNAB. Based on our survey, the accuracy of FNAB in Japan was relatively high compared with the goal of assessment of diagnostic accuracy. However, there were some false-negative and false-positive cases. Improvements in accuracy resulting from the learning points in the present study will lead to more useful and reliable diagnostic tools in clinical practice.     

痰和纤维支气管镜刷片细胞学检查在肺癌诊断中的意义

目的探讨痰和纤支镜刷片细胞学检查在肺癌诊断中的意义。方法收集532例同时进行痰和纤支镜检查的肺癌病例,分析痰和纤支镜刷片细胞学检查的敏感性和分型的准确性,与纤支镜咬检组织学对比,评价细胞学在肺癌诊断中的意义。结果痰细胞学的敏感性为33．8％,纤支镜刷片细胞学的敏感性为58．7％,纤支镜咬检组织学的敏感性为39．1％。痰细胞学分型诊断与组织学的符合率鳞癌为95．7％,腺癌为87．2％,小细胞癌为100．0％,痰细胞学区分小细胞癌和非小细胞癌的准确性为100．0％。纤支镜刷片细胞学分型诊断与组织学的符合率鳞癌为93．3％,腺癌为85．4％,小细胞癌为95．5％,纤支镜刷片细胞学区分小细胞和非小细胞癌的准确性为98．0％。结论纤支镜刷片细胞学具有较高的敏感性,在肺癌的诊断中有重要的应用价值。痰细胞学敏感性较低,但可作为纤支镜检查阴性和不能耐受纤支镜检查的肺癌患者的补充检查手段。两者的细胞学分型具有较高的可信度。     

Clinical utility of postchemoradiation endoscopic brush cytology and biopsy in predicting residual esophageal adenocarcinoma

BACKGROUND:

Esophageal adenocarcinoma generally carries a poor prognosis. Treatment with combination chemoradiation (CRT) followed by esophagectomy is becoming common. A pathologic complete response is uncommon but predicts improved survival. Identifying the subset of patients with residual carcinoma has potential management implications. Post‐CRT endoscopic brush cytology and biopsy may detect residual tumor; however, the accuracy and clinical value of these methods remain unclear.

METHODS:

Sixty‐seven patients with esophageal adenocarcinoma who underwent preoperative CRT and post‐CRT endoscopic brush cytology and biopsy followed by esophagectomy were identified. By using esophagectomy histology as the gold standard, the performance of cytology and biopsy was evaluated in diagnosing residual carcinoma. Two pathologists independently reviewed all false‐negative and false‐positive cases and resolved disagreements by consensus.

RESULTS:

The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cytology for diagnosing residual carcinoma were 26%, 95%, 92%, 35%, and 45%, respectively. For biopsy, these rates were 13%, 90%, 75%, 31%, and 36%, respectively. Sampling error accounted for false‐negative diagnoses in approximately 66% of cytology analyses and 98% of biopsy analyses. Approximately 33% of false‐negative cytology analyses and 1 false‐negative biopsy analysis were caused by the under–recognition of tumor cells. Major diagnostic pitfalls included obscuring acute inflammation, necrosis, tumor cells that mimicked benign cells with radiation/reactive atypia, and the under recognition of mucin‐containing adenocarcinoma cells.

CONCLUSIONS:

Brush cytology and biopsy were specific but not sensitive methods for predicting residual cancer after CRT. However, cytology was superior. The current results indicated that brush cytology can be used alone to diagnose residual esophageal carcinoma, and awareness of specific diagnostic pitfalls will help pathologists improve its accuracy. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

超声引导下甲状腺结节细针穿刺细胞学与粗针穿刺组织学检查的对比研究CSCD

目的比较超声引导下甲状腺结节细针穿刺细胞学与粗针穿刺组织学检查的诊断准确率、敏感度、特异性及并发症。方法收集95例超声检查疑似为恶性甲状腺结节患者的98个结节,行超声引导下细针穿刺细胞学与粗针穿刺组织学检查,并经术后常规病理检查证实。比较两种方法诊断甲状腺结节的准确率、敏感度、特异性及术后并发症。分析结节直径大小与取材满意率、诊断准确率的关系。结果 (1)细针穿刺取材满意率89.8%,粗针为96.9%。细针穿刺细胞学诊断甲状腺结节的准确率、敏感度、特异性分别为86.4%、90.5%、82.6%;粗针穿刺组织学诊断为90.5%、91.7%、88.6%;(2)粗针穿刺并发症发生率高于细针穿刺(14.3% vs.2.0%,P<0.05);(3)结节直径≥1.0 cm时,粗针穿刺诊断准确率高于细针穿刺(P<0.05)。结论细针穿刺细胞学与粗针穿刺组织学检查在甲状腺结节良恶性诊断中可互相补充。     

Brush cytology in the diagnosis of colonic neoplasms

During a three-year period (1986-1988), 234 colonic brush specimens were received in the authors' laboratory. Nine samples (4%) were deemed unsatisfactory for evaluation because of inadequate cellularity and/or poor fixation. In 11 cases concomitant or follow-up histologic specimens were not available. The remaining 214 specimens included 82 malignant neoplasms, 88 neoplastic polyps (adenomas), and 44 nonneoplastic lesions. Sixty-seven (82%) of malignant neoplasms were correctly diagnosed by brush cytology. Three cases of adenoma with severe dysplasia or in situ carcinoma were diagnosed as adenocarcinoma by cytology. No false-positive diagnoses were made of nonneoplastic lesions. Brush cytology was found to be a more sensitive technique in the diagnosis of colon cancer than endoscopic biopsy (82% and 74% sensitivity, respectively). The combination of the two techniques increased the sensitivity to 90% and improved the overall accuracy of the test. Seventy-one (82%) of the colonic adenomas were correctly diagnosed by cytology. Brush cytology is a convenient, safe, and accurate technique which should be used concurrently with endoscopic biopsy or polypectomy.     

Mutational analysis of cervical cytology improves diagnosis of endometrial cancer: A prospective multicentre cohort study

Endometrial carcinoma (EC) is traditionally diagnosed by a histopathological assessment of an endometrial biopsy, leaving up to 30% of patients undiagnosed due to technical failure or an inadequate amount of tissue. The aim of the current study is to assess whether mutational analysis of cervical cytology or pipelle endometrial biopsies improves the diagnostic accuracy of traditional histopathological diagnosis of EC. This prospective multicentre cohort study included patients surgically treated for EC or a benign gynaecological condition (control group). A Pap brush sample, cervicovaginal self-sample, pipelle endometrial biopsy and surgical specimen of either the EC or normal endometrium were obtained. A targeted next-generation sequencing panel was used to analyse these samples for mutations in eight genes. Sensitivity, specificity and predictive values were calculated. Fifty-nine EC patients and 31 control patients were included. In these patients, traditional histopathological diagnosis by pipelle had a sensitivity of 79% and a specificity of 100%. For EC patients, 97% of surgical specimens contained at least one mutation. Mutational analysis of Pap brush samples, self-samples and pipelle endometrial biopsies yielded a sensitivity of 78, 67 and 96% with a specificity of 97, 97 and 94%, respectively. Combining one of these three methods with histopathological pipelle endometrial biopsy evaluations yielded a sensitivity of 96, 93 and 96%, respectively. Our study has shown that mutational analysis of either cervical cytology or pipelle endometrial biopsies improves diagnosis of EC. Prospective validation will support implementation in clinical practice.     

细胞病理学在肺癌诊断中的意义

背景与目的 探讨痰和纤支镜刷片细胞学检查在肺癌诊断中的意义.方法 收集278例同时进行痰和纤支镜检查的肺癌病例.分析痰和纤支镜刷片细胞学检查的敏感性和分型的准确性,评价细胞学在肺癌诊断中的意义.结果 痰细胞学的敏感性为45.8%,纤支镜刷片细胞学的敏感性为61.8%.痰细胞学分型诊断与组织学的符合率鳞癌为93.7%,腺癌为86.2%,小细胞癌为100.0%,痰细胞学区分小细胞癌和非小细胞癌的准确性为100.0%.纤支镜刷片细胞学分型诊断与组织学的符合率鳞癌为94.3%,腺癌为82.9%,小细胞癌为95.5%,纤支镜刷片细胞学区分小细胞和非小细胞癌的准确性为98.0%.结论 纤支镜刷片细胞学具有较高的敏感性,在肺癌的诊断中有重要的应用价值.痰细胞学敏感性较低,但可作为纤支镜检查阴性和不能耐受纤支镜检查的肺癌患者的补充检查手段.两者的细胞学分型具有较高的可信度.     

323例乳腺肿块针吸细胞学诊断分析

目的 探讨乳腺癌针吸细胞学(FNAC)诊断准确性。方法 分析1326例乳腺肿块针吸细胞学诊断,并与323例手术后病理组织学诊断结果对比。结果 本组FNAC诊断敏感性为97.1％,特异性为97.3％,假阳性率为2.7％,假阴性率为2.9％,诊断符合为97.2％。结论 乳腺肿块FNAC检查是一种实用价值很高的诊断方法。文中对影响FNAC诊断的因素进行了讨论。     

323例乳腺肿块针吸细胞学诊断分析(英文)

目的探讨乳腺癌针吸细胞学(FNAC)诊断准确性。方法分析1326例乳腺肿块针吸细胞学诊断,并与323例手术后病理组织学诊断结果对比。结果本组 FNAC 诊断敏感性为97.1%,特异性为97.3%,假阳性率为2.7%,假阴性率为2.9%,诊断符合为97.2%。结论乳腺肿块 FNAC 检查是一种实用价值很高的诊断方法。文中对影响 FNAC 诊断的因素进行了讨论。     

Evaluation of the hybrid capture 2 assay for detecting anal high-grade dysplasia

Hybrid Capture 2 (HC2) Human Papillomavirus (HPV) DNA Test® is FDA approved and is a proven aid in detecting HPV infections of the cervix and as an aid in diagnosing, with cytology, cervical disease. A prospective feasibility study was conducted to determine if HC2 testing has utility when screening for high‐grade anal dysplasia (AIN2+). We enrolled 298 patients (45% HIV+) who had AIN2+ screening with cytology, histology and HC2 testing for two specimens: a swab into liquid‐based cytology medium and either a swab or a brush collection in specimen transport medium (STM). High‐resolution anoscopy was performed on all patients with biopsy of AIN2+ suspicious lesions. Cytology was benign (42%), atypical squamous cells of undetermined significance (30%), low‐grade squamous intraepithelial lesion (18%), high‐grade squamous intraepithelial lesion (1%), ASCUS possibly high‐grade dysplasia (1.7%) and nondiagnostic (7%) and 36% had AIN2+ histology. Sensitivity and specificity for predicting AIN2+ histology for any abnormal cytology were 77 and 52%, whereas HC2 sensitivity and specificity were 91 and 40% (p = 0.005 for sensitivity), respectively. There was no significant difference in HC2 sensitivity or specificity between brush and swab or STM and residual cells from cytology. AIN2+ was found in 20% of patients with benign cytology. Only nine AIN2+ specimens were HC2?. This prospective study indicates that HC2 may be useful when screening for anal dysplasia; however, a larger study is recommended.     

Gastroscopy plus cytology for the diagnosis of gastric cancer or precancerous diseases--report of 127 cases

One hundred and twenty-seven patients with gastric tumor or precancerous diseases were examined by gastroscopy plus cytology, and the results were compared with that of histopathology after operation. Out of 127 cases, 70 were diagnosed as gastric cancer (15 cases as early cancer, 55 as advanced cancer). The positive rate for early cancer was 21.4%, it comprised 11.2% of all gastric cancers diagnosed by gastroscopy during the same period. The preoperative positive rate of early gastric cancer was 100% (13/13) as examined by the combination of touch, brush cytology and mucosal biopsy. The combined method may increase the positive rate and the accuracy, not only for advanced but also for early gastric cancers. It is suggested that the combination of these methods be routinely used in the diagnosis of suspicious cancer in the gastric mucosa.     

Cytologic results of fine-needle aspiration biopsies of the central nervous system

The cytologic results of 34 fine-needle aspiration (FNA) biopsies of the central nervous system (CNS) are reported. There were 31 intraoperative biopsies performed at the time of craniotomy. All the cases were diagnosed using direct smear preparations stained with Papanicolaou and Diff-Quik (Harleco, NJ) stains. The sensitivity of the procedure was 90.7%, specificity 100%, positive predictive value 100%, and efficiency of the test of 91%. There were no false-positive diagnoses and three false-negative diagnoses. This study attests to the diagnostic accuracy of FNA cytologic examination of the central nervous system. Statistical analysis of the few previous FNA biopsy series of the CNS are presented. Review of the indications, advantages and complications of CNS needle biopsy are discussed. This report supports the role of fine-needle aspiration cytology in the evaluation of CNS lesions. With recent developments in radiologic imaging, especially ultrasound and computed tomography (CT) using stereotactic guidance, specimens can be obtained for cytologic diagnosis using thinner needles. Excellent diagnostic accuracy can be obtained, as pathologists gain greater familiarity with interpreting FNA biopsy material. Other advantages of FNA biopsy of the central nervous system include the low morbidity and mortality of the procedure and the ability to perform the biopsy through a burr hole under local anesthesia and thereby decrease hospitalization time and cost.     

纤支镜针吸与毛刷涂片在中心型肺癌诊断中的比较

目的 :比较纤支镜针吸 (transbronchialneedleaspiration ,TBNA)及毛刷涂片在中心型肺癌细胞学检查中的诊断价值。方法 :对 5 6例中心型肺癌患者进行纤支镜检查 ,分别应用纤支镜针吸技术及毛刷涂片进行细胞学检查。结果 :5 6例患者 ,49例 ( 87 5 % )获得了阳性细胞学诊断结果 ,其中TBNA检查阳性率为 73 2 % ,毛刷涂片检查阳性率为 62 5 %。 3 5例患者细胞学诊断与病理学组织类型相符 ,TBNA检查符合率为85 3 % ( 3 5 /4 1) ,毛刷涂片检查符合率为 48 6%( 17/3 5 )。结论 :TBNA比毛刷涂片在中心型肺癌细胞学诊断中有更高的应用价值 ;两种技术联合应用可进一步提高的诊断准确性     

超选择性支气管镜肺刷检对肺第5~9级支气管间占位性病变的诊断价值

[目的]探讨在高分辨率CT片定位下,气管镜下刷检对位于肺第5～9级支气管间的肺占位性病变的诊断价值.[方法]对85例肺部肿块位于肺第5～9级支气管间的患者,术前在高分辨率CT片定位下行支气管镜下刷检细胞学检查,以细胞病理学结果为诊断依据.[结果]经支气管镜肺刷检总阳性率为44.71％,其中非小细胞癌20例,小细胞癌18例.所有患者术后均未发生气胸、肺内大出血等严重并发症.[结论]高分辨率CT片定位下对位于第5～9级支气管的病灶进行超选择性的刷检具有一定的诊断价值.     

Prediction of recurrence in advanced gastric cancer patients after curative resection by gene expression profiling

The prognosis of patients with advanced gastric cancer remains unfavorable. Even after curative resection, 40% of patients with advanced gastric cancer die of recurrence. Conventional clinicopathlogic findings are sometimes inadequate for predicting recurrence in individuals. Hence, we tried to construct a new diagnostic system, which predicts recurrence in patients with advanced gastric cancer after curative resection based on molecular analysis. Gastric cancer progression is a function of multiple genetic events that may affect the expression of large number of genes. We performed gene expression profiling with 2,304 genes in 60 advanced gastric cancer patients who underwent curative resection using a PCR array technique, a high-throughput quantitative RT-PCR technique. The diagnostic system, which was constructed from the learning set comprised of 40 patients with the most informative 29 genes, classified each case into a good-signature or poor-signature group. Then, we confirmed the predictive performance in an additional test set comprised of 20 patients, and the prediction accuracy for recurrence was 75%. Kaplan-Meier analysis revealed significant difference between the good-signature and the poor-signature group (p = 0.0125). Especially in patients with smaller tumor (< or = 5 cm), less developed LN metastasis (N(0,1)), or earlier stage (stages I and II), the prediction accuracy was high (88.9%, 84.6%, or 81.8%, respectively). Our diagnostic system based on systematic analysis of gene expression profiling can predict the recurrence at clinically meaningful level. By combining our system with conventional clinicopathologic factors, we can improve the prediction of recurrence in patients with advanced gastric cancer who underwent curative surgery.     

Reliable identification of small cell lung cancer in cytological specimens by immunocytology

BACKGROUND: A reliable diagnosis of small cell lung cancers (SCLC) is of high clinical relevance. We investigated whether immunocytology substantially improves the diagnostic accuracy of conventional cytology in diagnosing SCLC. PATIENTS AND METHODS: 162 carcinomatous specimens clinically suspected to originate from pulmonary neoplasms were investigated by cytology and immunocytology. Immunocytology was performed on smears using HEA125 and pancytokeratin antibodies as epithelial markers and MOC-1 as SCLC probe. RESULTS: As histologically clarified, 114 specimens corresponded to pulmonary neoplasms (SCLC = 51; non-small cell lung cancer: NSCLC = 59; mixed SCLC/NSCLC = 2; carcinoid = 2), 48 to nonpulmonary adenocarcinomas. By conventional cytology tumor cells were clearly detected in 93 (57.4%) and suspected in another 43 (26.5%) cases (83.9% overall sensitivity). Considering SCLC samples, tumor cells were diagnosed or suspected in 36 (70.5%), not identified in 10 (19.6%), and misdiagnosed as hematological malignancy in 5 cases. Only 2 specimens were accurately diagnosed as SCLC. Using the epithelial antibodies all samples were identified as carcinomatous. MOC-1 stained all but one SCLC, both SCLC/NSCLC, and both carcinoids. One SCLC brush smear was MOC-1 negative, containing only squamous epithelium. 3 pulmonary adenocarcinomas stained falsely positive, all nonpulmonary carcinomas MOC-1 negative. CONCLUSION: Immunocytology substantially improves the diagnostic accuracy of cytology in diagnosing SCLC with a diagnostic sensitivity of 98% and specificity of 97%.