Jorda M, Rey L, Hanly A, Ganjei-Azar P
University of Miami and Jackson Memorial Hospital, Miami, Florida 33136, USA.
Cancer. 2000 Feb 25;90(1):47-54.
Fine-needle aspiration cytology has proved to be an accurate, cost-effective, and safe technique for diagnosing inflammatory and neoplastic lesions at different body sites. Its applicability in bone pathology, however, has been controversial due to a high percentage of inadequate samples and nonspecific results in the diagnosis of primary bone lesions. In this study, the diagnostic accuracy of the technique and its capacity for diagnosing primary bone lesions were assessed. In addition, the authors analyzed the diagnostic limitations with focus on specimen adequacy.
The authors reviewed 314 consecutive fine-needle aspirations of bone from 308 patients. Direct or cytospin smears from aspirated material were fixed in 95% alcohol and stained by a modified Papanicolaou technique. Ninety-seven smears (31%) initially were considered unsatisfactory and excluded from the study. A diagnosis was rendered in 217 cases (69%), which were classified into 4 categories: primary bone lesions (benign and malignant) (42%), metastatic bone tumors (37%), suspicious for malignancy (5%), and negative (16%).
The overall accuracy was 95%. Seventy-eight percent of primary bone lesions were correctly diagnosed by cytology. All cases diagnosed as metastatic by cytology were correct. The authors encountered difficulties diagnosing fibro-osseous lesions. Thirteen percent of cases were erroneously diagnosed as "negative" or "inflammatory conditions." On review, the absence of adequate cytologic material was noted in all of them. This sampling error could have been avoided by the presence of an on-site cytopathologist.
Fine-needle aspiration of bone is a simple, reliable, and accurate diagnostic technique that can facilitate patient management and preoperative decision-making and/or avoid unnecessary invasive procedures for patients with primary or metastatic bone lesions. However, the radiologist, cytopathologist, and orthopedic surgeon should work together for optimal results. Moreover, a definitive pathologic diagnosis should not be issued if diagnostic material is not adequate and/or clinicoradiologic information is incompatible.
细针穿刺细胞学检查已被证明是一种准确、经济高效且安全的技术，可用于诊断身体不同部位的炎症性和肿瘤性病变。然而，由于样本不足的比例较高以及在原发性骨病变诊断中结果不具特异性，其在骨病理学中的适用性一直存在争议。在本研究中，评估了该技术的诊断准确性及其诊断原发性骨病变的能力。此外，作者以样本充足性为重点分析了诊断局限性。
作者回顾了308例患者连续314次骨细针穿刺的情况。抽吸材料制成的直接涂片或细胞离心涂片用95%酒精固定，并用改良巴氏技术染色。97张涂片（31%）最初被认为不满意，被排除在研究之外。217例（69%）做出了诊断，分为4类：原发性骨病变（良性和恶性）（42%）、转移性骨肿瘤（37%）、可疑恶性（5%）和阴性（16%）。
总体准确率为95%。78%的原发性骨病变通过细胞学检查得到正确诊断。所有经细胞学诊断为转移性的病例均正确。作者在诊断纤维性骨病变时遇到困难。13%的病例被错误诊断为“阴性”或“炎症性疾病”。复查时，发现所有这些病例均缺乏足够的细胞学材料。若有现场细胞病理学家，这种采样误差本可避免。
骨细针穿刺是一种简单、可靠且准确的诊断技术，可为原发性或转移性骨病变患者的治疗管理和术前决策提供便利，和/或避免不必要的侵入性操作。然而，放射科医生、细胞病理学家和骨科医生应共同协作以取得最佳结果。此外，如果诊断材料不足和/或临床放射学信息不相符，则不应出具明确的病理诊断。
