Delgado P I, Jorda M, Ganjei-Azar P
University of Miami/Jackson Memorial Medical Center Department of Pathology, Miami, Florida 33136, USA.
Cancer. 2000 Oct 25;90(5):279-85.
When a diagnosis of small cell carcinoma is reached in a patient with a lung mass, a surgical treatment approach is no longer considered and chemotherapy becomes the treatment of choice. The aim of this study is to compare the diagnostic accuracy of fine-needle aspiration cytology in the diagnosis of small cell carcinoma with the diagnoses of other lung malignancies. The capacity of this technique to distinguish between these two categories is assessed.
Two hundred fifty-nine consecutive transthoracic fine needle aspirations of lung tissue from 235 patients with histologic diagnosis of malignancy were reviewed. The aspirates were performed over a 10-year period at the University of Miami/Jackson Memorial Medical Center, Miami, Florida. Two hundred and forty-two fine-needle aspirations from 221 patients yielded satisfactory smears and were included in the study. Fourteen patients were excluded. The cytologic diagnoses were classified into 5 categories: 1) small cell carcinoma (18 smears, 7%); 2) other lung malignancies (158 smears, 65%); 3) suspicious for malignancy (19 smears, 8%); 4) inflammatory process (7 smears, 3%); and 5) negative for malignancy (40 smears, 17%).
The histologic diagnoses were divided into two groups: small cell carcinomas (29 smears, 12%), and other lung malignancies (213 smears, 88%). The efficiency of fine-needle aspiration cytology in the diagnosis of these two groups was 96% versus 88%, respectively, with an equal specificity of 100%, and a sensitivity of 67% versus 81%. Once the diagnosis of malignancy was established, fine-needle aspiration cytology was found to be highly accurate in distinguishing small cell carcinoma from other neoplasms.
We conclude that fine-needle aspiration cytology of the lung is an accurate diagnostic tool for the diagnosis of lung malignancies and is an excellent technique for distinguishing small cell carcinoma from other malignant neoplasms. It can be used with confidence to select treatment modalities and to avoid unnecessary surgeries in patients with lung malignancies.
当对肺部肿块患者做出小细胞癌诊断时，不再考虑手术治疗方法，化疗成为首选治疗方式。本研究的目的是比较细针穿刺细胞学在小细胞癌诊断中的诊断准确性与其他肺恶性肿瘤的诊断准确性。评估该技术区分这两类疾病的能力。
回顾了235例经组织学诊断为恶性肿瘤的患者连续进行的259次经胸肺组织细针穿刺。这些穿刺在佛罗里达州迈阿密市迈阿密大学/杰克逊纪念医学中心进行，为期10年。来自221例患者的242次细针穿刺获得了满意涂片并纳入研究。14例患者被排除。细胞学诊断分为5类：1）小细胞癌（18张涂片，7%）；2）其他肺恶性肿瘤（158张涂片，65%）；3）可疑恶性（19张涂片，8%）；4）炎症过程（7张涂片，3%）；5）恶性阴性（40张涂片，17%）。
组织学诊断分为两组：小细胞癌（29张涂片，12%）和其他肺恶性肿瘤（213张涂片，88%）。细针穿刺细胞学对这两组疾病的诊断效率分别为96%和88%，特异性均为100%，敏感性分别为67%和81%。一旦确立恶性肿瘤诊断，发现细针穿刺细胞学在区分小细胞癌与其他肿瘤方面具有高度准确性。
我们得出结论，肺细针穿刺细胞学是诊断肺恶性肿瘤的准确诊断工具，是区分小细胞癌与其他恶性肿瘤的优秀技术。它可用于放心地选择治疗方式，并避免肺恶性肿瘤患者进行不必要的手术。
