Wakely P E, Kneisl J S
Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA.
Cancer. 2000 Oct 25;90(5):292-8.
Fine-needle aspiration (FNA) biopsy as a diagnostic modality for the pathologic evaluation of soft tissue neoplasms and non-neoplastic soft tissue mass lesions is uncommon and controversial. This procedure contrasts with more traditional diagnostic methods such as marginal excision, incisional (open) biopsy, or even core biopsy to procure tissue from somatic sites.
The authors reviewed the results of cytopathologic diagnoses obtained by fine-needle aspiration biopsy over a consecutive 11-month period in patients that presented primarily with a palpable soft tissue mass. A few patients with deep non-palpable soft tissue masses also were evaluated by radiologically guided FNA. Cytopathologic diagnoses were verified by different means including tissue examination either by concurrent cell block or subsequent surgical biopsy, flow cytometry, clinical outcome, or repetition of the FNA procedure. Patients were followed for a minimum of one year to evaluate the mass clinically, to determine whether any further therapy was administered, and to assess disease status.
Eighty-two aspirates were performed without complications from 77 patients ranging from 12-88 years of age (mean = 50 yrs.) with men outnumbering women 1.5:1. Soft tissue masses were most common in the extremities (41 cases), followed by the trunk (34 cases), retroperitoneum (5 cases), and head and neck (2 cases). Fine-needle aspirates were diagnosed as malignant in 42 (51%), benign in 32 (39%), nondiagnostic in 6 (7%), and atypical in 2 (2%) cases. Malignant aspirates were comprised of 24 sarcomas (57%), 9 carcinomas (21%), 6 malignant lymphomas (14%), and 3 melanomas (7%). Twenty-two aspirates (52%) had an initial diagnosis of malignancy, whereas 18 (43%) represented metastatic and 2 (5%) recurrent neoplasms. Confirmation of the cytopathologic diagnosis was by concurrent or subsequent tissue examination in 57%, flow cytometry in 5%, clinical outcome in 34%, and repeat aspiration in 4%. One false negative and no false positive diagnoses were issued for a sensitivity and specificity of 100% and 97% respectively in distinguishing benign and malignant lesions by FNA. Of the malignant aspirates, 83% could be subtyped whereas 72% of benign aspirates were correctly subtyped. For primary soft tissue sarcomas, 12 of 19 (63%) were accurately subtyped. In 48% of cases a concurrent cell block was obtained and found diagnostically useful in 54% of them.
Aspiration cytopathology of soft tissue mass lesions using FNA biopsy can be an accurate and minimally invasive method for the initial pathologic diagnosis of primary benign and malignant soft tissue masses, for the pathologic confirmation of metastatic tumors to soft tissue, and for the documentation of locally recurrent soft tissue neoplasms. FNA cytopathology is capable of specifically subtyping a large percentage of primary and metastatic soft tissue tumors if cellular material either in the form of a cell block or flow cytometry is obtained in addition to cell smears.
细针穿刺（FNA）活检作为一种用于软组织肿瘤和非肿瘤性软组织肿块病变病理评估的诊断方法并不常见且存在争议。该方法与更传统的诊断方法不同，如边缘切除、切开（开放）活检，甚至是从身体部位获取组织的粗针活检。
作者回顾了在连续11个月期间，主要表现为可触及软组织肿块的患者通过细针穿刺活检获得的细胞病理学诊断结果。少数深部不可触及的软组织肿块患者也通过放射学引导的FNA进行了评估。细胞病理学诊断通过不同方式进行验证，包括通过同时进行的细胞块或后续手术活检进行组织检查、流式细胞术、临床结果或重复FNA操作。对患者进行了至少一年的随访，以临床评估肿块，确定是否进行了任何进一步的治疗，并评估疾病状态。
对77例年龄在12至88岁（平均50岁）的患者进行了82次穿刺，无并发症发生，男性与女性比例为1.5:1。软组织肿块最常见于四肢（41例），其次是躯干（34例）、腹膜后（5例）和头颈部（2例）。细针穿刺诊断为恶性的有42例（51%），良性的有32例（39%），非诊断性的有6例（7%），非典型的有2例（2%）。恶性穿刺物包括24例肉瘤（57%）、9例癌（21%）、6例恶性淋巴瘤（14%）和3例黑色素瘤（7%）。22例穿刺物（52%）最初诊断为恶性，而18例（43%）为转移性肿瘤，2例（5%）为复发性肿瘤。细胞病理学诊断通过同时或后续组织检查得到证实的占57%，通过流式细胞术得到证实的占5%，通过临床结果得到证实的占34%，通过重复穿刺得到证实的占4%。在区分良性和恶性病变方面，FNA的敏感性和特异性分别为100%和97%，发出了1例假阴性诊断且无假阳性诊断。在恶性穿刺物中，83%可以进行亚型分类，而良性穿刺物中有72%被正确亚型分类。对于原发性软组织肉瘤，19例中有12例（63%）被准确亚型分类。在48%的病例中获得了同时进行的细胞块，其中54%在诊断上有用。
使用FNA活检对软组织肿块病变进行穿刺细胞病理学检查，对于原发性良性和恶性软组织肿块的初始病理诊断、软组织转移性肿瘤的病理证实以及局部复发性软组织肿瘤的记录，可能是一种准确且微创的方法。如果除了细胞涂片外还获得了细胞块形式或流式细胞术形式的细胞材料，FNA细胞病理学能够对很大比例的原发性和转移性软组织肿瘤进行特异性亚型分类。
