Nordemar Sushma, Högmo Anders, Lindholm Johan, Tani Edneia, Sjöström Björn, Auer Gert, Munck-Wikland Eva
Department of Otorhinolaryngology, Karolinska Hospital, Stockholm, Sweden.
Laryngoscope. 2002 Nov;112(11):1983-7. doi: 10.1097/00005537-200211000-00014.
OBJECTIVES/HYPOTHESIS: A branchial cleft cyst presents as a lump in the neck that, generally, is easily cured by surgical excision. The preoperative diagnosis is based on clinical examination and, especially in the Scandinavian countries, fine-needle aspiration cytology. However, at times, the histopathological analysis of the excised cyst reveals a cystic metastasis of squamous cell carcinoma of the head and neck. If adequate diagnosis could be obtained preoperatively, patients would most likely fare better. The study was performed to investigate whether the diagnostic accuracy for these lesions could be improved preoperatively by image cytometry DNA analysis of the fine-needle aspiration cytology specimen.
Image cytometry DNA analysis was performed on the preoperative fine-needle aspiration cytology specimen and the surgical specimens from 51 patients with solitary cysts in the lateral region of the neck. Thirty-six patients were selected because there was a discrepancy between findings on fine-needle aspiration cytology and the final histopathological diagnosis or an uncertain cytological diagnosis. There were 25 metastatic squamous cell carcinomas and 3 thyroid cancers, there was 1 lymphoma and 1 sialoadenitis, and there were 21 branchial cleft cysts.
The cytodiagnostic Giemsa-stained slides were destained in Methanol and then stained with Schiff's reagent. The paraffin-embedded material from excised cysts were cut and deparaffinized and then stained with Schiff's reagent. Ahrens image analysis was used for DNA analysis and lymphocytes were used as control cells. DNA valves exceeding 5c was regarded as aneuploid.
Image cytometry DNA analysis of the preoperative cytological specimen was possible in 41 of 51 patients. We found that in 53% of the cases with cystic metastasis, image cytometry DNA analysis, when possible, revealed aneuploidy, thus indicating malignancy. DNA analysis showed diploidy in all benign cases.
Aneuploidy is highly specific for malignancy. Image cytometry DNA analysis increases the diagnostic sensitivity for malignant cystic metastasis and therefore is a valuable supplement to conventional cytological study for these lesions.
目的/假设：鳃裂囊肿表现为颈部肿块，一般通过手术切除易于治愈。术前诊断基于临床检查，尤其是在斯堪的纳维亚国家，还包括细针穿刺细胞学检查。然而，有时切除囊肿的组织病理学分析显示为头颈部鳞状细胞癌的囊性转移。如果能在术前获得充分诊断，患者的预后很可能会更好。本研究旨在调查通过对细针穿刺细胞学标本进行图像细胞术DNA分析，能否在术前提高对这些病变的诊断准确性。
对51例颈部外侧孤立性囊肿患者的术前细针穿刺细胞学标本和手术标本进行图像细胞术DNA分析。选择36例患者是因为细针穿刺细胞学检查结果与最终组织病理学诊断存在差异或细胞学诊断不确定。其中有25例转移性鳞状细胞癌、3例甲状腺癌、1例淋巴瘤和1例涎腺炎，以及21例鳃裂囊肿。
将经吉姆萨染色的细胞诊断玻片用甲醇脱色，然后用席夫试剂染色。将切除囊肿的石蜡包埋材料切片、脱石蜡，然后用席夫试剂染色。采用阿伦斯图像分析进行DNA分析，以淋巴细胞作为对照细胞。DNA值超过5c被视为非整倍体。
51例患者中有41例可以对术前细胞学标本进行图像细胞术DNA分析。我们发现，在53%的囊性转移病例中，图像细胞术DNA分析（如可行）显示非整倍体，提示恶性。DNA分析显示所有良性病例均为二倍体。
非整倍体对恶性肿瘤具有高度特异性。图像细胞术DNA分析提高了对恶性囊性转移的诊断敏感性，因此是这些病变传统细胞学研究的有价值补充。
