Schwartz David A, Unni K Krishnan, Levy Michael J, Clain Jonathan E, Wiersema Maurits J
Division of Gastroenterology and Hepatology and Department of Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gastrointest Endosc. 2002 Dec;56(6):868-72. doi: 10.1067/mge.2002.129610.
The aims of this study were to determine the rate of false-positive diagnosis with EUS-guided fine-needle aspiration and to identify factors contributing to this type of error.
The records of 577 patients undergoing EUS-guided fine-needle aspiration were reviewed and a subset of 188 patients with malignant cytology who underwent surgery was identified. Operative histopathology was compared with EUS-guided fine-needle aspiration cytopathology and false-positive cases were identified. An experienced cytopathologist, who was not involved with the original interpretation of the specimens, reviewed these cases to identify any factor(s) contributing to the errors.
Three cases of false-positive diagnosis were identified (1.6%; 95% CI [0.3%, 4.6%]). By aspiration site, the false-positive rates were as follows: pancreas 2/39 (5.1%), 95% CI [0.6%, 17.3%]; lymph nodes 1/136 (0.7%), 95% CI [0.02%, 4.0%]; and other sites 0/13, 95% CI [0.0%, 24.7%]. In both instances of a false-positive diagnosis for a pancreatic aspiration cytologic specimen, interpretative errors were identified. The false-positive interpretation of cytologic material aspirated from a lymph node occurred in a patient without any evidence for malignancy at surgery. In 111 patients with confirmed esophageal, gastric, or rectal malignancy undergoing EUS-guided fine-needle aspiration of nonperitumoral lymph nodes, there was no false-positive diagnosis, suggesting that specimen contamination by luminal tumor is rare.
The overall rate of false-positive diagnosis for EUS-guided fine-needle aspiration is similar to that reported for other modalities. Most false-positive diagnoses are caused by interpretation errors.
本研究的目的是确定超声内镜引导下细针穿刺活检的假阳性诊断率，并识别导致此类错误的因素。
回顾了577例行超声内镜引导下细针穿刺活检患者的记录，并确定了188例接受手术的恶性细胞学患者的子集。将手术组织病理学与超声内镜引导下细针穿刺活检细胞病理学进行比较，识别假阳性病例。由一位未参与标本原始解读的经验丰富的细胞病理学家对这些病例进行复查，以识别导致错误的任何因素。
识别出3例假阳性诊断病例（1.6%；95%置信区间[0.3%，4.6%]）。按穿刺部位划分，假阳性率如下：胰腺2/39（5.1%），95%置信区间[0.6%，17.3%]；淋巴结1/136（0.7%），95%置信区间[0.02%，4.0%]；其他部位0/13，95%置信区间[0.0%，24.7%]。在两例假阳性的胰腺穿刺细胞学标本诊断中，均发现了解读错误。从淋巴结吸出的细胞学材料的假阳性解读发生在一名手术时无任何恶性证据的患者身上。在111例确诊为食管、胃或直肠恶性肿瘤并接受超声内镜引导下非肿瘤周围淋巴结细针穿刺活检的患者中，未出现假阳性诊断，这表明管腔内肿瘤造成的标本污染很少见。
超声内镜引导下细针穿刺活检的总体假阳性诊断率与其他检查方式报告的相似。大多数假阳性诊断是由解读错误引起的。
