Gupta Raj K, Naran Sarla, Lallu Sharda, Fauck Robert
Cytology Unit, Department of Laboratory Services, Wellington Hospital and School of Medicine, Wellington, New Zealand.
Diagn Cytopathol. 2003 Apr;28(4):175-80. doi: 10.1002/dc.10244.
The aim of this study was to evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes, which were analyzed in 210 cases. NAC in all the cases were performed by the conventional aspiration method and cytologic examination was done on site after staining smears with the Papanicolaou method. In addition, Diff-Quik-stained air-dried smears, Papanicolaou-stained fixed smears, and filter preparations from needle washings and hematoxylin-eosin-stained sections of cell blocks were studied. The NAC diagnosis was supported by examining cell blocks in 92/210 cases which showed a reliable histologic architecture; further support was also obtained with a tissue biopsy in 9/12 cases of inflammatory lesions, 7/7 cases with a suspicious diagnosis, 20/26 cases of melanomas, 15/15 cases of lymphomas, and/or a comparison with the primary tumor in other cases of metastatic tumors. Additionally, immunoperoxidase and/or histochemical stains were done. Twelve cases were diagnosed as inflammatory lesions and 88 cases were regarded as negative (normal cellular elements n = 40; reactive elements n = 48). In 58 cases a variety of metastatic tumors were diagnosed (melanoma n = 26; others n = 32) and in 15 cases a diagnosis of lymphoma was made. Seven cases were diagnosed as suspicious of malignancy and 30 cases were unsatisfactory due to scanty/acellular samples (despite 2-3 repeat samplings). However, in five of these malignant tumors were later found on a biopsy which was done due to a persistent and continued enlargement of lymph node(s). The sensitivity was 91.7%, specificity 98.2%, positive predictive value (PPV) 97.7.%, and negative predictive value (NPV) was 95.45%. Based on our study we feel that NAC as a first line of investigation is not only useful in the diagnosis of lesions in inguinal lymph nodes, but can also help in deciding on an appropriate management. Also, histologic architecture from cell blocks can be correlated with cytology and such material can be used for histochemical and immunomarker studies.
本研究的目的是评估针吸细胞学检查（NAC）在可触及腹股沟淋巴结评估中的诊断价值，共分析了210例病例。所有病例的NAC均采用传统穿刺方法进行，涂片用巴氏染色法染色后在现场进行细胞学检查。此外，还研究了Diff-Quik染色的风干涂片、巴氏染色的固定涂片、针吸冲洗液的滤膜制备物以及细胞块苏木精-伊红染色切片。在92/210例病例中，通过检查具有可靠组织结构的细胞块支持了NAC诊断；在9/12例炎症性病变、7/7例可疑诊断、20/26例黑色素瘤、15/15例淋巴瘤病例中，以及在其他转移性肿瘤病例中通过与原发肿瘤进行比较，也进一步获得了支持。此外，还进行了免疫过氧化物酶和/或组织化学染色。12例被诊断为炎症性病变，88例被视为阴性（正常细胞成分n = 40；反应性成分n = 48）。58例诊断为各种转移性肿瘤（黑色素瘤n = 26；其他n = 32），15例诊断为淋巴瘤。7例被诊断为可疑恶性，30例因样本量少/无细胞（尽管进行了2 - 3次重复采样）而不满意。然而，在其中5例中，由于淋巴结持续肿大而进行活检后发现了恶性肿瘤。敏感性为91.7%，特异性为98.2%，阳性预测值（PPV）为97.7%，阴性预测值（NPV）为95.45%。基于我们的研究，我们认为NAC作为一线检查方法不仅有助于腹股沟淋巴结病变的诊断，还能帮助确定合适的治疗方案。此外，细胞块的组织结构可与细胞学相关联，此类材料可用于组织化学和免疫标志物研究。
