Gupta Raj K, Naran Sarla, Lallu Sharda, Fauck Robert
Cytology Unit, Department of Laboratory Services, Wellington Hospital, School of Medicine, Wellington, New Zealand.
Acta Cytol. 2003 Jul-Aug;47(4):550-4. doi: 10.1159/000326567.
To evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable axillary lymph nodes and determine whether ancillary procedures can be useful in enhancing the diagnosis.
The material was analyzed in 336 cases with enlarged axillary lymph nodes in which NAC were performed by the conventional method. In all cases cytologic examination was done on site after staining the smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks, which showed the reliability of histologic architecture; further support was obtained with tissue biopsy and/or comparison with the primary tumor in some of the cases.
Twelve cases were diagnosed as inflammatory lesions, and 64 were unsatisfactory due to scanty/acellular samples (despite 2-3 repeat samplings). However, in 6 of these, malignant tumors were later found on a biopsy done due to persistent and continued enlargement of an axillary lymph node or nodes. One hundred twenty-two cases were regarded as negative (normal cellular elements, n = 52; reactive elements, n = 70), and 4 cases were suspicious for malignancy. In 124 cases a variety of metastatic tumors were diagnosed (breast, n = 63; melanoma, n = 22; others, n = 39), and in 10 cases a diagnosis of lymphoma was made.
NAC of palpable axillary lymph nodes as a first-line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on management. Also, histologic architecture from cell blocks can be correlated with cytology, and such material can be used for histochemical and immunomarker studies.
评估针吸细胞学检查（NAC）在可触及腋窝淋巴结评估中的诊断价值，并确定辅助检查是否有助于提高诊断准确性。
对336例腋窝淋巴结肿大患者的材料进行分析，采用常规方法进行NAC检查。所有病例均在涂片用巴氏染色法染色后进行现场细胞学检查。此外，还对空气干燥涂片、固定涂片、针吸冲洗液滤膜制备物和细胞块进行了研究。通过检查细胞块来支持NAC诊断，细胞块显示了组织结构的可靠性；在一些病例中，通过组织活检和/或与原发肿瘤进行比较获得了进一步支持。
12例被诊断为炎性病变，64例因样本量少/无细胞（尽管进行了2 - 3次重复采样）而诊断不满意。然而，其中6例因腋窝淋巴结持续肿大，后来活检发现为恶性肿瘤。122例被视为阴性（正常细胞成分，n = 52；反应性成分，n = 70），4例怀疑为恶性。124例诊断为各种转移性肿瘤（乳腺癌，n = 63；黑色素瘤，n = 22；其他，n = 39），10例诊断为淋巴瘤。
可触及腋窝淋巴结的NAC作为一线检查方法是一种经济有效的程序，不仅有助于诊断各种病变，还能辅助决策治疗方案。此外，细胞块的组织结构可与细胞学结果相关联，此类材料可用于组织化学和免疫标记研究。
