Gray D W, Richardson A, Hughes D, Fuggle S, Dunnill M, Higgins R, McWhinnie D, Morris P J
Nuffield Department of Surgery, University of Oxford John Radcliffe Hospital, Headington, United Kingdom.
Transplantation. 1992 Jun;53(6):1226-32. doi: 10.1097/00007890-199206000-00011.
Although conventional histology (CH) of needle core biopsies has been accepted as the gold standard for diagnosis of renal allograft rejection, this assumption has never been tested. Fine-needle aspiration cytology (FNAC) and monoclonal antibody (panleukocyte) staining of needle core biopsies (MABS) have been suggested to be superior to CH. A total of 50 patients received a cadaveric renal transplant followed by immunosuppression with triple therapy. Biopsies were taken routinely at days 7,14,21,28, and 90, with additional biopsies taken between these times if rejection was suspected (total biopsy sessions = 219). Specimens were taken for CH, FNAC, and MABS at each biopsy session, but only the result of one technique (previously randomly allocated) was communicated back to the clinical team, using a standardized grading system. Subsequently the presence or absence of rejection was determined by retrospective analysis of the clinical and biochemical course by 4 clinicians, without reference to the biopsy result. Graft survival was not significantly different in the three groups. The sensitivities for CH, FNAC, and MABS were 75%, 59%, and 77%, respectively, while the specificities were 87%, 96%, and 80%, respectively. Inadequate samples for analysis occurred frequently with the MABS technique--and, to a lesser extent, with CH--and both techniques tended to overdiagnose rejection. FNAC most often gave an answer but did miss clinically important rejection episodes. Needle-core biopsy processed for CH remains the most reliable biopsy technique for the diagnosis of rejection of renal allografts. FNAC is a useful technique for monitoring grafts with stable function or nonfunction. MABS does provide information equivalent to CH, but, in this study, had a high incidence of inadequate samples.
尽管针芯活检的传统组织学检查（CH）已被公认为诊断肾移植排斥反应的金标准，但这一假设从未得到验证。有人提出细针穿刺细胞学检查（FNAC）和针芯活检的单克隆抗体（全白细胞）染色（MABS）优于CH。共有50例患者接受了尸体肾移植，随后采用三联疗法进行免疫抑制。在第7、14、21、28和90天常规进行活检，如果怀疑有排斥反应，则在这些时间之间进行额外的活检（总活检次数 = 219次）。在每次活检时采集标本进行CH、FNAC和MABS检查，但仅将一种技术（先前随机分配）的结果使用标准化分级系统反馈给临床团队。随后，由4名临床医生通过回顾性分析临床和生化过程来确定是否存在排斥反应，而不参考活检结果。三组的移植物存活率无显著差异。CH、FNAC和MABS的敏感性分别为75%、59%和77%，而特异性分别为87%、96%和80%。MABS技术经常出现分析样本不足的情况，CH技术在较小程度上也存在这种情况，并且两种技术都倾向于过度诊断排斥反应。FNAC大多能给出结果，但确实会遗漏临床上重要的排斥反应事件。经CH处理的针芯活检仍然是诊断肾移植排斥反应最可靠的活检技术。FNAC是监测功能稳定或无功能移植物的有用技术。MABS确实能提供与CH相当的信息，但在本研究中，样本不足的发生率很高。
