Moriarty Ann T, Stastny Janet, Volk Emily E, Hughes Jonathan H, Miller Theodore R, Wilbur David C
AmeriPath Indiana, Indianapolis 46219, USA.
Arch Pathol Lab Med. 2004 May;128(5):513-8. doi: 10.5858/2004-128-513-FABAOF.
Body cavity fluid examination presents a common and sometimes difficult diagnostic challenge in daily cytology practice. Separating benign from malignant cellular changes may require meticulous screening, careful scrutiny of cellular features, and an understanding of the range of reactive changes. We use the data from the College of American Pathologists (CAP) Interlaboratory Comparison Program in Nongynecologic Cytology (NGC) to identify characteristics of fluids that place them at opposite ends of the diagnostic spectrum.
To assess the features of individual body cavity fluid slides that demonstrated good performance characteristics and compare them to slides that were poor performers.
A databank of 10 396 laboratory responses, including a variety of malignant and benign cases obtained from 1997 through 2001, was used to select cases. A cumulative slide history was used to identify slides that performed well or poorly in each reference diagnosis. Cases were confirmed by consensus of 4 CAP Cytopathology Resource Committee members. Observations and characterizations of good and bad performers in each category were recorded and summarized.
Percentage of concordance of poor performers ranged from 0% to 58%. Conversely, good performers were identified with high concordance of laboratory diagnosis in each reference category (>80%). Several patterns emerged. Poorly performing cases of adenocarcinoma consisted of slides with rare tumor cells, hypercellular malignant cases without 2 cell populations, and cases with single cells. Poor performance in confirmed squamous cell carcinoma cases related to rare cells without keratinization. Small cell carcinoma and melanoma cases performed poorly when there were few malignant cells. Lymphoma cases demonstrated poor performance when there were abundant pleomorphic lymphoid cells or when rare Reed- Sternberg-like cells were present. Reactive or negative slides performed best with a polymorphous population; poor performers were those with a predominant lymphocyte population mistaken for a hematopoietic neoplasm.
Close attention to classic cytologic criteria and careful examination of slides may enhance the educational experience of participants and the performance characteristics of body cavity fluid specimens in the CAP NGC program. Lessons from bad actors in the CAP NGC program may increase awareness of potential diagnostic problems in daily practice or help identify areas for laboratory quality improvement.
在日常细胞学实践中，体腔液检查是一项常见且有时颇具挑战性的诊断任务。区分良性与恶性细胞变化可能需要细致的筛查、对细胞特征的仔细审视以及对反应性变化范围的了解。我们利用美国病理学家学会（CAP）非妇科细胞学（NGC）实验室间比对项目的数据，来确定处于诊断范围两端的液体特征。
评估表现出良好性能特征的个体体腔液玻片的特征，并将其与表现不佳的玻片进行比较。
使用一个包含10396份实验室反馈的数据库来选择病例，这些反馈涵盖了1997年至2001年期间的各种恶性和良性病例。利用累积玻片历史记录来识别在每个参考诊断中表现良好或不佳的玻片。病例由4名CAP细胞病理学资源委员会成员达成共识后确认。记录并总结了每个类别中表现好与差的观察结果和特征。
表现不佳者的一致率范围为0%至58%。相反，在每个参考类别中，表现良好者的实验室诊断一致率较高（>80%）。出现了几种模式。腺癌表现不佳的病例包括肿瘤细胞稀少的玻片、没有两种细胞群的高细胞性恶性病例以及单细胞病例。确诊的鳞状细胞癌病例表现不佳与无角化的稀少细胞有关。当恶性细胞很少时，小细胞癌和黑色素瘤病例表现不佳。当存在大量多形性淋巴细胞或存在罕见的里德-斯腾伯格样细胞时，淋巴瘤病例表现不佳。反应性或阴性玻片在多形性细胞群体时表现最佳；表现不佳的是那些以主要淋巴细胞群体被误诊为造血系统肿瘤的玻片。
密切关注经典细胞学标准并仔细检查玻片，可能会提高CAP NGC项目参与者的教育体验以及体腔液标本的性能特征。CAP NGC项目中表现不佳者的经验教训可能会提高对日常实践中潜在诊断问题的认识，或有助于确定实验室质量改进的领域。
