Mazza Ernesto, Maddau Cristina, Ricciardi Alessandro, Falchini Massimo, Matucci Marzia, Ciarpallini Tommaso
Azienda Ospedaliera-Universitaria Careggi, Radiodiagnostica I, Radiologia Interventistica, Florence.
Radiol Med. 2005 Sep;110(3):141-8.
The aim of this study was to assess the usefulness of having a cytopathologist present during percutaneous CT-guided fine needle aspiration (FNA) of pulmonary lesions.
Three hundred and twenty-one FNAs of lung lesions were performed in 312 patients (218 males, 94 females; age range: 20-86 years; mean age: 66 yrs). Nodule sizes ranged from 0.5 to 8 cm. The sampling was performed by a radiologist under CT-guidance; the calibre of the needle used was 20-25 G. Smears were prepared in the Radiology Department and stained using a quick method by a cytopathologist: the sample adequacy was assessed and, if possible, a preliminary diagnosis was made. An additional FNA was requested if the first aspirate was considered diagnostically inadequate. The diagnostic accuracy was examined by reviewing the clinical data and by correlating with the histological material and the clinical outcome.
Satisfactory diagnostic material was obtained in 275 of the 321 FNA (86%): 231 were malignant (72%), 8 suspicious (3%) and 36 were negative for malignancy (11%). Forty-six of the 321 specimens (14%) were considered inadequate for any diagnostic verification. An additional FNA was performed immediately in 60 cases (19%). Forty-two subjects developed pneumothorax: 21 patients (50%) of these required thoracic drainage. Blood effusion around the lesion site or adjacent to the needle path was observed in 39 patients (12%). Sensitivity was 99%, specificity was 95% and diagnostic accuracy was 99%.
CT guided aspiration cytology can be a safe and fast procedure for lung nodule characterisation. On-site immediate evaluation of FNA specimens can be beneficial in determining the adequacy of the aspirate and in providing accurate preliminary diagnoses of the specimens, thus allowing for rapid clinical decisions.
本研究的目的是评估在经皮CT引导下对肺部病变进行细针穿刺抽吸（FNA）时，有细胞病理学家在场的实用性。
对312例患者（218例男性，94例女性；年龄范围：20 - 86岁；平均年龄：66岁）的321个肺部病变进行了FNA。结节大小为0.5至8厘米。采样由放射科医生在CT引导下进行；使用的针的口径为20 - 25G。涂片在放射科制备，并由细胞病理学家使用快速方法染色：评估样本充足性，并在可能的情况下做出初步诊断。如果首次抽吸被认为诊断不充分，则要求进行额外的FNA。通过回顾临床数据并与组织学材料和临床结果相关联来检查诊断准确性。
321例FNA中有275例（86%）获得了满意的诊断材料：231例为恶性（72%），8例可疑（3%），36例恶性阴性（11%）。321个标本中有46例（14%）被认为不足以进行任何诊断验证。60例（19%）立即进行了额外的FNA。42例患者发生气胸：其中21例（50%）需要胸腔引流。39例患者（12%）在病变部位周围或针道附近观察到血性渗出。敏感性为99%，特异性为95%，诊断准确性为99%。
CT引导下的穿刺细胞学检查对于肺部结节的特征性诊断是一种安全、快速的方法。对FNA标本进行现场即时评估有助于确定抽吸物的充足性，并对标本提供准确的初步诊断，从而实现快速的临床决策。
