Jonasson J G, Ducatman B S, Wang H H
Department of Pathology, Beth Israel Hospital, Boston, Massachusetts.
Mod Pathol. 1990 Nov;3(6):667-70.
We reviewed retrospectively reports on cytologic smears and cell blocks from body cavity fluids received in our department over a 12-mo period. In order to evaluate the usefulness of the two modalities independently, all available slides were studied with the reviewers blinded to the original diagnoses, history, and appearances on corresponding cytology/cell block. Of 524 cytology samples, 283 had cell blocks, of which 263 were available for comparative cytologic and histologic review. Twenty-four cases based on the original reports and 22 cases in the review had diagnoses with major discrepancies between the cell block and cytology. On original reports, cytology favored malignancy in 21 cases in which the cell block was benign, with one false suspicious cytology. In three cases, the cell block was suspicious/positive (two false suspicious cell blocks), but cytology was negative/atypical. In the review diagnoses, there were also 21 cases of suspicious/positive cytology (one false suspicious cytology) and negative/atypical cell blocks. In only one case did the cell block favor malignancy when cytology was benign (a false suspicious cell block). Review of Medicare data indicated that the physician's fee charged for these 283 cell blocks would range from about $7,000 to $28,000 to detect one additional malignancy. We conclude that the routine use of cell blocks is not a cost-effective method of detecting malignancy in body cavity fluids. We advise that samples be refrigerated or be kept fixed. If immunoperoxidase studies are desired following cytologic evaluation, they may be performed subsequently on fresh smears or a cell block.
我们回顾性分析了本部门在12个月内接收的体腔液细胞学涂片和细胞块报告。为了独立评估这两种方法的实用性，所有可用玻片均由审阅者在不知原始诊断、病史及相应细胞学/细胞块表现的情况下进行研究。在524份细胞学样本中，283份有细胞块，其中263份可用于细胞学和组织学对比审阅。根据原始报告，24例以及审阅中的22例在细胞块和细胞学诊断上存在重大差异。在原始报告中，细胞学诊断为恶性的21例中细胞块为良性，有1例假性可疑细胞学诊断。3例中细胞块可疑/阳性（2例假性可疑细胞块），但细胞学为阴性/非典型。在审阅诊断中，也有21例可疑/阳性细胞学（1例假性可疑细胞学）和阴性/非典型细胞块。仅1例细胞学为良性时细胞块诊断为恶性（1例假性可疑细胞块）。医疗保险数据审查表明，为检测出另外1例恶性肿瘤，这283个细胞块的医生收费约为7000美元至28000美元。我们得出结论，常规使用细胞块并非检测体腔液中恶性肿瘤的经济有效方法。我们建议样本冷藏或固定保存。如果在细胞学评估后需要进行免疫过氧化物酶研究，可随后在新鲜涂片或细胞块上进行。
