Andonian Sero, Okeke Zeph, Okeke Deidre A, Sugrue Chiara, Wasserman Patricia G, Lee Benjamin R
Smith Institute of Urology, Department of Pathology, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA.
J Endourol. 2008 Oct;22(10):2377-80. doi: 10.1089/end.2008.9724.
Renal Fine Needle Aspiration Cytology (FNAC) has gained popularity due to increasing options in management of renal lesions such as energy ablation and active surveillance. The diagnostic yield of renal FNAC varies between 40-90%. We hypothesized that adequate and diagnostic FNA samples would be associated with higher number of needle passes and higher number of slides examined.
The pathology database at our institution was retrospectively searched for renal FNACs performed between 1995 and 2005. Patient gender, side, indication, cytological diagnosis, final histological diagnosis when available, number of needle passes performed, number of slides examined, and adequacy of the FNAC sample as determined by Diff Quik staining by the cytotechnologist (CS) were recorded. Chi square test was performed for statistical analysis.
Out of 377 renal biopsies performed, 259 were core biopsies for medical renal disease, and 118 were FNACs for renal lesions, including 16 for indeterminate complex renal cysts and 102 for solid renal masses. Indeterminate renal cysts were excluded from the study. Out of 102 FNACs for solid renal masses, 22 were inadequate with 13 (59%) being non-diagnostic; and 80 FNACs were adequate with 3 (4%) being non-diagnostic. The number of needle passes was not significantly different between non-diagnostic and diagnostic samples (2.5 vs 3.2); and between inadequate and adequate samples (3.4 vs 3.0). Similarly, the number of slides examined was not significantly different between non-diagnostic and diagnostic samples (9.5 vs 10.9); and between inadequate and adequate samples (11.3 vs 10.6). Diff Quik adequate samples had significantly higher diagnostic yields when compared to Diff Quik inadequate samples (965 vs 41%; p<0.01).
The number of needle passes and microscopic slides examined did not correlate with sample adequacy or diagnostic yield of renal FNAC. Sample adequacy as determined by Diff Quik staining correlated with diagnostic FNAC. Despite the retrospective nature of this study, a cytotechnologist should be present during the FNA procedure to ensure adequate samples have been obtained to increase the diagnostic yield of renal FNAC.
由于在肾病变管理方面有了更多选择，如能量消融和主动监测，肾细针穿刺抽吸细胞学检查（FNAC）越来越受欢迎。肾FNAC的诊断率在40%至90%之间。我们推测，足够且具有诊断性的FNA样本会与更多的穿刺次数和更多的送检玻片数量相关。
对我们机构病理数据库进行回顾性检索，查找1995年至2005年间进行的肾FNAC病例。记录患者的性别、患侧、适应证、细胞学诊断、最终组织学诊断（若有）、穿刺次数、送检玻片数量以及细胞技术人员（CS）通过Diff Quik染色确定的FNAC样本是否足够。采用卡方检验进行统计分析。
在377例肾活检中，259例为内科肾病的芯针活检，118例为肾病变的FNAC，其中包括16例不确定的复杂性肾囊肿和102例实性肾肿块。不确定的肾囊肿被排除在研究之外。在102例实性肾肿块的FNAC中，22例样本不足，其中13例（59%）为非诊断性；80例样本足够，其中3例（4%）为非诊断性。非诊断性样本与诊断性样本的穿刺次数无显著差异（2.5次对3.2次）；样本不足与足够的样本之间也无显著差异（3.4次对3.0次）。同样，非诊断性样本与诊断性样本的送检玻片数量无显著差异（9.5张对10.9张）；样本不足与足够的样本之间也无显著差异（11.3张对1C.6张）。与Diff Quik染色不足的样本相比，Diff Quik染色足够的样本诊断率显著更高（96%对41%；p<0.01）。
穿刺次数和送检显微镜玻片数量与肾FNAC的样本充足性或诊断率无关。通过Diff Quik染色确定的样本充足性与诊断性FNAC相关。尽管本研究具有回顾性，但在FNA操作过程中应有细胞技术人员在场，以确保获取足够的样本，提高肾FNAC的诊断率。
