Semenova Ekaterina A, Milman Tatyana, Finger Paul T, Natesh Sribhargava, Kurli Madhavi, Schneider Susan, Iacob Codrin E, McCormick Steven A
The New York Eye Cancer Center, New York, NY 10065, USA.
Am J Ophthalmol. 2009 Nov;148(5):772-778.e1. doi: 10.1016/j.ajo.2009.06.015. Epub 2009 Aug 5.
To determine the reliability and role of conjunctival exfoliative cytologic and histopathologic diagnosis of biopsied tissue in ocular surface squamous neoplasia.
Retrospective review of an interventional case series of patients biopsied and treated for squamous conjunctival and corneal neoplasia.
Forty-nine patients who underwent conjunctival cytologic analysis (n = 36), conjunctival biopsy (n = 35), or both were evaluated. For the purposes of this study, three ocular pathologists reviewed the results of cytologic and biopsied tissue in a masked fashion.
Evaluation of cytologic smears revealed a 91% concordance in interpretation of conjunctival cytologic material as no dysplasia vs dysplasia. The concordance dropped to 59% in grading the degree of dysplasia. The cytologic material was found to be inadequate for interpretation in 1 case. Evaluation of subsequent biopsy revealed a 98% concordance between the pathologists in interpretation of biopsied tissue as no dysplasia vs any degree of dysplasia. The concordance decreased to 83% in grading the degree of dysplasia. Cytologic evaluation was capable of distinguishing a neoplastic from nonneoplastic process before tissue biopsy in 80% of cases.
Ocular surface cytologic analysis is a simple, safe, and relatively noninvasive diagnostic tool. It was found helpful in detecting dysplasia before surgical resection. It was used in the settings of recurrent tumor and for follow-up care of patients treated with topical chemotherapy. Although cytologic smears cannot replace incisional or excisional biopsy for definitive diagnosis, exfoliative cytologic analysis can play an important role in the diagnosis and management of patients with ocular surface squamous neoplasia.
确定结膜脱落细胞学检查及活检组织的组织病理学诊断在眼表鳞状上皮肿瘤中的可靠性及作用。
对接受结膜和角膜鳞状上皮肿瘤活检及治疗的患者进行的干预性病例系列回顾性研究。
对49例接受结膜细胞学分析（n = 36）、结膜活检（n = 35）或两者皆有的患者进行评估。为进行本研究，三名眼科病理学家以盲法审查了细胞学及活检组织的结果。
对细胞学涂片的评估显示，在将结膜细胞学材料解读为无异型增生与异型增生方面，一致性为91%。在对异型增生程度进行分级时，一致性降至59%。发现有1例细胞学材料无法用于解读。对后续活检的评估显示，病理学家在将活检组织解读为无异型增生与任何程度的异型增生方面，一致性为98%。在对异型增生程度进行分级时，一致性降至83%。在80%的病例中，细胞学评估能够在组织活检前区分肿瘤性与非肿瘤性病变。
眼表细胞学分析是一种简单、安全且相对无创的诊断工具。发现其有助于在手术切除前检测异型增生。它用于复发性肿瘤的情况以及接受局部化疗患者的随访。虽然细胞学涂片不能替代切开活检或切除活检进行明确诊断，但脱落细胞学分析在眼表鳞状上皮肿瘤患者的诊断和管理中可发挥重要作用。
