Min Joo-Won, Lee Sang-Min, Chung Doo Hyun, Yim Jae-Joon, Yang Seok-Chul, Yoo Chul-Gyu, Kim Young Whan, Han Sung Koo, Shim Young-Soo, Chung Hee Soon
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
Respirology. 2009 Sep;14(7):1042-50. doi: 10.1111/j.1440-1843.2009.01610.x.
More non-diagnostic pathology results may be reported following transthoracic needle lung biopsy (TTNB) when no on-site cytopathologist is available. This study was conducted to analyse the final outcomes in patients with non-diagnostic pathology results, and the factors related to the adequacy of specimens.
The medical records of consecutive patients who had undergone TTNB from January 2004 to January 2005 were retrospectively analysed. Non-diagnostic pathology results were classified into three groups: (i) atypical cells, (ii) non-specific inflammation and (iii) inadequate specimen. The final diagnosis and clinical outcome for each patient were analysed after additional diagnostic studies and clinical follow up.
TTNB was performed on 291 patients. Specimens were adequate in 256 cases. The results were non-diagnostic for 103 patients, and the percentages of atypical cells, non-specific inflammation and inadequate specimen were 15.5% (16/103), 50.5% (52/103) and 40% (35/103), respectively. In 14 patients (87.5%) the diagnosis of atypical cells was confirmed, and in 10 (62.5%) these were due to malignancies. In two patients (3.8%) the lesions reported as non-specific inflammation were eventually confirmed as malignancies. After repeated attempts to confirm their diagnoses, 22 patients (62.9%) with initial reports of inadequate specimen were diagnosed with specific diseases. Specimen adequacy correlated with technical skill, size of the lesion, guidance method and biopsy method.
Non-diagnostic pathology results from TTNB, in the absence of an on-site cytopathologist, are of value in assessing the clinical probability of malignancy and can be useful in the management of lung lesions. However, many other factors should be considered in patients with inadequate specimens.
在没有现场细胞病理学家的情况下，经胸针吸肺活检（TTNB）后可能会报告更多非诊断性病理结果。本研究旨在分析非诊断性病理结果患者的最终结局以及与标本充分性相关的因素。
回顾性分析2004年1月至2005年1月连续接受TTNB的患者的病历。非诊断性病理结果分为三组：（i）非典型细胞，（ii）非特异性炎症，（iii）标本不足。在进行额外的诊断性研究和临床随访后，分析每位患者的最终诊断和临床结局。
对291例患者进行了TTNB。256例标本充足。103例患者的结果为非诊断性，非典型细胞、非特异性炎症和标本不足的百分比分别为15.5%（16/103）、50.5%（52/103）和40%（35/103）。14例（87.5%）非典型细胞诊断得到证实，其中10例（62.5%）为恶性肿瘤。2例（3.8%）最初报告为非特异性炎症的病变最终被确认为恶性肿瘤。在多次尝试确诊后，22例（62.9%）最初报告标本不足的患者被诊断为特定疾病。标本充足性与技术水平、病变大小、引导方法和活检方法相关。
在没有现场细胞病理学家的情况下，TTNB的非诊断性病理结果在评估恶性肿瘤的临床可能性方面具有价值，并且对肺部病变的管理可能有用。然而，对于标本不足的患者，应考虑许多其他因素。
