Department of Pathology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71130, USA.
Cancer Cytopathol. 2012 Apr 25;120(2):134-41. doi: 10.1002/cncy.20181. Epub 2011 Jul 12.
To the authors' knowledge, the diagnostic value of cell block (CB) as an adjunct to ThinPrep liquid-based cytology (LBC) of bronchial washing specimens in the detection and subclassification of pulmonary neoplasms has not been well evaluated. The objective of the current study was to evaluate the diagnostic utility of CB in this setting.
A total of 74 bronchial washing specimens and concurrently prepared CBs with a diagnosis of malignant or suspicious/atypical obtained from bronchoscopy procedures performed during 2009 were reviewed along with 28 randomly selected negative cases. LBC and CBs were reviewed independently. Deeper levels and ancillary studies were performed on CBs for specific tumor classification if needed. LBC and CB diagnoses were correlated with final histology and/or bronchial brushings.
Use of CBs increased the number of positive diagnoses from 18 (LBC only) to 30 (combined LBC and CB) and 36 (combined LBC and CB with ancillary studies), with increased diagnostic yields of 67% and 100%, respectively. CB without ancillary techniques detected 22 malignancies whereas LBC detected 18 malignancies and CB with ancillary techniques detected 29 malignancies. A specific tumor diagnosis was possible in 22 of 29 (76%) malignancies detected by CB. Bronchial brushings and histology confirmed malignancy in 91% and 92% of cases, respectively.
CB combined with LBC was found to improve the rate of detection of malignancy over LBC alone, especially in cases with suspicious or atypical LBC diagnoses. Increased diagnostic yield is observed when CB is used with or without ancillary studies, but the yield is higher with CB using ancillary studies. CB serves as yet another available source of diagnostic material for immunohistochemical and molecular studies.
据作者所知，细胞块（CB）作为支气管灌洗标本 ThinPrep 液基细胞学（LBC）的辅助手段，在检测和亚分类肺部肿瘤方面的诊断价值尚未得到很好的评估。本研究的目的是评估 CB 在这种情况下的诊断效用。
回顾了 2009 年支气管镜检查过程中获得的 74 例支气管灌洗标本和同时制备的伴有恶性或可疑/非典型诊断的 CB，以及 28 例随机选择的阴性病例。LBC 和 CB 分别进行了回顾。如果需要特定肿瘤分类，对 CB 进行更深层次的检查和辅助研究。LBC 和 CB 诊断与最终组织学和/或支气管刷检相关。
使用 CB 使阳性诊断的数量从 18 例（仅 LBC）增加到 30 例（LBC 与 CB 联合）和 36 例（LBC 与 CB 联合并有辅助研究），诊断率分别提高了 67%和 100%。无辅助技术的 CB 检测到 22 例恶性肿瘤，而 LBC 检测到 18 例恶性肿瘤，CB 联合辅助技术检测到 29 例恶性肿瘤。29 例恶性肿瘤中有 22 例（76%）可以做出明确的肿瘤诊断。支气管刷检和组织学分别证实了 91%和 92%的病例存在恶性肿瘤。
与单独使用 LBC 相比，CB 与 LBC 联合使用发现可以提高恶性肿瘤的检出率，尤其是在 LBC 可疑或非典型诊断的情况下。当 CB 与或不与辅助研究联合使用时，诊断率会提高，但使用辅助研究的 CB 时，诊断率更高。CB 是免疫组织化学和分子研究的另一种可用的诊断材料来源。
