支气管内超声引导下经支气管针吸活检标本现场评估的效用
Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens.
作者信息
Griffin Adrienne Carruth, Schwartz Lauren Ende, Baloch Zubair W
机构信息
Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15261, USA.
出版信息
Cytojournal. 2011;8:20. doi: 10.4103/1742-6413.90081. Epub 2011 Nov 21.
BACKGROUND
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an integral tool in the diagnosis and staging of malignant tumors of the lung. Rapid on-site evaluation (ROSE) of fine needle aspiration (FNA) samples has been advocated for as a guide for assessing the accuracy and adequacy of biopsy samples. Although ROSE has proven useful for numerous sites and procedures, few studies have specifically investigated its utility in the assessment of EBUS-TBNA specimens. The intention of this study was to explore the utility of ROSE for EBUS-TBNA specimens.
MATERIALS AND METHODS
The pathology files at our institution were searched for all EBUS-TBNA cases performed between January 2010 and June 2010. The data points included number of sites sampled per patient, location of site(s) sampled, on-site evaluation performed, preliminary on-site diagnosis rendered, final cytologic diagnosis, surgical pathology follow-up, cell blocks, and ancillary studies performed.
RESULTS
A total of 294 EBUS-TBNA specimens were reviewed and included in the study; 264 of 294 (90%) were lymph nodes and 30 of 294 (10%) were lung mass lesions. ROSE was performed for 140 of 294 (48%) specimens. The on-site and final diagnoses were concordant in 104 (74%) and discordant in 36 (26%) cases. Diagnostic specimens were obtained in 132 of 140 (94%) cases with on-site evaluation and 138 of 154 (90%) without on-site evaluation. The final cytologic diagnosis was malignant in 60 of 132 (45%) cases with ROSE and 46 of 138 (33%) cases without ROSE, and the final diagnosis was benign in 57 of 132 (47%) with ROSE and 82 of 138 (59%) without ROSE. A cell block was obtained in 129 of 140 (92%) cases with ROSE and 136 of 154 (88%) cases without ROSE.
CONCLUSIONS
The data demonstrate no remarkable difference in diagnostic yield, the number of sites sampled per patient, or clinical decision making between specimens collected via EBUS-TBNA with or without ROSE. As a result, this study challenges the notion that ROSE is beneficial for the evaluation of EBUS-TBNA specimens.
背景
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是肺部恶性肿瘤诊断和分期的重要工具。细针穿刺抽吸（FNA）样本的快速现场评估（ROSE）已被提倡作为评估活检样本准确性和充分性的指导。尽管ROSE已被证明对许多部位和操作有用，但很少有研究专门调查其在评估EBUS-TBNA标本中的效用。本研究的目的是探讨ROSE在EBUS-TBNA标本评估中的效用。
材料与方法
检索我院2010年1月至2010年6月期间所有EBUS-TBNA病例的病理档案。数据点包括每位患者采样的部位数量、采样部位的位置、进行的现场评估、做出的初步现场诊断、最终细胞学诊断、手术病理随访、细胞块以及进行的辅助研究。
结果
共审查了294份EBUS-TBNA标本并纳入研究；294份中的264份（90%）为淋巴结，294份中的30份（10%）为肺肿块病变。294份标本中的140份（48%）进行了ROSE。现场诊断与最终诊断一致的有104例（74%），不一致的有36例（26%）。进行现场评估的140例中有132例（94%）获得了诊断性标本，未进行现场评估的154例中有138例（90%）获得了诊断性标本。进行ROSE的132例中有60例（45%）最终细胞学诊断为恶性，未进行ROSE的138例中有46例（33%）最终细胞学诊断为恶性；进行ROSE的132例中有57例（47%）最终诊断为良性，未进行ROSE的138例中有82例（59%）最终诊断为良性。进行ROSE的140例中有129例（92%）获得了细胞块，未进行ROSE的154例中有136例（88%）获得了细胞块。
结论
数据表明，在通过EBUS-TBNA采集的标本中，无论有无ROSE，诊断率、每位患者采样的部位数量或临床决策方面均无显著差异。因此，本研究对ROSE有利于评估EBUS-TBNA标本这一观点提出了挑战。
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