Mutreja D, Nijhawan Vijay S, Srinivasa V, Lakhtakia R, Subramanya H
Department of Pathology, 12 Air Force Hospital, Air Force Station, Gorakhpur, India.
J Cytol. 2012 Apr;29(2):103-10. doi: 10.4103/0970-9371.97148.
The cytological diagnosis of poorly differentiated tumors is challenging because the tumor cells may have morphologically difficult presentations in materials obtained by fine-needle aspiration cytology (FNAC). With the application of FNAC in primary diagnosis of malignant lesions, there has been a significant increase in the use of ancillary studies in the aspirated material.
We evaluated the value of ancillary studies, namely cell blocks, immunocytochemistry (ICC) and electron microscopy (EM), in the final interpretation of FNAC smears.
Sixty-nine cases of neoplastic swellings were subjected to FNAC. Material acquired was divided for ICC, consisting of immunoperoxidase staining of direct smears, and/or cellblocks and EM, in addition to routine light microscopy (LM). Correlation with the available histological material with immunohistochemistry and/or pertinent clinical information was used as a "gold" standard.
Five (7.2%) cases were excluded from the study, the material being necrotic or insufficient. Cell blocks were available in 46/64 (71.8%) cases, ICC evaluation was performed in 41/64 cases (64%) and EM studies were done in 57/64 cases (89%). Diagnostic accuracy of LM alone was 32/64 (50%). Cell blocks improved the diagnoses in 8/46 (17%) cases. The ICC data were diagnostic in 18/41 (43.9%) cases, helpful in 8/41 (19.6%) cases and non-helpful in 15/41 (36.5%) cases. EM studies were diagnostic in 22/57 (38.5%) cases, helpful in 18/57 (31.5%) cases and non-helpful in 17/57 (30%) cases. In 34/64 (53.1%) cases, all ancillary techniques (cell blocks, ICC and EM) were applied and their diagnostic accuracy was compared.
With appropriate case selection, ancillary studies performed on aspirated material can provide useful information in FNAC.
低分化肿瘤的细胞学诊断具有挑战性，因为在细针穿刺细胞学检查（FNAC）获取的材料中，肿瘤细胞可能呈现出形态学上难以判断的表现。随着FNAC在恶性病变初步诊断中的应用，对穿刺材料进行辅助检查的使用显著增加。
我们评估了辅助检查，即细胞块、免疫细胞化学（ICC）和电子显微镜检查（EM），在FNAC涂片最终解读中的价值。
对69例肿瘤性肿胀病例进行FNAC。获取的材料除进行常规光学显微镜检查（LM）外，还分为用于ICC（包括直接涂片的免疫过氧化物酶染色）、和/或细胞块及EM检查。将与可用的组织学材料进行免疫组织化学检查和/或相关临床信息的相关性作为“金”标准。
5例（7.2%）病例因材料坏死或不足被排除在研究之外。46/64例（71.8%）可获得细胞块，41/64例（64%）进行了ICC评估，57/64例（89%）进行了EM检查。仅LM的诊断准确率为32/64（50%）。细胞块在8/46例（17%）病例中改善了诊断。ICC数据在18/41例（43.9%）病例中具有诊断价值，在8/41例（19.6%）病例中有所帮助，在15/41例（36.5%）病例中无帮助。EM检查在22/57例（38.5%）病例中具有诊断价值，在18/57例（31.5%）病例中有所帮助，在17/57例（30%）病例中无帮助。在34/64例（53.1%）病例中应用了所有辅助技术（细胞块、ICC和EM）并比较了它们的诊断准确率。
通过适当的病例选择，对穿刺材料进行的辅助检查可为FNAC提供有用信息。
