经颈纵隔扩大淋巴结切除术获取的淋巴结的快速细胞学评估。

Fast cytological evaluation of lymphatic nodes obtained during transcervical extended mediastinal lymphadenectomy.

机构信息

Department of Pathology, Pulmonary Hospital, Zakopane, Poland.

出版信息

Eur J Cardiothorac Surg. 2013 Feb;43(2):297-301. doi: 10.1093/ejcts/ezs278.

DOI:10.1093/ejcts/ezs278

PMID:23319487

Abstract

OBJECTIVES

Evaluation of the diagnostic efficiency of the intraoperative cytological examination of lymphatic nodes obtained during transcervical extended mediastinal lymphadenectomy (TEMLA).

METHODS

All mediastinal nodes obtained during consecutive TEMLA operations in patients with confirmed lung cancer were examined. Cytological imprints from cross sections of nodes were performed, fixed in 96 proof alcohol and stained with Haematoxylin-Eosin. The cytological slides were evaluated by light microscopy intraoperatively, and a standard paraffin histological examination of the same nodes was done afterwards for confirmation of the final diagnosis.

RESULTS

Intraoperative cytological studies were performed in 63 patients (17 women and 46 men; overall in 453 mediastinal nodal stations) from 1 April 2009 to 28 February 2011. The mean number of nodes/procedure was 27.8. The mean time of performance of the examination was 37 min, including 7 min for smears, 13 min for staining and 17 min for microscopic examination (overall 37 min). The cytological study discovered neoplasmatic cells in 12 of 63 patients, nodal stations in 22 of 453 and nodes in 44 of 1724. According to the analysis of the 63 patients, the imprint cytology technique had a sensitivity of 92.3%, specificity of 100%, accuracy of 98.4%, positive predictive value of 100% and negative predictive value of 98.0%, as was confirmed by the final histopathological examination.

CONCLUSIONS

(i) Cytological imprints examination was characterized by a very high specificity and sensitivity, is technically simpler and faster and allows for the examination of several dozens of lymphatic nodes during a single TEMLA procedure within an acceptable time, and after the exclusion of N2 nodes enables the simultaneous performance of a radical lung resection. (ii) The presented technique was the alternative for the traditional histopathological examination of the material frozen in cryostat.

摘要

目的

评估经颈纵隔扩大淋巴结清扫术（TEMLA）中获取的淋巴结术中细胞学检查的诊断效率。

方法

对连续 TEMLA 手术中确诊肺癌患者的所有纵隔淋巴结进行检查。对淋巴结的横截面进行细胞学印片，用 96 度酒精固定并进行苏木精-伊红染色。术中通过光学显微镜对细胞学载玻片进行评估，然后对同一淋巴结进行标准石蜡组织学检查，以确认最终诊断。

结果

2009 年 4 月 1 日至 2011 年 2 月 28 日期间，对 63 例患者（17 名女性和 46 名男性；总共 453 个纵隔淋巴结站）进行了术中细胞学研究。平均每个手术切除的淋巴结数量为 27.8 个。检查的平均用时为 37 分钟，包括涂片 7 分钟、染色 13 分钟和显微镜检查 17 分钟（总共 37 分钟）。细胞学研究在 63 例患者中的 12 例、453 个淋巴结站中的 22 例和 1724 个淋巴结中的 44 例中发现了肿瘤细胞。根据对 63 例患者的分析，印片细胞学技术的敏感性为 92.3%、特异性为 100%、准确性为 98.4%、阳性预测值为 100%和阴性预测值为 98.0%，这与最终的组织病理学检查结果相符。