Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA.
Cancer Cytopathol. 2013 Aug;121(8):449-58. doi: 10.1002/cncy.21299. Epub 2013 May 15.
The diagnosis of pancreatic tumors is often complicated because of sampling and interpretive challenges. The current study was performed to determine the rates, types, and causes of diagnostic discrepancies.
The authors retrospectively reviewed cytology cases from 2004 to 2010 using matched surgical resection cases as the gold standard.
A total of 733 cases were divided into 3 categories: 1) positive or suspicious (290 cases); 2) negative or atypical (403 cases); and 3) unsatisfactory (40 cases). Of these cases, 101 fine-needle aspiration (FNA) cases had matched surgical resections including 58 positive diagnoses, 39 negative diagnoses, and 4 unsatisfactory diagnoses. All 19 discrepant cases represented false-negative diagnoses without any false-positive cases noted, which included 2 cases with interpretive errors (10%) and 17 cases with sampling errors (90%). All matched cytology cases were divided into 5 subgroups based on the type of lesion or type of error and were analyzed for sensitivity and specificity. The sampling error rate in cystic lesions (8 of 24; 33%) was significantly higher than that in solid lesions (9 of 73; 12%). The false-negative rate in the interpretive error group (3%) was significantly lower than that in the sampling error group (23%).
The results of the current study confirm that pancreatic endoscopic ultrasound-guided FNA diagnosis has a very low false-positive rate but a relatively high false-negative rate using matched surgical resections as the gold standard. The major cause of a false-negative cytology diagnosis is sampling error and the rate of sampling error in cystic lesions is significantly higher than that in solid lesions.
由于采样和解释方面的挑战,胰腺肿瘤的诊断通常较为复杂。本研究旨在确定诊断差异的发生率、类型和原因。
作者使用匹配的手术切除病例作为金标准,对 2004 年至 2010 年的细胞学病例进行了回顾性分析。
共有 733 例病例分为 3 类:1)阳性或可疑(290 例);2)阴性或非典型(403 例);3)不满意(40 例)。在这些病例中,有 101 例细针抽吸(FNA)病例有匹配的手术切除,包括 58 例阳性诊断、39 例阴性诊断和 4 例不满意诊断。所有 19 例不一致的病例均代表假阴性诊断,没有假阳性病例,包括 2 例解释性错误(10%)和 17 例采样错误(90%)。所有匹配的细胞学病例根据病变类型或错误类型分为 5 个亚组,分析其敏感性和特异性。囊性病变的采样错误率(24 例中的 8 例;33%)明显高于实性病变(73 例中的 9 例;12%)。解释性错误组的假阴性率(3%)明显低于采样错误组(23%)。
本研究结果证实,使用匹配的手术切除作为金标准,胰腺内镜超声引导下 FNA 诊断的假阳性率非常低,但假阴性率相对较高。假阴性细胞学诊断的主要原因是采样错误,囊性病变的采样错误率明显高于实性病变。