Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer Cytopathol. 2013 Nov;121(11):653-60. doi: 10.1002/cncy.21332. Epub 2013 Jul 9.
Over the past decade, the standardization of error classification in anatomic pathology has become an important issue. The objective of the current study was to assess the extent of errors occurring in the cytopathologic diagnosis of neuroendocrine lesions of the pancreas, and to classify these errors and their associated harm.
Information on all cases diagnosed as a neuroendocrine neoplasm either by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in cytology or by surgical pathology between 2000 and 2012 was collected. Using standardized error and harm classification, the authors reviewed the cytology and surgical pathology material and evaluated the type and the cause of diagnostic errors and their impact on the patient.
A total of 177 patients who underwent EUS-FNA were diagnosed with a neuroendocrine neoplasm either by cytology or surgical pathology. Eighty of these cases had surgical follow-up available at the study institution. Of these 80 cases, 56 had an adequate cell block and immunohistochemistry was performed. There were 14 discrepancies noted between cytologic and surgical pathologic diagnoses. There were 9 false-negative cases, consisting of 3 interpretation errors and 6 cytology sampling errors. There were 5 misclassifications, including 4 cases of solid pseudopapillary neoplasm and 1 case of neuroendocrine carcinoma (diagnosed as adenocarcinoma on cytology). There were no surgical pathology errors noted. All errors were associated with no or minor harm.
EUS-FNA of pancreatic neuroendocrine neoplasms has excellent diagnostic performance, with no false-positive diagnoses reported. When an adequate sample is obtained, the most significant error is misclassification, which is most often associated with solid pseudopapillary neoplasm. The harm associated with diagnostic errors is at most minor.
在过去的十年中，解剖病理学中错误分类的标准化已成为一个重要问题。本研究的目的是评估胰腺神经内分泌肿瘤细胞学诊断中出现的错误程度，并对这些错误及其相关危害进行分类。
收集了 2000 年至 2012 年间通过内镜超声引导下细针抽吸（EUS-FNA）细胞学或手术病理学诊断为神经内分泌肿瘤的所有病例的信息。使用标准化的误差和危害分类，作者回顾了细胞学和手术病理学材料，并评估了诊断错误的类型和原因及其对患者的影响。
共有 177 名接受 EUS-FNA 的患者通过细胞学或手术病理学诊断为神经内分泌肿瘤。其中 80 例在研究机构有手术随访。在这 80 例中，56 例有足够的细胞块，进行了免疫组织化学检查。细胞学和手术病理诊断之间存在 14 处差异。有 9 例假阴性病例，包括 3 例解释错误和 6 例细胞学取样错误。有 5 例误诊，包括 4 例实性假乳头状肿瘤和 1 例神经内分泌癌（细胞学诊断为腺癌）。未发现手术病理错误。所有错误均与无或轻微危害相关。
EUS-FNA 诊断胰腺神经内分泌肿瘤具有良好的诊断性能，未报告假阳性诊断。当获得足够的样本时，最主要的错误是分类错误，这最常与实性假乳头状肿瘤相关。诊断错误相关的危害最多为轻微。
