Naresh-Babu J, Neelima G, Reshma-Begum S K
Department of Spine Surgery, Mallika Spine Centre, 12-12-30 Old Club Road, Kothapet, Guntur & B-58, Journalist Colony, Jubilee Hills, Hyderabad 500033, India.
Department of Pathology, Osmania Medical College, Sultan Bazaar, Koti, Hyderabad 500001, India.
Spine J. 2014 Oct 1;14(10):2320-5. doi: 10.1016/j.spinee.2014.01.033. Epub 2014 Jan 23.
Obtaining adequate representative material has been a problem in transpedicular vertebral body biopsies resulting in inconclusive diagnosis and delayed management. By rapidly confirming the adequacy of the material intraoperatively, the rate of negative biopsies can be minimized. Present study evaluates the role of intraoperative cytology in increasing the diagnostic yield of vertebral biopsies.
To evaluate the role of intraoperative cytological confirmation in increasing the specimen adequacy of vertebral biopsies.
A prospective cytological and histopathologic study.
Thirty-nine patients undergoing transpedicular biopsy were included.
Adequacy and accuracy along with sensitivity and specificity of transpedicular biopsies with and without adopting scrape cytological screening were analyzed.
After obtaining transpedicular specimens, they were initially screened by intraoperative cytology before submitting for histopathologic examination. Cytological smears were prepared by rapid hematoxylin and eosin technique. Additional specimens were obtained if cytology showed inadequate or inconclusive cells.
Of 39 patients who underwent transpedicular biopsy, the intraoperative cytology confirmed 32 (82.1%) specimens as adequate, 5 (12.8%) inadequate, and 2 (5.1%) as inconclusive. Adequacy of biopsy specimens with intraoperative cytology was found to have a sensitivity of 96.9%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 87.5%. If the intraoperative cytology was not adopted, six of 39 (15.4%) patients would have required repeat biopsy. Of the 47 specimens from 39 lesions, 46 intraoperative cytological diagnoses correlated well with the histopathology, with an accuracy of 95.7%. The average time taken to report the adequacy was 8.9 ± 1.7 minutes.
Onsite intraoperative cytology is a rapid and an inexpensive technique to obtain accurate and adequate vertebral body tissue specimen with 100% diagnostic yield. The technique can be adopted easily into day-to-day practice and requires only few glass slides and regular reagents.
在经椎弓根椎体活检中，获取足够的代表性材料一直是个问题，这导致诊断不确定和治疗延迟。通过在术中快速确认材料是否足够，可以将活检阴性率降至最低。本研究评估术中细胞学检查在提高椎体活检诊断率方面的作用。
评估术中细胞学确认在提高椎体活检标本充足率方面的作用。
一项前瞻性细胞学和组织病理学研究。
纳入39例行经椎弓根活检的患者。
分析采用和不采用刮片细胞学筛查的经椎弓根活检的充足率、准确性以及敏感性和特异性。
获取经椎弓根标本后，在进行组织病理学检查之前，先通过术中细胞学进行初步筛查。细胞学涂片采用快速苏木精和伊红技术制备。如果细胞学检查显示细胞不足或不确定，则获取额外的标本。
在39例行经椎弓根活检的患者中，术中细胞学确认32例（82.1%）标本充足，5例（12.8%）不足，2例（5.1%）不确定。发现术中细胞学检查的活检标本充足率的敏感性为96.9%，特异性为100%，阳性预测值为100%，阴性预测值为87.5%。如果不采用术中细胞学检查，39例患者中有6例（15.4%）需要重复活检。在39个病变的47个标本中，46个术中细胞学诊断与组织病理学结果相关性良好，准确性为95.7%。报告充足率的平均时间为8.9±1.7分钟。
术中现场细胞学检查是一种快速且廉价的技术，能够获得准确且充足的椎体组织标本，诊断率达100%。该技术可轻松应用于日常实践，仅需少量载玻片和常规试剂。
