Vigliar E, Malapelle U, Bellevicine C, de Luca C, Troncone G
Pathology Division, Department of Public Health, University of Naples, Naples, Italy.
Cytopathology. 2015 Oct;26(5):312-7. doi: 10.1111/cyt.12221. Epub 2014 Nov 7.
Guidelines from the College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC) and the Association for Molecular Pathology (AMP) consider cytology suitable for testing epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma. The guidelines recommend that cytopathologists first discuss the possibility of testing squamous cell carcinomas (SqCC) in multidisciplinary meetings. Second, cell blocks should be analysed rather than smear preparations and, third, specimens should be sent to external molecular laboratories within three working days of receiving requests. This study monitored how these recommendations are met in practice.
Our laboratory received 596 requests from cytologists from 13 different institutions. For each case, the cytological diagnosis, cytopreparation type, and time between the request and sample mailing were compared with the recommendations.
Of the 596 samples, 32 (5.4%) had been reported as SqCC. Three of these (9.4%) showed EGFR mutation. Cytological slides, either ThinPrep(™) (51.2%) or direct smears (43.2%), were more frequently received than cell blocks (5.7%). The mean time between the oncologist's request and specimen dispatching was 5.8 working days.
The occurrence of mutations in samples reported as SqCC was higher than expected. This questions the reliability of the original diagnosis, which reinforced the recommendation to evaluate the opportunity for testing non-adenocarcinoma cytology on a case-by-case basis. In spite of CAP/IASLC/AMP recommendations, cell blocks were underutilized for EGFR testing, but cytological slides were suitable for DNA analyses. Significant efforts are needed to avoid delays in outsourcing cytological samples for EGFR testing.
美国病理学家学会（CAP）、国际肺癌研究协会（IASLC）和分子病理学协会（AMP）的指南认为，细胞学检查适用于检测肺腺癌中的表皮生长因子受体（EGFR）突变。这些指南建议，细胞病理学家应首先在多学科会议上讨论检测鳞状细胞癌（SqCC）的可能性。其次，应分析细胞块而非涂片标本，第三，标本应在收到请求后的三个工作日内送往外部分子实验室。本研究监测了这些建议在实际操作中的落实情况。
我们的实验室收到了来自13个不同机构的细胞学家的596份请求。对于每个病例，将细胞学诊断、细胞制备类型以及请求与样本邮寄之间的时间与建议进行了比较。
在596个样本中，有32个（5.4%）被报告为SqCC。其中三个（9.4%）显示EGFR突变。ThinPrep（™）细胞学玻片（51.2%）或直接涂片（43.2%）比细胞块（5.7%）更常被收到。肿瘤学家请求与标本发送之间的平均时间为5.8个工作日。
报告为SqCC的样本中突变的发生率高于预期。这对最初诊断的可靠性提出了质疑，这强化了逐案评估非腺癌细胞学检测机会的建议。尽管有CAP/IASLC/AMP的建议，但细胞块在EGFR检测中的利用率较低，但细胞学玻片适用于DNA分析。需要做出重大努力以避免将细胞学样本外包进行EGFR检测时出现延迟。
