From the Department of Pathology, University of California, San Francisco (Dr Tabatabai); the Department of Pathology, McGill University Health Center, Montreal, Quebec, Canada (Dr Auger); the Department of Pathology, Wisconsin State Lab of Hygiene, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Biostatistics, College of American Pathologists, Northfield (Ms Souers), and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago (Dr Nayar), Illinois; the Department of Pathology, University of Pittsburgh Medical Center-Shadyside, Pittsburgh, Pennsylvania (Dr Khalbuss); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); and the Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Kentucky (Dr Fraig).
Arch Pathol Lab Med. 2015 Feb;139(2):178-83. doi: 10.5858/arpa.2013-0282-CP.
Pulmonary bronchial brushing specimens can be processed by liquid-based or conventional methods. The ability to accurately diagnose a pulmonary malignancy with a liquid-based preparation (LBP) versus a conventional preparation may differ.
To compare the performance of LBPs of malignant pulmonary bronchial brushing specimens with the performance of conventional preparations.
Participant responses from 553 malignant pulmonary bronchial brushing samples were evaluated for concordance with the general diagnosis. The performance of LBPs was compared with that of classic preparations. A nonlinear mixed model was used to analyze the performance by reference diagnosis, preparation type, program years, participant type, and the interaction terms between these 4 factors.
Concordance with the general category of malignant disease was observed in 95.2% of conventional Papanicolaou-stained, 90.9% of modified Giemsa-stained, and 96.9% of LBP (P < .001) samples. The results were significantly different between individual reference diagnoses (P < .001). The performance of LBPs was consistently higher for most diagnoses and was significantly better for squamous cell carcinoma (P = .005), small cell carcinoma (P < .001), and metastatic carcinoma not otherwise specified (P < .001). All participant types performed significantly better with LBPs of small cell carcinoma. Pathologists and cytotechnologists performed significantly better with LBPs of squamous cell carcinoma. A significantly higher concordance was observed between the general diagnosis and program years 2007-2011 versus 2001-2006 (P = .006).
Liquid-based preparations performed better than conventional methods, with significantly higher performance in squamous cell, small cell, and metastatic carcinomas. Improved performance over time may reflect more frequent use of LBP methods and increased familiarity with interpreting the morphologic findings.
支气管刷检标本可采用液基或传统方法处理。采用液基制备（LBP）与传统制备准确诊断肺部恶性肿瘤的能力可能不同。
比较 LBP 与传统制备对恶性肺支气管刷检标本的诊断性能。
对 553 例恶性肺支气管刷检样本的参与者反应进行评估，以确定与一般诊断的一致性。比较 LBP 与经典制剂的性能。采用非线性混合模型，根据参考诊断、制剂类型、方案年份、参与者类型以及这 4 个因素之间的相互作用项来分析性能。
传统巴氏染色、改良吉姆萨染色和 LBP 的恶性疾病总体分类的一致性分别为 95.2%、90.9%和 96.9%（P<0.001）。各参考诊断之间的结果差异有统计学意义（P<0.001）。对于大多数诊断，LBP 的性能均较高，且对鳞状细胞癌（P=0.005）、小细胞癌（P<0.001）和未特指转移性癌（P<0.001）的诊断性能明显更好。所有参与者类型的小细胞癌 LBP 诊断性能均明显提高。病理学家和细胞技术专家对鳞状细胞癌的 LBP 诊断性能明显提高。2007-2011 年方案与 2001-2006 年方案之间的总体诊断与方案年份之间的一致性显著更高（P=0.006）。
液基制备的性能优于传统方法，在鳞状细胞癌、小细胞癌和转移性癌中的性能明显提高。随着时间的推移，性能提高可能反映了 LBP 方法的使用频率更高，以及对形态学发现解读的熟悉程度提高。
