Harada Shuko, Agosto-Arroyo Emmanuel, Levesque Jessica A, Alston Evan, Janowski Karen M, Coshatt Gina M, Eltoum Isam A
Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Cancer Cytopathol. 2015 Aug;123(8):480-7. doi: 10.1002/cncy.21561. Epub 2015 May 8.
In the era of personalized medicine, requests for molecular testing of specimens obtained with minimally invasive procedures such as fine-needle aspiration have been increasing. Although cell blocks (CBs) are the recommended specimens for molecular testing, their performance has not been well analyzed. The objective of this study was to assess the frequency and types of samples deemed unsatisfactory for molecular testing (quantity not sufficient [QNS]).
One year after the implementation of careful monitoring of QNS cases, cases submitted for lung cancer molecular testing were analyzed for the QNS rate. When the cases were rejected for the inadequacy of CBs of cytology specimens, air-dried, Diff-Quik (DQ)-stained smears were reviewed and used if they were adequate. The QNS rates were compared across 4 specimen categories: large resection, small biopsy, CB alone, and CB with DQ smears.
One hundred seventy-six cases were studied, and 45 (25.6%) were unsatisfactory. Only 1 of 73 large resection specimens was rejected because of decalcification. The QNS rate for small biopsy specimens was 35.9% (28 of 78), whereas 64% (16 of 25) of cytology cases ordered on CBs were rejected. In combination with DQ smears, the QNS rate of cytology specimens was 32% (8 of 25), which was a significant improvement over CBs only (P = .024) and was not significantly different from the QNS rate for small biopsies (P = .671).
The utilization of DQ-stained smears for molecular testing improves the adequacy of cytologic samples and provides a minimally invasive alternative to surgical biopsy when molecular analysis of tumor material is necessary.
在个性化医疗时代,对通过细针穿刺等微创程序获取的标本进行分子检测的需求不断增加。尽管细胞块(CBs)是分子检测推荐使用的标本,但其性能尚未得到充分分析。本研究的目的是评估被认为不适合分子检测(数量不足[QNS])的样本的频率和类型。
在对QNS病例进行仔细监测实施一年后,分析提交进行肺癌分子检测的病例的QNS率。当细胞学标本的CBs因不充分而被拒收时,对空气干燥、Diff-Quik(DQ)染色涂片进行复查,若涂片足够则予以使用。比较了4种标本类型的QNS率:大切除标本、小活检标本、单独的CBs以及CBs与DQ涂片。
共研究了176例病例,其中45例(25.6%)不令人满意。73例大切除标本中只有1例因脱钙被拒收。小活检标本的QNS率为35.9%(78例中的28例),而基于CBs送检的细胞学病例中有64%(25例中的16例)被拒收。结合DQ涂片后,细胞学标本的QNS率为32%(25例中的8例),与仅使用CBs相比有显著改善(P = 0.024),与小活检标本的QNS率无显著差异(P = 0.671)。
使用DQ染色涂片进行分子检测可提高细胞学样本的充分性,并在需要对肿瘤材料进行分子分析时提供一种微创的手术活检替代方法。