Eftekhar-Javadi Arezoo, Kumar Perikala Vijayananda, Mirzaie Ali Zare, Radfar Amir, Filip Irina, Niyazi Maximilian, Sadeghipour Alireza
Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran E-mail :
Asian Pac J Cancer Prev. 2015;16(16):7385-90. doi: 10.7314/apjcp.2015.16.16.7385.
Transthoracic fine needle aspiration (FNA) cytology and core needle biopsy (CNB) are two commonly used approaches for the diagnosis of suspected neoplastic intrathoracic lesions. This study compared the diagnostic accuracy of FNA cytology and concurrent CNB in the evaluation of intrathoracic lesions.
We studied FNA cytology and concurrent CNB specimens of 127 patients retrospectively, using hematoxylin and eosin (H and E), immunohistochemistry, and, on certain occasions cytochemistry. Information regarding additional tissue tests was derived from the electronic archives of the Department of Pathology and Laboratory Medicine as well as patient records. Diagnostic accuracy was calculated for each test.
Of 127 cases, 22 were inconclusive and excluded from the study. The remaining 105 were categorized into 73 (69.5%) malignant lesions and 32 (30.5%) benign lesions. FNA and CNB findings were in complete agreement in 63 cases (60%). The accuracy and confidence intervals (CIs) of FNA and CNB for malignant tumors were 86.3% (CI: 79.3-90.7) and 93.2% (CI: 87.3- 96.0 ) respectively. For epithelial malignant neoplasms, a definitive diagnosis was made in 44.8% of cases by FNA and 80.6% by CNB. The diagnostic accuracy of CNB for nonepithelial malignant neoplasms was 83.3% compared with 50% for FNA. Of the 32 benign cases, we made specific diagnoses in 16 with diagnostic accuracy of 81.3% and 6.3% for CNB and FNA, respectively.
Our findings suggest that FNA is comparable to CNB in the diagnosis of malignant epithelial lesions whereas diagnostic accuracy of CNB for nonepithlial malignant neoplasms is superior to that for FNA. Further, for histological typing of tumors and examining tumor origin, immunohistochemical work up plays an important role.
经胸细针穿刺抽吸（FNA）细胞学检查和粗针活检（CNB）是诊断可疑胸内肿瘤性病变的两种常用方法。本研究比较了FNA细胞学检查和同步CNB在评估胸内病变中的诊断准确性。
我们回顾性研究了127例患者的FNA细胞学检查和同步CNB标本，采用苏木精和伊红（H&E）染色、免疫组织化学染色，某些情况下还采用了细胞化学染色。关于额外组织检查的信息来自病理与检验医学科的电子档案以及患者记录。计算每种检查的诊断准确性。
127例病例中，22例结果不明确，被排除在研究之外。其余105例分为73例（69.5%）恶性病变和32例（30.5%）良性病变。FNA和CNB结果在63例（60%）中完全一致。FNA和CNB对恶性肿瘤的准确性及置信区间（CI）分别为86.3%（CI：79.3 - 90.7）和93.2%（CI：87.3 - 96.0）。对于上皮性恶性肿瘤，FNA在44.8%的病例中做出明确诊断，CNB为80.6%。CNB对非上皮性恶性肿瘤的诊断准确性为83.3%，而FNA为50%。在32例良性病例中，我们分别对16例做出了特异性诊断，CNB和FNA的诊断准确性分别为81.3%和6.3%。
我们的研究结果表明，FNA在诊断恶性上皮性病变方面与CNB相当，而CNB对非上皮性恶性肿瘤的诊断准确性优于FNA。此外，对于肿瘤的组织学分类和检查肿瘤起源，免疫组织化学检查起着重要作用。
