Ravaioli Sara, Bravaccini Sara, Tumedei Maria Maddalena, Pironi Flavio, Candoli Piero, Puccetti Maurizio
Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Pathology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.
Oncotarget. 2017 Feb 14;8(7):11199-11205. doi: 10.18632/oncotarget.13204.
In lung cancer patients, the only available diagnostic material often comes from biopsy or from cytological samples obtained by fine needle aspiration (FNA). There is a lack of easily detectable cytomorphological features for rapid on-site evaluation (ROSE) to orient lung cancer diagnosis towards a specific tumor histotype. We studied the cytological features evaluated on site to define tumor histotype and to establish the number of specimens to be taken. Cytological specimens from 273 consecutive patients were analyzed with ROSE: bronchoscopy with transbronchial needle aspiration (TBNA) had been performed in 72 patients and with endobronchial ultrasound (EBUS)-TBNA in 201. Cytomorphological features were correlated with the final diagnosis and diagnostic accuracy was measured. Analysis of the different cytomorphological parameters showed that the best sensitivity and specificity were obtained for adenocarcinoma by combining the presence of nucleoli and small/medium cell clusters, and for squamous cell carcinoma by considering the presence of necrosis ≥50% and large cell clusters. For small cell carcinoma, the best diagnostic accuracy was obtained by combining moderate necrosis (<50%) and the presence of single cells. Overall accuracy ranged from 90% to 97%. We showed that it was possible to establish the histotype of the most frequent lung cancers during ROSE using only a few easily identifiable cytomorphological parameters. An accurate diagnosis during ROSE could help endoscopists to decide how many tumor samples must be taken, e.g.a higher number of samples is needed for the biomolecular characterization of adenocarcinoma, whereas one sample may be sufficient for squamous cell carcinoma.
在肺癌患者中，唯一可用的诊断材料通常来自活检或细针穿刺抽吸（FNA）获得的细胞学样本。缺乏易于检测的细胞形态学特征用于快速现场评估（ROSE），以指导肺癌诊断朝向特定的肿瘤组织学类型。我们研究了现场评估的细胞形态学特征，以确定肿瘤组织学类型并确定需采集的标本数量。对273例连续患者的细胞学标本进行了ROSE分析：72例患者进行了经支气管针吸活检（TBNA）支气管镜检查，201例患者进行了支气管内超声（EBUS）-TBNA检查。细胞形态学特征与最终诊断相关，并测量了诊断准确性。对不同细胞形态学参数的分析表明，腺癌通过结合核仁的存在和小/中细胞簇可获得最佳的敏感性和特异性，鳞状细胞癌通过考虑≥50%的坏死和大细胞簇可获得最佳的敏感性和特异性。对于小细胞癌，通过结合中度坏死（<50%）和单个细胞的存在可获得最佳的诊断准确性。总体准确率在90%至97%之间。我们表明，在ROSE期间仅使用一些易于识别的细胞形态学参数就有可能确定最常见肺癌的组织学类型。ROSE期间的准确诊断可帮助内镜医师决定必须采集多少肿瘤样本，例如腺癌的生物分子特征分析需要更多的样本，而鳞状细胞癌一个样本可能就足够了。
