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美国病理学家学会非妇科细胞病理学实验室间比对项目344380份回复的体液细胞学分析性能特征

Performance Characteristics of Body Fluid Cytology Analysis of 344 380 Responses From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology.

作者信息

Tabatabai Z Laura, Nayar Ritu, Souers Rhona J, Crothers Barbara A, Davey Diane Davis

机构信息

From the Department of Pathology, University of California, San Francisco (Dr Tabatabai); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Nayar); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology and Area Laboratory Services, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers); and the Department of Clinical Sciences, University of Central Florida, Orlando (Dr Davey).

出版信息

Arch Pathol Lab Med. 2018 Jan;142(1):53-58. doi: 10.5858/arpa.2016-0509-CP. Epub 2017 Oct 19.

DOI:10.5858/arpa.2016-0509-CP
PMID:29048220
Abstract

CONTEXT

  • Body fluid cytology is an important diagnostic tool used to identify various conditions. However, an accurate diagnosis in this setting can sometimes be challenging.

OBJECTIVE

  • To identify the performance characteristics of body fluid cytology by analyzing participant responses from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology.

DESIGN

  • Participant responses from 5102 slides were analyzed for concordance to the general category (GC) and to the reference diagnosis (RD). Nonlinear mixed models were used to analyze concordance.

RESULTS

  • The overall GC concordance was 95.2%. The GC type, participant type, and preparation type were significantly associated with GC concordance ( P < .001). Concordance for malignant cases was higher than it was for benign cases. Cytotechnologists had better GC concordance compared to pathologists. ThinPrep (Hologic, Marlborough, Massachusetts) slides had the highest GC concordance. Participant type, fluid type, preparation type, and participant interpretation were significantly associated with RD concordance ( P < .001). Pathologists performed better than cytotechnologists did for RD concordance. Pericardial fluid had the lowest RD concordance, especially for cases with normal or reactive findings. Modified Giemsa-stained slides performed best for lymphoma and hematopoietic malignancy. Small cell carcinoma had the highest GC concordance, and its RD concordance was higher in pleural than in peritoneal fluids. Adenocarcinoma showed the highest concordance rates for both GC and RD.

CONCLUSIONS

  • This study illustrates the challenges associated with interpreting body fluid cytology, particularly in pericardial fluid, and the factors that may affect accurate diagnoses. The results also highlight the value of using multiple preparation types in challenging cases.
摘要

背景

  • 体液细胞学是用于识别各种病症的重要诊断工具。然而，在这种情况下进行准确诊断有时可能具有挑战性。

目的

  • 通过分析美国病理学家学会非妇科细胞病理学实验室间比较计划参与者的反应，确定体液细胞学的性能特征。

设计

  • 分析了来自5102张玻片的参与者反应，以确定与一般类别（GC）和参考诊断（RD）的一致性。使用非线性混合模型分析一致性。

结果

  • GC总体一致性为95.2%。GC类型、参与者类型和制片类型与GC一致性显著相关（P <.001）。恶性病例的一致性高于良性病例。与病理学家相比，细胞技术人员的GC一致性更好。ThinPrep（Hologic，马萨诸塞州马尔伯勒）玻片的GC一致性最高。参与者类型、体液类型、制片类型和参与者的解读与RD一致性显著相关（P <.001）。在RD一致性方面，病理学家的表现优于细胞技术人员。心包积液的RD一致性最低，尤其是对于正常或反应性结果的病例。改良吉姆萨染色玻片对淋巴瘤和造血系统恶性肿瘤的诊断效果最佳。小细胞癌的GC一致性最高，其在胸腔积液中的RD一致性高于腹腔积液。腺癌在GC和RD方面的一致性率最高。

结论

  • 本研究说明了解读体液细胞学所面临的挑战，尤其是在心包积液中，以及可能影响准确诊断的因素。结果还强调了在疑难病例中使用多种制片类型的价值。

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