Kar Asaranti, Satapathy Bharat, Pattnaik Kaumudee, Dash Prafulla K
Department of Pathology, S.C.B. Medical College, Cuttack, Odisha, India.
Department of Surgical Oncology, AHRCC, Cuttack, Odisha, India.
J Cytol. 2018 Jul-Sep;35(3):179-182. doi: 10.4103/JOC.JOC_63_18.
Preoperative pathologic diagnosis of pelvic tumors is mandatory for proper management of patients like neoadjuvant chemotherapy and interval debulking. Currently there are many minimally invasive methods available which include fine-needle aspiration cytology (FNAC) and trucut biopsy, mostly complimentary to each other. FNAC is a cheap, rapid and sensitive method for diagnosis of pelvic tumors. It can be done as an outpatient procedure without complications. But with it, the tissue architecture cannot be seen. Trucut biopsy on the other hand reveals tissue architecture and can help in grading and subtyping of malignant tumors. Trucut biopsy has to be done under image guidance like ultrasound and computed tomography. Patient is administered local anaesthetic and can be discharged safely after 2 hours. Pathologists familiar with histomorphology can give a correct diagnosis easily. But many times sampling errors may occur; especially in large tumors, resulting only in necrosis, hemorrhage and degenerated tissue bits. Also differentiation of borderline from malignant ovarian tumors is very difficult. In case of mixed tumors one component may be missed. Hard tumors like fibromas and leiomyomas yield scanty material and result in inadequate reporting. With FNAC, the overall accuracy rate is estimated to be around 96.3%. With trucut biopsy, adequacy is from 91 to 95% and accuracy is approximately 98% in different studies. When both methods are combined, the adequacy is 100%, diagnostic accuracy 95.5%, sensitivity 94.9% and specificity 100%. Therefore depending on the clinical diagnosis and the location of tumors, either FNAC and/or trucut biopsy can be chosen.
盆腔肿瘤的术前病理诊断对于患者的恰当管理（如新辅助化疗和间隔减瘤术）至关重要。目前有许多微创方法可供选择，包括细针穿刺细胞学检查（FNAC）和切割活检，这两种方法大多相辅相成。FNAC是一种诊断盆腔肿瘤的廉价、快速且敏感的方法。它可以作为门诊手术进行，且无并发症。但通过这种方法无法看到组织结构。另一方面，切割活检能显示组织结构，有助于恶性肿瘤的分级和亚型分类。切割活检必须在超声和计算机断层扫描等影像引导下进行。患者接受局部麻醉，2小时后可安全出院。熟悉组织形态学的病理学家能够轻松做出正确诊断。但很多时候可能会出现取样误差；尤其是在大肿瘤中，可能仅得到坏死、出血和退变的组织碎片。此外，交界性卵巢肿瘤与恶性卵巢肿瘤的鉴别非常困难。对于混合性肿瘤，可能会遗漏其中一个成分。像纤维瘤和平滑肌瘤这样的硬肿瘤取材较少，导致报告不充分。FNAC的总体准确率估计约为96.3%。在不同研究中，切割活检的取材充足率为91%至95%，准确率约为98%。当两种方法联合使用时，取材充足率为100%，诊断准确率为95.5%，敏感性为94.9%，特异性为100%。因此，根据临床诊断和肿瘤位置，可以选择FNAC和/或切割活检。
