Christopher Mary M, Ku Chieh-Ko
Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.
Front Vet Sci. 2018 Oct 9;5:246. doi: 10.3389/fvets.2018.00246. eCollection 2018.
Descriptive probability modifiers are used often to convey the uncertainty of a pathology diagnosis, but they also contribute to ambiguity in communication between pathologists and clinicians. Our goal was to determine the frequency and use of probability modifiers in canine and feline lymph node cytology diagnoses, and to determine the actual likelihood of neoplasia for diagnoses with and without modifiers, based on the histologic outcome. Canine and feline lymph node cytology and histology reports over an 11-year period (2001-2011; = 367) were evaluated retrospectively. Diagnoses were categorized as neoplastic/malignant (lymphoma, metastatic) or non-neoplastic/benign. The frequency and type of modifier, and the sensitivity, specificity, and predictive values for neoplasia were determined for modified and unmodified diagnoses using histology as the gold standard. Ninety-one of 367 (24.8%) cytology diagnoses were modified by probability terms, including 25/204 (12.2%) diagnoses of non-neoplastic lesions and 66/163 (40.5%) diagnoses of neoplasia. In addition, 26 unmodified diagnoses of neoplasia were followed by a probability phrase indicating specific tumor type. Based on the histologic outcome, modified diagnoses had higher sensitivity (87.3%, confidence interval [CI] 75.5, 94.7%) but lower specificity (50.0%, CI 32.9, 67.1%) for neoplasia than did unmodified diagnoses (60.6 and 100%, respectively; < 0.0001, Chi square). Modified phrases indicating the probability of a specific tumor type were accurate in 22/26 (84.6%) cases. Positive predictive values for neoplasia were 100% (CI 96.2, 100%) for unmodified and 72.7% (CI 60.4, 83.0%) for modified diagnoses. Negative predictive values were 65.9% (CI 58.5, 72.8%) for unmodified and 72.0% (CI 60.4, 83.0%) for modified diagnoses. No significant difference was found in the likelihood of neoplasia for individual terms used to modify a cytologic diagnosis except for "cannot rule out" ( = 0.0368). Most modified diagnoses of cancer in canine and feline lymph node cytology have a 60-83% likelihood of neoplasia based on histologic outcome, compared with 96-100% for unmodified diagnoses. Non-neoplastic lesions, regardless of modifiers, have a 12-49% likelihood of neoplasia. A limited number of risk categories based on these likelihoods may be a more effective and accurate way to communicate the risk of malignancy in lymph node cytology.
描述性概率修饰词常用于传达病理诊断的不确定性，但它们也会导致病理学家和临床医生之间沟通的模糊性。我们的目标是确定犬猫淋巴结细胞学诊断中概率修饰词的使用频率和情况，并根据组织学结果确定有和没有修饰词的诊断中肿瘤形成的实际可能性。回顾性评估了11年期间（2001 - 2011年；共367例）犬猫淋巴结细胞学和组织学报告。诊断分为肿瘤性/恶性（淋巴瘤、转移性）或非肿瘤性/良性。以组织学为金标准，确定修饰词的频率和类型，以及修饰和未修饰诊断中肿瘤形成的敏感性、特异性和预测值。367例细胞学诊断中有91例（24.8%）被概率术语修饰，包括204例非肿瘤性病变诊断中的25例（12.2%）和163例肿瘤形成诊断中的66例（40.5%）。此外，26例未修饰的肿瘤形成诊断后跟着一个表明特定肿瘤类型的概率短语。基于组织学结果，修饰诊断对肿瘤形成的敏感性高于未修饰诊断（分别为87.3%，置信区间[CI] 75.5，94.7%和60.6%；P < 0.0001，卡方检验），但特异性较低（分别为50.0%，CI 32.9，67.1%和100%）。表明特定肿瘤类型概率的修饰短语在26例中有22例（84.6%）是准确的。肿瘤形成的阳性预测值未修饰诊断为100%（CI 96.2，100%），修饰诊断为72.7%（CI 60.4，83.0%）。阴性预测值未修饰诊断为65.9%（CI 58.5，72.8%），修饰诊断为72.0%（CI 60.4，83.0%）。除了“不能排除”外，用于修饰细胞学诊断的各个术语在肿瘤形成可能性上没有显著差异（P = 0.0368）。基于组织学结果，犬猫淋巴结细胞学中大多数修饰的癌症诊断有60 - 83%的肿瘤形成可能性，而未修饰诊断为96 - 100%。非肿瘤性病变，无论有无修饰词，有12 - 49%的肿瘤形成可能性。基于这些可能性的有限数量的风险类别可能是在淋巴结细胞学中传达恶性风险的更有效和准确的方式。
