Perrino Carmen M, Cramer Harvey M, Chen Shaoxiong, Idrees Muhammad T, Wu Howard H
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Diagn Cytopathol. 2018 Nov;46(11):895-900. doi: 10.1002/dc.23979.
Utilization of fine-needle aspiration (FNA) biopsy for the evaluation of renal masses has been increasing at our institution. At times diagnostic material on direct smears is superior to that in the cell block/core biopsy, therefore assigning an accurate nuclear grade in the cytopathology report would provide useful prognostic information.
Search of the pathology database identified renal FNAs performed during an 11-year period (2006-2017). Corresponding core biopsies and resections were identified. Cases with a diagnosis of primary renal neoplasia on FNA, core biopsy, and/or resection were included. Two pathologists reviewed all cases and assigned a World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grade to each FNA, core biopsy, and resection case.
A total of 162 kidney FNAs were identified. Primary renal neoplasia was diagnosed in 137 cases on core biopsy/resection. Among diagnostic FNAs of clear cell RCC and papillary RCC with core biopsy/resection specimens for re-review (n = 52), reviewers assigned a concordant WHO/ISUP grade to 83% (43/52) of cases. Among 9 cases with discrepant scores, all had a discrepancy of 1 grade and were undergraded on FNA. Using a two tier grading system (low vs. high grade), reviewers assigned a concordant grade to 88% (46/52) of cases. Among 6 cases with discrepant scores, all were classified as low grade (WHO/ISUP grade 2) on FNA versus high grade (WHO/ISUP grade 3) on resection.
The WHO/ISUP grade assigned on FNA shows good concordance with subsequent resection/core specimens (83%), with all discrepant cases being undergraded by one grade.
在我们机构，利用细针穿刺（FNA）活检评估肾肿块的情况日益增多。有时，直接涂片上的诊断材料优于细胞块/芯针活检中的材料，因此在细胞病理学报告中给出准确的核分级将提供有用的预后信息。
检索病理数据库，确定11年期间（2006 - 2017年）进行的肾FNA。确定相应的芯针活检和切除术。纳入在FNA、芯针活检和/或切除术中诊断为原发性肾肿瘤的病例。两名病理学家复查所有病例，并为每个FNA、芯针活检和切除病例指定世界卫生组织（WHO）/国际泌尿病理学会（ISUP）分级。
共确定162例肾FNA。137例经芯针活检/切除诊断为原发性肾肿瘤。在有芯针活检/切除标本可供复查的透明细胞肾细胞癌和乳头状肾细胞癌的诊断性FNA中（n = 52），复查人员对83%（43/52） 的病例给出了一致的WHO/ISUP分级。在9例评分不一致的病例中，所有病例的分级差异均为1级，且FNA分级偏低。使用两级分级系统（低级别与高级别），复查人员对88%（46/52） 的病例给出了一致的分级。在6例评分不一致的病例中，所有病例在FNA中被分类为低级别（WHO/ISUP 2级），而在切除术中为高级别（WHO/ISUP 3级）。
FNA给出的WHO/ISUP分级与随后的切除/芯针标本显示出良好的一致性（83%），所有不一致的病例分级均低一级。
