Chandra Smita, Chandra Harish, Shukla Sushil Kumar, Sahu Shantanu
Address: Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Cytojournal. 2019 Jan 22;16:1. doi: 10.4103/cytojournal.cytojournal_5_18. eCollection 2019.
Image-guided fine-needle aspiration has emerged as an effective diagnostic tool for precise diagnosis of deep-seated lesions. Although occasional studies have made an attempt to classify the gallbladder carcinoma on cytology, literature lacks the standardized cytological nomenclature system used for it. The present study was conducted to study the role of fine-needle aspiration cytology (FNAC) in diagnosis of gallbladder lesions with an attempt of cytomorphological classification.
The study included cases of image-guided FNAC of the gallbladder over a period of 3½ years. An attempt was made to categorize gallbladder lesions on basis of architectural and cytomorphological features along with analysis of management.
The study included 433 cases and lesions were categorized on FNAC into five categories ranging from Category 1 (inadequate), Category 2 (negative for malignancy), Category 3 (atypical cells), Category 4 (highly atypical cells suggestive of malignancy), and Category 5 (positive for malignancy). The most common architectural pattern observed on FNAC of neoplasm was sheets and acini with predominance of columnar cells and adenocarcinoma being the most common malignancy. The histopathological diagnosis was available in 93 cases with cytohistopathological concordance of 94.4% in malignant cases.
Image-guided FNAC plays an important role in diagnosis of gallbladder lesions with minimal complications. The cytomorphological classification of gallbladder lesions provides an effective base for accurate diagnosis and management. Category 3 and 4 are the most ambiguous category on FNAC which should be managed by either repeat FNAC or surgery in the light of worrisome radiological features. The vigilant examination of architectural pattern and cytomorphological features of the smears may be helpful in clinching the diagnosis and precisely subtyping malignant tumors along with prognostication of these tumors.
图像引导下细针穿刺已成为精确诊断深部病变的有效诊断工具。尽管偶尔有研究尝试对胆囊癌进行细胞学分类，但文献中缺乏用于此的标准化细胞学命名系统。本研究旨在探讨细针穿刺细胞学检查（FNAC）在胆囊病变诊断中的作用，并尝试进行细胞形态学分类。
本研究纳入了3年半期间接受图像引导下胆囊FNAC检查的病例。尝试根据结构和细胞形态学特征以及治疗分析对胆囊病变进行分类。
本研究共纳入433例病例，FNAC检查的病变分为五类，从第1类（不充分）、第2类（恶性阴性）、第3类（非典型细胞）、第4类（高度非典型细胞提示恶性）和第5类（恶性阳性）。肿瘤FNAC检查中最常见的结构模式是片状和腺泡状，柱状细胞占优势，腺癌是最常见的恶性肿瘤。93例有组织病理学诊断，恶性病例的细胞组织病理学一致性为94.4%。
图像引导下FNAC在胆囊病变诊断中起重要作用，并发症极少。胆囊病变的细胞形态学分类为准确诊断和治疗提供了有效依据。第3类和第4类是FNAC检查中最模糊的类别，鉴于令人担忧的放射学特征，应通过重复FNAC或手术进行处理。仔细检查涂片的结构模式和细胞形态学特征可能有助于确诊并精确区分恶性肿瘤亚型以及预测这些肿瘤的预后。
