Farahani Sahar J, Baloch Zubair
Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, Pennsylvania.
Diagn Cytopathol. 2019 Nov;47(11):1145-1159. doi: 10.1002/dc.24278. Epub 2019 Jul 13.
Cytology is widely utilized in the initial evaluation of fluid accumulation in the body cavities. The aim of this study was to determine the accuracy of cytology in distinguishing between benign and malignant (MAL) effusions.
A comprehensive and systematic review of the literature was conducted to evaluate the accuracy of serous effusion cytology (SEC) against tissue biopsy/resection histology, imaging, or clinical follow-up as the reference test. Risk of publication bias and level of heterogeneity in the included studies was assessed. Meta-regression was performed to assess the effect of various variables on the accuracy of SEC.
Eighty studies met the inclusion criteria for meta-analysis comprising of 34 941 samples; of which 52 (0.2%), 22 202 (72.7%), 194 (0.6%), 711 (2.3%), and 6507 (21.3%) could be reclassified as nondiagnostic (ND), negative for malignancy (NFM), atypical (atypia of uncertain significance-AUS), suspicious for malignancy (SFM), and malignant (MAL), respectively. On follow-up, the mean risk of malignancy for ND, NFM, AUS, SFM, MAL was 17.4%, 20.7%, 65.9%, 81.8%, and 98.9%, respectively. A total of 73 studies were included in estimating the diagnostic accuracy of SEC. The bivariate mixed-effect model estimated the SEC sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio as 73.1%, 99.9%, 7850.6%, 2112.2%, and 0.27%, respectively.
Serous effusion cytology shows high specificity and moderate sensitivity in the evaluation of serous effusions. A tiered classification scheme can improve the consistency of terminology for reporting SEC results, thus improving communication between the pathologists and clinical team, and quality of patient care.
细胞学广泛应用于体腔积液的初步评估。本研究的目的是确定细胞学在鉴别良性和恶性（MAL）积液方面的准确性。
对文献进行全面系统的综述，以评估浆液性积液细胞学（SEC）相对于组织活检/切除组织学、影像学或临床随访作为参考标准的准确性。评估纳入研究的发表偏倚风险和异质性水平。进行Meta回归分析以评估各种变量对SEC准确性的影响。
80项研究符合Meta分析的纳入标准，共34941个样本；其中52个（0.2%）、22202个（72.7%）、194个（0.6%）、711个（2.3%）和6507个（21.3%）样本分别可重新分类为非诊断性（ND）、恶性阴性（NFM）、非典型（意义不明确的非典型性-AUS）、可疑恶性（SFM）和恶性（MAL）。随访时，ND、NFM、AUS、SFM、MAL的恶性平均风险分别为17.4%、20.7%、65.9%、81.8%和98.9%。共有73项研究纳入了SEC诊断准确性的评估。双变量混合效应模型估计SEC的敏感性、特异性诊断比值比、阳性似然比和阴性似然比分别为73.1%、99.9%、7850.6%、2112.2%和0.27%。
浆液性积液细胞学在浆液性积液评估中显示出高特异性和中等敏感性。分层分类方案可以提高SEC结果报告术语的一致性，从而改善病理学家与临床团队之间的沟通以及患者护理质量。
