Pai Radha Ramachandra, Shenoy Krithika Damodar, Minal Jessica, Suresh Pooja K, Chakraborti Shrijeet, Lobo Flora D
Address: Department of Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Pathologist and Section Head, Division of Cytogenetics and FISH, Strand Life Sciences Private Limited, Health Care Global Hospital, Bengaluru, Karnataka, India.
Cytojournal. 2019 Jun 28;16:13. doi: 10.4103/cytojournal.cytojournal_37_18. eCollection 2019.
Abdominal paracentesis is a routine diagnostic procedure for assessment of patients with recent onset or worsening of ascites.
The objective of the study is to (1) review clinically confirmed cases of malignancy with negative, atypical, and suspicious cytology reports and provide reasoning for discrepancies and (2) recalculate sensitivity, specificity, and predictive values after review.
Papanicolaou smears of ascitic fluid paracentesis samples received over one calendar year were reviewed retrospectively by an expert in cytopathology blinded to the final clinical and/or histopathological diagnoses. Cases with discrepancies after review were noted. Sensitivity, specificity, and predictive values were calculated before and after review of slides. Data were analyzed using SPSS version 16.
Malignant etiology was identified in 49/115 cases (42.6%) with female genital tract being the most common site of malignancy (22, 44.8%). The remaining 66 (57.4%) had a benign etiology with hepatic cirrhosis in 42 cases (63.6%). A review revealed discrepancies in five cases, three of which were earlier called negative for malignant cells (one case each of ovarian adenocarcinoma, cecal adenocarcinoma, and cholangiocarcinoma). Two cases of ovarian adenocarcinoma that were reported as atypical/reactive mesothelial hyperplasia showed malignant cells upon review. Sensitivity and specificity after review were 69.4% and 100%, respectively, with 100% positive predictive value.
Being a minimally invasive procedure, abdominal paracentesis continues to be an important diagnostic tool in guiding patient management. A proper morphological assessment with adequate clinical information and correlation with other investigations can be used to arrive at a definitive diagnosis in most cases. The term "atypical" can be misleading and is often used for want of clinical information and is best avoided.
腹腔穿刺术是评估近期出现腹水或腹水病情恶化患者的常规诊断程序。
本研究的目的是(1) 回顾临床确诊的恶性肿瘤病例，这些病例的细胞学报告为阴性、非典型和可疑，并对差异提供原因分析；(2) 在回顾后重新计算敏感性、特异性和预测值。
由一位对最终临床和/或组织病理学诊断不知情的细胞病理学专家，对一历年内接收的腹水穿刺样本的巴氏涂片进行回顾性分析。记录回顾后存在差异的病例。在玻片回顾前后计算敏感性、特异性和预测值。使用SPSS 16版软件进行数据分析。
在115例病例中的49例(42.6%)中确定为恶性病因，女性生殖道是最常见的恶性肿瘤部位(22例，44.8%)。其余66例(57.4%)病因良性，其中42例(63.6%)为肝硬化。回顾发现5例存在差异，其中3例早期被称为恶性细胞阴性(卵巢腺癌、盲肠腺癌和胆管癌各1例)。2例报告为非典型/反应性间皮增生的卵巢腺癌经回顾显示为恶性细胞。回顾后的敏感性和特异性分别为69.4%和100%，阳性预测值为100%。
作为一种微创手术，腹腔穿刺术仍然是指导患者管理的重要诊断工具。在大多数情况下，通过适当的形态学评估、充分的临床信息以及与其他检查结果的关联，可以得出明确的诊断。“非典型”一词可能会产生误导，通常是由于缺乏临床信息而使用，最好避免使用。
