Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer Cytopathol. 2021 Jan;129(1):75-82. doi: 10.1002/cncy.22345. Epub 2020 Aug 18.
The International System for Reporting Serous Fluid Cytopathology was recently proposed as a tiered structure to provide consistent reporting terminology for serous effusions. Because of the variation in reporting practices for indeterminate serous effusions, namely, the atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) groups, the authors retrospectively reviewed cases in these 2 categories at their institution and determined the associated risk of malignancy (ROM).
Pleural, peritoneal, and pericardial effusions that were reported as AUS or SFM over a 1-year period were reviewed, and their associated ROMs were calculated based on confirmation of malignancy by previous and/or subsequent fluid and/or tissue biopsy specimens from the same general location.
In total, 145 AUS and 98 SFM serous effusion cases were identified. The AUS category was used when the cells in question lacked the requisite quantitative (cell number) and/or qualitative (morphologic) features for a definitive diagnosis. Immunohistochemistry (IHC) or flow cytometry (FCM) was available in 15% of cases (n = 22) with inconclusive results. The ROM based on 69 cases with available follow-up results was 39%. In contrast, the SFM category demonstrated cells that were morphologically suspicious for malignancy but sparse, precluding IHC or FCM (n = 63; 64%) or yielding inconclusive results (n = 35; 36%). The ROM in the SFM category, based on follow-up results of 61 cases, was 64%.
The ROM for SFM was significantly higher than that for AUS (P < .01), supporting separate diagnostic categories for these 2 groups.
国际浆膜腔液细胞学报告系统最近被提议为一个分层结构，为浆膜腔积液提供一致的报告术语。由于不确定的浆膜腔积液（即意义未明的不典型性（AUS）和疑似恶性肿瘤（SFM）组）的报告实践存在差异，作者回顾了他们机构中这两个组别的病例，并确定了相关的恶性肿瘤风险（ROM）。
回顾性分析了 1 年内报告为 AUS 或 SFM 的胸腔、腹腔和心包积液，并根据同一部位的先前和/或后续液体和/或组织活检标本证实的恶性肿瘤，计算其相关的 ROM。
共确定了 145 例 AUS 和 98 例 SFM 浆膜腔积液病例。当有疑问的细胞缺乏明确诊断所需的定量（细胞数量）和/或定性（形态学）特征时，使用 AUS 类别。15%的病例（n=22）有不确定的结果，可进行免疫组织化学（IHC）或流式细胞术（FCM）检查。基于 69 例有随访结果的病例，ROM 为 39%。相比之下，SFM 类别显示出形态上疑似恶性肿瘤但稀疏的细胞，排除了 IHC 或 FCM（n=63；64%）或得出不确定的结果（n=35；36%）。基于 61 例随访结果，SFM 类别的 ROM 为 64%。
SFM 的 ROM 明显高于 AUS（P<0.01），支持这两个组别的单独诊断类别。
