Frable W J, Kardos T F
Section of Surgical and Cytopathology, Virginia Commonwealth University, Medical College of Virginia, Richmond.
Am J Surg Pathol. 1988;12 Suppl 1:62-72.
A review of fine needle aspiration biopsies of lymph nodes was performed to determine accuracy and reproducibility among observers for the diagnosis of malignant lymphomas and lymphoproliferative diseases and to identify problem areas in the diagnosis of lymphomas and lymphoproliferative diseases by this biopsy method. Not including cases of carcinoma, 85% of the lymphomas and lymphoproliferative processes were correctly identified by seven of eight observations from a blind review without clinical information. Four problem areas in diagnosis from aspirates were identified: (a) distinction of lymphoid hyperplasia from non-Hodgkin's lymphoma by relying significantly on polymorphism versus monomorphism of the smear pattern; (b) separating undifferentiated carcinoma from large cell lymphoma; (c) overinterpreting extensive lymphoid polymorphism as Hodgkin's disease; and (d) diagnosing some aspirates of granulomatous lymphadenopathy, viral infection, or nodes with extensive necrosis as Hodgkin's disease. From the analysis of this series, a programmed approach was developed for diagnosing lymph node aspirates. History, physical examination, correct performance of the aspiration biopsy, and proper handling of the specimen are the four basic elements. Microscopic evaluation includes assessment of overall cellularity, pattern of cell arrangement, identification of predominant cell type, and background elements.
对淋巴结细针穿刺活检进行回顾，以确定观察者对恶性淋巴瘤和淋巴增殖性疾病诊断的准确性和可重复性，并通过这种活检方法识别淋巴瘤和淋巴增殖性疾病诊断中的问题区域。不包括癌的病例，在无临床信息的盲法回顾中，85%的淋巴瘤和淋巴增殖性病变通过八次观察中的七次被正确识别。确定了穿刺物诊断中的四个问题区域：(a) 通过显著依赖涂片模式的多形性与单形性来区分淋巴样增生与非霍奇金淋巴瘤；(b) 将未分化癌与大细胞淋巴瘤区分开；(c) 将广泛的淋巴样多形性过度解读为霍奇金病；(d) 将一些肉芽肿性淋巴结病、病毒感染或有广泛坏死的淋巴结穿刺物诊断为霍奇金病。通过对该系列的分析，制定了一种用于诊断淋巴结穿刺物的程序化方法。病史、体格检查、穿刺活检的正确操作以及标本的妥善处理是四个基本要素。显微镜评估包括对总体细胞数量、细胞排列模式、主要细胞类型的识别以及背景成分的评估。
