Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA.
Department of Pathology and Laboratory Medicine, ARUP Laboratories, Salt Lake City, Utah, USA.
Diagn Cytopathol. 2021 Aug;49(8):909-914. doi: 10.1002/dc.24769. Epub 2021 May 10.
Cytopathologists reviewing pulmonary specimens are expected to classify samples into clinically useful categories. Clinicians prefer reports to convey a definitively benign or definitively malignant diagnosis. Cytopathologists recognize a spectrum of morphologic features with increasing degrees of atypia between clearly benign and clearly malignant. A variety of terms are used to convey to clinicians how concerned a cytologist is that a malignancy maybe present. These terms include "atypia", "atypical" and "suspicious for malignancy", but have had variable meanings among cytopathologists and clinicians. Categorization schemes have been proffered to include standardization of terminology with many of these systems containing one or more intermediate categories.
An electronic search of the University of Missouri cytology reporting system was made for all bronchial brushings specimens diagnosed using the Papanicolaou Society of Cytopathology System for Reporting Respiratory Cytology (PSCSR) between January 2019 and December 2019. Slides were reviewed to determine adequate cellularity and preparation quality. From those found to be adequately cellular and of good quality, four bronchial brushing specimens from each PSCSR category were randomly selected. For each case a slide was digitized and at least 70 of the most "atypical" cells were analyzed by the Aperio System for nuclear area and nuclear/cytoplasmic ratio. Distribution of measured parameters among categories was analyzed by the Kruskal-Wallis test.
During the study period, only the PSCSR categories "benign", "atypical" and "malignant" were recorded. A significant difference in distribution of nuclear/cytoplasmic ratio was seen between the "benign" and "atypical" categories but not between the "atypical" and "malignant" categories. The "atypical" category appeared to be bi-modal indicating that it could be divided into two categories, "atypical" and "suspicious for malignancy".
The categories "atypical" and "suspicious for malignancy" served to divide the spectrum of cytomorphologic changes between "benign" and "malignant" into clinically useful groups. The use of these categories is supported by cytomorphometric analysis of bronchial brushing specimens.
病理学家在审查肺部标本时，预计将样本分为临床有用的类别。临床医生希望报告能够明确诊断为良性或恶性。病理学家认识到形态学特征的范围，从明显良性到明显恶性之间存在程度不断增加的非典型性。有多种术语用于向临床医生传达细胞病理学家对恶性肿瘤存在的担忧程度。这些术语包括“非典型性”、“非典型”和“疑似恶性”，但在细胞病理学家和临床医生之间具有不同的含义。已经提出了分类方案，以包括术语的标准化，其中许多系统包含一个或多个中间类别。
对 2019 年 1 月至 2019 年 12 月期间使用美国密苏里大学细胞学报告系统根据美国细胞病理学学会呼吸系统细胞学报告系统（PSCSR）诊断的所有支气管刷检标本进行电子搜索。对所有幻灯片进行了评估，以确定细胞数量和制片质量是否足够。在那些被认为具有足够细胞数量和良好质量的标本中，从每个 PSCSR 类别中随机选择 4 个支气管刷检标本。对每个病例的一张幻灯片进行数字化处理，然后使用 Aperio 系统对至少 70 个最“非典型”的细胞进行核面积和核/细胞质比值分析。通过 Kruskal-Wallis 检验分析测量参数在类别间的分布。
在研究期间，仅记录了 PSCSR 类别“良性”、“非典型”和“恶性”。在“良性”和“非典型”类别之间观察到核/细胞质比值分布存在显著差异，但在“非典型”和“恶性”类别之间没有观察到差异。“非典型”类别似乎呈双峰分布，表明可以将其分为“非典型”和“疑似恶性”两个类别。
“非典型”和“疑似恶性”类别用于将“良性”和“恶性”之间的细胞形态学变化范围划分为临床有用的组别。支气管刷检标本的细胞形态计量分析支持这些类别的使用。
