Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China.
Diagn Cytopathol. 2021 Sep;49(9):997-1007. doi: 10.1002/dc.24804. Epub 2021 May 21.
Recently, the International System for Reporting Serous Fluid Cytopathology (TIS) has been established, with an aim to standardize reporting and guide clinical decision making.
The cytological and clinicopathological data of pleural effusions were retrieved from the pathology database and electronic medical records. All specimens were evaluated and reclassified in accordance with the TIS recommendations. Finally, the risk of malignancy (ROM) and performance parameters were measured.
A total of 2454 pleural effusion specimens were included, among which 30 (1.2%), 1670 (68.1%), 151 (6.2%), 54 (2.2%) and 549 (22.4%) patients were classified into non-diagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM) and malignancy (MAL) groups, respectively. The most commonly diagnosed malignancies were lung cancer (48.4%), ovary cancer (10.2%), breast cancer (7.5%), and 21.3% unknown primary site (UPS). Among the 36 UPS patients, the most common site of origin was lung (36.1%), followed by ovary (13.9%) and breast (11.1%) via immunocytochemistry of cell block. The calculated ROM values were 26.7%, 12%, 62.3%, 77.8% and 100% for ND, NFM, AUS, SFM and MAL groups, respectively. When considering MAL as the only positive group, the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were determined to be 95.2%, 81.9%, 100%, 100% and 93.6%, respectively.
The newly proposed TIS is an easy-to-master, user-friendly, and standardized classification system, especially when applying on pleural effusions. An adequate serous sample, application of immunocytochemistry, review of cytomorphological data and past medical history could enhance the accuracy of cytological diagnosis.
最近，国际浆膜液细胞学报告系统（TIS）建立，旨在规范报告并指导临床决策。
从病理数据库和电子病历中检索胸腔积液的细胞学和临床病理数据。所有标本均按照 TIS 建议进行评估和重新分类，最后测量恶性肿瘤风险（ROM）和性能参数。
共纳入 2454 例胸腔积液标本，其中 30 例（1.2%）、1670 例（68.1%）、151 例（6.2%）、54 例（2.2%）和 549 例（22.4%）患者分别归入非诊断性（ND）、无恶性肿瘤（NFM）、意义未明的非典型（AUS）、疑似恶性肿瘤（SFM）和恶性肿瘤（MAL）组。最常见的诊断恶性肿瘤为肺癌（48.4%）、卵巢癌（10.2%）、乳腺癌（7.5%）和 21.3%原发灶不明（UPS）。在 36 例 UPS 患者中，最常见的起源部位为肺（36.1%），其次是卵巢（13.9%）和乳腺（11.1%），这是通过细胞块免疫细胞化学检测出来的。ND、NFM、AUS、SFM 和 MAL 组的计算 ROM 值分别为 26.7%、12%、62.3%、77.8%和 100%。当仅考虑 MAL 为阳性组时，诊断准确性、敏感性、特异性、阳性和阴性预测值分别为 95.2%、81.9%、100%、100%和 93.6%。
新提出的 TIS 是一种易于掌握、用户友好且标准化的分类系统，特别是在应用于胸腔积液时。获得足够的浆膜液样本、应用免疫细胞化学、回顾细胞形态学数据和既往病史可以提高细胞学诊断的准确性。
