Departments of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Diagn Cytopathol. 2022 Apr;50(4):143-145. doi: 10.1002/dc.24944. Epub 2022 Feb 21.
Historically, the word "atypia" has been applied as a descriptor for cytomorphologic changes that deviate from what is expected; the assessment of deviant vs. expected cytomorphology is in the eye of the beholder. "Atypia" has been used to define a spectrum of changes which includes reactive changes known to be benign, but also for those concerning for malignancy, as well as everything in-between. The absence of a standardized reporting system and/or the lack of communication with clinicians can lead to the overutilization of the atypical category. When faced with a high rate of atypical diagnoses, clinicians are unable to distinguish patients who need more aggressive follow up from those that do not. Patients accessing their test results may not understand what an "atypical" diagnosis means; this can lead to unnecessary patient anxiety. Finally, atypical diagnoses can trigger reflex ancillary testing. This impacts ancillary test performance, as performance depends upon the pre-test probability of the cohort being tested. The inappropriate testing of low-risk patients can result in an increased number of false positive tests, which in turn lead to unnecessary procedures. Given these challenges, we present this special issue on "atypical" diagnoses in the field of cytopathology. In this issue, experts in various areas of cytopathology review the literature and discuss the diagnostic dilemmas of rendering "atypical" cytologic diagnosis, associated controversies, the effect on patient management, and abuse of ancillary studies. This issue also includes brief commentaries from clinicians from four different medical specialties who often encounter indeterminate cytologic diagnoses.
从历史上看，“非典型性”一词被用作描述细胞形态学变化的描述符，这些变化偏离了预期；对异常与预期细胞形态学的评估取决于观察者的眼光。“非典型性”已被用于定义一系列变化，包括已知良性的反应性变化，但也包括恶性的变化，以及介于两者之间的变化。缺乏标准化的报告系统和/或与临床医生缺乏沟通可能导致非典型类别被过度使用。当面临高比例的非典型诊断时，临床医生无法区分需要更积极随访的患者和不需要的患者。患者查看自己的测试结果时可能不理解“非典型”诊断的含义；这可能导致不必要的患者焦虑。最后，非典型诊断可能会引发辅助检查。这会影响辅助检查的性能，因为性能取决于接受测试的队列的预测试概率。对低风险患者进行不适当的测试会导致假阳性测试数量增加，从而导致不必要的程序。鉴于这些挑战，我们在细胞病理学领域提出了这个关于“非典型”诊断的特刊。在本期特刊中，细胞病理学各个领域的专家回顾了文献，并讨论了做出“非典型”细胞学诊断的诊断难题、相关争议、对患者管理的影响以及对辅助研究的滥用。本专题还包括来自四个不同医学专业的临床医生的简短评论，他们经常遇到不确定的细胞学诊断。
