Department of Public Health, University of Naples "Federico II", Naples, Italy.
Hematology Section, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
Cytopathology. 2022 Nov;33(6):668-677. doi: 10.1111/cyt.13172. Epub 2022 Sep 5.
Fine needle cytology (FNC) is widely used as a first-line procedure in the diagnostic algorithm of lymphadenopathies. In a metastatic setting, a first-line diagnostic approach identifies non-haematopoietic malignancy; however, cytopathologists could also provide a second diagnostic level, identifying the origin of the primary tumour. This paper outlines a comprehensive and practical approach to the cytological diagnosis of lymph node metastases.
Cytological diagnoses of lymph node metastases performed over a 10-year period were selected and divided into two groups. The first group, labelled "oncological," comprised patients with a previous history of malignancy; the second group, labelled "naïve," included patients with no relevant history. Pathology records were retrieved to record microscopic findings, namely, background appearance, group architecture, and specific cell features; data from cell block (CB) preparations were also collected.
Overall, 982 cases were selected: 497 cases (50.61%) in the naïve group, and 485 (49.39%) in the oncological group. Overall, a second diagnostic level was achieved in 834/982 cases (84.92%); cases diagnosed as carcinoma not otherwise specified were more frequent in the naïve group than in the oncological group (17.51% vs. 8.04%, P < 0.01). Notably, although CB material was available in only 44.87% of the naïve cases, we were able to achieve a second diagnostic level thanks to the integration of clinical and cytomorphological findings, plus lymph node topography, in 82.49% of the cases.
Our results confirmed that in a metastatic setting, FNC can reliably lead to the identification of the origin of the primary tumour.
细针细胞学（FNC）广泛用作淋巴结病诊断算法的一线程序。在转移性疾病中，一线诊断方法可识别非造血恶性肿瘤；然而，细胞病理学家也可以提供第二个诊断级别，确定原发性肿瘤的起源。本文概述了一种全面实用的方法，用于诊断淋巴结转移的细胞学。
选择了在过去 10 年中进行的淋巴结转移的细胞学诊断，并将其分为两组。第一组，标记为“肿瘤学”，包括有恶性肿瘤病史的患者；第二组，标记为“幼稚”，包括没有相关病史的患者。检索病理记录以记录显微镜检查结果，即背景外观、组结构和特定细胞特征；还收集了细胞块（CB）制备的数据。
共选择了 982 例病例：幼稚组 497 例（50.61%），肿瘤组 485 例（49.39%）。总体而言，834/982 例（84.92%）达到了二级诊断水平；幼稚组中诊断为非特指癌的病例比肿瘤组更常见（17.51%比 8.04%，P < 0.01）。值得注意的是，尽管只有 44.87%的幼稚病例有 CB 材料，但由于整合了临床和细胞学发现，加上淋巴结解剖结构，我们能够在 82.49%的病例中达到二级诊断水平。
我们的结果证实，在转移性疾病中，FNC 可以可靠地确定原发性肿瘤的起源。
