细针抽吸中多形性腺瘤的诊断准确性：导致假阳性和假阴性诊断的特征，以及细胞块的应用。
The diagnostic accuracy of pleomorphic adenoma in fine needle aspiration: Features leading to false positive and false negative diagnoses and the utility of cell blocks.
机构信息
Department of Pathology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Pathology Department, Fimlab Laboratories, Tampere, Finland.
出版信息
Diagn Cytopathol. 2023 May;51(5):283-293. doi: 10.1002/dc.25109. Epub 2023 Feb 1.
OBJECTIVE
Fine needle aspiration (FNA) is a well-established tool in preoperative diagnosis of salivary gland lesions with diagnostic accuracy of 90%. Pleomorphic adenoma (PA) is the most common salivary gland tumor comprising 45%-74% of all salivary gland tumors with FNA diagnostic accuracy of 89.5%-96.2%. The aim of the present study was to determine and analyze potential cytomorphological pitfalls and evaluate the diagnostic accuracy in FNA diagnosis of PA.
METHODS
Salivary gland specimens with both cytological and histological diagnoses were searched over a 10-year-period (2009-2018) from a laboratory information system of Pathology Department, Fimlab Laboratories, Tampere and matched to determine concordant and discordant PA cases. Sufficient material in histological and cytological sample was found in 401 cases. In 218 cases (54.4%) diagnosis was true-negative PA, in 169 cases (42.1%) diagnosis was true-positive PA and there were 14 discordant cases: 4 false-positive cases and 10 false-negative cases. False-negative cases were reclassified and subgrouped according to The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).
RESULTS
Cytomorphologically, cell type predominance was more often myoepithelial in true-positive cases (65%) and epithelial both in false-negative (70%, p = .007) and false-positive cases (75%, p = .027). Well-formed ducts were present in cytology in all true-positive cases (p < .001). Only 10% of true-positive cases did not show any matrix in cytology (p < .001). Nuclear changes were common in false-negative cases (80%, p = .002) and false-positive cases (75%, p = .003). Beneficial cell block (CB) was more common in true-positive cases (85%) than in false-negative cases (50%, p = .041) or in false-positive cases (50%, p = .116) and a lack of beneficial CB led more often to a false diagnosis (70% false diagnosis without beneficial CB versus 29% false diagnosis with beneficial CB).
CONCLUSION
The present study showed diagnostic accuracy of 96.5% for FNA in PA diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value were 94.4%, 98.2%, 97.7%, and 95.6%, respectively. The benefit of CBs was more evident in true-positive cases (85%).
目的
细针抽吸（FNA）是术前诊断唾液腺病变的一种成熟工具，诊断准确率为 90%。多形性腺瘤（PA）是最常见的唾液腺肿瘤，占所有唾液腺肿瘤的 45%-74%，FNA 诊断准确率为 89.5%-96.2%。本研究旨在确定和分析潜在的细胞形态学陷阱，并评估 FNA 诊断 PA 的诊断准确性。
方法
在 10 年期间（2009-2018 年），从坦佩雷 Fimlab 实验室病理科的实验室信息系统中搜索具有细胞学和组织学诊断的唾液腺标本，并进行匹配以确定一致和不一致的 PA 病例。在 401 例病例中发现了足够的组织学和细胞学标本。在 218 例（54.4%）中诊断为真阴性 PA，在 169 例（42.1%）中诊断为真阳性 PA，有 14 例不一致病例：4 例假阳性病例和 10 例假阴性病例。假阴性病例根据米兰唾液腺细胞病理学报告系统（MSRSGC）重新分类和分组。
结果
在细胞学上，真阳性病例中细胞类型优势更常为肌上皮（65%），而假阴性（70%，p=0.007）和假阳性病例（75%，p=0.027）中上皮细胞均占优势。所有真阳性病例的细胞学均存在形成良好的导管（p<0.001）。仅 10%的真阳性病例的细胞学中没有任何基质（p<0.001）。假阴性病例中核变化常见（80%，p=0.002），假阳性病例也常见（75%，p=0.003）。良性细胞块（CB）在真阳性病例中更为常见（85%），而非假阴性病例（50%，p=0.041）或假阳性病例（50%，p=0.116）。缺乏良性 CB 更常导致误诊（无良性 CB 的误诊率为 70%，而有良性 CB 的误诊率为 29%）。
结论
本研究显示 FNA 诊断 PA 的准确率为 96.5%。灵敏度、特异性、阳性预测值和阴性预测值分别为 94.4%、98.2%、97.7%和 95.6%。CB 的益处在真阳性病例中更为明显（85%）。
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