建议的悉尼系统对淋巴结细针抽吸细胞学分类的效用：三级保健中心的回顾性研究。

Utility of the Proposed Sydney System for Classification of Fine-Needle Aspiration Cytopathology of Lymph Node: A Retrospective Study at a Tertiary Care Center.

机构信息

Department of Pathology, Seth G.S. Medical College and KEM Hospital, Mumbai, India.

Department of Pathology, All India Institute of Medical Sciences (AIIMS), Kalyani, India,

出版信息

Acta Cytol. 2023;67(5):455-467. doi: 10.1159/000530984. Epub 2023 May 11.

DOI:10.1159/000530984

PMID:37231736

Abstract

INTRODUCTION

Fine-needle aspiration cytology (FNAC) is an established first-line technique for the evaluation of lymphadenopathy and, with the help of ancillary testing, can in many instances obviate the need for an open biopsy. The Sydney system was recently proposed to provide consensus guidelines for the performance, classification, and reporting of lymph node FNAC. The present study was undertaken to evaluate its utility and study the impact of rapid on-site evaluation (ROSE).

MATERIAL AND METHODS

A retrospective analysis in which 1,500 lymph node FNACs was reviewed and assigned a diagnostic category from the Sydney system. Cyto-histopathological correlation and adequacy parameters were evaluated.

OBSERVATION AND RESULTS

The cervical group of lymph nodes was the commonest group aspirated (89.7%). A total of 1,205/1,500 (80.3%) cases were category II (benign), and necrotizing granulomatous lymphadenitis was the most common pathology. The 750 cases with ROSE were subclassified as follows: 15 category I (inadequate), 629 category II (benign), 2 category III (atypia of undetermined significance), 9 category IV (suspicious for malignancy), and 95 category V (malignant). Among 750 cases without ROSE, 75 cases were in category I, 576 in category II, 3 in category III, 6 in category IV, and 90 in category V. Category I was thus significantly lower in the ROSE group compared to the non-ROSE group. Overall, the risk of malignancy was L1-0%, L2-0.20%, L3-100%, L4-92.3%, and L5-100%. Accuracy parameters revealed a sensitivity of 97.7%, specificity of 100%, PPV of 100%, NPV of 99.10%, and diagnostic accuracy of 99.54%.

DISCUSSION AND CONCLUSION

FNAC can be used as the 1st line of treatment for lymph node pathology. ROSE can be used as an add-on to FNAC for reducing unsatisfactory rates and help triage material for ancillary testing whenever possible. The Sydney system should be implemented for achieving uniformity and reproducibility.

摘要

简介

细针穿刺细胞学检查（FNAC）是评估淋巴结疾病的一种成熟的一线技术，借助辅助检测，在许多情况下可以避免开放性活组织检查。最近提出了悉尼系统，旨在为淋巴结 FNAC 的操作、分类和报告提供共识指南。本研究旨在评估其效用，并研究快速现场评估（ROSE）的影响。

材料与方法

对 1500 例淋巴结 FNAC 进行回顾性分析，并根据悉尼系统分配诊断类别。评估细胞病理学相关性和充分性参数。

观察与结果

最常穿刺的是颈部组淋巴结（89.7%）。总共 1205/1500（80.3%）例为 2 类（良性），坏死性肉芽肿性淋巴结炎是最常见的病理类型。有 ROSE 的 750 例被细分如下：15 例 1 类（不充分），629 例 2 类（良性），2 例 3 类（意义未明的不典型），9 例 4 类（可疑恶性），95 例 5 类（恶性）。在没有 ROSE 的 750 例中，75 例为 1 类，576 例为 2 类，3 例为 3 类，6 例为 4 类，90 例为 5 类。与非 ROSE 组相比，ROSE 组 1 类明显较低。总体而言，恶性风险为 L1-0%，L2-0.20%，L3-100%，L4-92.3%，L5-100%。准确性参数显示敏感性为 97.7%，特异性为 100%，PPV 为 100%，NPV 为 99.10%，诊断准确性为 99.54%。