Ciliberti Valeria, Maffei Elisabetta, D'Ardia Angela, Sabbatino Francesco, Serio Bianca, D'Antonio Antonio, Zeppa Pio, Caputo Alessandro
Pathology Department, University Hospital 'San Giovanni e Ruggi d'Aragona', Salerno, Italy.
Oncology Department, University Hospital 'San Giovanni e Ruggi d'Aragona', Salerno, Italy.
Cytopathology. 2024 Jan;35(1):78-91. doi: 10.1111/cyt.13318. Epub 2023 Oct 24.
Fine needle aspiration cytology (FNAC) combined with rapid on-site evaluation (ROSE) and ancillary techniques is an accurate diagnostic tool for many pathologies. However, in some cases, it may not be sufficient for actionable diagnoses or molecular testing, especially for cases that require large immunohistochemical panels or cases in which histological features are mandatory for the diagnosis. Core needle biopsy (CNB), on the contrary, provides samples that are suitable for histological features and sufficient for all ancillary studies. However, CNB is often performed by radiologists or clinicians without the direct participation of cytopathologists, which can lead to missed or delayed diagnoses. This study reports on the experience of combining FNAC and CNB performed in one setting by cytopathologists. The aim was to evaluate the impact of CNB on FNAC and the diagnostic efficiency of the combined procedures.
One hundred forty-two FNAC and CNB procedures performed in the same setting over a period of 2 years were analysed. The FNAC diagnoses were compared and integrated with the subsequent CNB diagnoses. The impact of CNB was categorized as follows: non-contributory, in cases of inadequate samples; confirmed, when the CNB and FNAC diagnoses were the same; improved, when the CNB diagnosis was consistent with the FNAC diagnosis and further specified the corresponding entity; allowed, when CNB produced a diagnosis that could not be reached by FNAC; changed, when the CNB changed the previous FNAC diagnosis.
CNB confirmed the FNAC diagnosis in 40.1% of cases (n = 57/142). CNB improved the FNAC diagnosis in 47.2% of cases (n = 67/142). CNB allowed a diagnosis that could not be performed on FNAC in 2.1% of cases (n = 3/142). CNB changed a previous FNAC diagnosis in 2.1% of cases (n = 3/142). CNB was non-contributory in 8.4% of cases (n = 12/142). CNB produced a positive impact on the whole diagnostic procedure in 51.4% of total cases (n = 73/142). The combined FNAC and CNB resulted in actionable diagnoses in 91.5% of all cases (n = 130/142). A complete molecular assessment was successfully performed in 14.7% of cases (n = 21/142) utilizing either FNAC or CNB material.
The combined use of FNAC and CNB in one setting improves the diagnostic accuracy of both procedures. This approach exploits the advantages of each procedure, enhancing the accuracy of the final diagnosis.
细针穿刺细胞学检查（FNAC）结合快速现场评估（ROSE）及辅助技术是诊断多种疾病的准确工具。然而，在某些情况下，它可能不足以做出可指导治疗的诊断或进行分子检测，特别是对于需要大量免疫组化检测的病例或诊断必须依靠组织学特征的病例。相反，粗针活检（CNB）提供的样本适合进行组织学特征分析，且足以开展所有辅助研究。然而，CNB通常由放射科医生或临床医生进行，细胞病理学家并不直接参与，这可能导致诊断遗漏或延迟。本研究报告了细胞病理学家在同一环境下联合进行FNAC和CNB的经验。目的是评估CNB对FNAC的影响以及联合操作的诊断效率。
分析了在两年内于同一环境下进行的142例FNAC和CNB操作。将FNAC诊断结果与随后的CNB诊断结果进行比较和整合。CNB的影响分类如下：无贡献，样本不足的情况；确认，CNB和FNAC诊断相同；改善，CNB诊断与FNAC诊断一致并进一步明确了相应病变；允许，CNB得出FNAC无法得出的诊断；改变，CNB改变了先前的FNAC诊断。
CNB在40.1%的病例（n = 57/142）中确认了FNAC诊断。CNB在47.2%的病例（n = 67/142）中改善了FNAC诊断。CNB在2.1%的病例（n = 3/142）中得出了FNAC无法做出的诊断。CNB在2.1%的病例（n = 3/142）中改变了先前的FNAC诊断。CNB在8.4%的病例（n = 12/142）中无贡献。CNB在51.4%的总病例（n = 73/142）中对整个诊断过程产生了积极影响。联合使用FNAC和CNB在91.5%的所有病例（n = 130/142）中得出了可指导治疗的诊断。利用FNAC或CNB材料，在14.7%的病例（n = 21/142）中成功进行了完整的分子评估。
在同一环境下联合使用FNAC和CNB提高了两种操作的诊断准确性。这种方法利用了每种操作的优势，提高了最终诊断的准确性。
