回顾性应用世卫组织肺细胞病理学报告系统评估恶性肿瘤风险。

Retrospective application of WHO reporting system for lung cytopathology with assessment of risk of malignancy.

机构信息

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Department of Pulmonary Medicine and Critical Care Unit, All India Institute of Medical Sciences, New Delhi, India.

出版信息

J Am Soc Cytopathol. 2024 May-Jun;13(3):183-193. doi: 10.1016/j.jasc.2024.02.003. Epub 2024 Feb 23.

DOI:10.1016/j.jasc.2024.02.003

PMID:38514360

Abstract

INTRODUCTION

The recently introduced World Health Organization (WHO) Reporting System for Lung Cytopathology presents 5 diagnostic categories with corresponding risk of malignancy (ROM) and management protocols. This study uses the system to categorize our institutional respiratory tract cytology specimens, evaluating ROM and diagnostic accuracy for each category.

MATERIALS AND METHODS

In a retrospective analysis (May 2020 to August 2021), the following respiratory cytology specimens were classified based on the WHO categories: bronchoalveolar lavage (BAL), bronchial wash/bronchial brushings (BB/BW), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), fine-needle aspiration cytology (FNAC), sputum, biopsy imprint (BI), and endotracheal wash. Exclusions comprised pleural effusions and EBUS-TBNA from mediastinal and hilar lymph nodes. Correlation of cytologic and histopathologic diagnoses was performed to assess ROM collectively and individually.

RESULTS

A total of 1518 respiratory samples (BAL [968], BW/BB [380], EBUS-TBNA [42], FNAC [32], sputum [80], BI [11] and endotracheal wash [5]) of 1410 patients were screened, of which 522 cases (34.3%) had histopathologic correlation. One hundred forty-one cases (9.3%) were Insufficient/Inadequate/Non-Diagnostic (ND), 1221 (80.4%) were Benign (B), 3 (0.2%) were Atypical (A), 32 (2.1%) were Suspicious for malignancy (SM) and 121 (8.0%) were Malignant (M). The estimated ROM for each category was 49.2% for ND, 13.3% for B, 66.6% for A, 81.5% for SM and 92.7% for M. FNAC and EBUS-TBNA exhibited the highest sensitivity (100%) compared with BW/BB (66.3%). Specificity ranged from 96.8% to 100% across the samples, while diagnostic accuracy varied from 58.8% to 100%.

CONCLUSIONS

Application of the WHO reporting system enhances standardized terminology, aiding clinicians in informed decision-making and improving patient care through accurate risk assessment of malignancy.

摘要

简介

最近引入的世界卫生组织（WHO）肺部细胞学报告系统提出了 5 个诊断类别，每个类别都有相应的恶性肿瘤风险（ROM）和管理方案。本研究使用该系统对我院呼吸道细胞学标本进行分类，评估每个类别的 ROM 和诊断准确性。

材料与方法

在一项回顾性分析中（2020 年 5 月至 2021 年 8 月），根据 WHO 分类对以下呼吸道细胞学标本进行分类：支气管肺泡灌洗（BAL）、支气管冲洗/支气管刷检（BB/BW）、经支气管超声引导下经支气管针吸活检（EBUS-TBNA）、细针抽吸细胞学（FNAC）、痰、活检印片（BI）和气管冲洗。排除性标本包括胸腔积液和 EBUS-TBNA 来自纵隔和肺门淋巴结。对细胞学和组织病理学诊断进行相关性分析，以评估整体和个别类别的 ROM。

结果

共筛选了 1410 名患者的 1518 例呼吸道样本（BAL[968]、BW/BB[380]、EBUS-TBNA[42]、FNAC[32]、痰[80]、BI[11]和气管冲洗[5]），其中 522 例（34.3%）有组织病理学相关性。141 例（9.3%）为不足/不充分/非诊断（ND），1221 例（80.4%）为良性（B），3 例（0.2%）为不典型（A），32 例（2.1%）为可疑恶性（SM），121 例（8.0%）为恶性（M）。每个类别的估计 ROM 分别为 ND 为 49.2%，B 为 13.3%，A 为 66.6%，SM 为 81.5%，M 为 92.7%。FNAC 和 EBUS-TBNA 与 BW/BB（66.3%）相比具有最高的敏感性（100%）。特异性在不同样本中从 96.8%到 100%不等，而诊断准确性从 58.8%到 100%不等。