Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas.
Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Galveston, Texas.
J Am Soc Cytopathol. 2024 Jul-Aug;13(4):303-308. doi: 10.1016/j.jasc.2024.03.001. Epub 2024 Mar 19.
Serous fluids offer crucial diagnostic insights, but inconsistent analysis hampers reporting quality, especially in indeterminate (ID) categories like atypia of undetermined significance (AUS) and suspicious for malignancy (SFM). The 2020 International System for reporting Serous Fluid Cytopathology (TIS) aims to standardize communication and reduce reporting disparities. This study evaluates TIS's role in AUS and SFM categories within our institution.
A 4-year retrospective search of cytopathology reports from December 2015 to December 2019 for AUS and SFM diagnoses in pleural, ascitic, pericardial fluids, and peritoneal washings was performed and results reclassified using TIS definitions. The risk of malignancy (ROM) was calculated for existing and reclassified diagnoses.
Over 4 years, we received 2998 serous fluid specimens. AUS constituted 2.3% (70 cases), while SFM constituted 0.5% (16 cases). Excluding repeats, 80 cases were TIS-reviewed. Sixteen cases of ID diagnoses were reclassified. Two cases of AUS were changed to negative for malignancy (NFM) and 12 to SFM. Two SFM cases were upgraded to malignancy. ROM shifted from 63% to 60% for AUS and 100% to 85% for SF (TIS's ROM range: AUS: 66% ± 10%; SFM: 82% ± 4.8%).
This institution's ID diagnosis rate is low. AUS ROM is challenging but aligns with TIS, primarily favoring benign. All SFM diagnoses are highly suspicious but quantitatively inadequate for definitive malignancy, explaining the elevated ROM. AUS rate should gauge quality, not serve as a catch-all category. Algorithmic cytology with cell blocks and ancillary studies aids reclassification. TIS is user-friendly and is a consistent methodology for standardized reporting. Further studies are needed to evaluate ROM and define reproducible diagnostic criteria for each category for better system utilization.
浆膜液提供了至关重要的诊断见解，但分析结果不一致会影响报告质量，尤其是在不明确（ID）类别中，如不明确意义的非典型性（AUS）和疑似恶性肿瘤（SFM）。2020 年国际浆膜液细胞学报告系统（TIS）旨在标准化沟通并减少报告差异。本研究评估了 TIS 在我们机构的 AUS 和 SFM 类别中的作用。
对 2015 年 12 月至 2019 年 12 月期间胸膜、腹水、心包液和腹腔灌洗液的细胞学报告中 AUS 和 SFM 诊断进行了为期 4 年的回顾性搜索，并使用 TIS 定义重新分类结果。计算了现有和重新分类诊断的恶性肿瘤风险（ROM）。
在 4 年期间，我们共收到 2998 份浆膜液标本。AUS 占 2.3%（70 例），SFM 占 0.5%（16 例）。不包括重复标本，共有 80 例 TIS 审查。16 例 ID 诊断被重新分类。2 例 AUS 改为无恶性肿瘤（NFM），12 例改为 SFM。2 例 SFM 病例升级为恶性肿瘤。AUS 的 ROM 从 63%变为 60%，SF 的 ROM 从 100%变为 85%（TIS 的 ROM 范围：AUS：66%±10%；SFM：82%±4.8%）。
本机构的 ID 诊断率较低。AUS 的 ROM 具有挑战性，但与 TIS 一致，主要倾向于良性。所有 SFM 诊断均高度可疑，但定量上不足以明确恶性肿瘤，这解释了较高的 ROM。AUS 率应衡量质量，而不是作为一个包罗万象的类别。细胞块的算法细胞学和辅助研究有助于重新分类。TIS 使用方便，是标准化报告的一致方法。需要进一步研究来评估 ROM 并为每个类别定义可重复的诊断标准，以更好地利用该系统。
