Ahuja Sana, Khan Adil Aziz, Ahluwalia Charanjeet, Ranga Sunil
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
J Am Soc Cytopathol. 2025 Jan-Feb;14(1):44-54. doi: 10.1016/j.jasc.2024.09.004. Epub 2024 Oct 4.
Soft tissue tumors are complex neoplasms requiring accurate diagnosis, often through fine needle aspiration (FNA). The World Health Organization (WHO) classification system aims to standardize cytopathological diagnoses and assess the risk of malignancy (ROM) for these tumors.
This retrospective study reviewed cytological specimens from January 2022 to June 2023. Samples were categorized using the WHO classification into 6 categories: nondiagnostic, benign, atypical, soft tissue neoplasm of uncertain malignant potential, suspicious for malignancy (SFM), and malignant. Histopathological correlation was performed, and ROM, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated.
A total of 203 samples were analyzed: 62.5% benign, 13.8% SFM, and 9.9% malignant. ROMs were 33.3% (nondiagnostic), 1.2% (benign), 40% (atypical), 25% (soft tissue neoplasm of uncertain malignant potential), 80% (SFM), and 100% (malignant). Histopathological correlation was available for 117 cases. Sensitivity and diagnostic accuracy were highest (77.3% and 93.9%) when SFM and malignant categories were combined as positive for malignancy. Specificity was highest (100%) when only malignant cases were considered positive. The interobserver agreement was moderate (Cohen's kappa 0.45).
The WHO classification system for soft tissue cytopathology improves diagnostic accuracy and standardizes reporting. It effectively categorizes soft tissue tumors and guides clinical management, though further refinement is needed for broader applicability.
软组织肿瘤是复杂的肿瘤，通常需要通过细针穿刺抽吸活检（FNA）来进行准确诊断。世界卫生组织（WHO）分类系统旨在使这些肿瘤的细胞病理学诊断标准化，并评估其恶性风险（ROM）。
本回顾性研究对2022年1月至2023年6月的细胞学标本进行了分析。样本根据WHO分类分为6类：无法诊断、良性、非典型、恶性潜能不确定的软组织肿瘤、疑似恶性（SFM）和恶性。进行了组织病理学相关性分析，并计算了ROM、敏感性、特异性、阳性预测值、阴性预测值和诊断准确性。
共分析了203个样本：62.5%为良性，13.8%为SFM，9.9%为恶性。ROM分别为33.3%（无法诊断）、1.2%（良性）、40%（非典型）、25%（恶性潜能不确定的软组织肿瘤）、80%（SFM）和100%（恶性）。117例病例有组织病理学相关性。当将SFM和恶性类别合并为恶性阳性时，敏感性和诊断准确性最高（分别为77.3%和93.9%）。仅将恶性病例视为阳性时，特异性最高（100%）。观察者间一致性为中等（Cohen's kappa 0.45）。
WHO软组织细胞病理学分类系统提高了诊断准确性并使报告标准化。它有效地对软组织肿瘤进行了分类并指导了临床管理，不过为了更广泛的适用性还需要进一步完善。
