Jin Xiaobing, Lew Madelyn, Smola Brian, Huang Tao, Jing Xin
Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA.
Cytopathology. 2025 Sep;36(5):479-483. doi: 10.1111/cyt.13509. Epub 2025 May 14.
Our institution utilises diagnostic frameworks similar to WHO Reporting System for Lung Cytopathology (WHORSLC) for assessment of lung fine needle aspiration (FNA) specimens. This study reports risk of malignancy (ROM) across diagnostic categories for comparison with the WHORSLC published data.
A SNOMED search of the electronic pathology database in our institution (01/2022-12/2023) was conducted to retrieve endobronchial ultrasound (EBUS)-guided lung FNA specimens with a concurrent or subsequent surgical biopsy. Cytologic interpretation of these FNA specimens was performed using diagnostic frameworks similar to WHORSLC. Diagnostic distribution and ROM across the diagnostic categories were evaluated.
Among the 280 identified specimens, 125 (45%) were categorised as malignant, followed by 62 (22%) non-diagnostic, 45 (16%) benign, 33 (12%) atypical, and 15 (5%) suspicious for malignancy (SFM). The corresponding biopsies revealed malignancy in all FNAs categorised as malignant or SFM, as well as 57%, 35%, and 20% of atypical, non-diagnostic, and 20% benign cases, respectively. Among the histology-proven malignancies across the diagnostic categories, the majority were primary lung carcinomas, which most commonly were adenocarcinoma. Non-pulmonary malignancies were mostly seen in atypical (36%) followed by non-diagnostic (27%), SFM (13%), and malignant (10%) categories.
EBUS-guided lung FNA specimens in our cohort categorised as malignant or SFM showed a higher ROM and cyto-histologic concordance (100%) than those reported by the WHORSLC. While our study resulted in a similar ROM for benign, atypical, and malignant categories, the ROM was lower for the non-diagnostic category. These findings contribute to the limited data available and may help further refine the ROM for different categories within the current WHORSLC framework.
我们机构使用类似于世界卫生组织肺部细胞病理学报告系统（WHORSLC）的诊断框架来评估肺部细针穿刺抽吸（FNA）标本。本研究报告了各诊断类别的恶性风险（ROM），以便与WHORSLC公布的数据进行比较。
对我们机构电子病理数据库（2022年1月 - 2023年12月）进行SNOMED检索，以获取经支气管内超声（EBUS）引导的肺部FNA标本，并伴有同期或后续手术活检。这些FNA标本的细胞学解释使用类似于WHORSLC的诊断框架进行。评估了各诊断类别的诊断分布和ROM。
在280份鉴定出的标本中，125份（45%）被归类为恶性，其次是62份（22%）无法诊断，45份（16%）为良性，33份（12%）为非典型，15份（5%）为恶性可疑（SFM）。相应的活检显示，所有归类为恶性或SFM的FNA均为恶性，非典型、无法诊断和良性病例中分别有57%、35%和20%为恶性。在各诊断类别中经组织学证实的恶性肿瘤中，大多数是原发性肺癌，最常见的是腺癌。非肺部恶性肿瘤大多见于非典型类别（36%），其次是无法诊断类别（27%）、SFM类别（13%）和恶性类别（10%）。
我们队列中归类为恶性或SFM的EBUS引导肺部FNA标本显示出比WHORSLC报告的更高的ROM和细胞 - 组织学一致性（100%）。虽然我们的研究在良性、非典型和恶性类别中得出了相似的ROM，但无法诊断类别的ROM较低。这些发现为现有有限数据做出了贡献，并可能有助于在当前WHORSLC框架内进一步完善不同类别的ROM。
