Pinto M M, Rizvi S, Forino M
Department of Pathology and Laboratory Medicine, Bridgeport Hospital, Connecticut 06610.
Am J Surg. 1993 Sep;166(3):311-2. doi: 10.1016/s0002-9610(05)80982-1.
Differentiating abscesses from necrotic tumors has important therapeutic implications. Currently, cytologic examination is the "gold standard," but it has a low sensitivity for cystic/necrotic tumors. To address this problem, a prospective study was conducted comparing the results of cytologic examination with those of carcinoembryonic antigen (CEA) immunoassay of fine-needle aspirates in 24 patients undergoing radiologically or surgically guided fine-needle aspiration. Of 26 fine-needle aspirates, 20 were malignant and 6 benign. Final results were correlated with pathologic examination (when available), clinical review, and follow-up. Three patients had an abscess associated with perforated, recurrent carcinoma, of whom only one had cytologic assessment prior to drainage. The sensitivity of fine-needle aspiration was 85%, and for adenocarcinoma alone, 80%. CEA sensitivity (greater than 5 ng/mL) was 50%, and for adenocarcinoma, 90%; the specificity of the assay was 64%. A high CEA level alone was diagnostic of metastatic carcinoma of the colon in two fine-needle aspirates. Cytologic assessment and CEA assay of fine-needle aspirates and cyst/abscess drainage facilitate the diagnosis of unsuspected adenocarcinoma.
鉴别脓肿与坏死性肿瘤具有重要的治疗意义。目前，细胞学检查是“金标准”，但对囊性/坏死性肿瘤的敏感性较低。为解决这一问题，开展了一项前瞻性研究，对24例接受放射学或手术引导下细针穿刺抽吸的患者，比较细针穿刺抽吸物的细胞学检查结果与癌胚抗原（CEA）免疫测定结果。在26份细针穿刺抽吸物中，20份为恶性，6份为良性。最终结果与病理检查（如有）、临床复查及随访结果相关。3例患者存在与穿孔性复发性癌相关的脓肿，其中仅1例在引流前进行了细胞学评估。细针穿刺抽吸的敏感性为85%，仅腺癌的敏感性为80%。CEA敏感性（大于5 ng/mL）为50%，腺癌为90%；该检测的特异性为64%。仅CEA水平高即可诊断两份细针穿刺抽吸物中的结肠转移癌。细针穿刺抽吸物的细胞学评估和CEA检测以及囊肿/脓肿引流有助于诊断未被怀疑的腺癌。
