Costa M J, Campman S C, Davis R L, Howell L P
Department of Pathology, University of California, Davis 95817, USA.
Diagn Cytopathol. 1996 Jul;15(1):23-32. doi: 10.1002/(SICI)1097-0339(199607)15:1<23::AID-DC6>3.0.CO;2-R.
Fine-needle aspiration cytology (FNA) is useful because of its low cost, quick turn around time, and low incidence of complications. This study investigates the role FNA plays in the evaluation of sarcoma. We reviewed all the pathologic material from patients with sarcoma or a FNA diagnosis suggestive of sarcoma at the University of California-Davis Medical Center (1985-1994). Fifty-two of 196 patients identified (26.5%) were evaluated with FNA exhibiting 46 soft tissue and 6 bone lesions located in the extremities (19), trunk (19), head and neck (8), retroperitoneum (3), and abdominal cavity (3). Among 196 patients identified, those evaluated by FNA had soft tissue rather than bone lesions (P < .001) and primary sites other than in the extremities (P < .001). The primary neoplasms for the 52 FNA patients included 47 sarcomas (10 malignant fibrous histiocytomas and 16 other types), 1 intramuscular myxoma, 2 lymphomas, and 2 spindle cell (sarcomatoid) carcinomas. In 43 patients (22% of total), FNA was used first, before a primary diagnosis. The FNA report showed the correct specific neoplasm in only 20.9%. However, the FNA reports reflected an effective positive diagnosis leading to appropriate diagnostic biopsy in 88.4%, while only 7.0% were misleading (benign or inflammatory) and 4.6% inadequate. Review of FNA slides for 32 of 43 patients in which FNA was used first, in a blinded fashion, exhibited 21.9% specificity for the specific neoplasm, and 88.4% effective positive diagnoses. In 9 patients, FNA was utilized to investigate recurrence. Five out of 5 instances of recurrent sarcoma were identified by FNA. However, FNA misidentified recurrence in 3/4 instances, exhibiting suspicious cells from regenerating skeletal muscle (2) and a traumatic neuroma (1). The specific diagnosis for sarcomas is challenging even with surgical material. FNA usually does not provide a specific diagnosis (only in 20.9% of cases) and review of routinely prepared slides showed the same specificity as reflected by the original FNA report, at times formulated with the benefit of immunohistochemistry or electron microscopy. FNA effectively evaluated lesions in 45 of 52 patients (86.5%), confirming the useful screening role for this technique in sarcomas.
细针穿刺细胞学检查（FNA）因其成本低、周转时间短且并发症发生率低而很有用。本研究调查了FNA在肉瘤评估中的作用。我们回顾了加利福尼亚大学戴维斯分校医学中心（1985 - 1994年）所有肉瘤患者或FNA诊断提示为肉瘤的患者的病理材料。在196例确诊患者中，52例（26.5%）接受了FNA评估，其中46例为软组织病变，6例为骨病变，分布于四肢（19例）、躯干（19例）、头颈部（8例）、腹膜后（3例）和腹腔（3例）。在196例确诊患者中，接受FNA评估的患者有软组织而非骨病变（P < 0.001），且原发部位不在四肢（P < 0.001）。52例接受FNA检查的患者的原发性肿瘤包括47例肉瘤（10例恶性纤维组织细胞瘤和16例其他类型）、1例肌内黏液瘤、2例淋巴瘤和2例梭形细胞（肉瘤样）癌。在43例患者（占总数的22%）中，FNA在初次诊断之前首先被使用。FNA报告仅在20.9%的病例中显示出正确的特定肿瘤。然而，FNA报告在88.4%的病例中反映出有效的阳性诊断，从而导致进行适当的诊断性活检，而只有7.0%的报告有误导性（良性或炎症性），4.6%的报告不充分。对43例首先使用FNA的患者中的32例的FNA玻片进行盲法复查，结果显示对特定肿瘤的特异性为21.9%，有效阳性诊断率为88.4%。在9例患者中，FNA用于调查复发情况。5例复发性肉瘤中有5例通过FNA被识别出来。然而，FNA在4例中有3例错误识别了复发情况，表现为再生骨骼肌（2例）和创伤性神经瘤（1例）的可疑细胞。即使有手术材料，肉瘤的特异性诊断也具有挑战性。FNA通常不能提供特异性诊断（仅在20.9%的病例中），对常规制备玻片的复查显示出与原始FNA报告相同的特异性，有时借助免疫组织化学或电子显微镜检查会更准确。FNA有效地评估了52例患者中45例（86.5%）的病变，证实了该技术在肉瘤筛查中的有用作用。
