Eisenhut C C, King D E, Nelson W A, Olson L C, Wall R W, Glant M D
Diagnostic Cytology Laboratories, Inc., Indianapolis, IN 46268, USA.
Diagn Cytopathol. 1996 Feb;14(1):43-50. doi: 10.1002/(SICI)1097-0339(199602)14:1<43::AID-DC9>3.0.CO;2-W.
Diagnostic Cytology Laboratory, Inc., has an outpatient Fine Needle Biopsy Clinic, which evaluated 7,487 fine-needle biopsies (FNB) from January 1989 to February 1992. Two hundred eighty-eight (3.8%) of these specimens were collected from patients 19 years old or younger and this represents the largest study of this population in the scientific literature. The majority of these specimens were obtained from palpable masses in the head and neck region [lymph nodes (58.3%), thyroid (7.6%), and salivary gland (5.2%)] while a smaller number were collected from miscellaneous soft tissue (18.8%) and breast masses (10.1%). Thirteen (4.5%) (from 12 patients) were diagnosed as malignant by FNB and 275 (95.5%) (264 patients) were benign by FNB. This benign:malignant ratio (22:1) is significantly higher than has been reported from tertiary care institutions and is a reflection of the difference of this outpatient population. Two hundred nine of 276 patients (75.7%) had adequate follow-up, including 137 (49.6%) patients followed by observation, 48 (17.4%) patients followed by surgical biopsy, and 24 (8.7%) patients followed by some other modality: imaging studies, flow cytometry, or treatment. There was a single false positive diagnosis (a pilomatrixoma) and one (1) false negative interpretation (a cystic acinic cell carcinoma) resulting in a diagnostic sensitivity of 92.3% and a specificity of 99.6%. The positive predictive value was 92.3%, the negative predictive value was 99.6%, and the test efficiency was 99.3%. The utility, cost-effectiveness and uniqueness of the clinic population is discussed.
诊断细胞学实验室有限公司设有一家门诊细针穿刺活检诊所，该诊所在1989年1月至1992年2月期间评估了7487例细针穿刺活检（FNB）。其中288例（3.8%）标本取自19岁及以下患者，这是科学文献中对该人群规模最大的研究。这些标本大多取自头颈部可触及的肿块[淋巴结（58.3%）、甲状腺（7.6%）和唾液腺（5.2%）]，而少数取自其他软组织（18.8%）和乳腺肿块（10.1%）。13例（4.5%）（来自12名患者）FNB诊断为恶性，275例（95.5%）（264名患者）FNB诊断为良性。这种良性与恶性比例（22:1）显著高于三级医疗机构报告的比例，反映了该门诊患者群体的差异。276名患者中有209名（75.7%）得到了充分随访，其中137名（49.6%）患者通过观察随访，48名（17.4%）患者通过手术活检随访，24名（8.7%）患者通过其他方式随访：影像学检查、流式细胞术或治疗。有1例假阳性诊断（1例毛母质瘤）和1例假阴性诊断（1例囊性腺泡细胞癌），诊断敏感性为92.3%，特异性为99.6%。阳性预测值为92.3%，阴性预测值为99.6%，检测效率为99.3%。本文讨论了该诊所患者群体的实用性、成本效益和独特性。
