Cajulis R S, Hayden R, Frias-Hidvegi D, Brody B A, Yu G H, Levy R
Department of Pathology, Northwestern University, Chicago, Illinois, USA.
Acta Cytol. 1997 Mar-Apr;41(2):481-6. doi: 10.1159/000332542.
To determine the accuracy of cytology in the intraoperative diagnosis of central nervous system (CNS) lesions in human immunodeficiency (HIV)-positive patients.
We prospectively studied 75 cases of computed tomography- or magnetic resonance imaging-guided brain biopsies performed with stereotactic instrumentation and a Nashold biopsy cannula over the course of five years. Biopsy samples were sent for both frozen section and immediate cytologic evaluation. Crush preparations (Papanicolaou and Diff-Quik stained) were used for cytologic assessment. There were 23 cases of progressive multifocal leukoencephalopathy (PML), 8 of toxoplasmosis (toxo), 3 of herpes simplex virus, 26 of lymphoma, 3 of HIV encephalitis, 1 of melanoma, 1 of hamartoma and 10 of nonspecific changes (paraffin section).
Using permanent hematoxylin and eosin-stained histologic sections as the "gold standard," frozen section had a sensitivity of 78% and a specificity of 90%, while cytology had a sensitivity of 88% and specificity of 90%. Most of the false negative cases in cytology and frozen section were due to the predominance of necrosis and/or gliosis, present in six cases of toxo. Two of the false positive cases in frozen section (diagnosed as lymphoma) showed toxo, while two false positive cases in cytology (diagnosed as PML) showed only gliosis with negative immunoperoxidase staining for PML in the permanent sections.
First, cytology had higher sensitivity that frozen section. Second, cytology provided faster results in most instances, primarily due to the nature of specimen preparation. Third, most misdiagnoses occurred in infectious diseases, especially toxo; this should therefore be kept in mind when nonspecific changes with an atypical lymphocytic infiltrate are seen. Fourth, cytology can be an alternative to frozen section for the intraoperative diagnosis of CNS lesions in HIV-positive patients. Another advantage of cytology is elimination of the need for cutting potentially infectious fresh tissue.
确定细胞学检查在人类免疫缺陷病毒（HIV）阳性患者中枢神经系统（CNS）病变术中诊断中的准确性。
我们前瞻性地研究了75例在五年期间使用立体定向器械和Nashold活检套管针进行的计算机断层扫描或磁共振成像引导下的脑活检病例。活检样本同时送去进行冰冻切片和即时细胞学评估。采用压片制备（巴氏染色和Diff-Quik染色）进行细胞学评估。其中有23例进行性多灶性白质脑病（PML）、8例弓形虫病（toxo）、3例单纯疱疹病毒感染、26例淋巴瘤、3例HIV脑炎、1例黑色素瘤、1例错构瘤以及10例非特异性改变（石蜡切片）。
以永久性苏木精和伊红染色的组织学切片作为“金标准”，冰冻切片的敏感性为78%，特异性为90%，而细胞学检查的敏感性为88%，特异性为90%。细胞学检查和冰冻切片中的大多数假阴性病例是由于坏死和/或胶质增生占主导，在6例弓形虫病病例中出现。冰冻切片中的2例假阳性病例（诊断为淋巴瘤）显示为弓形虫病，而细胞学检查中的2例假阳性病例（诊断为PML）在永久性切片中仅显示胶质增生且PML免疫过氧化物酶染色为阴性。
第一，细胞学检查的敏感性高于冰冻切片。第二，在大多数情况下，细胞学检查能更快得出结果，主要是由于样本制备的性质。第三，大多数误诊发生在传染病中，尤其是弓形虫病；因此，当看到伴有非典型淋巴细胞浸润的非特异性改变时应牢记这一点。第四，细胞学检查可作为HIV阳性患者CNS病变术中诊断的冰冻切片替代方法。细胞学检查的另一个优点是无需切割可能具有传染性的新鲜组织。
