Bommer K K, Ramzy I, Mody D
Cytopathology Laboratory, Baylor College of Medicine, Houston, Texas 77030, USA.
Cancer. 1997 Jun 25;81(3):148-56. doi: 10.1002/(sici)1097-0142(19970625)81:3<148::aid-cncr4>3.0.co;2-n.
Fine-needle aspiration (FNA) biopsy has proved to be a cost-effective technique, with low complication risks and high diagnostic value in distinguishing neoplastic versus nonneoplastic lesions in many organs. This study was designed to determine the reliability, areas of diagnostic difficulty, and limitations of FNA in the diagnosis of bone lesions encountered in a university-affiliated tertiary care hospital.
The cytology of 450 FNA biopsies of bone lesions, performed on 427 patients between 1979 and 1996, were reviewed. The results were correlated with the corresponding histology when available, and with clinical follow-up, in an attempt to define the role of FNA in managing patients with bony lesions.
The patients ranged in age from 5 to 94 years, with a male-to-female ratio of 1.25:1. The spine was the most frequently aspirated site (49%), followed by the ilium, sacrum, mandible, ribs, and femur. Three hundred and eighty-five aspirates (86%) were adequate for evaluation, with 215 cases diagnosed cytologically as positive for malignancy, 11 cases as suspicious but not diagnostic of malignancy, and 2 cases as inconclusive. One hundred and fifty-seven cases were interpreted as showing no evidence of malignancy. Metastatic carcinoma was present in 175 of the 215 malignant aspirates, and 67% of these were adenocarcinomas. Forty cases were primary malignant bone neoplasms, including myeloma, lymphoma, Ewing's sarcoma, chondrosarcoma, ameloblastoma, chordoma, neurofibrosarcoma, and unclassified high grade sarcoma. False-negative diagnoses were rendered in ten cases; however, on review, material representative of the bone lesion was not present in six cases. Five cases were correctly diagnosed as malignant but were misclassified with regard to the type of malignancy.
FNA biopsy of bone lesions is a reliable and easily performed diagnostic test for metastatic and primary bone tumors. False-positive results have major therapeutic implications, hence the significance of the authors' conservative diagnostic approach, which resulted in a false-positive rate of 0.2%. Areas of difficulty were due to inadequate sampling or misclassification with regard to the exact type of malignancy. The simplicity and accuracy of this procedure, which does not require any surgical incisions (open biopsy or manipulation), supports its important role in triaging and managing bone lesions with minimum risk or morbidity.
细针穿刺（FNA）活检已被证明是一种具有成本效益的技术，在许多器官中区分肿瘤性与非肿瘤性病变时并发症风险低且诊断价值高。本研究旨在确定FNA在一所大学附属三级医疗医院诊断骨病变中的可靠性、诊断困难领域及局限性。
回顾了1979年至1996年间对427例患者进行的450例骨病变FNA活检的细胞学检查结果。将结果与可获得的相应组织学结果以及临床随访结果相关联，以试图确定FNA在管理骨病变患者中的作用。
患者年龄范围为5至94岁，男女比例为1.25:1。脊柱是最常穿刺的部位（49%），其次是髂骨、骶骨、下颌骨、肋骨和股骨。385例穿刺样本（86%）足以进行评估，其中215例细胞学诊断为恶性阳性，11例可疑但不能诊断为恶性，2例结果不确定。157例被解释为无恶性证据。215例恶性穿刺样本中有175例存在转移性癌，其中67%为腺癌。40例为原发性恶性骨肿瘤，包括骨髓瘤、淋巴瘤、尤因肉瘤、软骨肉瘤、成釉细胞瘤、脊索瘤、神经纤维肉瘤和未分类的高级别肉瘤。有10例诊断为假阴性；然而，复查时发现6例中不存在代表骨病变的材料。5例被正确诊断为恶性，但在恶性类型分类上有误。
骨病变的FNA活检是诊断转移性和原发性骨肿瘤的可靠且易于实施的诊断测试。假阳性结果具有重大治疗意义，因此作者采用保守诊断方法的意义在于其假阳性率为0.2%。诊断困难的领域是由于取样不足或在恶性肿瘤的确切类型分类上有误。该程序的简单性和准确性，无需任何手术切口（开放活检或操作），支持了其在以最小风险或发病率对骨病变进行分类和管理中的重要作用。
