Zardawi I M
Department of Pathology, Royal Darwin Hospital, Casuarina, Northern Territory, Australia.
Acta Cytol. 1998 Jul-Aug;42(4):883-7. doi: 10.1159/000331963.
To compare, contrast and analyze the value and limitations of fine needle aspiration (FNA) cytology and core biopsy (CB) in a rural setting.
Retrospective analysis of 100 FNA cytology and 100 CB results of mass lesions from 193 patients matched for age, sex and body organs, and referred for FNA or CB in rural New South Wales, Australia, between September 1990 and May 1996.
FNA cytology and CB results from 193 patients were analyzed, based on anatomic location and cytologic criteria. Sites included lung, retroperitoneum, liver, breast, kidney, pancreas and ovary. The FNA group contained 6 inadequate, 14 benign, 3 atypical, 6 suspicious and 71 malignant cases, whereas the CB group had 1 inadequate, 24 benign and 75 malignant conditions. The inadequate samples in both groups were due to technical difficulty in obtaining representative material. The indeterminate (atypical and suspicious) group, which was the main pitfall of FNA, contained 4 low grade carcinomas, 3 low grade non-Hodgkin's lymphomas and 2 fibrocystic breast changes. The benign FNA group comprised 8 cysts, 5 inflammatory/reactive conditions and 1 benign tumor/hamartoma, whereas the benign CB group contained 11 cysts, 9 inflammatory/reactive conditions and 4 benign tumors.
FNA was comparable to CB at most anatomic sites. CB occasionally offered additional information. This slight advantage was due to the availability of tissue from the first and often the only pass for assessment of architecture and performance of ancillary tests, which obviated the need for further sampling. On-site assessment of the core imprints at the time of the procedure by the highly skilled and experienced interventional cytopathologist was responsible for limiting the number of attempts to one core in most of the instances, therefore minimizing complications. Pathologists are encouraged to become more familiar with the criteria of aspiration cytology, which has proven its validity in the new cost-conscious environment. Despite the recent surge in the popularity of core biopsy, FNA cytology, when practiced in a multidisciplinary setting, with involvement of pathologists, radiologists and clinicians, is an extremely accurate test with very high sensitivity, which approaches that of surgical pathology, and specificity very similar to that of frozen section. FNA has a positive predictive value for a malignant diagnosis of almost 100%. FNA is a well-tolerated, relatively noninvasive test with a very low risk of complications.
比较、对比并分析细针穿刺抽吸（FNA）细胞学检查和粗针活检（CB）在农村地区的价值及局限性。
对193例患者的100份FNA细胞学检查结果和100份CB结果进行回顾性分析，这些患者在年龄、性别和身体器官方面相匹配，于1990年9月至1996年5月期间在澳大利亚新南威尔士州农村地区接受FNA或CB检查。
根据解剖部位和细胞学标准，对193例患者的FNA细胞学检查和CB结果进行了分析。部位包括肺、腹膜后、肝脏、乳腺、肾脏、胰腺和卵巢。FNA组有6份样本不充分、14份良性、3份非典型、6份可疑和71份恶性病例，而CB组有1份样本不充分、24份良性和75份恶性病例。两组样本不充分均是由于获取代表性材料存在技术困难。不确定（非典型和可疑）组是FNA的主要陷阱，其中包括4例低级别癌、3例低级别非霍奇金淋巴瘤和2例乳腺纤维囊性改变。FNA良性组包括8例囊肿、5例炎症/反应性病变和1例良性肿瘤/错构瘤，而CB良性组包括11例囊肿、9例炎症/反应性病变和4例良性肿瘤。
在大多数解剖部位，FNA与CB相当。CB偶尔能提供额外信息。这一微小优势归因于首次穿刺（通常也是唯一一次穿刺）就能获取组织用于评估结构和进行辅助检查，从而无需进一步采样。在操作过程中，由技术熟练且经验丰富的介入细胞病理学家对粗针印片进行现场评估，这在大多数情况下将穿刺次数限制为一次，因此将并发症降至最低。鼓励病理学家更熟悉穿刺细胞学检查标准，在新的注重成本的环境中，该标准已证明其有效性。尽管最近粗针活检越来越受欢迎，但在多学科环境中，当有病理学家、放射科医生和临床医生参与时，FNA细胞学检查是一项极其准确的检查，具有很高的敏感性，接近手术病理学，特异性与冰冻切片非常相似。FNA对恶性诊断的阳性预测值几乎为100%。FNA是一种耐受性良好、相对无创的检查，并发症风险极低。
