骨肿瘤的针吸细胞学诊断

Needle aspiration cytologic diagnosis for osseous tumor

目的 :探讨骨肿瘤针吸细胞学的诊断标准。方法 :分析 46例骨肉瘤针吸细胞学涂片 ,并与 2 4例骨巨细胞瘤和 12例骨转移性癌进行对照 ,找出骨肉瘤的细胞学特征 ,并与组织学对照分析。结果 :观察到骨肿瘤中有关 10种细胞学改变 :骨肉瘤涂片中 ,多形性大核细胞 (91 3% ) ,核仁明显 (6 9 5 % ) ,单核瘤巨细胞 (76 % ) ,多核瘤巨细胞 (6 5 2 % ) ,核分裂象 (36 9% ) ,出血、坏死 (93 4% )。骨巨细胞瘤以多核巨细胞 (10 0 % )、无多型性大核细胞 (87 5 % )为主要成分。骨转移性癌则以无多形性大核细胞 (10 0 % )、核仁明显 (75 % )、有核分裂象为主要特征。三者均有出血、坏死。骨肉瘤的细胞学诊断与组织学对照符合率为 93 4% ,骨巨细胞瘤为 87 5 % ,骨转移性癌为 91 6 %。结论 :这种方法简便快速而准确 ,结合临床和X线检查对于骨肿瘤术前诊断有重要意义 ,可作为术前常规检查的手段之一。

Purpose To determine the role of needle aspiration cytology in the diagnosis of osteosarcoma.Methods Forty six cases of osteosarcoma, 24 giant cell tumor and 12 metastatic tumors of the bone were evaluated by needle aspiration. The characteristics of cytology were compared with the histopathology of the subsequent operation specimens. Results Ten categories of cytologic features found in the smear of osseous tumors were pleomorphic giant nuclear cell (91 3%), obvious nucleoli(69 5%),mononuclear gaint cell(76%), multinuclear gaint cell(65 2%),karyokinesis(36 9%), hemorrhage and necrosis(93 4%). The dominant features of bone giant cell tumor were multinuclear tumor giant cell(100%) and mononuclear tumor cell(87 5%). Pleomorphic giant nucleus(100%), obvious nucleoli(75%) and karyokinesis were the main elements in the smear of bone metastatic carcinoma. Hemorrhage and necrosis were found among three bone lesions. The diagnostic accuracy rates were 93 4% in osteosarcoma, 87 5% in bone giant cell tumor, 91 6% in bone metastatic carcinoma. Conclusion Needle aspiration is a simple, accurate technique. Combining with clinical history and X ray finding it can improve the diagnostic accuracy of osseous tumors.