浆膜腔积液标本细胞病理学诊断的回顾性分析

Cytopathological diagnosis of serous cavity effusion:a retrospective analysis

目的评估《浆膜腔积液细胞病理学检查专家共识》(ECCDSE)分类的规范化和标准化水平,以提高诊断的准确率。方法检索2015-01-01—2020-12-31期间胸、腹腔积液的细胞学诊断和临床病理资料,按ECCDSE标准重新评估和分类,并计算恶性肿瘤风险(ROM)和相关性能参数。结果胸、腹腔积液样本共1999份,其中无法诊断(ND)、未见肿瘤细胞(NFM)、不典型细胞,不能明确意义(AUS)、可疑(恶性)肿瘤细胞(NFM)和恶性肿瘤细胞(MAL)分别为:12(0.6%)、1263(63.2%)、108(5.4%)、61(3.1%)和555(27.7%)例。最常见的恶性肿瘤细胞来源于肺和胃肠道腺癌。各分类中ROM分别为胸腔积液:42.8%、28.6%、50.6%、80.0%、100.0%;腹腔积液40%、27.6%、62.1%、88.4%、100.0%。以MAL为阳性组,诊断准确率、敏感性、特异性、阳性预测值和阴性预测值分别为胸腔积液72.7%、100%、100.0%、87.4%和90.6%;腹腔积液80.9%、100.0%、100.0%、88.9%和92.4%。结论ECCDSE是一个易于掌握的标准化分类系统,对恶性肿瘤细胞诊断具有较高敏感性、特异性和阳性预测值。足够的样本量、细胞形态学和既往病史可提高细胞学诊断的准确性。

Objective To evaluate the performance of the Expert Consensus on Cytopathological Examination of Serosal Cavity Effusion(ECCDSE)in the cytopathological diagnosis of serous fluid.Methods The cytological and clinicopathological data of pleural and peritoneal effusion collected between January 2015 and December 2020 were reviewed in the pathological database of Shanghai Yueyang Hospital,and reclassified according to the ECCDSE.The risk of malignancy(ROM)as well as performance parameters of ECCDSE were calculated.Results A total 1999 pleural and peritoneal effusion samples were included in this study,classified as non-diagnostic(ND,12 specimens)(0.6%),negative for malignancy(NFM,1263 specimens)(63.2%),atypia of undetermined significance(AUS,108 specimens)(5.4%),suspicious of malignancy(SFM,61 specimens)(3.1%)and malignant(M,555 specimens)(27.7%),respectively.The most common diagnosed malignancy was lung adenocarcinoma in pleural effusion,while the most common malignant tumor was gastrointestinal adenocarcinoma in peritoneal effusion.The ROM was,for each of the aforementioned categories,42.8%,28.6%,50.6%,80%,and 100%in pleural effusions;40%,27.6%,62.1%,88.4%,and 100%in peritoneal effusions,respectively.Setting M as the positive group,sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 72.7%,100%,100%,87.4%,and 90.6%for pleural effusions,and 80.9%,100%,100%,89.9%,and 92.4%for peritoneal effusion,respectively.Conclusion ECCDSE is a standardized classification system that is easy to master with high specificity,sensitivity and positive predictive value for the diagnosis of malignancy.The diagnostic accuracy may be improved by enough specimens,review of cell morphology as well as the medical history.