背景:最近出现了肺细胞学标本的分类术语系统。样品不足,归类为“非诊断性”,“在确定细胞数量的阈值和恶性肿瘤(ROM)的风险方面提出了挑战。
方法:该研究回顾性回顾了248例支气管内超声引导下经支气管针吸活检(EBUS-TBNA)样本:46例样本不足,60个低细胞性样本,和142个足够的样本。特征如细胞性,良性和恶性细胞的数量,和背景特征进行了评估。进行接收器工作特征曲线分析以建立用于诊断的细胞充足阈值。
结果:在分析的248个样本中,108人被归类为良性,94为恶性,46是不够的。研究发现,细胞块和细胞学样本中诊断的细胞数阈值分别为≥50个细胞和≥100个细胞,分别。两种细胞的肿瘤细胞计数阈值均≥1-10个细胞,分别。相当大,尽管在修订后达到诊断阈值,但一些低细胞含量样本最初被分类为不足.ROM因样本类别而异,ROM为10.9%的样品不足,良性样本15.7%,可疑样本92.0%,和恶性样本100%。
结论:EBUS-TBNA样本不足增加了诊断和管理方面的挑战。这项研究确定了样本不足的根本原因,包括与人类有关的因素,诊断方法,采样,和实验室处理。通过了解根本原因,可以制定诊断建议以改善诊断过程。研究结果强调了标准化分类和术语系统对于医疗保健专业人员和机构之间清晰沟通的重要性,最终改善患者护理和启用质量保证措施。
BACKGROUND: The classification terminology systems for pulmonary cytology specimens have recently emerged. Inadequate samples, classified as \"nondiagnostic,\" raise challenges in determining the threshold of cell numbers and the risk of malignancy (ROM).
METHODS: The study retrospectively reviewed 248 endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples: 46 insufficient samples, 60 low cellularity samples, and 142 adequate samples. Characteristics as cellularity, number of benign and malignant cells, and background features were assessed. Receiver operating characteristic curve analysis was performed to establish cell sufficiency thresholds for the diagnosis.
RESULTS: Out of the 248 samples analyzed, 108 were classified as benign, 94 as malignant, and 46 as insufficient. The study found that the cellularity thresholds for diagnosis in cell blocks and cytological samples were ≥50 cells and ≥100 cells, respectively. The thresholds for tumor cell counts were ≥1 - 10 cells for both types of cells, respectively. Considerably, some low cellularity samples were initially classified as insufficient despite meeting the diagnostic thresholds upon revision. The ROM varied across sample categories, with insufficient samples having a ROM of 10.9%, benign samples 15.7%, suspicious samples 92.0%, and malignant samples 100%.
CONCLUSIONS: Insufficient EBUS-TBNA samples raise challenges in diagnosis and management. This study identified the root cause of insufficient samples, including factors related to humans, diagnostic methods, sampling, and laboratory processing. By understanding the root causes, diagnostic recommendations can be developed to improve the diagnostic process. The findings emphasize the importance of standardized classification and terminology systems for clear communication among healthcare professionals and institutions, ultimately improving patient care and enabling quality assurance measures.