背景:腹部纤维脂肪组织的细针抽吸(FNA)是检测淀粉样变性的常用方法。虽然通常被认为是一种准确和特定的检测方法,灵敏度是可变的。这项研究的目的是研究脂肪垫FNA相对于其他组织活检在检测淀粉样变性中的表现。
方法:对2014年1月1日至2022年12月31日的脂肪垫FNA结果进行了分类。确定每个病例的临床数据,包括FNA适应症。还评估了通过刚果红染色评估的淀粉样变性的任何后续组织活检/活检的结果。探讨了诊断解释的挑战。
结果:共鉴定出334个脂肪垫FNA。最常见的适应症是周围神经病变(29.3%),心肌病/心力衰竭(28.1%),单克隆丙种球蛋白病(27.8%),多发性骨髓瘤/淋巴浆细胞性淋巴瘤(21.0%)。细胞学解释为:7(2.1%)非诊断性,284(85.0%)阴性,18(5.4%)不确定,16人(4.8%)可疑,淀粉样蛋白沉积阳性9例(2.7%)。在我们的样本中,103例(30.8%)患者对随后的手术标本进行了刚果红检测,包括:7例非诊断病例中的3例,在随后的手术中无阳性;284例阴性病例中有70例,27例在随后的手术中呈阳性;18例不确定病例中有11例,7例在随后的手术中呈阳性;16例可疑病例中有13例,2例,在随后的手术中呈阳性;9例阳性病例中有6例,3,在随后的手术中呈阳性。对FNA解释的挑战包括缺乏细胞,聚焦染色/双折射,和过度染色。
结论:最好将脂肪垫抽吸与其他组织活检结果视为辅助诊断测试,应在临床环境和临床上对淀粉样变性的总体怀疑的背景下进行解释。
BACKGROUND: Fine-needle aspiration (FNA) of abdominal fibroadipose tissue is a commonly utilized method for the detection of amyloidosis. While generally regarded as an accurate and specific detection method, the sensitivity is variable. The objective of this study was to investigate the performance of fat pad FNAs in detecting amyloidosis relative to other tissue biopsies.
METHODS: Fat pad FNA results from January 1, 2014, to December 31, 2022, were catalogued. Clinical data including FNA indication were ascertained for each case. The results of any subsequent tissue biopsy/biopsies evaluated for amyloidosis by Congo red staining were also assessed. Challenges to diagnostic interpretation were explored.
RESULTS: A total of 334 fat pad FNAs were identified. The most common indications were peripheral neuropathy (29.3%), cardiomyopathy/heart failure (28.1%), monoclonal gammopathy (27.8%), and multiple myeloma/lymphoplasmacytic lymphoma (21.0%). Cytologic interpretations were: 7 (2.1%) nondiagnostic, 284 (85.0%) negative, 18 (5.4%) indeterminate, 16 (4.8%) suspicious, and 9 (2.7%) positive for amyloid deposition. In our sample, 103 (30.8%) patients had Congo red testing performed on a subsequent surgical specimen(s) including: 3 of 7 of nondiagnostic cases, none which were positive on the subsequent surgical; 70 of 284 negative cases, 27 which were positive on the subsequent surgical; 11 of 18 indeterminate cases, 7 which were positive on the subsequent surgical; 13 of 16 suspicious cases, 2 which were positive on the subsequent surgical; and 6 of 9 positive cases, 3 which were positive on the subsequent surgical. Challenges to FNA interpretation included scant cellularity, focal staining/birefringence, and overstaining.
CONCLUSIONS: It is best to view fat pad aspiration versus other tissue biopsy results as complimentary diagnostic tests that should be interpreted in the context of the clinical setting and overall clinical suspicion for amyloidosis.