背景:有时需要对腋窝淋巴结进行术中评估以确定手术范围。在这项研究中,我们希望评估细胞学涂片(CS)在确定淋巴结是否累及肿瘤方面的可靠性。理论上,CS比触摸压印细胞学提供更多的检查物质,并且比冷冻切片(FS)更快。我们假设CS对淋巴结肿瘤细胞检测的敏感性与FS相似,至少0.90。
方法:这是Rambam卫生保健校园的一项回顾性观察研究(1月,2013-6月,2020)。使用CS或FS进行术中淋巴结评估,根据检查时细胞学家的可用性。将两种术中评估与福尔马林固定后的最终病理进行比较。
结果:分析了88例接受术中分析的患者(51CS,37FS)。仅在通过两种方法中的每一种评估的1名患者中记录假阴性测试。这导致CS的灵敏度为0.91(95CI0.59,1.00),FS的灵敏度为0.88(95CI0.47,1.00),CS的特异性1.00(95CI0.91,1.00)和FS的特异性1.00(95CI0.88,1.00),CS的阳性预测值为1.00(95CI0.69,1.00),FS的阳性预测值为1.00(95CI0.59,1.00),CS的阴性预测值为0.98(95CI0.87,1.00),FS的阴性预测值为0.97(95CI0.83,1.00)。
结论:本研究中CS的灵敏度与FS相当,并且由于所需的分析时间较短,因此是我们机构的首选方法。
BACKGROUND: Intraoperative evaluation of axillary lymph nodes is sometimes required to determine the extent of surgery. In this study, we wished to assess the reliability of cytologic smear (CS) in determining lymph node involvement with tumor. Theoretically, CS provides more substance for examination than touch-imprint cytology and is faster to perform than frozen section (FS). We hypothesized that CS sensitivity for tumor cell detection in the lymph nodes would be similar to FS, at least 0.90.
METHODS: This was a retrospective observational study at the Rambam Health Care Campus (January, 2013-June, 2020). Lymph nodes underwent intraoperative evaluation using either CS or FS, based on the availability of a cytologist at the time of the examination. Both intraoperative evaluations were compared to the final pathology following fixation with formalin.
RESULTS: Eighty-eight patients undergoing intraoperative analysis were analyzed (51 CS, 37 FS). False-negative tests were recorded in only 1 patient evaluated by each of the 2 methods. This resulted in sensitivity 0.91 (95%CI 0.59, 1.00) for CS and 0.88 (95%CI 0.47, 1.00) for FS, specificity 1.00 (95%CI 0.91, 1.00) for CS and 1.00 (95%CI 0.88, 1.00) for FS, positive predictive value 1.00 (95%CI 0.69, 1.00) for CS and 1.00 (95%CI 0.59, 1.00) for FS, and negative predictive value 0.98 (95%CI 0.87, 1.00) for CS and 0.97 (95%CI 0.83, 1.00) for FS.
CONCLUSIONS: The sensitivity of the CS in this study is comparable to that of FS and due to shorter analysis time required is the preferred method at our institution.