背景细胞病理学是呼吸系统疾病的调查和诊断不可或缺的,在过去的十年左右,通过支气管内超声进行经支气管针吸活检,可以在一次手术中对恶性胸部肿瘤进行诊断和分期。此外,介入团队越来越多地包括细胞病理学家和细胞技师,通过提供快速的现场评估,确保胸腔内目标的有效采样,以准确诊断为最终目标,并为全面的预测性测试提供足够的材料。尽管如此,“传统”细胞学检查,如支气管冲洗,仍在进行刷洗和灌洗,以调查可疑的肿瘤和非肿瘤条件,所有这些程序仍然产生标本,其中的良性细胞模仿恶性肿瘤,而真正的肿瘤细胞静静地潜伏在背景中。此外,即使没有怀疑肿瘤,准备和解释中的问题可能会导致最终评估不准确,因此,临床上无益,或误导。在本概述中,我们试图采用一种格式,部分模拟从临床采集到实验室终点的标本,从而在沟通中潜在的陷阱,临床相互作用,运输,和基于临床的制备以及形态学,免疫细胞化学和预测性测试的适用性。它不是详尽的,但突出了可能经常遇到的领域,或者是我们个人经验的一部分。摘要该帐户强调了从采集到报告的关键阶段呼吸道细胞病理学中的潜在陷阱,并以流程图和表格形式介绍了这些陷阱。我们希望这对于细胞技师和细胞病理学家日益合作的角色以及他们在临床研究团队中的更广泛参与是有用的。关键信息正确的临床和放射学信息至关重要,并促进细胞病理学标本的正确获取和处理。跨学科协作工作确保最有效地使用标本,使诊断,并对最佳材料进行预测测试,减少误解的可能性。尽管如此,即使使用最佳材料,形态学模拟和非典型抗原表达可能会误导并使准确诊断具有挑战性。
BACKGROUND: Cytopathology is integral to the investigation and diagnosis of respiratory disease, and, in the last decade or so, transbronchial needle aspiration by endobronchial ultrasound has made possible diagnosis and staging of malignant thoracic tumours at a single procedure. In addition, interventional teams increasingly include cytopathologists and cytotechnologists who, by providing rapid onsite evaluation, ensure efficient sampling of intrathoracic targets with the ultimate goal of accurate diagnosis as well as sufficient material for comprehensive predictive testing. Nonetheless, \"traditional\" cytological investigations such as bronchial washings, brushings, and lavages are still carried out for investigation of both suspected neoplastic and non-neoplastic conditions, and all these procedures still produce specimens in which florid benign cells mimic malignancy, while truly neoplastic cells lurk quietly in the background. Furthermore, even when neoplasia is not suspected, issues in preparation and interpretation may render a final assessment inaccurate and, therefore, clinically unhelpful or misleading. In this overview, we have tried to adopt a format partly modelled on the passage of a specimen from clinical acquisition to laboratory endpoint, thus taking in potential
pitfalls in communication, clinical interaction, transport, and clinic-based preparation, as well as in morphology, immunocytochemistry, and suitability for predictive testing. It is not exhaustive but highlights areas that may frequently be encountered or are part of our personal experience.
CONCLUSIONS: The account highlights potential
pitfalls in respiratory cytopathology at key stages of the process from acquisition to reporting and presents these in both flow diagram and tabular form. We hope this is useful for the increasingly collaborative roles of cytotechnologist and cytopathologist and their wider involvement in the clinical investigative teams.
CONCLUSIONS: Correct clinical and radiological information is crucially important and promotes the correct acquisition and processing of cytopathological specimens. Cross-discipline collaborative working ensures the most efficient use of the specimen such that diagnoses and predictive tests are performed on optimal material, reducing the potential for misinterpretation. Nonetheless, even with optimal material, morphological mimics and atypical antigen expression may mislead and render accurate diagnosis challenging.