Application of the international system for reporting serous fluid cytopathology on pleural effusion cytology with paired pleural biopsy: A new insight and novel approach on risk of malignancy

IF 1.2 4区医学 Q4 CELL BIOLOGY

Cytopathology Pub Date : 2024-08-01 DOI:10.1111/cyt.13423

Zahra Maleki, Ashleigh J. Graham, Robert Jones, Ricardo Pastorello, Paul Morris, Alessandra C. Schmitt, Erika F. Rodriguez

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Abstract

Introduction

The risk of malignancy (ROM) remains an area of interest for further evaluation in reporting systems including in International System for reporting serous fluid cytopathology (TIS), which is a standardized system for reporting effusion cytology. Herein, we report our findings in further investigation of ROM in TIS by studying on paired pleural effusion specimens and corresponding pleural biopsies with emphasis on negative for malignancy, and atypia of undetermined significance categories.

Materials and Methods

The Johns Hopkins Hospital pathology database was retrospectively searched for patients with a pleural biopsy (PBX) and a paired pleural effusion (PF) cytology specimens over a 4-year period. We employed the TIS categories. The following statistical parameters were evaluated: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM.

Results

A total of 223 patient cases were included. Effusions TIS reclassification and ROM were as follows: 1.8% non-diagnostic (ROM 75%), 75.8% negative for malignancy (ROM 23%), 4.9% atypical cells of undetermined significance (ROM 45%), 2.2% suspicious for malignancy (ROM 80%), and 15.2% malignant (ROM 100%). Overall accuracy, sensitivity, specificity, PPV and NPV were calculated and were 79.4%, 45%, 97.7%, 91.2% and 77%, respectively. Among, discordant cases diagnosed negative for malignancy on PF and positive for malignancy on PBX, there were significant number of lymphomas, mesotheliomas, and sarcomas. Lung cancer was the most common carcinoma; however, rare types of carcinomas were noted. Cells blocks and immunohistochemistry (IHC) studies were utilized to confirm either malignant conditions or rule out malignancy in both cell blocks and histology biopsies.

Conclusion

This study demonstrates the high specificity and ROM for ‘malignant’ and ‘suspicious for malignancy’ categories in the TIS reporting system and highlights the modest negative predictive value for the ‘negative for malignancy’ category. Although Tissue biopsies are usually considered as ‘gold standard’, any definitive diagnosis of malignancy of body fluid should be considered positive for malignancy in further clinical decision-making.

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将国际浆液细胞病理学报告系统应用于胸腔积液细胞学配对胸膜活检：关于恶性肿瘤风险的新见解和新方法。

导言：恶性肿瘤风险（ROM）仍是报告系统中需要进一步评估的领域，包括国际浆液细胞病理学报告系统（TIS），该系统是报告渗出液细胞学的标准化系统。在此，我们通过研究成对的胸腔积液标本和相应的胸膜活检，重点研究恶性肿瘤阴性和意义未定的不典型性类别，报告我们在进一步研究 TIS 中 ROM 的发现：我们在约翰霍普金斯医院病理数据库中回顾性检索了4年内胸膜活检（PBX）和配对胸腔积液（PF）细胞学标本的患者。我们采用了 TIS 分类。对以下统计参数进行了评估：敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和 ROM：结果：共纳入 223 例患者。结果：共纳入 223 例患者：1.8%为非诊断性（ROM 75%），75.8%为恶性阴性（ROM 23%），4.9%为意义不明的非典型细胞（ROM 45%），2.2%为恶性可疑细胞（ROM 80%），15.2%为恶性（ROM 100%）。计算得出的总体准确率、敏感性、特异性、PPV 和 NPV 分别为 79.4%、45%、97.7%、91.2% 和 77%。在 PF 诊断为恶性肿瘤阴性而 PBX 诊断为恶性肿瘤阳性的不一致病例中，有大量淋巴瘤、间皮瘤和肉瘤。肺癌是最常见的癌症，但也有罕见类型的癌症。利用细胞块和免疫组织化学（IHC）研究来确认细胞块和组织学活检中的恶性病变或排除恶性病变：本研究表明，在 TIS 报告系统中，"恶性 "和 "恶性可疑 "类别的特异性和 ROM 都很高，并强调了 "恶性阴性 "类别的阴性预测值并不高。虽然组织活检通常被视为 "金标准"，但在进一步的临床决策中，任何体液恶性肿瘤的明确诊断都应被视为恶性肿瘤阳性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cytopathology 生物-病理学

CiteScore

2.30

自引率

15.40%

发文量

107

审稿时长

6-12 weeks

期刊介绍： The aim of Cytopathology is to publish articles relating to those aspects of cytology which will increase our knowledge and understanding of the aetiology, diagnosis and management of human disease. It contains original articles and critical reviews on all aspects of clinical cytology in its broadest sense, including: gynaecological and non-gynaecological cytology; fine needle aspiration and screening strategy. Cytopathology welcomes papers and articles on: ultrastructural, histochemical and immunocytochemical studies of the cell; quantitative cytology and DNA hybridization as applied to cytological material.