淋巴结细针抽吸细胞学的误区。

IF 1.6 4区 医学 Q3 PATHOLOGY
Acta Cytologica Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI:10.1159/000535906
Min En Nga
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引用次数: 0

摘要

背景细针穿刺细胞学检查(FNAC)是一种准确、微创且经济有效的肿大淋巴结活检方法。淋巴结细针穿刺细胞学检查在诊断感染性或反应性疾病以及转移性恶性肿瘤方面的作用毋庸置疑,但在诊断淋巴瘤方面仍存在不同观点。然而,无论在何种实践环境中,都存在误区和潜在错误,病理学家有责任意识到这些误区,因为这是防止错误的第一道防线。摘要 本次讨论将重点关注潜在的解释错误,特别强调导致假阴性和假阳性诊断以及肿瘤分类错误的情况,重点是细胞形态学。此外,还讨论了病理学家可能忽略的潜在实体--所谓的 "非雷达实体",提醒病理学家在发现形态特征异常的病例时应考虑广泛鉴别。造成假阴性诊断的一些原因包括:低级别淋巴瘤模仿混合、多形性反应性淋巴细胞群;或由于取样错误或实体的固有性质(如结节性淋巴细胞占优势的霍奇金淋巴瘤),抽吸物中病变细胞较少。本文还讨论了造成假阳性诊断的一些潜在原因,包括病毒相关性淋巴结病、菊池-藤本淋巴结炎或模仿转移性恶性肿瘤的良性附件病变。肿瘤分类错误包括转移癌、肉瘤、黑色素瘤和淋巴瘤相互模仿,以及霍奇金淋巴瘤及其模仿体。最后,还简要提及了较少见的实体,如滤泡树突状细胞肉瘤等,以提醒我们注意那些可能在我们的诊断雷达下漏诊的疾病。关键信息 本文对诊断误区和陷阱进行了系统回顾,并提出了一些避免这些陷阱的建议。强调了诊断工作的三重方法,包括严格的临床病理相关性、关注细胞形态学和明智地应用辅助检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pitfalls in Lymph Node Fine Needle Aspiration Cytology.

Background: Fine needle aspiration cytology (FNAC) is an accurate, minimally invasive, and cost-effective biopsy method for enlarged lymph nodes. While the role of lymph node FNAC in the diagnosis of infectious or reactive conditions and metastatic malignancy is unquestioned, differing views still exist on its role in the diagnosis of lymphoma. Nevertheless, regardless of the practice setting, pitfalls and potential for error exist, and it is incumbent upon the pathologist to be aware of these pitfalls, as this is the first line of defence against errors.

Summary: This discussion will focus on potential interpretational errors, specifically highlighting scenarios leading to false-negative and false-positive diagnosis and errors in tumour classification, with an emphasis on cytomorphology. Potential entities that may fly below the radar of the pathologist - so-called off-radar entities - are also discussed, as a reminder to consider broad differentials in cases with unusual morphologic features. Some reasons for false-negative diagnoses include low-grade lymphomas that mimic a mixed, polymorphous reactive lymphoid population or aspirates with a paucity of lesional cells, through either sampling error or the intrinsic nature of the entity, e.g., nodular lymphocyte predominant Hodgkin lymphoma. Some of the potential causes of false-positive diagnoses that are discussed include viral-associated lymphadenopathy, Kikuchi-Fujimoto lymphadenitis, or benign adnexal lesions mimicking metastatic malignancy. Errors in tumour classification covered include metastatic carcinoma, sarcoma, melanoma, and lymphoma mimicking each other, and Hodgkin lymphoma and its mimics. Finally, less common entities such as follicular dendritic cell sarcoma and others are briefly mentioned, to remind us of conditions that may slip under our diagnostic radar.

Key messages: A systematic review of diagnostic pitfalls and traps is elucidated here, with some tips to avoid these traps. The triple approach to the diagnostic workup is emphasised, which includes rigorous clinicopathologic correlation, attention to cytomorphology, and judicious application of ancillary tests.

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来源期刊
Acta Cytologica
Acta Cytologica 生物-病理学
CiteScore
3.70
自引率
11.10%
发文量
46
审稿时长
4-8 weeks
期刊介绍: With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.
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