The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma
The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma
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DOI：
10.1378/chest.111.1.106
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发表时间：
1997-01-01
期刊：
影响因子：
9.6
通讯作者：
Cibas, ES
中科院分区：
文献类型：
--
作者：
Renshaw, AA;Dean, BR;Cibas, ES
研究目的：早期治疗恶性间皮瘤（MM）可提高生存率。胸腔积液的细胞学检查是这些患者的首选诊断技术之一。本研究的目的是确定胸膜液细胞学检查在促进早期诊断中的作用，设计：回顾了胸膜MM患者的病历和细胞学切片，设置：回顾了两个机构的病历：一个大型综合医院和一个癌症医院。29例患者，年龄范围为32 - 81岁（平均年龄59岁）符合研究标准，干预措施：所有患者至少进行一次细胞学胸腔积液检查，测量和结果：所有患者从初始症状到诊断为MM的中位时间为8周，对于细胞学结果阳性或可疑的患者，中位时间为4周，对于细胞学结果阴性的患者，中位时间为12周，细胞学检查诊断MM的总敏感性为32%，胸水细胞遗传学分析的敏感性为56%，其中1例细胞学检查阴性，从发病到确诊时间超过1年的患者，尽管有石棉暴露史，但细胞学结果均为阴性，随后长期未进行进一步检查。阳性或可疑的细胞学结果与缩短的中位诊断时间相关。不幸的是，细胞学检查诊断MM的敏感性仅为32%。在更好的诊断技术被开发出来之前，我们建议对疑似MM且胸水细胞学检查阴性的患者立即进行胸膜活检。
Study objective: Treatment of malignant mesothelioma (MM) at an early stage results in increased survival. Cytologic examination of pleural effusions is one of the first diagnostic techniques attempted in these patients. The objective of this study was to define the role of cytologic examination of pleural fluid in facilitating early diagnosis,Design: The medical records and cytologic slides of patients with pleural MM were reviewed,Setting: Medical records were reviewed from two institutions: a large general hospital and a cancer hospital.Patients: Twenty-nine patients ranging in age from 32 to 81 years (mean, 59 years) met the study criteria,Interventions: All patients had at least one cytologic pleural fluid examination,Measurements and results: The median time from initial symptoms to the diagnosis of MM was 8 weeks for all patients, For patients with a positive or suspicious cytologic result, the median was 4 weeks, and in those with a negative cytologic result, it was 12 weeks, The overall sensitivity of cytologic examination for the diagnosis of MM was 32%, Cytogenetic analysis of pleural fluid had a sensitivity of 56%, and was positive in 1 case in which results of cytologic examination were negative, Patients in whom the time from presentation to diagnosis was greater than 1 year all had negative cytologic results followed by long periods without further workup, despite a history of exposure to asbestos,Conclusions: A positive or suspicious cytologic result was associated with a decreased median time to diagnosis. Unfortunately, the sensitivity of cytologic examination for a diagnosis of MM was only 32%, Until better diagnostic techniques are developed, we recommend immediate pleural biopsy in patients in whom MM is suspected and cytologic evaluation of pleural fluid gives negative results.