Aetiology of non-diagnostic renal fine-needle aspiration cytologies in a contemporary series
Aetiology of non-diagnostic renal fine-needle aspiration cytologies in a contemporary series
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DOI：
10.1111/j.1464-410x.2008.07942.x
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发表时间：
2009-01-01
影响因子：
4.5
通讯作者：
Lee, Benjamin R.
中科院分区：
文献类型：
--
作者：
Andonian, Sero;Okeke, Zeph;Lee, Benjamin R.
为了确定非诊断性肾脏细针穿刺细胞学（FNAC）的病因，我们回顾性分析了1995年至2005年期间进行的肾脏FNAC的机构数据库。有118例肾脏病变患者接受了FNAC。FNAC的适应症为不确定的复杂性肾囊肿、显著的医学合并症、既往恶性肿瘤史、多发性双侧肾脏病变和疑似转移性疾病。在FNA程序期间，细胞技术人员在场，以进行Diff-Quik染色，并确保获得足够的细胞样本。除7例（6例开放，1例超声引导）外，所有FNAC均在CT引导下进行，每次FNAC的平均通过次数（范围）为2.7（1-6）。在16例不确定复杂性肾囊肿的FNAC中，9例（56%）足以进行良性囊肿的细胞学诊断。在7个不充分的标本中，3个有良性囊肿，另外3个由于无细胞性而无法诊断。因此，不确定复杂性肾囊肿的技术失败率为19%（3/16）。最后一名患者的细胞学诊断为良性囊肿，最终组织学诊断为肾细胞癌（RCC;乳头状，III级）。因此，这表示抽样误差（假阴性率）为0.8%（1/118）。在102例肾实质性肿块中，22例（22%）Diff-Quik染色标本不全。技术失败率（无法获得足够的上皮细胞）为16%（16）。在18例患者中，免疫细胞化学（ICC）被用来区分原发性肾实质肿瘤从其他如移行细胞癌（TCC），淋巴增生，结肠和肺。有2例FNAC误诊（2%），未使用ICC。在这两例患者中，细胞学诊断均为TCC，最终组织学诊断为RCC的一例和非典型尿路上皮病的另一例。非诊断性肾脏FNAC可归因于误诊（2%），采样错误（0.8%）和技术失败（16%）。
To determine the aetiology of non-diagnostic renal fine-needle aspiration cytologies (FNACs) in a contemporary series.We retrospectively reviewed our institutional database of renal FNACs performed between 1995 and 2005. There were 118 patients with renal lesions that underwent FNAC. Indications for FNAC were indeterminate complex renal cysts, significant medical comorbidities, previous history of malignancy, multiple bilateral renal lesions, and suspected metastatic disease. A cytotechnologist was present during the FNA procedure to perform Diff-Quik staining and ensure an adequate sample of cells were obtained. Except for seven (six open, one ultrasound-guided), all of the FNACs were performed with CT guidance.The median (range) number of passes for each FNAC session was 2.7 (1-6). Of the 16 FNACs performed for indeterminate complex renal cysts, nine (56%) were adequate with the cytodiagnosis of benign cysts. Of the seven inadequate specimens, three had benign cysts and another three were non-diagnostic due to acellularity. Therefore, the technical failure rate was 19% (3/16) for indeterminate complex renal cysts. The last patient had a cytodiagnosis of benign cyst and the final histological diagnosis of renal cell carcinoma (RCC; papilllary, grade III). Therefore, this represents a sampling error (false negative rate) of 0.8% (1/118). For the 102 solid renal masses, 22 (22%) had inadequate specimen by Diff-Quik staining. The technical failure rate (inability to obtain sufficient epithelial cells) was 16% (16). In 18 patients, immunocytochemistry (ICC) was used to differentiate primary renal parenchymal tumours from others such as transitional cell carcinoma (TCC), lymphoproliferative, colon, and lung. There were two FNACs with misdiagnosis (2%), where ICC was not used. In both, the cytodiagnosis was TCC and the final histological diagnosis was RCC in one and atypical urothelium in another.Non-diagnostic renal FNACs can be attributed to misdiagnosis (2%), sampling error (0.8%) and technical failure (16%).