Challenges and Pitfalls of Morphologic Identification of Fungal Infections in Histologic and Cytologic Specimens A Ten-Year Retrospective Review at a Single Institution
Challenges and Pitfalls of Morphologic Identification of Fungal Infections in Histologic and Cytologic Specimens A Ten-Year Retrospective Review at a Single Institution
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DOI：
10.1309/ajcp99ooozsniscz
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发表时间：
2009-03-01
影响因子：
3.5
通讯作者：
Banaei, Niaz
中科院分区：
文献类型：
--
作者：
Sangoi, Ankur R.;Rogers, William M.;Banaei, Niaz
尽管提供早期推定诊断的优势，真菌的组织病理学分类可能是困难的，并可能导致诊断错误。为了评估真菌感染培养（“金标准”）的组织学诊断的准确性，我们在我们的机构进行了10年的回顾性回顾。在338例霉菌和酵母菌培养阳性患者中，有47例在没有已知真菌感染史的同时进行手术病理评估，其中37例（79%）根据组织学和/或细胞学标本的形态特征被正确识别。10个不一致的诊断（21%）包括分隔和非分隔菌丝生物和酵母形式的错误识别。错误是由于形态学的模仿，使用不恰当的术语和真菌学知识的不完整。准确性与既往抗真菌治疗无显著相关(P =。14)或使用特殊的污渍(P =。34)，并且不依赖于操作者。在临床随访的8个差异中，2个出现了潜在的不良临床后果。虽然组织切片和细胞学制剂中真菌的组织病理学鉴定容易出错，但标准化报告格式的实施应提高诊断准确性并防止不良后果。
Despite the advantages of providing an early presumptive diagnosis,fungal classification by histopathology can be difficult and may lead to diagnostic error. To assess the accuracy of histologic diagnosis of fungal infections culture ("gold standard'), we performed a 10-year retrospective review at our institution. Of the 4 7 of 338 positive mold and yeast cultures with concurrent surgical pathology evaluation without known history of a fungal infection, 3 7 (79%) were correctly identified based on morphologic features in histologic and/or cytologic specimens. The 10 discrepant diagnoses (21%) included misidentification of septate and nonseptate hyphal organisms and yeast forms. Errors resulted from morphologic mimics, use of inappropriate terminology and incomplete knowledge in mycology. The accuracy did not cot-relate with preceding antifungal therapy (P =. 14) or use of special stains (P =. 34) and was not operator-dependent. Among 8 discrepancies with clinical follow-up available, 2 potential adverse clinical consequences resulted. While histopathologic identification of fungi in tissue sections and cytologic preparations is prone to error, implementation of a standardized reporting format should improve diagnostic accuracy and prevent adverse outcomes.