폐질환에 있어 세포검사와 조직검사의 진단 일치율 및 정확도에 대한 조사 연구

김성철 ( Sung-chul Kim ),노정환 ( Joung-whan Ro ),김태전 ( Tai-jeon Kim ) 대한임상검사과학회 2009 대한임상검사과학회지(KJCLS) Vol.41 No.4

Lung cancer is a type of cancer with high mortality; its 5-year survival rate is at a low 14%. Related cytological tests include sputum, bronchial brushing, bronchial washing and fine needle aspiration cytology test etc. From the test specimens in which sputum, bronchial brushing, bronchial washing, and fine needle aspiration cytology were performed, the sensitivity, specificity and accuracy between cytology test and histology test. In the sputum test, sensitivity was 27.71% and specificity was 98.02%, and the bronchial brushing test showed sensitivity of 93.33% and a specificity of 91.3%. The bronchial washing test was a sensitivity of 53.7% and its specificity was 98.9%, and the fine needle aspiration cytology test showed sensitivity and specificity were 88.46% and 72.97%, respectively. In the specimens diagnosed as normal at the sputum test, malignant diagnosis was found in 21 specimens of bronchial brushing, 30 cases of bronchial washings and 37 cases of fine needle aspiration cytology specimens. In the specimens diagnosed as normal at the bronchial washing test, malignant diagnosis was found in 5 specimens of sputum, 7 specimens of bronchial brushin and 1 cases of fine needle aspiration cytology. One specimens found to be normal in fine needle aspiration cytology turned out to maligant in sputum test. The result of this research shows that, in diagnosis lung cancer, a test method of high sensitivity and specificity should be pursued. However, depending on the location and malignancy of the illness, diagnosis may not be obtained in some cases. Therefore, we conclude that the cytological tests performed for lung cancer testing such as sputum, bronchial brushing, bronchial washing, and fine needle aspiration cytology should be carried out in a mutually complementary manner.

吸入 細胞檢査의 診斷的 意義 및 評價 : 여러 人體 藏器에서 經驗한 1005例를 中心으로 An Analysis of 1,005 Cases from Various Human Organs

高一香,石東壽 인제대학교 1987 仁濟醫學 Vol.8 No.2

吸入 細胞檢査(Aspiration Biopsy Cutology, ABC)는 目的 病巢에서 細針을 揷入하여 吸入한 微細組織切片을 細胞學的 檢査法으로 判讀 診斷하는 檢査法이다. 매우 簡單하고 迅速한데 比해 正確性과 安定性이 높고, 뿐만 아니라 患者에게 心的 肉體的 負擔과 合倂症이 적고 低廉한 費用으로 行할 수 있어 最近 우리나라에서도 漸次的으로 利用度가 높아지고 있다. 短點이라면 僞陰性 結果가 不可避하다는 것이다. 이를 最少限으로 줄이기 爲해서는 技法의 熟練과 判讀하는 病理專門醫들의 豊富한 經驗이 必要하다. 本 硏究 結果 診斷의 正確度는 90%이었으며 將次 向上될 것으로 期待된다. An analysis of 1,005 cases of Aspiration Biopsy Cytology (ABC) performed at Seoul Paik Hospital from February 1984 to September 1986 was reviewed. The following results were obtained. 1.Number of the test performed is 173 in 1984, 387 in 1985 and 445 in 1986, respectively. 2.Aspiration Biopsy Cytology was most frequently applied to lymph node with incidence of 394 (39%), breast 296 (29%), thyroid 132 (13%), deep organs 86 (9%) and others 97 cases (10%). 3.The most frequently made Aspiration Biopsy Cytology diagnosis was mammary dysplasia of 144 cases followed by reactive hyperplasia of lymph node 118, lymph node malignancy 73 and adenomatous goiter 50. Malignancy is the most frequent diagnosis made in this study, occupying over 23% of the test performed. The result is indirectly suggested that the Aspiration Biopsy Cytology is an important tool for detection of the malignant lesion. 4.Histological diagnosis was made in 116 cases and diagnostic accuracy of Aspiration Biopsy Cytology ranged from 75.1(81.1)% to 94.3(98.0)%. The mean accuracy is 89.3(91.5)%. 5.There were 3(2.6%) cases of false positive and 9(7.8%) false negative reports of Aspiration Biopsy Cytology. The former consists of 1 case of granuloma and 2 cases of osteomyelitis reported as highly suspicious Aspiration Biopsy Cytology impresssion. The fault was made due to atypical epitheloid cells and active osteoblasts. The false nagative consists of 3 cases of sampling error, 4 cases of misinterpretation and 2 cases of diagnostic difficulty; one well differenciated follicular carcinoma impressed as adenomatous goiter in Aspiration Biopsy Cytology and the other well differenciated duct adenocarcinoma of breast with impression of papilloma in Aspiration Biopsy Cytology. 6.Diagnosis of non-neoplastic lesion is also significantly effective. For example; diagnosis of tuberculosis is more effectively made with combination study of Aspiration Biopsy Cytology and acid fast (rhodamine) stain. 7.Aspiration Biopsy Cytology is an extention of morphologic diagnosis within both diagnostic cytology and histopathology. It is quite valuable method previously underused and wider use of this established and simple procedure is encouraged.

갑상선 결절의 임상양상과 미세침흡인검사의 의의

원진호,한희정,채수홍,김현진,송민호,김영건 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

We evaluated clinical manifestation of nodular thyroid disease and fine-needle aspiration cytology results to establish an appropriate diagnostic approach to thyroid nodule. We examined 594 patients who visited Chungnam National University Hospital with one or more thyroid nodules between Jan. 1996 and Dec. 1998. Fine-needle aspiration cytology was carried out after clinical evaluation including medical history, physical examination(hardness,size, multinodularity,fixation) and laboratory test(scan, thyroid function test). Among the 594 cases, 53 cases(8.9%) were diagnosed as cancer and 457 cases(77%) were diagnosed as benign nodule. None of these factors - age, sex. soft and firm nodule, multinodularity, thyroid scan, thyroid sonography, and thyroid function test - were significant to predict cancer in our study. The prevalence of cancer was significantly higher in hard nodule(28. 5%,39/137) than firm(3.8%,12/316) or soft nodule(0%,0/72). There was size difference between malignant(24.2±62.8ml) and benign nodules(12.6±26.1ml),but the size difference wasn't shown to an indicator to say whether malignant or benign. The prevalence of cancer in relation to fixation was significantly higher in fixation(50%,19/38) and partial fixation nodule(33%,4/12) than movable nodules(5.8%,28/476). Rapid growing, vocal cord palsy,and lymphadenopathy among the medical history had higher relative risk to cancer (relative risk= 14, 4.8, 10.2. respectively). We also examined 67 cases which were diagnosed by histology after operation and, through comparison between the results of histology and cytology., evaluated the effectiveness of fine-needle aspiration cytology. Sensitivity, specificity, false negative rate, and false positive rate of fine-needle aspiration cytology were 92-100%, 47-63%, 0-20%, 0-50%,respectively. Our data suggests that thyroid nodules of the patients which are characterized firm, fixed, rapid growing, lymphadenopathy, and vocal cord palsy require more careful evaluation for thyroid cancer. We also recommand thyroid aspiration cytology in first step evaluation to rule out thyroid cancer.

갑상선 결절의 수술 범위 결정시 세침흡인세포검사와 동결절편생검의 유용성

이영돈,조현준,Yeoung Don Lee,M.D. and Hyeoun Jun Cho,M.D. 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1

Purpose: Traditionally the extent of thyroidectomy in patients with nodular thyroid disease has been based on fine needle aspiration cytology and intraoperative frozen section examination. The value of routine frozen section examination for intraoperative diagnosis of thyroid cancer and determination of extent of thyroidectomy is controversial and needs to be evaluated. Methods: We reviewed the fine needle aspiration cytology, frozen section examination, and final pathology of 142 consecutive patients who underwent thyroidectomy for nodular thyroid mass in an 3-year period. The diagnosis were classified as indeterminant, benign, or malignant. The utility and impact of the diagnosis from fine needle aspiration or frozen section on the operative procedure performed was analyzed. Results: Fine needle aspiration cytology (FNA) as a diagnostic test for thyroid nodules demonstrated an indeterminant rate of 23.9% (34 patients), with diagnostic accuracy of 93.9% for malignant disease. In frozen section (FS) results, the indeterminant rate was 19.7%, and the diagnostic accuracy 98.3% for malignant disease. Of the 50 patients with the benign results on FNA, 3 patients was diagnosed as malignancy on FS. Of the 34 patients with indeterminant results on FNA, the intraoperative FS diagnosis showed 16 patients of benign, 3 patients of malignancy, and diagnosis on 15 patients was deferred to permanent section; in 15 patients, benign disease was diagnosed in 12 patients, and 3 patients were diagnosed as malignancy. And one of 10 patients with inadequate result on FNA was diagnosed as malignancy on FS. Therefore the decision about the extent of surgical thyroid resection was changed in 7 patients (4.9%) based on the FS results, and including the 16 patients diagnosed as benign on FS with indeterminant results on FNA, overall, in 23 patients (16.2%) the intraoperative surgical decision was affected by FS. Conclusion: The fine needle aspiration cytology and intraoperative frozen section examination showed the limitation on diagnosis of follicular neoplasm, but intraoperative frozen section examination proved useful in determining the extent of operation and affected intraoperative decision making in thyroid surgery. (Korean J Endocrine Surg 2001;1:78-83)

세침 폐생검 세포검사의 진단적 의의

김영철(Young Chol Kim),박용주(Yong Ju Park),김두섭(Doo Sub Kim),홍득민(Duk Min Hong),양윤식(Yoon Shig Yang),심원보(Won Bo Shim),윤중근(Jung Geun Yoon),김종인(Jong In Kim),이성주(Seong Joo Lee),이태원(Tae Won Lee) 대한내과학회 1991 대한내과학회지 Vol.41 No.6

N/A Seventy-five patients with either pulmonary nodules or masses that could not be confirmed with sputum examination or bronchoscopic examination underwent transthoracic fineneedle aspiration with 22 or 23 gauze needles under fluoroscopy for cytologic diagnosis. There were 51 men and 24 women, and the age range was 43-78 years old. The lesion distribution and sizes were as follow: 48 cases in the right lung, 2l cases in the left lung, 23 cases under 4 cm in size, and 52 cases over 4 cm in size. There were no meaningful correlations in lesion size or site with malignant or benign cytologic findings. Among the 46 malignant cases squamous cell carcinoma was 32 cases, large cell carcinoma 5 cases, small cell carcinoma 4cases, lymphoma 3 cases, and bronchioalveolar carcinoma 2 cases. Among the other cases, pulmonary tuberculosis was. 11 cases and lung abcess 3 cases. Among the 49 cases proven malignant after operation or follow-up by now, 46 cases were malignant at fine- needle aspiration biopsy cytology (sensitivity 93.9%), and among the 23 cases proven benign after follow up, all showed no malignancy by fine-needle aspiration biopsy cytology (specificity 100%). Three cases failed in the follow-up due to various causes. In the benign cases, there were some who had difficulty in being diagnosed with this procedure alone, but we were helped a great deal in differentiating malignancies by this procedure. Complications were minimal, but 5 cases of pneumoth-orax occurred, and 2 cases among these needed closed thoracotomy and soon improved. In conclusion, transthoracic fine-needle aspiration biopsy cytology is very helpful in diagnosing patients with lung nodules or masses that failed to be confirmed with sputum examination or bronchoscopic procedure and in differentiating a malignant state from a benign one, with minimal complications. So, active clinical trial of this procedure is recommended.

Analysis of Fine Needle Aspiration Cytology and Ultrasonography of Metastatic Tumors to the Thyroid

조은윤,오영륜,Cho, Eun-Yoon,Oh, Young-Lyun The Korean Society for Cytopathology 2007 대한세포병리학회지 Vol.18 No.2

Cytologic diagnosis of the metastatic tumors to the thyroid is important in the management of the patients. There have been rare reports analyzing fine-needle aspiration (FNA) cytology of metastatic tumors to the thyroid. This study examines comprehensive cytologic findings of metastatic tumors to the thyroid with radiologic findings. The FNA cytology slides obtained from 12 cases with metastatic tumors of the thyroid; lung cancer (n=5), tongue and tonsil cancer (n=3), esophageal cancer (n=2), and breast cancer (n=2) were reviewed. Radiological study showed single mass with heterogeneous texture or multiple masses without calcification. Metastatic tumor was easily considered in a differential diagnosis of FNA cytology because they had peculiar cytological features which were not seen in primary thyroid tumor. The smear background varied from predominantly necrotic, bloody, and inflammatory to colloid. The aspirates exhibited a mixture of benign follicular cells and malignant cells in 6 cases. The characteristic cytoplasmic features of the tumor cells, such as keratin, mucin and melanin, were found in 9 cases. Although some cases mimic primary thyroid neoplasm, a careful examination of the cytological characteristics may help cytopathologists to recognize a metastatic tumor in the thyroid by FNA, and may help the clinicians to establish a proper treatment plan.

장간막에서 발생한 염증성 근섬유모세포종의 세침흡인 세포학적 소견 - 1예 보고 -

손현진,김주헌,문우성,최호열,강명재,Son, Hyun-Jin,Kim, Joo-Heon,Moon, Woo-Sung,Choi, Ho-Yeul,Kang, Myoung-Jae 대한세포병리학회 2000 대한세포병리학회지 Vol.11 No.1

Since inflammatory myofibroblastic turner was initially recognized in the lung, this tumor has been described in other extrapulmonary sites. In spite of relatively uniform histologic findings in various organs, a rarity in extrapulmonary sites and highly vascular characteristics frequently lead to a misdiagnosis in preoperative radiology and fine needle aspiration cytology. We present a case of inflammatory myofibroblastic tumor occurring in the mesentery of a 4-month-old girl. Fine needle aspiration cytology smear disclosed characteristic spindle cells intermixed with prominent mature plasma cells and lymphocytes. According to the immunohistochemical staining, we recognized that the intervening spindle cells are myofibroblasts which have reactivity for the both actin and vimentin.

타액선병변의 세침흡인 세포검사

이승숙,박인애,함의근,이상국,Lee, Seung-Sook,Park, In-Ae,Ham, Eui-Keun,Lee, Sang-Kook 대한세포병리학회 1993 대한세포병리학회지 Vol.4 No.2

Fine needle aspiration cytology has become a frequently used technique for the diagnosis of lesions in the head and neck. Fine needle aspiration cytology of the salivary glands were performed on 66 patients. In 59 patients with satisfactory samples, cytologic diagnoses were as follows; there were 47 benign lesions, including pleomorphic adenoma(20), Warthin's tumor(3), benign cystic lesion(4), Inflammatory lesion(4), lymphoid lesion(3), myoepithelioma(1), unspecified benign neoplasm (5), and unclassified benign lesion(7). There were 6 cases of undetermined malignancy and 6 malignant lesions including mucoepidermoid carcinoma(3), adenoid cystic carcinoma(1), carcinoma ex pleomorphic adenoma(1), and metastatic carcinoma(1) in cytologic diagnosis. In 25 patients, the cytologic diagnosis was correlated with histologic findings. The sensitivity of the benign lesion was 96% and the specificity was 82%. There was no false-positive diagnosis. The sensitivity and the specificity of pleomorphic adenoma were 75% and 95%, respectively. Some of Warthin's tumors were confused with benign cystic lesion due to frequent cystic change of the tumor. The sensitivity and specificity of the malignant lesions were 56% and 88%, respectively. There were three false negative diagnoses. Two mucoepidermoid carcinomas were correctly diagnosed by cytology. Two of three adenoid cystic carcinomas were misdiagnosed as benign tumors.

유방의 세침흡인 세포검사: 수기 액상세포검사법(Liqui-$PREP^{TM}$)과 고식적 도말법과의 비교

정지윤,김정식,김영수,김혜정,박지영,Jeong, Ji-Yun,Kim, Jeong-Shik,Kim, Young-Su,Kim, Hye-Jung,Park, Ji-Young 대한세포병리학회 2008 대한세포병리학회지 Vol.19 No.1

Fine needle aspiration (FNA) cytology of the breast is a useful method for diagnosing breast lesions. Yet making the definite diagnosis with performing FNA is limited by some problems, such as the low cellularity, the poor preservation and the obscuring background. Recent studies have found that liquid-based cytology solves such problems, but it is an expensive method and it is limited by the loss of the background information. The purpose of this study is to compare the Liqui-$PREP^{TM}$, a new manual liquid-based method of cytology, and the conventional smears for analyzing breast FNA cytology materials. A total of 31 randomized FNA specimens of breast were studied. In each case, both the conventional smears and the Liqui-$PREP^{TM}$ method were performed, and the smears were evaluated for cellularity, cellular preservation, the background, the cytologic features and the architectural arrangement. The cellularity and architectural arrangement were equal for both preparations. The Liqui-$PREP^{TM}$ specimens showed better cellular preservation, loss of the obscuring background, no overlapping of cells and a smaller area to screen compared with the conventional smears. Moreover, it has the potential advantages of being able to use the remaining specimens for immunohistochemical study and ploidy analysis, and it can reduce the costs for preparation compared with the other liquid-based methods of cytology. But some background information is lost in the Liqui-$PREP^{TM}$ specimens, the same as the other liquid-based methods of cytology. In conclusion, the Liqui-$PREP^{TM}$ and conventional smears showed good correlation, but they have their respective advantages and disadvantages. These results suggest that Liqui-$PREP^{TM}$ can contribute to making the accurate diagnosis with performing breast FNA cytology when it is used along with other methods.

Cytological Results of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules: Emphasis on Correlation with Sonographic Findings

Mi-Jung Lee,김은경,홍순원,정웅윤,곽진영,김민정 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.5

Purpose: To compare the cytological results of ultrasound-guided fine-needle aspiration (US-FNA) cytology of thyroid nodules to sonographic findings and determine whether US findings are helpful in the interpretation of cytological results. Materials and Methods: Among the thyroid nodules that underwent US-FNA cytology,we included the 819 nodules which had a conclusive diagnosis. Final diagnosis was based on pathology from surgery, repeated FNA cytology or follow-up of more than one year. Cytological results were divided into five groups: benign, indeterminate (follicular or Hurthle cell neoplasm), suspicious for malignancy, malignant,and inadequate. US findings were categorized as benign or suspicious. Cytological results and US categories were analyzed. Results: Final diagnosis was concluded upon in 819 nodules based on pathology (n=311), repeated FNA cytology (n=204) and follow-up (n=304), of which 634 were benign and 185 were malignant. There were 560 benign nodules, 141 malignant nodules, 49 nodules with inadequate results, 21 with indeterminate results, and 48 that were suspicious for malignancy. The positive and negative predictive values of the US categories were 59.1% and 97.0%, and those of the cytological results were 93.7% and 98.9%. The US categories were significantly correlated with final diagnosis in the benign (p=0.014) and suspicious for malignancy (p<0.001) cytological result groups, but not in the inadequate and indeterminate cytological results groups. The false positive and negative rates of cytological results were 1.9% and 3.2%. Conclusion: Sonographic findings can be useful when used alongside cytological results, especially in nodules with cytological results that are benign or suspicious for malignancy.