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Diagnostic efficacy and molecular testing by combined fine needle aspiration and core needle biopsy in patients with a lung nodule.

肺结节患者细针穿刺联合芯针活检的诊断效能和分子检测。

  • 影响因子:3.49
  • DOI:10.1002/cncy.22234
  • 作者列表:"Chen L","Jing H","Gong Y","Tam AL","Stewart J","Staerkel G","Guo M
  • 发表时间:2020-01-08
Abstract

BACKGROUND:Combined image-guided fine needle aspiration biopsy (FNA) and core needle biopsy (CNB) has become the standard of care for diagnosis and/or molecular testing for patients with a solitary lung nodule at our institution. Our purpose was to evaluate the efficacy of this practice. METHODS:We identified patients who underwent combined lung FNA/CNB during 2012 at our institution. A total of 667 patients who underwent 682 combined lung FNA/CNB procedures were included in the study, including 355 men and 312 women. Combined lung FNA/CNB procedures were performed by a radiologist. The adequacy of FNA specimens was assessed immediately by a cytopathologist. The FNA and CNB specimens were interpreted separately by a cytopathologist and a surgical pathologist, respectively. The diagnostic accuracy of the combined technique was determined. RESULTS:The rate of diagnostic consistency between FNA and CNB was 83.4%, and the rate of diagnostic accuracy for malignancy was 98.5% for combined FNA/CNB. Combined FNA/CNB showed a high diagnostic efficacy for malignancy (sensitivity, 97.6%; specificity, 100%). Combined FNA/CNB had a lower false-negative rate for malignancy (2.2%) than either FNA (7.2%) or CNB (6.2%) alone. FNA contributed to 10.3% of molecular analyses as a complementary tissue source. CONCLUSIONS:Combined lung FNA/CNB has high diagnostic efficacy for malignancy and a lower false-negative rate than either procedure alone. FNA was a valuable complement to CNB for molecular testing, potentially reducing patient inconvenience and morbidity associated with repeated lung needle biopsy.

摘要

背景: 影像引导下细针穿刺活检 (FNA) 和粗针穿刺活检 (CNB) 联合已成为我们机构孤立性肺结节患者诊断和/或分子检测的标准护理。我们的目的是评估这种做法的疗效。 方法: 我们确定了 2012年在我们机构接受联合肺 FNA/CNB 的患者。共有 667 例接受 682 次联合肺 FNA/CNB 手术的患者纳入研究,其中男性 355 例,女性 312 例。由放射科医师进行联合肺 FNA/CNB 手术。细胞病理学家立即评估 FNA 标本的充分性。FNA 和 CNB 标本分别由细胞病理学家和外科病理学家解释。确定了联合技术的诊断准确性。 结果: FNA 与 CNB 的诊断符合率为 83.4%,联合 FNA/CNB 对恶性肿瘤的诊断符合率为 98.5%。联合 FNA/CNB 对恶性肿瘤显示出较高的诊断效能 (敏感性,97.6%; 特异性,100%)。联合 FNA/CNB 对恶性肿瘤的假阴性率 (2.2%) 低于单独 FNA (7.2%) 或 CNB (6.2%)。FNA 作为互补组织来源贡献了 10.3% 的分子分析。 结论: 联合肺 FNA/CNB 对恶性肿瘤的诊断效能高,假阴性率低于单独任何一种手术。FNA 是 CNB 分子检测的有价值的补充,可能减少患者不便和重复肺穿刺活检相关的发病率。

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影响因子:3.94
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DOI:10.1016/j.taap.2019.114847
作者列表:["Bernstein DM","Toth B","Rogers RA","Kling DE","Kunzendorf P","Phillips JI","Ernst H"]

METHODS::The interim results from this 90-day multi-dose, inhalation toxicology study with life-time post-exposure observation has shown an important fundamental difference in persistence and pathological response in the lung between brake dust derived from brake-pads manufactured with chrysotile, TiO2 or chrysotile alone in comparison to the amphiboles, crocidolite and amosite asbestos. In the brake dust exposure groups no significant pathological response was observed at any time. Slight macrophage accumulation of particles was noted. Wagner-scores, were from 1 to 2 (1 = air-control group) and were similar to the TiO2 group. Chrysotile being biodegradable, shows a weakening of its matrix and breaking into short fibers & particles that can be cleared by alveolar macrophages and continued dissolution. In the chrysotile exposure groups, particle laden macrophage accumulation was noted leading to a slight interstitial inflammatory response (Wagner-score 1-3). There was no peribronchiolar inflammation and occasional very slight interstitial fibrosis. The histopathology and the confocal analyses clearly differentiate the pathological response from amphibole asbestos, crocidolite and amosite, compared to that from the brake dust and chrysotile. Both crocidolite and amosite induced persistent inflammation, microgranulomas, and fibrosis (Wagner-scores 4), which persisted through the post exposure period. The confocal microscopy of the lung and snap-frozen chestwalls quantified the extensive inflammatory response and collagen development in the lung and on the visceral and parietal surfaces. The interim results reported here, provide a clear basis for differentiating the effects from brake dust exposure from those following amphibole asbestos exposure. The subsequent results through life-time post-exposure will follow.

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DOI:10.1042/BST20191010
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