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TAČNOST CITOLOŠKE ANALIZE U DIJAGNOSTICI MALIGNIH OBOLJENJA PLEURE
THE ROLE AND ACCURACY OF CYTOLOGY OF PLEURAL EFFUSION IN DIAGNOSIS OF PLEURAL MALIGNANT DISEASES

Authors

 

Tegeltija Dragana1,2, Samardžija Golub1,3, Lovrenski Aleksandra 1,2, Eri Živka1,2, Milan Popović4

1Katedra za patologiju, Medicinski fakultet, Univerzitet u Novom Sadu
2Centar za patologiju, Institut za plućne bolesti Vojvodine, Sremska Kamenica
3Institut za kardiovaskularne bolesti Vojvodine, Sremska Kamenica
4Katedra za histologiju i embriologiju, Medicinski Fakultet, Univerzitet u Novom Sadu

 


Rad je primljen 18.11.2017. / Prihvaćen 12.12.2017.

 


Correspondence to


asist. dr Dragana Tegeltija,
Katedra za patologiju, Medicinski fakultet, Univerzitet u Novom Sadu
Hajduk Veljkova 3, 21 000 Novi Sad
e-mail: dragana.tegeltija@mf.uns.ac.rs

 

 

Sažetak

 

Citološka analiza pleuralnog izliva je: jednostavna, brza, tačna, jeftina, minimalno invazina i najmanje bolna dijagnostička procedura za bolesnika. Ova analiza je bazirana na analizi ćelija koje su spontano odbačene u pleuralnu šupljnu. Cilj ove studije je da se oceni tačnost citološke analize pleuralnog izliva u dijagnostikovanju malignih oboljenja pleure. Retrospektivno smo analizirali 4 544 citoloških uzoraka pleuralnog izliva i 600 biopsijskih uzoraka pleure kod bolesnika lečenih na Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici od 2006. - 2010. godine. Bolesnici su imali od 1 - 97 godina (prosečno 60±14,3). Muškaraca je bilo (63.6%), a žena (36.4%). U 83.5% slučajeva pleuralni izliv je bio udružen sa benignim procesima, a suspektno maligne i maligne ćelije su nađene u 16.5% slučajeva. U biopsijskim uzorcima pleure maligno oboljenje je bilo dijagnostikovano u 24% slučajeva od kojih je adenokarcinom bio najčešći histološki tip (42%). Kod 267 bolesnika smo analizirali pleuralni izliv i biopsiju pleure. Tačno negativan nalaz pleuralnog izliva bio je kod 67.87%, tačno pozitivan kod 10.47%, lažno negativan kod 17.98% i lažno pozitivan kod 0.75% pacijenata. Senzitivnost metode iznosila je (37.6%), specifičnost (98.9%), sveukupna tačnost (81.0%), pozitivna prediktivna vrednost (94%) i negativna prediktivna vrednost (79.6%). Senzitivnost i specifičnost citologije pleuralnog izliva je dobra te ova metoda treba da se koristi kao rutinska dijagnostička metoda. Niska senzitivnost i visoka specifičnost u našoj studiji je najverovatniije posledica primene strožijih kriterijuma u citološkoj analizi pleuralnog izliva. Konačnu dijagnozu treba donositi timski. Preduslov tačnijih citoloških dijagnoza pleuralnog izliva je timski rad, utreniranost i permanentna edukacija citopatologa i citotehničara.

 

 

 

Ključne reči:

pleuralni izliv, citologija, pleura.

 

 

Abstract

 

Cytological analysis of pleural effusion is simple, fast, precise, economic, minimally invasive and the least painful diagnostic procedure which is based on the examination of cells spontaneously released into the pleural cavity. The aim of this study is to evaluate the accuracy of cytological analysis of pleural effusion for diagnosis of malignant pleural diseases. We analyzed retrospectively 4 544 cytological samples of pleural effusion and 600 pleural biopsy samples of patients treated at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica in period from 2006. to 2010. Patient`s age ranged from one to 97, with men to women ratio of 63.6% to 36.4%. In 83.4% of cases, pleural effusion was linked to the benign condition whereas malignant cells and those highly suspected for malignancy were found in 16.5% cases. In pleural biopsies malignant diseases were present in 24% cases from which the adenocarcinoma was the most frequent type (42%). In 267 patients we analyzed both pleural effusion and pleural biopsy. In patients with pleural effusions, true negative result was present in 67.87%, true positive in 10.47%, false negative in 17.98%, and false positive in 0.75% cases. Sensitivity was 37.6%, specificity was 98.9%, overall accuracy was 81%, positive predictive value was 94% and negative predictive value was 79.6%. Sensitivity and specificity of this method is satisfying and therefore this method should be used as routine diagnostic procedure. Low sensitivity and high specificity in our study is probably due to the application of very strict criteria in cytological analysis of pleural effusion. Team approach is suggested in bringing up the final diagnosis. Prerequisite for improved accuracy of cytologic diagnosis is team work, regular updates and permanent education of cytopathologists and cytotechnicians.

 

 

Key words:

pleural effusion, cytology, malignant effusions.

 

 

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PDF Tegeltija D. et al • MD-Medical Data 2017;9(4): 229-233

 

 

 

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