- 期刊
細針穿刺細胞學檢查於唾液腺腫瘤的診斷準確率－單一醫學中心十三年經驗回顧
Diagnostic Accuracy of FNA Cytology for Major Salivary Glands Tumors-Thirteen-Year Experience from One Medical Center
摘要
背景：本研究之目的為回顧台灣地區，單一醫學中心內唾液線腫瘤術後之病人，其術前細針穿刺的細胞學檢查之準確率、敏感度、特異度、陽性預測值及陰性預測值。方法：收案的對象為於2007年至2020年間，於亞東醫院接受腮腺切除手術以及下頜腺切除手術，並於術前有接受過細針穿刺的病人，收案的病人必須要有正式的細胞學以及病理學報告。結果：在2007年到2020年間，共有434名病人於亞東醫院在唾液腺手術前接受細針穿刺，細針穿刺的結果為270名良性；13名惡性；當中45名（10.4%）indeterminate以及106名（24.4%）為inadequate，表示檢體不夠支持病理醫師在細胞學做出判斷（non-diagnostic），故檢體診斷率（diagnostic rate）僅為65.2%（283/434）。術後正式的病理報告399名為良性診斷，35名為惡性診斷。排除indeterminate以及inadequate的檢體，細針穿刺的整體敏感度、特異度、陽性預測值、陰性預測值分別是76.92%、98.15%、66.67%及98.88%，準確率為97.17%（275/283）。若將indeterminate以及inadequate的組別視為錯誤診斷納入計算，得到的整體準確率為63.4%（275/434）。結論：細針穿刺細胞學檢查對於唾液腺腫瘤的敏感度低而特異度高。細胞學檢查結果non-diagnostic比例高達三成五，遇到non-diagnostic的細胞學報告，處理及說明都需要小心。
關鍵字
fine-needle aspiration ； parotid gland ； submandibular gland ； ultrasound（細針穿刺切片 ； 腮腺 ； 下頷腺 ； 超音波）並列摘要
BACKGROUND: The aim for this study is to review the diagnostic accuracy of pre-operative fine needle aspiration (FNA) cytology for major salivary glands tumors. METHODS: We retrospectively reviewed adults who underwent parotidectomy and submandibulectomy between 2007 and 2020. The inclusion criteria included patients with US-FNA cytology report prior to operation and pathology report after the operation. RESULTS: 434 patients with major salivary gland tumors were recruited between 2007 and 2020. There were 399 benign and 35 malignant lesions. FNA results were benign in 270, malignant in 13, indeterminate in 45 and inadequate in 106. The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy for US-FNA cytology were 76.92%, 98.15%, 66.67%, 98.8% and 97.17%, respectively. The diagnostic accuracy of FNA decreased to 63.4% (275/434), when indeterminate and inadequate results were defined as false results. CONCLUSIONS: FNA cytology had low sensitivity but high specificity for the diagnosis of major salivary gland tumors. The clinicians should be careful with the interpretation of non-diagnostic cytology reports.