Policies and reporting guidelines for small biopsy specimens of mediastinal masses
ml>目前，胸腺恶性肿瘤治疗方案大多是根据术后病理确定，然而，多数临床治疗决策需要在术前通过活检小标本的病理报告来制定。所以，术前活检小标本的正确获取和病理解读对治疗决策的制定显得非常重要[1]。这些标本包括细针活检标本，带芯穿刺活检标本和手术切取活检标本[2-7]。由于胸腺肿瘤的病理诊断对组织的获取方法和获取量都有较高的要求，加之对病理的描述也没有统一的标准，使得小标本在诊断胸腺瘤方面存在诸多问题。为此，ITMIG在病理科医生和外科医生回顾相关文献和提出初步建议的基础上，经集体讨论制定了活检规范操作流程，提出了对纵隔肿物小活检标本处理和病理报告的建议。旨在为术前患者的治疗提供一个统一和...
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| Published in | Zhongguo fei ai za zhi Vol. 17; no. 2; pp. 104 - 109 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
China
Chinese Anti-Cancer Association Chinese Antituberculosis Association
01.02.2014
Chinese Anti-Cancer Association; Chinese Antituberculosis Association |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1009-3419 1999-6187 1999-6187 |
| DOI | 10.3779/j.issn.1009-3419.2014.02.07 |
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| Abstract | ml>目前，胸腺恶性肿瘤治疗方案大多是根据术后病理确定，然而，多数临床治疗决策需要在术前通过活检小标本的病理报告来制定。所以，术前活检小标本的正确获取和病理解读对治疗决策的制定显得非常重要[1]。这些标本包括细针活检标本，带芯穿刺活检标本和手术切取活检标本[2-7]。由于胸腺肿瘤的病理诊断对组织的获取方法和获取量都有较高的要求，加之对病理的描述也没有统一的标准，使得小标本在诊断胸腺瘤方面存在诸多问题。为此，ITMIG在病理科医生和外科医生回顾相关文献和提出初步建议的基础上，经集体讨论制定了活检规范操作流程，提出了对纵隔肿物小活检标本处理和病理报告的建议。旨在为术前患者的治疗提供一个统一和具有循证医学证据的方法；同时，将有利于全球数据之间的比较和开展合作研究，充分利用医疗资源。 1 纵隔肿物活检方法的概述 纵隔肿瘤、囊肿或其它病变的病理标本获取技术有X线透视、胸部超声或CT引导下穿刺，胸腔镜手术，前纵隔切开术和小切 开胸术或Chamberlain手术[1-7]。总的来说均较安全，发生气胸、出血或其他并发症的概率不到5%。但有报道认为肺门处肿物经胸穿刺活检发生气胸的概率高达34%。纵隔囊肿活检偶有感染的报道。活检后种植转移仅限于极少数的个案报道[8,9]。位于前纵隔的肿瘤可行胸部B超或CT引导下细针抽吸活检或带芯穿刺活检或小切 开胸手术活检[2,3,6,8-17]。中纵隔肿瘤可行纵隔镜活检，或经支气管内镜超声引导活检，或经食管超声引导穿刺活检[17]。后纵隔肿瘤可经胸超声或CT引导穿刺活检，但多数情况下需要行VATS手术[18]。不同诊断方法的敏感性和特异性见表1[1-3,6,7,10-15,17,19-22]。 2 重视临床和影像诊断与病理诊断相关的重要性 此处不讨论纵隔肿瘤的鉴别诊断，但在活检之前了解患者的年龄、性别、肿瘤位置和影像学表现有助于正确的病理诊断。例如，对于儿童或20岁-30岁的前纵隔肿瘤患者，鉴别诊断要考虑生殖细胞肿瘤、淋巴管瘤、霍奇金淋巴瘤和淋巴母细胞瘤。对于年龄较大的前纵隔肿瘤患者，鉴别诊断则应考虑胸腺瘤或其他胸腺上皮肿瘤[1]。发生在上纵隔的肿瘤常为甲状腺起源。而成年人合并重症肌无力的前纵隔肿瘤多为胸腺瘤。中纵隔的肿瘤和囊肿常发生在成年人，多为淋巴瘤、纵隔囊肿、转移瘤、硬化性纵隔炎等。后纵隔肿瘤的鉴别诊断包括神经源性肿瘤、胃肠源性囊肿等[1]。纵隔转移瘤最常见的原发部位是肺。常见原发性纵隔肿瘤 |
|---|---|
| AbstractList | ml>目前，胸腺恶性肿瘤治疗方案大多是根据术后病理确定，然而，多数临床治疗决策需要在术前通过活检小标本的病理报告来制定。所以，术前活检小标本的正确获取和病理解读对治疗决策的制定显得非常重要[1]。这些标本包括细针活检标本，带芯穿刺活检标本和手术切取活检标本[2-7]。由于胸腺肿瘤的病理诊断对组织的获取方法和获取量都有较高的要求，加之对病理的描述也没有统一的标准，使得小标本在诊断胸腺瘤方面存在诸多问题。为此，ITMIG在病理科医生和外科医生回顾相关文献和提出初步建议的基础上，经集体讨论制定了活检规范操作流程，提出了对纵隔肿物小活检标本处理和病理报告的建议。旨在为术前患者的治疗提供一个统一和具有循证医学证据的方法；同时，将有利于全球数据之间的比较和开展合作研究，充分利用医疗资源。 1 纵隔肿物活检方法的概述 纵隔肿瘤、囊肿或其它病变的病理标本获取技术有X线透视、胸部超声或CT引导下穿刺，胸腔镜手术，前纵隔切开术和小切 开胸术或Chamberlain手术[1-7]。总的来说均较安全，发生气胸、出血或其他并发症的概率不到5%。但有报道认为肺门处肿物经胸穿刺活检发生气胸的概率高达34%。纵隔囊肿活检偶有感染的报道。活检后种植转移仅限于极少数的个案报道[8,9]。位于前纵隔的肿瘤可行胸部B超或CT引导下细针抽吸活检或带芯穿刺活检或小切 开胸手术活检[2,3,6,8-17]。中纵隔肿瘤可行纵隔镜活检，或经支气管内镜超声引导活检，或经食管超声引导穿刺活检[17]。后纵隔肿瘤可经胸超声或CT引导穿刺活检，但多数情况下需要行VATS手术[18]。不同诊断方法的敏感性和特异性见表1[1-3,6,7,10-15,17,19-22]。 2 重视临床和影像诊断与病理诊断相关的重要性 此处不讨论纵隔肿瘤的鉴别诊断，但在活检之前了解患者的年龄、性别、肿瘤位置和影像学表现有助于正确的病理诊断。例如，对于儿童或20岁-30岁的前纵隔肿瘤患者，鉴别诊断要考虑生殖细胞肿瘤、淋巴管瘤、霍奇金淋巴瘤和淋巴母细胞瘤。对于年龄较大的前纵隔肿瘤患者，鉴别诊断则应考虑胸腺瘤或其他胸腺上皮肿瘤[1]。发生在上纵隔的肿瘤常为甲状腺起源。而成年人合并重症肌无力的前纵隔肿瘤多为胸腺瘤。中纵隔的肿瘤和囊肿常发生在成年人，多为淋巴瘤、纵隔囊肿、转移瘤、硬化性纵隔炎等。后纵隔肿瘤的鉴别诊断包括神经源性肿瘤、胃肠源性囊肿等[1]。纵隔转移瘤最常见的原发部位是肺。常见原发性纵隔肿瘤 |
| Author | Strobel, Philipp Yousem, Samuel Marx, Alex Suster, Saul Marino, Mirella Zakowski, Maureen Marchevsky, Alberto Venuta, Federico |
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| References_xml | – reference: 10859010 - Acta Oncol. 2000;39(2):195-8 – reference: 7519823 - Am J Pathol. 1994 Aug;145(2):268-75 – reference: 20015257 - Cytopathology. 2010 Feb;21(1):6-26 – reference: 21847055 - J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1730-8 – reference: 16104355 - Semin Thorac Cardiovasc Surg. 2005 Spring;17(1):2-11 – reference: 15620969 - Ann Thorac Surg. 2005 Jan;79(1):323-4 – reference: 17479313 - Surg Endosc. 2008 Jan;22(1):86-90 – reference: 14991904 - J Pathol. 2004 Mar;202(3):375-81 – reference: 9255257 - Am J Surg Pathol. 1997 Aug;21(8):936-40 – reference: 10765390 - Radiol Clin North Am. 2000 Mar;38(2):281-91 – reference: 11756705 - Radiology. 2002 Jan;222(1):57-62 – reference: 20667324 - Ann Thorac Surg. 2010 Aug;90(2):427-34 – reference: 16711402 - Semin Diagn Pathol. 2005 Aug;22(3):213-22 – reference: 14528209 - Gastrointest Endosc. 2003 Sep;58(3):362-8 – reference: 14959740 - Surg Endosc. 2003 Nov;17(11):1851 – reference: 11100059 - Arch Pathol Lab Med. 2000 Dec;124(12):1792-9 – reference: 12440649 - Ann Thorac Surg. 2002 Nov;74(5):1720-2; discussion 1722-3 – reference: 18514125 - Hematol Oncol Clin North Am. 2008 Jun;22(3):433-42 – reference: 14762710 - J Cancer Res Clin Oncol. 2004 Apr;130(4):222-4 – reference: 9080146 - Eur J Cardiothorac Surg. 1997 Feb;11(2):218-21 – reference: 9620029 - Am J Clin Pathol. 1998 Jun;109(6):722-6 – reference: 11068551 - Am J Clin Pathol. 2000 Nov;114(5):760-6 – reference: 17517183 - Chin Med J (Engl). 2007 Apr 20;120(8):675-9 – reference: 1384372 - Am J Surg Pathol. 1992 Oct;16(10):988-97 – reference: 16766268 - Cancer Imaging. 2006 Jun 08;6:43-50 – reference: 9930146 - Am J Clin Pathol. 1999 Feb;111(2):235-40 – reference: 8166555 - Ann Thorac Surg. 1994 Apr;57(4):992-5 – reference: 20859120 - J Thorac Oncol. 2010 Oct;5(10 Suppl 4):S281-5 – reference: 10406900 - Haematologica. 1999 Jul;84(7):600-3 – reference: 20715425 - Trop Gastroenterol. 2010 Apr-Jun;30(2 Suppl):S4-19 |
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| Snippet | ml>目前，胸腺恶性肿瘤治疗方案大多是根据术后病理确定，然而，多数临床治疗决策需要在术前通过活检小标本的病理报告来制定。所以，术前活检小标本的正确获取和病理解读对... |
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| SubjectTerms | Biopsy Biopsy - standards Cancer Cellular biology Endoscopy Health Policy Humans Lung neoplasms Lymphoma Mediastinal Neoplasms - diagnosis Mediastinal Neoplasms - pathology Thoracic Neoplasms - diagnosis Thoracic Neoplasms - pathology Thoracic surgery Tumors Ultrasonic imaging |
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| Title | Policies and reporting guidelines for small biopsy specimens of mediastinal masses |
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