Clinical significance of an inconclusive cytopathologic diagnosis: a five-year experience at Duke University Medical Center. II. Analysis and follow-up of specimens from the respiratory tract.
OBJECTIVE
As a follow-up of our initial report, we critically examined a selected number of cases from the respiratory tract with an original diagnosis of "atypical cells present suspicious for malignancy" in order to ascertain if any particular features of the specimen or the atypical cells were predictors of malignancy.


METHODS
From a total of 563 such cases, 31 were identified with subsequent histologic findings of a nonneoplastic pathologic process. An additional 45 cytologic cases were randomly selected to represent those with subsequent histologic findings confirming the suspicion of malignancy. All the cytologic specimens were examined without knowledge of the histologic follow-up results.


RESULTS
Analysis of the cellular composition of the specimens identified no discernible difference between specimens from benign and malignant processes. Quantitative analysis of the atypical cells and qualitative assessment of the nuclear abnormalities revealed that marked nuclear hyperchromasia and a very high nuclear/cytoplasmic ratio were more likely to represent a malignant process. However, none of the parameters examined could consistently predict the presence or absence of malignancy.


CONCLUSIONS
When a single cytologic specimen is inconclusive as to the presence or absence of malignancy, standard cytologic criteria cannot reliably predict a malignant process.
Wax
T D
TD
Department of Pathology, Cabarrus Memorial Hospital, Concord, North Carolina, USA.
Coogan
A C
AC
Johnston
W W
WW
D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D012140:Respiratory Tract Diseases / Q000473:pathology*; D012142:Respiratory Tract Neoplasms / Q000473:pathology*