葉力森李繼忠臺灣大學：王尚麟Wang, Shang-LinShang-LinWang2007-11-282018-07-092007-11-282018-07-092007http://ntur.lib.ntu.edu.tw//handle/246246/59942細胞學診斷最早是在1960年代開始應用在獸醫方面，現今對於臨床醫師來說已被認為是一項不可或缺的診斷工具。它提供了一個快速、低侵入性且經濟的方式來獲取初步的診斷結果。但是還是有些臨床醫師對此診斷準確度抱持著存疑的態度，為了證明細胞學檢驗在臨床上可提供的診斷價值，我們在此研究中蒐集了157個淺層體表腫塊細胞學診斷案例，並和之後的組織病理學結果作比較，期望能給予一個診斷準確度的評估。 在本研究中，我們詳細描述不同型態之細胞在快速染色下的細胞學特徵，並描繪評斷細胞惡性的準則，最終評估細胞學診斷和組織病理結果之一致性。其中有40.76%的案例是完全準確的；38.85%的病例是部份準確或是無法完全確診的結果；38.85%的病例則是完全不準確。至於在評估腫塊細胞來源之分類上，細胞學診斷之準確度可達72.61%。在診斷腫瘤方面，細胞學診斷可提供70.4%的敏感性，73.3%的特異性，陽性預測值為96.2%，陰性預測值為20.8%。總體細胞學準確率為70.7%。 造成細胞學檢驗和組織病理學結果有差異之潛在因子，在此也將一併說明及討論，期望能提供往後診斷方面上的改進。當擁有良好的訓練及經驗後，許多常見的病灶都可經由此方法來確認。Cytology, first introduced to veterinary medicine in the 1960s, is regarded as an indispensable diagnostic tool for clinician. It provides a rapid, minimally invasive, and inexpensive means of obtaining a preliminary diagnosis. However, its accuracy in making correct diagnosis has always been doubted by many veterinarian. In order to provide evidence of its usefulness in providing fast diagnosis in clinic, we analyzed 157 cytologic cases results and compare with the later histopathological results. In this study, we interpret the characteristic of different cell types by quick staining methods, describe the cytologic criteria for malignancy potential, and evaluate the concordance between cytological diagnoses and histopathological results. There are 40.76% cases exhibit complete agreement, 20.38% cases reveal partial agreement or inconclusive results, and 38.85% cases were disagreement. Concordance of identified cell origin between cytology and histopathology was 72.61%. For diagnosing neoplasia, cytologic evaluation had a sensitivity of 70.4%, and a specificity of 73.3%. Positive predictive value was 96.2% and negative predictive value was 20.8%. The overall agreement between cytologic and histopathologic examination was 70.7%. The potential factors behind the set of two discordant results are postulate and discussed in hoping to provide the improvement of this invaluable tool. With proper training and experiences, most of the common lesions are readily recognizable口試委員會審定書……………………………………………………i 誌謝……………………………………………………………………ii 中文摘要…………………………………………………………………v Abstract………………………………………………………………vi Chapter I : Introduction……………………………………………1 Chapter II : Literatures Reviews…………………………………4 Chapter III : Objectives……………………………………………9 Chapter IV : Materials and Methods……………………………10 (1) Criteria for case selection…………………………………10 (2) Procedure of sample collection……………………………10 (3) Categories of cytologic and histopathologic diagnoses...11 (4) Categories of comparison results…………………………12 (5) Statistical analysis…………………………………………13 Chapter V : Interpretation of Cell Types……………………14 (1) Epithelial cells…………………………………………14 (2) Mesenchymal cells………………………………………15 (3) Round cells………………………………………………15 (4) Others………………………………………………………17 Chapter VI : Cytologic Criteria for Malignancy……………18 Chapter VII : Results………………………………………………21 (1) Basic data of the patients……………………………21 (2) The accuracy of cytologic category…………………22 (3) Comparison results in each cytologic category…23 (4) The causes of partial agreement in comparison results.................................................25 (5) Comparisons of tumor location ……………………………26 (6) Correlation between tumors and locations in dogs……27 (7) Sensitivity and specificity of cytology in neoplasm diagnosis……………29 Chapter VIII : Discussion…………………………………………30 References……………………………………………………………601424447 bytesapplication/pdfen-US細胞學組織病理學細針採樣體表淺層腫塊準確度cytologyhistopathologyfine needle aspirationsuperficial massconcordancethesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/59942/1/ntu-96-R93629025-1.pdf