CLINICAL-SIGNIFICANCE OF AN INCONCLUSIVE CYTOPATHOLOGIC DIAGNOSIS - A5-YEAR EXPERIENCE AT DUKE-UNIVERSITY MEDICAL-CENTER .2. ANALYSIS AND FOLLOW-UP OF SPECIMENS FROM THE RESPIRATORY-TRACT

OBJECTIVE: As a follow-up of our initial report, we critically examine d a selected number of cases from the respiratory tract with an origin al diagnosis of ''atypical cells present suspicious for malignancy'' i n order to ascertain if any particular features of the specimen or the atypical cells were predictors of malignancy. STUDY DESIGN: From a to tal of 563 such cases, 31 were identified with subsequent histologic f indings of it nonneoplastic pathologic process. An additional 45 cytol ogic cases were randomly selected to represent those with subsequent h istologic findings confirming the suspicion of malignancy. All the cyt ologic specimens were examined without knowledge of the histologic fol low-up results. RESULTS: Analysis of the cellular composition of the s pecimens identified no discernible difference between specimens from b enign and malignant processes. Quantitative analysis of the atypical c ells 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, non e of the parameters examined could consistently predict the presence o r absence of malignancy. CONCLUSION: When a single cytologic specimen is inconclusive as to the presence or absence of malignancy, standard cytologic criteria cannot reliably predict a malignant process.