Diagnostic Cytopathology最新文献

Background: Endobronchial ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is the predominant method for investigation of centrally located solitary pulmonary nodules. The method is associated with good to excellent diagnostic sensitivity and specificity with the positive predictive value of the test reaching 100% and reported negative predictive values for FNA of pulmonary nodules ranging from 53% to 97%. The impact of correlating cytologic results with imaging and clinical findings for improvement of negative predictive value has been poorly studied.

Materials and methods: An electronic search of the cytology records of the University of Missouri was made for all EBUS-TBNA specimens with surgical pathology follow-up. The associated imaging and clinical impressions were obtained. The clinical impression/assessment was the assessment given in the clinical summary section of the clinical note. Results of each technique were designated as benign, indeterminate, or malignant. Diagnostic triplets were constructed, and calculation of sensitivity, specificity, positive predictive value and negative predictive value was performed for each modality as well as the triplets.

Results: Search revealed a total of 254 cases with definitive surgical follow up. Thirty-two of these were excluded because they were either cytologically non-diagnostic or fell into one of the intermediate categories. One hundred sixty-three and 84 of these cases had definitive imaging or clinical interpretive results respectively. Definitive diagnostic triplets were obtained in 58 cases (22.8%). Cytology was associated with a sensitivity of 66.7% and specificity of 81.1%. Its positive predictive value was 87.7% and its negative predictive value was 54.5%. Imaging was associated with a sensitivity of 90.7%, a specificity of 22.2%, a positive predictive value of 75.4% and a negative predictive value of 47.6% and these statistics were 96.7%, 33.3%, 78.4%, and 80.0% respectively for clinical analysis. The positive predictive value of a triplet analysis was 92.9% and the negative predictive value was 100%.

Conclusions: Diagnostic triplets were obtainable in only a minority of cases, but they resulted in significant improvement in positive and negative predictive values.

Cytopathology is a cost-effective diagnostic method crucial for investigating suspected neoplastic lesions, particularly in Nigeria's healthcare system, where non-communicable diseases, especially with increasing rates of cancer. This review highlights the evolution of cytopathology practice in Nigeria, detailing its historical development, current methodologies, and the challenges faced within the healthcare framework. Despite advancements in diagnostic techniques such as immunocytochemistry and molecular diagnostics globally, conventional methods remain essential due to their affordability and accessibility. Fine needle aspiration cytology (FNAC) has gained acceptance for its diagnostic accuracy; however, significant disparities exist in the availability of cytological services across various regions. The lack of trained personnel and inadequate infrastructure further complicate the effective implementation of cytopathology practices. The findings highlight the urgent need for specialized training programs and improved resource allocation to enhance cytopathology services in Nigeria. We advocate for strategic interventions aimed at optimizing cytopathology's potential to improve cancer diagnosis and patient outcomes in resource-limited settings across the country.

Introduction: Standardized pathology reports enhance completeness and readability, contributing to the overall improvement in the management of patients. The standardization of urine cytology reporting has gained widespread acceptance with the use of the Paris system (TPS) for reporting urinary cytology, primarily focused on detecting high-grade urothelial carcinoma (HGUC). The next phase at the Institute of Pathology, Medical Faculty, University of Ljubljana, was the implementation of TPS, including standardized additional findings on non-neoplastic changes, into a software-based standardized structured reporting (SBSSR) system.

Methods: The implementation of SBSSR for urinary cytology at the Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, began in March 2023. Before daily usage, the SBSSR template was tested and approved by all cytopathology team members. An informative briefing for clinicians was organized to facilitate inter-specialty communication. To assess the impact of the SBSSR system on reporting efficiency, the turnaround time was tracked from the receipt of the cytology sample in the lab to the time of digital signature on its diagnostic report during two consecutive 11-month periods (04/01/2022-03/01/2023 and 04/01/2023-03/01/2024).

Results: All team members easily adopted the new SBSSR for urinary cytology. Reports are generated, costs are calculated, and they are digitally signed in a single step. The adoption of SBSSR for urinary cytology led to the replacement of dictation and administrative tasks. The average turnaround time for urine cytology has been reduced from 1,8 days (based on 2843 samples) to 1,5 days (based on 3438 samples).

Conclusions: The introduction of SBSSR for urinary cytology increased the quality of patient care with a shorter time to diagnosis and a higher level of report clarity.

Introduction: Thyroid lesions are one of the most common diseases observed in clinical practice in the North India. These diseases have distinct cytological morphology and thus FNAC is done frequently. Here we report a case of adenomatoid goitre mimicking adenoid cystic carcinoma (ACC) of salivary gland on cytology. Such close resemblance on morphology makes this a case of unusual morphological presentation of a very common condition.

Case summary: We report here a case of a 60-year-old female who developed a right anterior neck swelling six years back. Systemic clinical findings were unremarkable. Routine laboratory investigations, including thyroid function test were within normal limits. A High-resolution ultrasound of neck was performed, and a TIRADS-IV lesion measuring 28.8 × 22.9 mm was reported. Fine needle aspiration was done. Seven smears were made and stained with MGG, H&E and PAP stains. Smears were moderately cellular and abundant globular, amorphous material was observed with lesional cells forming three-dimensional rosette-like structures around them, producing an ACC-like pattern. A second consultation and immunohistochemistry on cell block we performed which led to a diagnosis of adenomatoid goitre, confirmed later histologically.

Conclusion: Benign lesions of thyroid can sometime mimic adenoid cystic carcinomas of salivary glands. Misdiagnosing any such case based solely on morphology can lead to wrong prognostication and thus wrong treatment. Extensive review of literature and a second consultation with an experienced pathologist should be done. Whenever needed a cell block preparation and a complete immunohistochemistry panel should be performed.

Background: Extramedullary hematopoiesis (EMH) is usually seen in the reticuloendothelial system such as the spleen and liver; however, there have been rare case reports when EMH is seen in serous fluids (SFs). The aim of this study included analyzing the cytomorphological features of EMH in SFs in correlation with various clinicopathologic parameters and recognizing potential diagnostic pitfalls as well as their prognostic significance.

Methods: Clinicopathologic parameters and radiologic and pathologic information from the patients with a cytologic diagnosis of EMH were evaluated with cytology slides.

Results: The cytomorphologic features of EMH and diagnostic pitfalls were evaluated. Seven patients with cytologically determined EMH in SF samples, including five pleural fluids, one ascitic fluid, and one cerebrospinal fluid, were identified over the past 20 years at a comprehensive cancer center. Their mean age was 67.5 years. Most patients (n = 5) had a history of advanced myelofibrosis.

Conclusions: This study uncovered methods to differentiate EMH from peripheral blood (PB) contamination in samples in the SF. PB contamination is an important differential for EMH, and cytomorphology remains a salient parameter for the diagnosis. The comparison of the number of red blood cells and white blood cells in the PB and SF helped to distinguish EMH from PB contamination when megakaryocytes were absent. The study showed that most patients died within a year of their EMH diagnosis in SF, suggesting a strong prognostic association of this finding with poor survival outcomes.

Granular cell tumors (GCTs) are relatively rare, whereas malignant GCTs are extremely rare. This brief report describes a cytological case of metastatic malignant GCT in the lymph node with immunocytochemical analysis. A 77 years old Japanese female with a history of surgical resection for malignant GCT in the back 8 years earlier presented with swelling of the right neck. Intraoperative touch smear of the biopsy specimen of the neck lymph node showed the presence of clusters of polygonal neoplastic cells as well as single neoplastic cells containing rich granular cytoplasm and eccentrically located large round to oval nuclei in a background of granular material. Immunocytochemical analysis demonstrated that these neoplastic cells showed positivity for S-100 protein and SOX10, and negativity for Melan-A and HMB45. According to these findings, a cytodiagnosis of metastatic malignant GCT was made with consideration of her history. Histopathological analysis confirmed a metastatic malignant GCT. The present study indicates that immunocytochemical staining for S-100 protein and SOX10 combined with cytomorphological features might be useful for the cytodiagnosis of malignant GCT.

Introduction: Gastric malignancies are one of the leading causes of morbidity and mortality globally. Rapid accurate interpretation of gastric cytology aids in early diagnosis and management. This study evaluates the utility of gastric cytology in diagnosing gastric malignancies.

Methods: This retrospective, cross-sectional study was conducted in the Department of Pathology for a period of 3.5 years. The cases with clinical suspicion of gastric malignancy and those who have had both cytology and histopathology examinations were included. Cytology results were reported as positive for malignancy, suspicious for malignancy, atypical cells-favor reactive, and negative for malignancy. The cytology and histopathology results were correlated, and descriptive statistics were used to analyze data.

Results: Among 118 patients included in the study, 103 cases were malignant and 15 were nonmalignant. Out of 103 malignant cases, 89 cases were detected in cytology. False positive cases consisted of four gastritis cases with florid reactive atypia and one with moderate dysplasia. False negative cases were of diffuse and intestinal subtypes of adenocarcinoma, followed by non-Hodgkin lymphoma. Sensitivity and specificity were found to be 86.41% and 66.67%, respectively. The positive predictive value is 94.68% with 41.67% negative predictive value and a diagnostic accuracy of 83.90%.

Conclusion: Gastric cytology is a reliable screening and diagnostic tool with a high positive predictive value and acceptable sensitivity. Negative cytology in suspected cases of gastric malignancy should always be correlated with biopsy reports. Diffuse type, intestinal type gastric adenocarcinoma and non-Hodgkin lymphoma were the major pitfall on cytology. The cells in the background must be meticulously observed for the malignant features. Gastric cytology is cost-effective and yields rapid diagnosis with a high positive predictive value, sensitivity, and diagnostic accuracy.

Background: The South African Cervical Cancer Prevention and Control Policy was updated in June 2017, recommending liquid-based cytology (LBC) as the preferred screening method and the investigation of self-sampling for cervical cancer screening.

Aim: To compare the performance of the Self Collection Cervical Health Screening Kit [SelfCerv (applicator tampon)] to the Cervex-Brush Combi for cytology screening. The study further aimed to compare high-risk (hr-) human papillomavirus (HPV) and LBC test results from both methods.

Methods: The study included 446 paired samples, comprising self-collected (SelfCerv) and healthcare provider-collected (Cervex-Brush Combi) samples from women aged ≥ 18 years attending gynaecology outpatient clinics at a tertiary hospital in Pretoria, South Africa. LBC slides were prepared using the ThinPrep 5000 processor and manually stained with Hematoxylin and Eosin (H&E). Detection of 14 hr-HPV types was performed using the Abbott RealTime HR-HPV assay. Statistical analyses were performed using STATA version 17.0 (Stata Corp., College Station, Texas, USA).

Results: A statistically significant difference in cervical cytology detection between the two methods was observed (p = 0.0025). The Cervex-Brush Combi was more effective in collecting endocervical cells (73.4%; 95% CI: 69.0-77.9) compared to the SelfCerv applicator tampon (7.3%; 95% CI: 4.7-9.9); (p < 0.001). Cytological abnormalities were detected in 65.4% (136/208) of participants who tested positive for hr-HPV by healthcare provider sampling compared to 40.8% (84/206) by self-sampling. A fair agreement (κ: 0.35) with a concordance rate of 96.2% (95% CI: 94.4-98.0) was observed for specimen adequacy and diagnosis parameters [κ: 0.34, with a concordance rate of 67.7% (95% CI: 63.2-72.1)] between the two methods.

Conclusion: The findings of this study do not support the implementation of applicator tampon-based self-collection as a method for cytology-based cervical cancer screening.