Journal of Cytology最新文献

Background: Liquid-based cytology (LBC) is a newer method of preparing cervical cell samples. This technique involves collecting cells in a liquid fixative and preparing and evaluating them.

Aim: This study aims to investigate cervical smears prepared using the Ezi-Prep LBC method and analyze the positivity rate for cervical cancer and assess the diagnostic accuracy of LBC in detecting cervical abnormalities among females with abnormal vaginal conditions attending a tertiary care center.

Materials and methods: The present diagnostic study was performed in a tertiary care hospital over a period of 1 year (April 1, 2021-November 30, 2021). A total of 230 women, aged 21-70 years, presented at the gynecology outpatient department for either routine cervical screening or with complaints of vaginal bleeding, discharge, or pelvic pain. Cervical smears were prepared using the Ezi-Prep method and stained with ULTRA-PAP stain.

Results: LBC smears are monolayer smears and are without nuclear overlapping with spread over a diameter of 16 mm. Minimum cellular overlapping and crowding were observed in LBC smears. The mean age of the participants was 35.5 ± 5.1 years. The smears were studied by using nine morphological parameters.

Conclusion: The majority of the smears were inflammatory smears. A total of 16 cases and three cases were found to be bacterial vaginosis and candidiasis, respectively. In an 8-month study, HSIL was found in two cases, whereas LSIL was found in only one case. The positivity rate was observed to be 0.9% in HSIL cases and 0.4% in LSIL cases, 0.9% ASC-US case, and 0.4% invasive carcinoma case.

Background: Borderline ovarian tumors (BOTs) comprise 15%-20% of all ovarian epithelial malignancies. The majority of them are serous tumors followed by mucinous tumors. Pre-operative cytological diagnosis plays an important role with histopathology being the gold standard. The present study aimed to assess the sensitivity, specificity, and diagnostic accuracy of cytology in the diagnosis of epithelial ovarian tumors with special emphasis on the cytologically borderline category.

Materials and methods: The present study was conducted in our institute over five years from January 2017 to December 2022. This was a retrospective study and included 92 patients with ovarian masses who were subjected to ultrasound-guided fine needle aspiration (FNA) as a preliminary diagnostic procedure. Cytology smears were examined and categorized as benign, borderline, and malignant. The sensitivity, specificity, and diagnostic accuracy were assessed considering histopathology as the gold standard.

Results: In the present study, 92 ovarian FNA cytology were performed. Aspirates were adequate in all but 10 cases. Out of 82 cases, 75 were epithelial tumors. Twelve cases of BOTs were compiled and cytological findings were assessed.

Conclusion: To conclude, diagnosis of BOTs on cytology is difficult, however, aspiration from multiple sites from the lesion, critical cytomorphological assessment, and cell-block preparation with immunocytochemistry/immunohistochemistry can overcome the pitfalls.

Introduction: Urine cytology is a morphological diagnostic test that is, patient-friendly and easy to sample but subjective in morphological evaluation. This study aims to evaluate the effect of combining cell findings to assess urine cytology.

Materials and methods: Thirty cell findings found in high-grade urothelial carcinoma (HGUC) were selected for morphological abnormalities, each with detailed definitions. All 66 HGUC and 30 benign cases were examined for morphological abnormalities. The number of cases with at least one abnormal cell finding deviating from normal cells was used. The HGUC and benign cases were compared using significance difference tests. Using the cell findings extracted by the exact tests, discriminant analysis was performed to determine the valid cell findings for HGUC diagnosis.

Results: There was a difference in the detection rate of abnormal findings between HGUC and benign cases. Additionally, 20 cell findings were detected significantly more frequently in patients with HGUC. Furthermore, the discriminant analysis revealed that six cellular findings (high nucleus-to-cytoplasm ratio, hyperchromasia, eccentric nuclei, nuclear protrusion, unevenly distributed chromatin, and irregular nuclear shape) showed high accuracy in confirming the diagnosis of HGUC.

Conclusions: Five- to six-cell findings were individually valid; however, the combination of cell findings is crucial for an objective and accurate diagnosis of HGUC.

Background: The Bethesda System for Reporting Thyroid Cytology (TBSRTC) recommended for the interpretation of needle aspiration cytology of the thyroid, is the most widely used worldwide. Studies have shown that the disagreement between observers, especially in the Bethesda III and IV diagnostic categories, is not insignificant at 10%-40%. In the TBSRTC 2023 version, some definitions were removed and simplified, and molecular pathology was proposed as a complement to cytopathology. The current availability of molecular tests is limited because they can be performed in a few centers and are expensive. Therefore, our study investigated intra- and inter-observer agreement according to TBSRTC 2023 using only immunohistochemically BRAFV600E antibodies.

Materials and methods: The study included 173 cases with aspiration cytology evaluated between 2019 and 2022. The immunohistochemical procedure applied BRAFV600E (RM8) monoclonal antibody to cell block sections. All slides were assessed and categorized by three different observers. Data were interpreted using Cohen's kappa and Fleiss's kappa test in the Statistical Package for Social Sciences Windows 2021 program.

Results: For the applied RM8 antibody, sensitivity was 64.71% and specificity was 87.27%. In terms of diagnostic categories, inter-observer agreement was good for Bethesda II (K = 0.606) and moderate for Bethesda III (K = 0.429), Bethesda IV (K = 0.523), Bethesda V (K = 0,464), and Bethesda VI (K = 0.544), respectively.

Conclusion: In conclusion, the study reveals that the 2023 version of TBSRTC provides improvement, especially in the categories of uncertain diagnosis, but is still insufficient to improve cytological diagnostic accuracy, at which point molecular analyses become even more important.

Background and aims: Chordomas are rare notochordal tumors. They are suitable candidates for squash smear cytology (SSC) owing to their gelatinous consistency and destructive nature. SSC is an important tool for making a quick intra-operative preliminary diagnosis and taking real-time surgical and further management decisions. This study aimed to evaluate the diagnostic accuracy of SSC for chordoma cases.

Materials and methods: This retrospective study conducted in a North Indian tertiary care center enrolled chordoma cases histopathologically diagnosed between 01.01.2013 and 31.07.2023, for which SSC was also performed. SSC smears and their corresponding histopathology slides (±immunohistochemistry [IHC] slides) were retrieved. Histo-cytological correlation was performed.

Results: In total, 13 such cases were retrieved. The mean age was 34.4 + 5.6 years. The male-female ratio was 1:1.6. The most common location was the spheno-occipital region (10 cases), followed by sacro-coccygeal (two cases) and vertebral regions (1 case). The SSC was positive for chordoma in 10/13 cases. Thus, the calculated accuracy of SSC in chordoma diagnosis was 76.9%. A total of 3/13 (23.1%) cases where SSC was inconclusive for chordoma were difficult to diagnose cases, requiring IHC for ultimate diagnosis. Cytological features such as abundant myxoid matrix and physaliphorous cells help in correct diagnosis of chordoma on SSC.

Conclusions: We found the diagnostic accuracy of SSC in chordoma diagnosis to be 76.9%. Features such as abundant myxoid matrix and physaliphorous cells are helpful in correct diagnosis on SSC. Thus, even though chordomas are rare, one should consider them among the differential diagnoses in cases presenting with appropriate clinico-radiological features and characteristic cytological findings.

Background: The role of fine needle aspiration cytology (FNAC) in the diagnosis of renal malignancies is established and has been getting more precise and important over a period of time. Knowledge of the pathology of uncommon renal neoplasms along with radiological and clinical correlations often aids in correct diagnosis.

Aims: The present study aims to describe the cytomorphological and immunohistochemical findings in the varied spectrum of renal tumors, other than renal cell carcinomas (RCC).

Materials and methods: Data of 238 cases of ultrasound-guided renal FNAC performed in our tertiary cancer institute over 4 years were collected from the department registry. All nondiagnostic cases and cases diagnosed as RCC were excluded from the study, so 57 cases of renal tumors were reviewed along with the cell blocks and ancillary studies.

Results: Out of the 57 cases, 35 cases were primary renal neoplasms, which included renal oncocytoma (3.5%), angiomyolipoma (3.5%), rhabdoid tumor (1.8%), Wilms tumor (28.0%), Ewing sarcoma (3.5%), urothelial carcinoma (8.8%), and small round cell tumor unclassified (12.3%). Twenty two cases were metastatic tumors, which included hematolymphoid neoplasm (14%) and metastatic carcinomas (24.6%) from various other primary carcinomas.

Conclusion: Our study shows that renal FNAC is safe and fairly accurate in diagnosing a wide spectrum of renal tumors and has high diagnostic accuracy, when performed along with cell block and immunohistochemistry. Awareness of the pathology of uncommon renal tumors along with relevant clinical history and radiological findings may aid in identifying the type of tumor for further appropriate management.

Background: Fine-needle aspiration cytology (FNAC) of the lymph nodes is the first-line evaluation of lymphadenopathy of unknown etiology. For better diagnostic clarity and proper communication to clinicians, the Sydney System was proposed in 2020 for the performance, classification, and reporting of lymph node cytopathology. The present study was conducted to analyze the diagnostic performance and risk of malignancy (ROM) associated with each of the diagnostic categories of the proposed Sydney System.

Materials and methods: This retrospective study was conducted over 2 years. All patients with lymphadenopathy undergoing FNAC during the study period for which subsequent histopathological examination (HPE) reports or clinical follow-up data were available were included in the study. The original diagnoses were reviewed, and each case was assessed according to the first diagnostic level of the Sydney System classification. The diagnostic accuracy and ROM were correlated with FNAC diagnoses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of lymph node FNAC were calculated using SPSS version 20.0.

Results: A total of 456 out of 753 cases were selected in the study as they had subsequent histopathological correlation and/or clinical follow-up data. The majority were females n = 294 (64.4%). The most common lymph node was the cervical group (n = 274, 60%).

On statistical analysis: sensitivity 82.8%, specificity 97.5%, PPV 95.3%, NPV 90.1%, and diagnostic accuracy 92%.

Conclusion: The sydney system, which introduces a uniform categorization, may increase the lymph node FNAC diagnostic accuracy.

Introduction: Among thyroid malignancies, papillary thyroid carcinoma (PTC) is the most common, with the classical variant being the most common subtype. Some histological variants have aggressive behavior, advanced presentation stages, poor clinical outcomes, and may require additional therapy. Due to overlapping cytologic features and heterogeneity of lesions, the PTC classification is not adhered to in conventional reporting practice. This study aimed to classify the PTC cytology cases into a particular cytological variant by applying an algorithmic approach and correlating these variants with histology.

Materials and methods: An analysis of all histopathologically confirmed cases of PTC who had previously been diagnosed with fine needle aspiration cytology (FNAC) from January 2014 to December 2019 was conducted. FNAC samples of thyroid nodules were blindly reviewed and classified into different morphological variants using a stepwise algorithmic approach based on architectural, nuclear, and cytoplasmic features.

Results: A review of 77 histologically proven cases of PTC variants or with a predominant area of variant histomorphology was done. One case was inadequate (TBSRTC I), nine cases were benign (TBSRTC II), two were follicular lesions of undetermined significance (TBSRTC III), and 65 cases were suspicious or definite for PTC (TBSRTC V/VI). Retrospective algorithmic cytopathological analysis of 65 cases that are suspicious or definite of PTC (TBSRTC V/VI) showed classical PTC (5), follicular variant-PTC (35), tall cell variant (20), diffuse sclerosing variant (1), warthin-like variant (2), and solid variant (2). Diagnostic accuracy of cytopathology in diagnosing the PTC variants when compared with histopathological diagnosis varied from 81.3% to 100% (mean 78.9%). Cluster analysis justified that our classification showed good agreement with the actual classification based on the cytopathological features identified by the cluster analysis.

Conclusion: An awareness of cytomorphological features of aggressive variants may facilitate early and accurate diagnosis and appropriate clinical management with better patient outcomes. FNAC can subclassify PTC into different variants based on this algorithmic approach or aggressive and nonaggressive variants based on certain more frequently observed features.