Journal of Cytology最新文献

Background: Salivary gland (SG) fine-needle aspiration (FNA) is a well-accepted tool for preoperative management of salivary gland lesions (SGLs). First and second editions of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) were published in the years 2018 and 2023, respectively. The MSRSGC aims to improve patient care by providing better communication between clinicians and institutions. It has six ascending diagnostic categories having a definite risk of malignancy (ROM) and corresponding management schema. Our study assessed the incidence and corresponding ROM of each MSRSGC category within a tertiary care northern India referral center and compared each ROM with those laid down in the two editions of the MSRSGC.

Aims and objectives: The main aims and objectives are as follows:1. Validating the utility of the MSRSGC for the diagnosis of SG-FNAs in a North Indian Tertiary Care Center.2. Comparing the Risk of Malignancy with its Two Editions.

Materials and methods: Data on SG-FNAs performed between 01.01.2010 and 31.03.2024 were searched from the hospital information system. The cytopathology and histopathological slides were retrieved, and each case was separately reviewed and retrospectively classified into the I) non-diagnostic (ND), II) non-neoplastic (NN), III) atypia of undetermined significance (AUS), IVA) benign neoplasms (NB), IVB) SG neoplasm of uncertain malignant potential (SUMP), V) suspicious for malignancy (SFM), or VI) malignant categories according to the MSRSGC. Cyto-histopathological correlation analysis was performed, and the ROM for each category was calculated.

Results: A total of 793 such cases were obtained. Histopathological follow-up was available in 267 cases, which included 2 (0.7%) ND, 29 (10.9%) NN, 5 (1.9%) AUS, 190 (71.2%) NB, 11 (4.1%) SUMP, 10 (3.7%) SFM, and 20 (7.5%) malignant cases. The calculated ROM for these ascending categories were 0%, 27.6%, 60%, 11.8%, 45.5%, 90%, and 100%, respectively.

Conclusion: MSRSGC is a valuable means to standardize the reporting and preoperatively stratify SGLs as per the ROM for each ascending risk category. This study, to the best of our knowledge, is the largest Indian study to authenticate the utility and reproducibility of the MSRSGC in our tertiary care institute.

Objective: This study conducted an unsupervised learning cluster analysis on urine cytological images of high-grade urothelial carcinoma to assess their explanatory potential.

Materials and methods: A total of 124 urine cytology specimens of urothelial carcinoma, collected between December 2010 to December 2021 at Gunma University Hospital, were analyzed. Ten cytological image fields per specimen were captured, and pathological T factors were examined using principal component analysis and t-distributed stochastic neighbor embedding (t-SNE) with machine learning (ML) software. Common image features were also verbalized and manually reevaluated.

Results: In the t-SNE analysis, the T1-dominant region was characterized by "few cells in the background," whereas the T2-dominant region showed "many cells in the image," "numerous neutrophils in the image," and "abundant tumor cells in the image." Human reassessment identified significant differences related to muscle invasion status for all findings except "abundant tumor cells in the image." Furthermore, we confirmed that histological neutrophil infiltration was related to the abundance of neutrophils in the cytological specimens.

Conclusion: This study is noteworthy as the cluster analysis identified previously unreported variations in background cell types and quality linked to muscle invasion status, and it also demonstrated the explainability of ML-derived findings through manual reassessment.

Introduction: Whereas liquid-based cytology (LBC) is often the preferred method in gynecological and non-gynecological cytopathology compared to conventional preparation, it does have several limitations. This study aims to evaluate the diagnostic accuracy and specific cytomorphologic characteristics of the newly developed WellPrep^® (WP) in comparison with SurePath™ (SP) in serous effusion cytology.

Materials and methods: A total of 178 body cavity effusion samples were collected, which were divided and further processed using both WP and SP methods. The LBC slides of the cases were independently evaluated regarding their cytomorphologic features by three pathologists. Among them, the diagnosis of 66 cases (42.6%) was confirmed as non-neoplastic or malignant using a combination of histopathological, clinical, and/or radiological follow-up. Statistical analysis was conducted to assess the diagnostic concordance and differences in selected cytomorphologic features between the two LBC methods.

Results: WP demonstrated diagnostic performance comparable to SP, with a concordance rate of 75.7% (kappa = 0.659; Spearman's ρ = 0.920). Furthermore, the diagnostic accuracy measures tested were not different between WP and SP. No case processed with WP or SP showed suboptimal slide quality. For cytomorphologic features, cellular degeneration was less frequently observed in WP than in SP. SP showed more even cellular distribution and better preservation of architectural patterns. SP also more frequently exhibited prominent nucleoli, cytoplasmic vacuoles, and signet ring cell features.

Conclusion: WP offers comparable slide quality and diagnostic accuracy with SP in serous effusion cytopathology. However, more research using larger patient cohorts would provide more evidence regarding WP.

Background: Touch imprint and crush cytology are simple, rapid, and cost-effective methods to distinguish between benign and malignant lesions, particularly in sentinel lymph nodes, ovarian neoplasms, and central nervous system tumors. This study was undertaken to assess the utility of imprint and crush cytology in making the diagnosis of both malignant as well as non-neoplastic diseases of the upper gastrointestinal (UGI) tract and compare the results with corresponding histopathology.

Materials and methods: The study was conducted on patients who underwent UGI endoscopic biopsies over a period of 1.5 years. Touch imprints and crush smears were prepared for each case and stained with Giemsa and Papanicolaou stains. The cytology results were compared with the corresponding histopathology.

Results: The overall sensitivity and specificity of imprint and crush cytology when compared to histopathology were found to be 95.7% and 98.8%, respectively. For Helicobacter pylori infection, the sensitivity, specificity, and diagnostic accuracy of cytology were 71.4%, 99%, and 97.19%, respectively. Both crush and imprint smears had similar efficacy in rendering the cytological diagnosis.

Conclusion: Imprint/crush smear cytology is a valuable complement to histopathology in UGI endoscopic biopsies. Evaluation of biopsy adequacy, distinguishing between malignant and benign lesions, and diagnosing specific infections such as H. pylori, Candia, and Herpes simplex virus are reliably possible on impression cytology.

Introduction: Cytological appearances may be insufficient to establish the diagnosis of pancreatic cystic lesions, especially for premalignant neoplasms. This study aimed to evaluate three commonly used cytological grading systems [C1-C5, Papanicolaou (Pap), and World Health Organization (WHO) classification systems] in assessing pancreatic cystic lesions.

Materials and methods: A total of 210 pancreatic cytology specimens were classified based on the aforementioned grading systems, 127 of which had supporting histology reported across 6 years, at a single-tertiary referral center.

Results: We excluded 26 cases because of inadequate cytology. The most common cystic lesions were intraductal papillary mucinous neoplasms (IPMNs, n = 71) and pseudocysts (n = 55). Among IPMN, 27 were moderate/high-grade, and 44 were low-grade. There were 12 mucinous cystic neoplasms, 75 benign cysts (pseudocysts, serous cystadenomas, lymphoepithelial cysts, and others), and 15 malignant cases, with 11 cysts being of uncertain etiology. There were 21 high-risk and potentially malignant (WHO grade V) cases in comparison with 42 cases using the C grading (C4 and C5). However, according to Pap grading, 87 had varying risks of malignancy (Category IVB). According to the WHO classification, 63 cases were classified as low-risk pancreaticobiliary neoplasms (WHO grade IV). The remaining cases 85 were benign to very low-risk malignant potential and, therefore, were less likely to be considered for surgical intervention. Diagnostic concordance was higher between cytology and core biopsies in low-grade IPMN.

Conclusion: The WHO system provides better risk stratification for neoplasms, optimizing surgical management. However, the C1-C5 system does not recognize cystic lesions with malignant potential.

Foregut duplication cysts are rare congenital anomalies that can occur anywhere along the gastrointestinal tract, including the tongue. They are usually diagnosed by imaging studies; rarely, aspiration cytology is performed. Fine needle aspiration cytology (FNAC) can help to differentiate foregut duplication cysts from other types of tongue lesions, such as dermoid cysts, lymphangiomas, or malignancies. Present report describes FNAC findings of this condition in a seven year old girl who presented with a painless swelling on the dorsal aspect of her tongue for the past 5 months.

Small cell malignant melanoma (SCMM) is a rare melanoma variant, and its prognosis is worse than other melanomas. A case of SCMM metastasis on the mediastinal lymph node is presented in this study. A 54-year-old male patient had a lesion on the palmar side of the right hand and mediastinal lymph node metastasis. Fine needle aspiration biopsies were performed from the lymph nodes. Cytologically, cellular smears consisted of isolated discohesive cells, nuclear aggregates, small layers of cells, and pseudo-rosettes. Two kinds of cells were observed: one with small, round-oval cells, and the other with small to medium cells. Immunohistochemically, tumor cells were positive with S-100, SRY-related HMG-box gene 10, MelanA, and human melanoma black 45. Friend leukemia virus integration 1 was positive in over 10% of tumor cells. Metastatic malignant melanoma may present with different cytomorphologic features. SCMM is a tumor to be aware of because it can be confused with other small round blue cells and misdiagnosed.

Background: Fine needle aspiration biopsy (FNAB) breast remains the prime investigation in distinguishing benign breast lesions from malignant ones in low socioeconomic settings. To overcome the problems of non-uniform reporting systems in breast cytology, the Yokohama system for reporting breast fine needle aspiration biopsy cytopathology (YSRB) was introduced.

Aim: To assess the agreement among observers with variable experience using YSRB in a teaching institute.

Materials and methods: Retrospective study in which all breast FNABs (n = 1003) over one year were retrieved and re-categorized according to YSRB by three observers (postgraduate resident (PG), senior resident (SR), and consultant). Cyto-histological correlation was done in cases with discordant cytological diagnoses between SR and consultant. The agreement level between observers was calculated using the Fleiss kappa score. A P value < 0.05 was considered significant.

Results: The agreement between PG-SR and PG-Consultant was 0.637 and 0.641, respectively (P < 0.001). SR and the consultant had an excellent agreement with Fleiss' kappa score of 0.947 (P < 0.001), having only a few discordant cases (n = 27). Reasons for discrepancies were evaluated in 22/27 cases where histomorphology diagnoses were available.

Conclusion: YSRB can be implemented with ease as a standardized reporting system for routine reporting of breast FNABs in a tertiary care teaching institute.

Hydatid cyst may mimic other diseases including carcinoma and tuberculosis which may raise diagnostic dilemma that may be more enhanced in areas where tuberculosis is endemic. This may result in delayed diagnosis of hydatid cyst leading to its complications. The present case is therefore being reported as it was clinically and radiologically diagnosed as tuberculosis but on fine needle aspiration cytology (FNAC) turned out to be a case of hydatid cyst. In addition, vigilant cytological examination revealed only protoscolices and hooklets instead of laminated cyst membrane which is more commonly and easily observed. FNAC serves as a valuable adjunctive tool in the diagnosis of hydatid cysts providing rapid and accurate diagnosis that can guide clinical management and improve patient outcome.

Background: Solid-pseudopapillary neoplasm (SPEN) is a rare pancreatic tumor, constituting 2-3% of all pancreatic neoplasms, primarily affecting young women with a median age of 30. Its prognosis is generally favorable due to the low incidence of metastasis and successful surgical resection. Accurate preoperative diagnosis is crucial, as its cytological features are distinctive.

Aim: To elucidate the significance of cytopathology in the detection of SPEN, associated diagnostic pearls and pitfalls, and histopathologic correlation.

Materials and methods: All SPEN cases diagnosed through cytomorphology were retrieved from the hospital medical records, and relevant clinical information was compiled. Cytopathology and histopathology slides were obtained from the archives and reviewed.

Results: All four cases were middle-aged women (mean age = 40 years) presenting with abdominal pain. Imaging showed solid-cystic lesions. The diagnosis of SPEN was rendered on fine needle aspiration cytology (FNAC), with characteristic papillary and glandular patterns. Histology confirmed the diagnosis with 100% cytohistological concordance in all four cases.

Conclusion: FNAC is an effective tool for the detection of SPEN, allowing precise diagnosis, guiding surgery, and reducing the need for extensive resection.