Journal of Cytology最新文献

Introduction: Intraoperative tumor evaluation is essential for optimizing surgical decision-making and can prevent the need for unnecessary radical surgeries. Although frozen section (FS) is the gold standard for such evaluations in advanced centers, scrape cytology presents a simpler, cost-effective alternative that could be beneficial in resource-limited settings. However, this technique is often overlooked in favor of FS due to greater pathologist confidence in FS.

Materials and methods: This study included 80 consecutive intraoperative samples from the Department of Pathology. Both scrape cytology and FS were independently evaluated, and results were compared with those of the final histopathology, taken as the gold standard. Statistical analysis assessed the concordance, sensitivity, specificity, and diagnostic accuracy for each method.

Results: Scrape cytology and FS demonstrated a concordance rate of 87.5%, with sensitivity and specificity of 89.3% and 90.4%, respectively, for scrape cytology. Positive predictive value was 83.3%, and negative predictive value was 94%. Scrape cytology significantly reduced diagnostic time, averaging 10 min compared to 20 min for FS. Tissue-specific discrepancies were noted, particularly in lymph nodes and parathyroid cases.

Conclusion: Scrape cytology proved to be a reliable, cost-effective, and time-efficient alternative to FS, especially in settings where FS is unavailable. Although FS remains optimal for architectural detail, scrape cytology provides high diagnostic accuracy and utility for intraoperative decision-making in resource-limited environments.

Background: Chromosomal instability (CI) is essential for carcinogenesis. Micronuclei (MN), nuclear budding (NB), chromatin bridge (CB), and multipolar mitosis (MPM) are the morphological markers of CI. These markers can be studied in the effusion fluids like pleural and ascitic fluid. This study aimed to analyze their significance in differentiating between benign and malignant pleural and ascitic effusion fluids.

Materials and methods: A prospective observational study was conducted on 100 pleural and ascitic effusion fluids, out of which 71 were benign and 29 were malignant. A total of 20 malignant cases were confirmed by cell block preparation and immunohistochemistry. Leishman-stained slides were screened under oil immersion (1000×) for MN, CB, NB, and MPM. The number of cells with each of these markers were counted per 1000 cells. The data were analyzed by calculating the mean, standard deviation (SD), and Student's t test. A P value was also computed.

Results: Mean (SD) of MN, CB, NB, and MPM in malignant effusion cytology were 9.01 (4.65), 0.8846 (1.07), 0.96 (1.24), and 0.92 (0097) per 1000 cells counted, whereas, the mean for benign were1.0 (0.90), 0.39 (0.54), 0.51 (0.65), and 0.50(0.73) per 1000 cells, respectively. The difference between benign and malignant effusion cytology and MN score came out to be statistically significant with a P value of <0.0001.

Conclusion: The markers of CI help to differentiate between malignant and benign effusion cytology in low-resource settings.

Background: Platinum resistance in cancer cells plays an important role in the recurrence and progression of high-grade serous carcinoma (HGSC). Advanced or recurrent HGSC often presents with substantial ascites fluid retention.

Aims: To demonstrate that ascites fluid sampling could help evaluate the predictive markers for platinum resistance or sensitivity in peritoneal lesions of HGSC, we compared the expression of platinum response markers of cancer cells in ascites fluid with that in peritoneal lesions.

Materials and methods: Thirty samples from 10 HGSC patients were collected, including formalin-fixed paraffin-embedded specimens obtained from peritoneal lesions and primary ovarian lesions, and cell block specimens obtained from ascites fluid. The morphology of the cancer cells was evaluated by hematoxylin and eosin staining. The expression of predictive markers for platinum response in cancer cells was evaluated by immunohistochemistry for excision repair cross-complementation group 1 (ERCC1) and Schlafen 11 (SLFN11).

Results: The morphology of cancer cells in cell blocks (CBs) was similar to that in peritoneal and primary lesions. The expression of ERCC1 and SLFN11 in cancer cells in CBs was positively correlated with that in peritoneal lesions. These results indicated that CBs of ascites fluid would be useful for evaluating the expression of predictive markers for platinum resistance and sensitivity.

Conclusion: This study demonstrated that HGSC cells in ascites fluid may reflect the expression of predictive markers for platinum resistance or sensitivity in cancer cells in peritoneal metastatic lesions.

Conventional fluid cytology is a simple and efficient diagnostic modality that plays an imperative role in the workup of serous cavity effusion fluids. Endometrial carcinoma with pleural metastases is quite uncommon, and isolated cases without lung parenchymal involvement are even more uncommon. Herein, we present a case of a 60-year-old female diagnosed with high-grade endometrioid carcinoma with clear cell change, who presented with right-sided pleural effusion, which turned out to be positive for metastatic carcinoma without the involvement of lung parenchyma, making it a rare presentation of endometrial carcinoma metastasis diagnosed on conventional fluid cytology.

Background: The International Academy of Cytology (IAC) Yokohama System has developed a standardized system of reporting breast cytology. The current study aimed to apply the newly proposed YOKOHAMA classification system along with American College of Radiology Breast Imaging Reporting and Data system (ACR-BI-RADS) scoring to breast fine-needle aspiration cytology (FNAC) cases from the department archives and to assess the risk of malignancy (ROM) for each category.

Materials and methods: All breast FNACs done between January 20017 and June 2023 were reclassified according to the proposed IAC Yokohama reporting system. Histopathological correlation of the IAC Yokohama system and BI-RADS was done wherever available. A three-category approach was followed based on benign versus malignant, and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using histopathology as the gold standard.

Results: A total of 2130 breast FNACs were performed, of which 469 had a histopathological correlation and 892 had a BI-RADS correlation. The ROM for insufficient, benign, atypical, suspicious, and malignant categories were 29.16%, 3.28%, 28.57%, 100%, and 92.18%, respectively. Maximum specificity (96.8%) was observed when only malignant (cat A) and when both suspicious and malignant cases (Cat B) were taken as positive test results. Highest sensitivity (92.7%) was achieved when atypical, suspicious, and malignant cases were taken as positive test results (Cat C) and highest diagnostic accuracy (94.8%) was seen in category B. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of BI-ADS were 78.67%, 92%, 85.5%, 87.8%, and 87%, respectively.

Conclusion: FNAC and imaging are the key modalities for diagnosing breast lesions. The IAC Yokohama system along with ACR-BI-RADS provides a simple yet useful approach for effectively categorizing the different breast lesions, which is useful for patient management and risk stratification.

Leishmaniasis is an endemic health issue in tropical and subtropical countries and is a protozoal disease caused by leishmania species. The most common clinical type of leishmaniasis is cutaneous leishmaniasis (CL), and its diagnosis requires confirmation by laboratory tests since treatment for the condition necessitates long-term medication and poses a risk of harmful drug exposure. In developing nations, advanced diagnostic tools like molecular procedures and culture are not available in all centers. The conventional scraping procedure stained by Giemsa is the most preferred diagnostic tool used extensively. This case report highlights the importance of scrape cytology in the diagnosis of CL.

Background: Detection of extrapulmonary tuberculosis (EPTB) by Ziehl-Neelsen (Z-N) staining in fine needle aspirates is challenging due to the low yield of acid-fast bacteria (AFB). Mycobacterial culture, the gold standard, takes 4-8 weeks. Polymerase chain reaction with 100% sensitivity and 92.1% specificity is expensive. Mycobacterial antigens produced by the tubercle bacilli consist of several proteins and enzymes. The protein purified from Mycobacterium tuberculosis is called MPT. The MPT64, a 24-kd protein, has not been detected in non-tuberculous mycobacteria. We aim to study the role of immunocytochemical (ICC) in the detection of EPTB in fine needle aspiration cytology materials by using MPT64 antibody and compare it with culture and Z-N staining, as ICC is not routinely practiced for diagnosing EPTB.

Materials and methods: A total of 134 patients having enlarged nodes with suspected EPTB were included; however, only 96/134 cases were suitable for statistical analysis. Papanicolaou, May-Grünwald-Giemsa, Z-N staining, ICC, and mycobacteria culture were performed.

Results: AFB was positive in 16%, 22.9% of culture-positive, and 11% of MPT64 positive. The sensitivity and specificity of ICC compared to mycobacterial culture were 45.4% and 99%, respectively. ICC and culture had a moderate agreement with the Kappa value of 0.535. The positive and negative predictive values of ICC with culture were 91% and 86%, respectively.

Conclusion: This study tried to improve the technique's sensitivity to facilitate its use in routine laboratory practice. Nonetheless, our results showed no significant improvement over the currently popular Z-N stain, although a comparison between the ICC technique performed on smears and cell block sections showed better results in the latter.

The incidences of pancreatic neoplasms are exceedingly rare during childhood and adolescence. Most common among pancreatic neoplasms are solid pseudopapillary neoplasm (SPN) of the pancreas, a rare pancreatic neoplasm with low malignant potential that occurs predominantly in young females. We present a case of SPN with cytomorphological, immunohistochemical, and also histomorphological findings in a 10-year-old boy diagnosed by endoscopic ultrasound-fine-needle aspiration.

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays an important diagnostic role in concealed pulmonary diseases. However, diagnosing sarcoidosis and differentiating it from tuberculosis is a diagnostic quandary. We, thus, aimed to evaluate EBUS-TBNA cytology in these cases in a tubercular-endemic zone.

Methods: A prospective 5-year study was done in a tertiary care center on 118 patients with tuberculosis versus sarcoidosis with mediastinal lymphadenopathy who underwent EBUS-TBNA. All samples obtained were sent for cytomorphological and microbiological evaluation. On cytology analysis, demonstration of acid-fast bacilli was considered diagnostic of tuberculosis. However, in its absence, a multidisciplinary diagnostic (MDD) approach was followed to establish a diagnosis.

Results: EBUS-TBNA cytology contributed in reaching the final diagnosis in 88.1% cases. Of the 55 cases of tuberculosis, cytomorphological features were contributory in 90.9% cases. Out of 29 cases of sarcoidosis, 24 showed granulomas. Microbiological tests were contributory in the final diagnosis of tuberculosis in only 21.8% cases as compared to 90.9% by cytology analysis. In 10 cases, a definitive diagnosis could not be made on cytology analysis and were finally diagnosed on the basis of MDD. A definitive distinction between tuberculosis and sarcoidosis could not be made despite MDD in four cases.

Conclusion: While a diagnosis of tuberculosis can be made independently on cytological features, MDD with contributory cytological findings is essential for the diagnosis of sarcoidosis. EBUS-TBNA cytology, thus, plays an important role in the multidisciplinary strategy of approaching thoracic lesions.

Background and aims: The International Serous Fluid Cytopathology Reporting System aimed to establish standardized protocols to ensure consistency in the reporting of serous fluid cytological specimens. In the search for higher diagnostic accuracy and a reduction in indeterminate categories, such as atypia of undetermined significance (AUS), ancillary tests like immunohistochemical (IHC) staining panels were performed. In our study, we aimed to evaluate whether the category of cases diagnosed as AUS by initial examination would change at the end of IHC studies.

Materials and methods: In total, 375 serous fluid cytology samples were examined in our laboratory for 10 months. Of these, 37 cases that were initially diagnosed as AUS were included in the study. A control group, comprising 20 cases initially diagnosed as negative for malignancy (NFM) was used. For the IHC study, sections from cell blocks were used for each group Then, the slides were stained with Ep-CAM/epithelial specific antigen (MOC31), Hector Battifora mesothelial-1 (HBME-1), and cluster of differentiation 68 (CD68).

Results: Following the IHC study involving MOC31, HBME-1, and CD68, a significant reclassification was observed in cases initially diagnosed as AUS. Specifically, in 86.1% of these cases, a definitive categorization into either NFM or malignant was achieved. Statistical analysis revealed a significant difference between the two groups in terms of achieving a definitive category after the IHC study (P < 0.05).

Conclusion: Our study emphasizes the critical importance of enhancing the initial IHC panel, initially composed of epithelial and mesothelial markers, with CD68. This strategic addition contributed significantly to the reduction of cases categorized as AUS.