Cytopathology最新文献

Objective: This study aimed to analyze the morphological characteristics of cells observed in pleural effusion cytology specimens using computer-assisted image analysis (CAIA).

Methods: We examined 166 pleural effusion cytology specimens obtained for suspected lung cancer, including 80 negative, 22 suspicious and 64 positive cases. Whole-slide images (WSIs) were generated from Papanicolaou-stained specimens, and image analysis was performed using virtual slide cytology image analysis software. A scatter plot was then created, with the x-axis representing the area of each cell or cell cluster and the y-axis representing the maximum nuclear area within that cluster. The resulting plot type and the positive rate (PR) were subsequently evaluated.

Results: Four distinct plot types were defined from the scatter plots: small cluster type (S-type), horizontal type (H-type), vertical type (V-type) and diagonal type (D-type). Overall, S-type and H-type patterns were commonly observed in non-cancer or cytologically negative cases, whereas V-type and D-type patterns predominated in cytologically positive cases. In suspicious cases, S-type and V-type plots each accounted for roughly half of the samples. The PR was significantly higher in cytologically positive cases relative to non-cancer and cytologically negative cases (p < 0.0001).

Conclusions: In pleural cytology specimens from patients with lung cancer, the degree of cell aggregation and nuclear overlap is an important factor for distinguishing benign from malignant lesions. Moreover, although AI-based image analysis has advanced rapidly in recent years, this study emphasizes the continued value of CAIA approaches that employ algorithms readily interpretable by humans.

Background: Pancreatic adenocarcinoma (PDAC) arises from transformed pancreatic stem cells. Different stemness pathways are thought to be involved in the progression of PDAC.

Objective: To assess the expression of four stem cell markers to determine the best candidate for targeted therapy.

Methods: Seventy-one PDAC cell blocks were immunoassayed for CD24, OCT4, DCLK1 and CD44 expression and genotyped for common KRAS mutations.

Results: OCT4 was detected in 82.9% of PDAC and undetected in healthy pancreas. CD24 was detected in 23.9% of PDACs, while DCLK1 and CD44 were detected in 25.7% and 34.8% of PDACs, respectively. CD24 localisation was primarily nuclear in PDAC and membranous in healthy pancreas tissues. OCT4 expression and nuclear localisation correlated positively with CD24 expression and nuclear localisation (r = 0.264, p = 0.023; r = 0.238, p = 0.041, respectively). OCT4 expression was lower in KRAS mutation-positive specimens (β -0.54, 95% CI: -0.37 - (-0.088), p = 0.002).

Conclusion: OCT4 expression is a specific biomarker for PDAC. Its increased expression signified PDAC progression and CD24 activation in a subset of PDAC. KRAS mutants have lower OCT4 expression, suggesting an alternative mechanism for cancer progression than that in OCT4 positive PDAC.

Pneumoconiosis results from inhalation of occupational dusts and is most commonly due to silica, asbestos, or coal dust. Foundry workers are classically associated with silicosis; however, historical exposure to asbestos, particularly before regulatory restrictions in the 1980s, places this population at risk for mixed pneumoconiosis. Progressive massive fibrosis (PMF), an advanced form of pneumoconiosis, can radiographically and metabolically mimic malignancy, creating significant diagnostic challenges. Recognition of asbestos fibres in cytologic specimens is critical because of their prognostic, surveillance and medico-legal implications.

Metastatic papillary thyroid carcinoma (PTC) presenting in serous effusion cytology is rare and usually reflects advanced disease with an adverse prognosis. Accurate identification in effusion specimens is diagnostically challenging because of overlapping cytomorphological features with other papillary malignancies. We report a case of a 74-year-old woman with a prior history of PTC who presented with bilateral pleural effusion. Cytological examination of the pleural fluid revealed papillary clusters of tumour cells, psammoma bodies and frequent intranuclear cytoplasmic inclusions. Cell block sections demonstrated tumour cell clusters that were immunoreactive for PAX8 and TTF-1. Subsequent pleural biopsy confirmed metastatic PTC. This case highlights the importance of careful cytomorphological assessment, correlation with clinical history and the critical role of immunocytochemistry-including PAX8, TTF-1 and thyroglobulin-in establishing the correct diagnosis of metastatic PTC in effusion cytology.

This case describes the initial detection of cervical small cell neuroendocrine carcinoma on conventional endometrial and cervicovaginal liquid-based cytology. Given its rarity and high aggressiveness, early recognition and rapid, intensive treatment are crucial for improving patient outcomes.

Introduction: Performance feedback aims to improve quality, yet challenges in data selection, presentation and management of human interactions persist. Interactive dashboards summarising key performance indicators (KPIs) and fostering active engagement may enhance feedback. This study presents our experience with the CytoLog application-an updated version of the pilot dashboard at Eurofins-Medserv Laboratory (EML)-and pilot results at the Cytology Laboratory, Kenézy Gyula Campus, University of Debrecen (CLUD).

Material and methods: Data extraction, processing (including KPI calculation), and dashboard development were performed in Python and deployed as a web-based application. API endpoints were utilised to ensure secure, anonymized patient data access and user-specific dashboards. CytoLog introduces data tables, trend charts, and a quality gauge as additions to the pilot dashboard and supports quarterly updates.

Results: At EML, 1,045,034 Pap tests and 14,227 thyroid cytology cases (2018-2024) were examined, involving 11 cytopathologists (CPs) and 23 cytotechnologists (CTs). A gratifying improvement in the ASC/LSIL ratio (0.8 to 1.7) was observed, and the ASC-US/ASC-H ratio corrected between 2023 and 2024 (75.7%/24.3% to 80.3%/19.7%). The abnormal rate decreased (6.6% to 3.5%). At CLUD, 198,663 Pap tests (2020-2024) were examined, involving 3 CPs and 10 CTs. A decrease in both the abnormal rate (8.3% to 5.3%) and the ASC/LSIL ratio (6.6 to 3.2) was observed.

Conclusion: The CytoLog application enables continuous performance monitoring while ensuring secure data management and adaptability across different laboratory environments. The improvement of the ASC/LSIL and ASC-US/ASC-H ratios at EML testify to the impact of self-directed quality improvement even without structured interventions. Awareness of metric limitations and potential bias remains essential when interpreting data-driven trends.

Background: Central nervous system (CNS) involvement in paediatric B-acute lymphoblastic leukaemia (B-ALL) significantly impacts relapse risk and survival. Conventional cytomorphology (CM) of cerebrospinal fluid (CSF) is rapid and specific but has low sensitivity because of limited cellularity and morphological overlap with reactive lymphocytes.

Objective: To evaluate the diagnostic utility and resource efficiency of immunocytochemistry (ICC) as an adjunct to CM in detecting leukaemic infiltration of CSF in paediatric B-ALL.

Methods: In Cohort 1 (n = 45), all CSF samples underwent CM and ICC using CD3, CD79a, and TdT. In Cohort 2 (n = 44), ICC was applied selectively to samples with pleocytosis (> 4 cells/μL) on the basis of a triage algorithm.

Results: In Cohort 1, ICC upgraded a subset of "doubtful" CM cases to definitive leukaemic infiltration, particularly with CD79a and TdT. CD3 reliably confirmed reactive T-cell morphology, enhancing specificity. In Cohort 2, selective ICC use maintained diagnostic yield, detecting blasts in doubtful cases while conserving slides and resources. Together, ICC demonstrated added diagnostic value, especially in morphologically equivocal and higher-cellularity specimens.

Conclusion: ICC complements CM in CSF evaluation for paediatric B-ALL, improving sensitivity and supporting a pragmatic triage strategy. A combination of CD3 and CD79a is optimal when two smears are available; with limited material, marker choice should be guided by morphology. This cost-effective workflow enhances detection of CNS involvement where flow cytometry or molecular assays are not readily available.

Objective: This study evaluated the diagnostic performance of high-resolution whole slide imaging (WSI) for primary cytological diagnosis across a broad range of specimen types and preparations.

Methods: In a single-centre, retrospective validation study, 88 archived cytology cases representative of routine clinical practice were scanned at 40× equivalent magnification (0.23 μm/pixel) using the Hamamatsu NanoZoomer S360MD Slide scanner system. Specimens included gynaecological and non-gynaecological exfoliative and fine needle aspirate samples, prepared as smears, ThinPreps, cytospins or cell blocks. WSI were each reviewed independently by two expert cytopathologists with minimal prior digital cytology reporting experience, blinded to original light microscopy (LM) diagnoses. Discordant cases underwent LM review. Diagnostic concordance and agreement were assessed using percentage concordance and Cohen's κ (unweighted and weighted, for non-gynaecological cases only). A post-study questionnaire captured qualitative feedback.

Results: Of the 88 cases, 65 showed concordance between digital and LM diagnoses. Amongst the remaining 23 cases, 15 demonstrated diagnostic discrepancy by LM. Excluding these, the digital-LM concordance rate was 95.1%. When all cases were included, concordance ranged from 89.5% for within-observer analysis to 89.8% when compared with a majority LM diagnosis. Agreement analysis demonstrated substantial to near-perfect digital-LM agreement (unweighted κ = 0.86; weighted κ = 0.83-0.95), improving further following exclusion of diagnostically discrepant cases (κ = 0.89-0.97). Inter-observer agreement was lower than intra-observer agreement for both digital and LM comparisons. Feedback indicated that image quality was generally good. Challenges included visualising thick smear preparations, three-dimensional cell clusters, sparse atypical cells and screening gynaecological (cervical) cytology cases. All participants expressed openness to adopting digital cytology.

Conclusion: High-resolution WSI demonstrated strong diagnostic concordance with traditional LM across a wide range of cytological specimen types and preparations. Despite limited prior experience, digital cytology was considered acceptable and feasible, supporting its integration into routine clinical practice, with appropriate training and quality assurance.

Background: Granulomatous mastitis (GM) is a rare, chronic inflammatory breast condition that clinically and radiologically mimics breast carcinoma. GM is most commonly reported as tubercular (TB) mastitis. This study aims to identify predictive factors differentiating idiopathic and tubercular GM based on cytomorphology.

Methods: Data were retrieved from the departmental archives between January 2019 and June 2024. Additional investigations and therapeutic responses were recorded during follow-up. Based on correlation with gold standard diagnostic tools and therapeutic responses, cases were categorised into idiopathic and tubercular GM groups using cytomorphological features and analysed for risk stratification.

Results: A total of 25 GM cases were included in the study, with a mean age of 29 ± 5.7 years. Ziehl-Neelsen (ZN) staining was positive in three cases. A histological correlation was available for 21 cases, PCR for 5 and therapeutic response for all 25 cases. Seven cases responded to antitubercular therapy (ATT), while 18 responded to steroids. Cytological diagnosis identified TB GM in 8 cases and nonspecific GM in 17 cases. The agreement between original and revised diagnoses was excellent after correlation with gold standard methods and therapeutic outcomes. Univariate and multivariate analyses revealed that a cytological diagnosis of GM with well-formed granulomas, absence of neutrophils, presence of many lymphocytes and lack of plasma cell infiltration was significantly associated (p < 0.05) with TB GM. In univariate analysis, age under 30 years was significantly associated with TB GM (p = 0.025); however, this was not significant in multivariate analysis.

Conclusion: Cytomorphology is a valuable and rapid tool for differentiating between TB and idiopathic GM, helping to prevent unnecessary surgical interventions while awaiting results from ancillary diagnostic techniques.

Objective: Small cell lung carcinoma (SCLC) comprises molecular subtypes defined by transcription factor expression, but cytologic correlates of these groups remain poorly characterised. We investigated whether cytomorphologic features differ across subtypes and identified variants that may confound diagnosis.

Methods: We conducted a single-center, retrospective study of 30 SCLC cases diagnosed between 2021 and 2024. Molecular subtypes were assigned on histologic tissue using immunohistochemistry and classified as SCLC-A (ASCL1), SCLC-N (NEUROD1), SCLC-P (POU2F3) and SCLC-I (inflamed subtype). Paired cytology specimens, including conventional smears stained with Papanicolaou and Giemsa as well as liquid-based cytology, were reviewed. Classical morphology was defined by established SCLC criteria, and non-classical morphology by deviations such as enlarged nuclei with prominent nucleoli, increased cytoplasm and reduced nuclear moulding.

Results: Twelve tumours were classified as SCLC-A, 6 as SCLC-N, 9 as SCLC-P and 3 as SCLC-I. Cytomorphology was uniformly classical in 28 cases, encompassing all SCLC-A, SCLC-N and SCLC-I tumours. Two SCLC-P cases demonstrated non-classical morphology with relatively abundant cytoplasm and conspicuous nucleoli, imparting an appearance more reminiscent of non-small cell carcinoma.

Conclusions: Cytomorphology is largely conserved across molecular subtypes of SCLC, but a minority of POU2F3-positive tumours may display non-classical features. Recognition of this variant is important to avoid misclassification, particularly when only limited cytology material is available. These findings suggest that lineage-defining programs may occasionally imprint the cytologic phenotype and highlight the value of considering subtype-oriented ancillary testing in challenging cases.