Cytopathology最新文献

Introduction

Participation in diagnostic intercomparison programs is a mandatory requirement for accreditation of cytology laboratories. Results described by these programs in cervico vaginal cytology (CVC) show a significant number of discrepancies. We hypothesised whether the use of IA systems, such as the ThinPrep Genius system, would improve diagnostic concordance.

Methods

We simulated an intercomparison program between two centres in which four observers used the same 30 cases of CVC with negative diagnoses, ASCUS, LSIL and HSIL and observed them with light optic microscopy (OM) and two Genius (G1 and G2) systems, one from each centre.

Results

The diagnostic agreement between OM and the two Genius was similar, with overall agreement values of 82% for G1 and 78% for G2 and OM, and similar kappa values for the three techniques. However, both Genius diagnosed glandular lesions that were not included in the selected cases and were not diagnosed with OM.

Conclusion

The concordance obtained in both OM and Genius is acceptable and falls within the range of that obtained in what is described in intercomparison programs. We must consider the greater affinity for diagnosing glandular lesions with Genius and the fact that there may be discrete differences between two different devices, probably due to calibration.

Context

High-grade serous carcinoma (HGSC), the most prevalent and lethal form of ovarian cancer, is increasingly recognised to originate in the fimbrial end of the fallopian tube (FT). Timely detection remains a critical unmet clinical need due to ineffective screening methods. This prospective observational study assesses the diagnostic potential of FT brush cytology by correlating cytomorphological and immunocytochemical findings with histologically confirmed HGSC.

Methods and Material

A total of 134 FT from 89 patients undergoing salpingo-oophorectomy (with or without hysterectomy) were analysed. Liquid-based cytology samples were evaluated for morphological abnormalities and subjected to immunocytochemistry using p53 and Ki-67 markers. Cytological results were classified as benign, suspicious or malignant. Statistical analyses included sensitivity, specificity and odds ratio calculations via logistic regression (α = 0.05), performed using the R software.

Results

Histopathology confirmed HGSC in 15 patients. Of these, brush cytology identified 12 as suspicious or malignant, demonstrating high diagnostic concordance. Aberrant p53 expression was found in 11 cases, and a high Ki-67 proliferation index was observed in 10. These findings underscore the strong correlation between cytological, immunocytochemical and histological features of tubal HGSC.

Conclusions

In conclusion, FT brush cytology combined with p53 and Ki-67 immunocytochemistry shows promise as a minimally invasive approach for early HGSC detection. Future research should focus on larger prospective cohorts, ideally incorporating in vivo hysteroscopic sampling.

Background

Thyroid tumours occur in patients with Birt-Hogg-Dubé syndrome (BHD), a condition caused by germline alterations in the FLCN gene that confers an increased cancer risk. Somatic FLCN mutations may also contribute to tumorigenesis. In this study, we present the first description of the cytopathology of two thyroid tumours evaluated by fine-needle aspiration (FNA) and harbouring pathogenic FLCN mutations.

Methods

We encountered two patients with oncocytic thyroid tumours in which comprehensive next-generation sequencing (NGS) identified pathogenic FLCN mutations. We present the FNA cytologic findings and corresponding histopathology, and discuss the diagnostic challenges posed by the FNAs, one of which was initially confounded by negative preoperative molecular testing.

Results

Both patients were middle-aged females. Patient 1 had an incidental thyroid nodule and a history of BHD. FNA of a TI-RADS 5 mass was diagnosed as suspicious for papillary thyroid carcinoma (PTC), Bethesda V, leading to total thyroidectomy. Patient 2 presented with a palpable nodule. Compressive symptoms prompted lobectomy, revealing an angioinvasive oncocytic carcinoma. Subsequent FNA findings of a metastasis cytologically resembled oncocytic PTC; however, it was correctly diagnosed as oncocytic carcinoma after correlation with prior histologic findings. Expanded NGS testing facilitated the final diagnosis of FLCN-mutated oncocytic adenoma in Patient 1 and high-grade differentiated oncocytic carcinoma in Patient 2.

Conclusion

Thyroid tumours harbouring FLCN mutations with oncocytic features may mimic PTC cytologically. Although rare, correct diagnosis of these tumours is essential to ensure appropriate treatment. For early detection, patients with BHD may benefit from thyroid ultrasound surveillance.

Objective

To evaluate the application of The International System for Serous Fluid Cytopathology (TIS) in cytology cases of cerebrospinal fluid (CSF).

Methods

A retrospective analysis was conducted on 618 CSF samples from two hospitals in Athens, Greece, over a 5-year period. CSF samples were processed with conventional cytological techniques or liquid-based preparations, stained with Giemsa and Papanicolaou staining. Immunocytochemistry was used when necessary. Samples were classified by two cytopathologists into the five TIS categories: nondiagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM) and malignant (MAL).

Results

Of the 618 CSF samples, 78.8% were classified as NFM, 19.4% as MAL and 1.3% as ND. Only 0.5% of cases were categorised as AUS, and no cases were classified as SFM. In patients with a history of neoplasia and suspected CSF involvement, the malignancy detection rate was 38%, while it was only 5.6% in patients with neurological symptoms but no known neoplasia. The most common metastatic cancers in the CSF were breast carcinoma, lung adenocarcinoma and lymphomas.

Conclusions

The classification of CSF cytology samples using TIS proved to be feasible and effective. Notably, the majority of samples fell into the NFM and MAL categories, while the AUS and ND categories were rare. These findings suggest that this classification could provide a reliable framework for CSF cytology reporting, improving diagnostic accuracy and potentially aiding in clinical decision-making.

Two-Liner: This study offers proof of the value of the application of The International System for Serous Fluid Cytopathology in the cytological interpretation of cases of cerebrospinal fluid.