Cytopathology最新文献

Objective

Using bibliometric analysis to inform factors impacting career mobility, focusing on gender and regional variations in academic cytopathology.

Methods

The Scopus database was used to determine the productivity and experience of cytopathologists who are faculty from the 92 fellowship programs. The dependent variable was promotion to the rank of Professor. A regression analysis was conducted with productivity (h-index), experience (years in publication) and one's geographic work location as covariates to investigate the role of gender in promotion.

Results

The gender distribution is skewed towards females at the Assistant (62.4% vs. 37.58%) and Associate Professors (70.51% vs. 29.49%) levels, but the gap narrows at the full-professor rank (52.98% vs. 47.02%). The regression model showed significant regional variation in promotion for the Southern (0.35; 95% CI, 0.16–0.79; p = 0.012) and Northeastern (0.24; 95% CI, 0.10–0.57; p = 0.001) regions compared to the West. Active years of publishing (1.18; 95% CI, 1.11–1.27; p < 0.001) and productivity (1.09; 95% CI, 1.06–1.12; p < 0.001) were factors in promotion. The mean HI productivity was comparable between the males and females in the first (4.41 for males and 4.40 for females) and the second decade (13.81 for males and 12.84 for females). However, the gap widened into the third decade (30.27 for males and 26.40 for females), suggesting potential areas for improvement.

Conclusion

While the academic cytopathology workforce is progressing towards gender equity, there is still room for improvement. Our findings suggest that focusing on mid-career professionals(between the second to third decades) by providing additional resources for research and facilitating work–life flexibility can help close the gender gap at the highest level.

Objectives

Immunocytochemistry is often required in the cytologic assessment of malignant serous effusion, particularly for differentiating metastatic carcinoma from mesothelioma. To summarise the diagnostic performance of the monoclonal antibody B72.3, a systematic review and meta-analysis was conducted.

Methods

Five databases were searched for relevant studies and reviewed for data extraction and risk of bias assessment. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under curve of summary receiver operating characteristics (AUC-SROC) were calculated for the diagnostic performance of B72.3. Heterogeneity and publication bias were assessed by the I² index and Deeks' funnel plot.

Results

In total, 19 studies (1159 cases) were included. Overall pooled sensitivity and specificity were 0.76 (0.72–0.79) and 0.90 (0.74–1.00), respectively. The NLR, PLR and DOR were 0.27 (0.21–0.34), 7.66 (< 0.001–20.46) and 28.26 (0–75.96), respectively. The AUC-SROC was 0.98, indicating a good overall diagnostic accuracy for B72.3. Subgroup analysis for adenocarcinoma (0.75, 0.71–0.79), mesothelioma (0.92, 0.85–0.98) and benign/reactive mesothelial cells (0.96, 0.93–1.00) showed similar sensitivity and specificity, while the sensitivity for adenocarcinomas of the gastrointestinal/hepatobiliary tract (0.56, 0.41–0.71) and breast (0.55, 0.38–0.71) was significantly lower. High heterogeneity was observed in the majority of our analyses, while no evidence of publication bias was identified.

Conclusions

B72.3 has an acceptable performance with low sensitivity. With a good specificity, B72.3 may find use in an immunocytochemical panel for excluding benign mesothelial processes.

Objective

The aim of this study was to evaluate the accuracy of detecting malignancies by directly sampled endometrial cytology using globally adopted ThinPrep with a novel preparation technique.

Methods

Medical records and reports of pathology and cytology from June 2019 to March 2022 were reviewed. We selected 112 endometrial cytology specimens using ThinPrep with the novel preparation technique, where the clinical course or pathological samples confirmed negative or positive results. Eight cytotechnologists or cytopathologists examined the cytology specimens and provided reports based on standardised criteria from the descriptive reporting system for endometrial cytology (the Yokohama System).

Results

The 112 specimens were evenly smeared and well prepared, featuring high quality, with no issues hindering microscopic examination. Examiners unfamiliar with endometrial cytology using ThinPrep showed high diagnostic accuracy, demonstrating that this modality of preparation for endometrial cytology is feasible for clinical use.

Conclusions

The novel preparation method using ThinPrep successfully provided high-quality, standardised specimens. Furthermore, employing the Yokohama System enabled high accuracy in detecting endometrial malignancies, even for examiners with minimal experience with this cytological technique. This suggests that ThinPrep-based endometrial cytology can be globally adopted with ease, potentially contributing significantly to the early detection of endometrial cancer.

Objective

To analyse the diagnostic role of trefoil factor-1 and -3 (TFF1, TFF3), forkhead box protein A1 (FOXA1), carbonic anhydrase XII (CA XII) and trichorhinophalangeal syndrome type 1 (TRPS1) in serous effusions. The prognostic role of these markers in breast carcinoma was additionally studied.

Methods

Protein expression by immunohistochemistry was analysed in 247 effusions, consisting of 60 breast carcinomas, 54 tubo-ovarian carcinomas, 47 mesotheliomas, 44 lung carcinomas, 20 uterine corpus and cervical carcinomas, 17 gastrointestinal carcinomas and 5 cancers of other origin.

Results

TFF1, TFF3, FOXA1, CA XII and TRPS1 expression was found in 67%, 70%, 88%, 82% and 83% of breast carcinomas, respectively. Expression of all markers was seen in some carcinomas of other origin, most commonly in GI metastases, but was least frequent for TRPS1. CA XII expression was additionally seen in mesotheliomas and reactive mesothelial cells. All 5 markers were significantly overexpressed in breast compared to tubo-ovarian carcinoma (all p < 0.001) and lung carcinoma (all p < 0.001 except for FOXA1, p = 0.023). TFF1 (p = 0.003), TFF3 (p = 0.008) and FOXA1 (p = 0.017) expression was significantly higher in receptor-positive compared to receptor-negative primary breast carcinomas. In survival analysis for 44 breast carcinoma patients with clinical data, TFF1 expression was associated with a trend for longer overall (p = 0.096) and disease-free (p = 0.06) survival.

Conclusion

TFF1, TFF3, FOXA1, CA XII and TRPS1 are sensitive breast carcinoma markers, with FOXA1 performing best in terms of sensitivity and TRPS1 being the most specific. Whether the expression of these markers in breast carcinoma effusions is informative of survival merits further research.

Objective

Despite the growing attention on the use of cytology samples for genetic analysis, the impact of the time from sample collection to fixation, referred to as ‘cold’ ischemic time, has not been sufficiently studied. Therefore, we investigated the quality of nucleic acids prior to fixation in body cavity fluid samples, focusing on the benign/malignant status, differences in collection methods and tumour cell content.

Methods

We analysed 49 body cavity fluid samples collected using different methods: aspiration (n = 21), drainage (n = 5), and surgery (n = 15). The samples were collected from 26 malignant and 23 benign cases. DNA and RNA were extracted from all samples, and their yield and quality were assessed using Agilent TapeStation. Tumour cell content was calculated as the ratio of malignant to benign cells.

Results

DNA and RNA yields were significantly higher in malignant than in benign cases (p < 0.05). Regarding nucleic acid quality, there was a significant difference in RNA quality between malignant and benign cases, but no significant difference in DNA quality. Among the 26 malignant cases, there were significant differences in integrity number (RIN) and RNA percentage of nucleic acid fragments with > 200 nucleotides (DV200) between samples collected via aspiration and surgery (p < 0.05). Tumour cell content (median, 36%; range, 20%–72%) showed no correlation with nucleic acid yield or quality.

Conclusions

This study's findings suggest that DNA extracted from cytology samples is highly stable, while RNA is affected by cold ischemic time. Thus, prompt fixation after collection is necessary to maintain RNA quality.

Fine needle aspiration cytology (FNAC) is a cost-effective, minimally invasive diagnostic tool requiring collaboration among pathologists, radiologists, nurses, and technicians for optimal outcomes. However, interprofessional collaboration remains limited, leading to diagnostic delays and reduced patient satisfaction. This study identifies the need for an interprofessional FNAC training module through a comprehensive needs assessment among the stakeholders involved in FNAC service.

Methods

A mixed-methods approach was used, comprising a retrospective laboratory audit for the quantitative arm (2007 FNAC procedures were audited for diagnostic accuracy, turnaround time, and non-diagnostic aspirates) and focus group discussions (FGDs) and in-depth interviews (IDIs) for the qualitative arm. SPSS Version 20 was used to evaluate the quantitative data, and thematic content analysis was used to analyse the qualitative data.

Results

Quantitative analysis of 2007 FNAC procedure revealed a diagnostic accuracy rate of 87.5%, with 12.5% discordant cases and 4.58% non-diagnostic aspirates. Key issues from qualitative research included incorrect labelling of slides and improper disposal of FNAC items. However, effective collaboration, particularly between laboratory technicians and pathologists, enhanced the smear quality.

Conclusion

This needs assessment highlights critical deficiencies in FNAC services, emphasising the urgency of an interprofessional training module. Addressing gaps in guided FNACs, sample handling, waste disposal, and patient scheduling, the module can enhance diagnostic accuracy, reduce errors, and improve patient care. Implementing this initiative promotes collaboration, fostering a culture of excellence and continuous improvement in healthcare.

Background

Management of axillary lymph nodes (ALNs) in breast cancer patients remains pivotal for staging and planning therapeutic strategies. However, In low-resource settings, achieving accurate axillary staging while avoiding overtreatment remains a challenge as the majority of patients present with advanced stage. In this prospective validation study, we assessed the efficacy of axillary ultrasound (AUS) combined with touch imprint cytology (TIC) for predicting negative axillary status in cT2-3 breast cancer patients.

Methods

This study was a prospective, single-centre validation study conducted in the Breast and Endocrine Unit of the Department of Surgery and the Department of Pathology in a tertiary teaching hospital in central India from September 2022 to April 2024. Eligible participants included adult female patients (aged ≥ 18 years) with core needle biopsy-proven invasive breast cancer classified as cT2-3, cN0, and scheduled for primary surgical treatment. The primary outcomes were the Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the AUS + TIC approach in predicting pathologically negative axillary status.

Results

AUS + TIC had a sensitivity of 100% (95% CI: 47.82%–100%), a specificity of 100% (95% CI: 91.19%–100%) and an overall accuracy of 100% (95% CI: 92.13%–100%). There were no false negatives.

Conclusion

Our findings suggest that the combination of AUS + TIC provides a reliable technique with high diagnostic accuracy, sensitivity, and specificity for assessing ALN in low resource settings.