Acta Cytologica最新文献

Introduction: This study critically evaluates adherence to Pap test screening practices in cytology-based cervical cancer screening in the state of Amazonas over a 10-year period.

Materials and methods: A retrospective analysis was conducted of the results of cytological screening examinations (Pap test) in Amazonas State from 2013 to 2023. For this purpose, Brazilian public databases Cervical Cancer Information System (SISCOLO) and Cancer Information System (SISCAN) (from The Department of Information and IT of the Unified Health System - DATASUS) were consulted.

Results: There was a decrease in the number of Pap tests performed during the period from 2019 to 2021, likely related to the COVID-19 pandemic. This was followed by a subsequent increase in the post-pandemic period. Notably, in municipalities with fewer than 10,000 annual Pap examinations there was a decrease in the average number of tests when comparing the years 2016-2018 to 2013-2015, and an even greater decrease during the pandemic.

Conclusions: There is considerable variation in utilization of the cytological Pap test across different municipalities. This lack of uniformity throughout the State likely compromises the capacity to detect early stage cervical intraepithelial lesions.

Key words: Cervical cancer screening, cervical cytology, cytology in low-resource settings, Primary screening, Public health.

Thyroid cytopathology, particularly in cases of atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS), suffers from suboptimal sensitivity and specificity challenges. Recent advancements in digital pathology and artificial intelligence (AI) hold promise for enhancing diagnostic accuracy. This systematic review included studies from 2000 to 2023, focusing on diagnostic accuracy in AUS/FLUS cases using AI, whole slide imaging (WSI), or both. Of the 176 studies, 13 met the inclusion criteria. The datasets range from 145 to 964 WSIs, with an overall number of 494 AUS cases ranging from eight to 254. Five studies used convolutional neural networks (CNN), and two used artificial neural networks (ANN). The preparation methods included Romanowsky-stained smears either alone or combined with Papanicolaou-stained or H&E, and Liquid-based cytology (ThinPrep). The scanner models that were used for scanning the slides varied, including Leica/Aperio, Alyuda Neurointelligence Cupertino, and PANNORAMIC™ Desk Scanner. Classifiers used include Feedforward Neural Networks (FFNN), Two-Layer Feedforward Neural Networks (2L-FFNN), Classifier Machine Learning Algorithm (MLA), Visual Geometry Group 11 (VGG11), Gradient Boosting Trees (GBT), Extra Trees Classifier (ETC), YOLOv4, EfficientNetV2-L, Back-Propagation on Multi-Layer Perceptron, and MobileNetV2. Although cytopathology is late in adopting AI, available studies have shown promising results in differentiating between thyroid lesions, including AUS/FLUS. Our review showed that AI can be especially effective in removing sources of errors such as subjective assessment, variation in staining, and algorithms. CNN has been successful in processing WSI data and identifying diagnostic features with minimal human supervision. ANNs excelled in integrating structured clinical data with image-derived features, particularly when paired with WSI, enhancing diagnostic accuracy for indeterminate thyroid lesions. A combined approach using both CNN and ANN can take advantage of their strengths. While AI and WSI integration shows promise in improving diagnostic accuracy and reducing uncertainty in indeterminate thyroid cytology, challenges such as the lack of standardization need to be addressed. This review highlights the heterogeneity in study designs, dataset sizes, and evaluation metrics. Future studies should focus on hybrid AI models, CNNs, ANNs, and standardized methodologies to maximize clinical applicability.

Introduction: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a highly sensitive and accurate method for identifying pancreatic neuroendocrine tumors (PanNETs). However, research on grading and assessing the Ki67 proliferation index in FNA samples is limited.

Methods: This study analyzed 335 EUS-FNA cases performed between 2016 and 2022, of which 12 cases of PanNET were further evaluated. The morphology, Ki-67 index, and grading (G) of cell blocks (CB) obtained from the PanNET aspirations were compared to those of the resected material.

Results: Out of 12 PanNET's with rapid on-site evaluation(ROSE), in FNA samples and CB,7 (58.3%) cases were G1,while 5 (41.7%) cases were G2.On the other hand,resection of these cases,6 (50%) were diagnosed as G1,5(41.7%) cases were G2,and 1 case(8.3%) was G3.The average ki67 index in CB was 2.92(min: 1-max: 10), while in resections it was 4.67(min: 1-max: 22).Only 2(16.6%) showed a discordance between grade and ki67, resulting in an overall concordance of over 80%.On average,1.83 needle passes were made(range: 1-3), while the average number of slides and cell blocks were 9.33(range: 1-24) and 2.17(range: 1-6),respectively.There were no significant differences in the number of passes,slides,or cell blocks between the consistent and discordant groups.

Conclusion: Optimal counting techniques and sensitivity for Ki67 are crucial in grading PanNETs in both aspiration and resection materials.The grade and Ki67 index demonstrated high concordance when comparing CB and resection. However, in low-volume centers, ROSE support can be beneficial in obtaining sufficient slides and cell blocks for an adequate diagnosis.

Introduction: Although the widespread use of screening tests and HPV vaccines for squamous cell carcinoma has led to early detection and treatment, effectiveness is limited for cervical adenocarcinoma. Lobular endocervical glandular hyperplasia (LEGH) corresponds to gastric metaplasia, but is regarded as a pathological condition with subtle morphological abnormalities. LEGH is a benign lesion and a precursor to gastric-type adenocarcinoma. We herein developed an objective and quantitative method by applying an image analysis technique to overcome the difficulties associated with the differential diagnosis of LEGH in uterine cervical cytology. This approach is expected to enable the early detection and accurate diagnosis of LEGH.

Methods: We extracted signal values for the nucleus and cytoplasm from microscopic images of cytological specimens of normal endocervical (EC) and LEGH cells. These values were then converted into CIELAB and sRGB values to create color distribution maps, and color unmixing techniques were applied to assess the spectral absorbance of each pigment.

Results: The CIELAB signal values extracted from the nuclear images of LEGH cells exhibited lower values than those of EC cells. Furthermore, based on color distribution maps, the cytoplasm of EC cells exhibited shades from purple to pink, while LEGH cells showed a distribution towards yellow.

Conclusions: This study reveals that, compared to EC cells, LEGH cells exhibit lower nuclear signal values and increased nuclear chromatin content. Thus, assessing the relative difference in cytoplasmic color tones between them may become an effective indicator for distinguishing between EC and LEGH cells.

Background: The application of immunocytochemistry (ICC), as a diagnostic and predictive tool in the workup of head and neck lesions has followed the changes and progresses in the surgical pathology evaluation. The contribution of ICC has shown a significant role in the head and neck cytology, demonstrating as its contribution can support the diagnosis in many lesions. Furthermore, its role has been evolving as an important asjuvant tool in targeted therapies. An additional useful role is defined by the recent introduction of ICC-markers related to genetic alterations, which has opened the door to the adoption of a surrogate of molecular evaluation also on cytological material. SUMMARY The current review article analyzes the role of ICC in the field of head and neck cytology, showing that it might represent a valid diagnostic tool in difficult cases. The review will include all the different head and neck lesions, demonstrating how we could rely on organ-specific ICC markers but also on ICC markers able to discriminate between benign and malignant lesions.

Introduction: Thyroid and salivary gland cytopathology frequently present diagnostic challenges due to complex presentations, overlapping features between benign and malignant conditions, particularly with grey-zone entities and rare pathologies. To address these issues, the 45th European Congress of Cytology (ECC) held a slide seminar focused on challenging cases. This article reviews key findings from the six cases discussed, emphasizing the importance of a comprehensive diagnostic approach. The objective of this article is to illustrate the diagnostic challenges of rare thyroid and salivary gland lesions through case presentations, showing the need for a comprehensive, multidisciplinary approach to accurately reach a final diagnosis and steer the patient's management.

Case presentation: The seminar presented cases involving fine-needle aspiration cytology (FNAC) followed by histopathological correlation, molecular and cytogenetic analyses or immunohistochemistry (IHC) markers to elucidate cytomorphological features, differential diagnoses, and final diagnoses of rare cases in thyroid and salivary gland cytopathology. Challenging thyroid cytology cases included differentiating thyroid sarcoidosis from malignancy, identifying intrathyroidal ectopic thymus versus lymphoid neoplasms, and recognizing poorly differentiated thyroid carcinoma initially misinterpreted as a benign follicular neoplasm. Complex salivary gland cases addressed the distinction of basal cell adenocarcinoma from adenoid cystic carcinoma, metastatic SMARCB1-deficient carcinoma diagnosed via immunohistochemistry and a parotid mass initially identified as a Warthin tumor.

Conclusion: These cases highlight the critical role of integrating cytological, clinical and histopathological data to navigate the diagnostic complexities of thyroid and salivary gland lesions. A multidisciplinary approach and standardized algorithms are essential for improving diagnostic accuracy and patient outcomes.

Background: Mesothelioma is an aggressive malignancy of the serosal surfaces with very poor prognosis. It traditionally manifests in older patients and at an advanced stage which results in minimal improvement in prognosis despite the recent advances in management. Early detection would therefore significantly impact management and potentially improve survival. Mesothelioma frequently presents with recurrent effusions, posing cytology as the initial procedure in the workup. A definitive diagnosis would not only spare the patients additional diagnostic procedures but also potentially afford them an opportunity for early surgical intervention and therapy.

Summary: In this article we review the role of immunocytochemistry (ICC) in the work up of mesothelioma. The various ICC markers to confirm or rule out mesothelial lineage are reviewed. In addition, newly introduced molecular surrogates that confirm the malignant nature of the mesothelial cells and support a definitive diagnosis of mesothelioma are discussed. We also briefly discuss the theranostic implications of such markers and potential impact of such recent advances on the cytological diagnosis and reporting of mesothelioma.

Key messages: The cytological diagnosis of mesothelioma no longer requires the extensive expertise in morphological analysis and can be offered based on supporting ICC that confirms the mesothelial lineage and malignant nature of the cells.

Introduction: The International Academy of Cytology and the American Society of Cytopathology developed the International System of Serous Fluid Cytopathology (TIS) to standardize cytological reports. Effusions in pleural, peritoneal, and pericardial cavities are valuable sources of information for medical diagnosis, especially in oncological scenarios. The TIS classification is divided into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspected malignancy (SFM), and malignant (MAL). It facilitates global communication between specialists, aiming for future clinical management guidelines based on malignancy risk assessment.

Methods: This quantitative analytical and retrospective study evaluated serous fluids (pleural, pericardial, and peritoneal) sent to the Instituto de Patologia de Araçatuba (IPAT), São Paulo, Brazil, from public and private hospitals between January 2017 and December 2022. Epidemiological and clinical data were collected from institutional files, including biopsies and immunohistochemical results.

Results: The study included 719 patients with 763 serous fluid samples (pericardial, pleural, and peritoneal) analyzed over six years. The majority of samples were from pleural effusions (n = 438; 57.4%), followed by peritoneal (n = 293; 38.4%) and pericardial effusions (n = 32; 4.2%). Samples were classified using the International Serous Fluid Cytopathology System (TIS), revealing the following distribution: ND (0.41%), NFM (70.30%), AUS (0.95%), SFM (11.90%), and MAL (16.44%). The risk of malignancy calculated for each category were ND 66.67%, NFM 23.39%, AUS 28.57%, SFM 48.28%, and MAL 84.17%.

Conclusion: The ROM was out of the interval proposed by the TIS in all categories. These findings suggest the applicability of TIS even outside of the cancer center environment, although the presented ROM frequencies were out of the recommended range.

Introduction: Fine-needle aspiration (FNA) is a valuable diagnostic tool for evaluating breast lesions, yet its use is less frequent compared to core needle biopsies in high-resource settings. This study aimed to assess the diagnostic performance and clinical utility of FNA in correlation with surgical pathology outcomes.

Methods: We performed a 3-year retrospective search (2021-2023) using our institutional database to identify cases of breast mass FNAs performed by interventional radiologists under ultrasound guidance. We retrieved and re-evaluated all glass slides from the archive. Additionally, we reviewed the cytopathology reports and correlated the cytologic diagnoses with concurrent or subsequent surgical pathology results.

Results: A total of 65 breast FNA cases from patients were reviewed. The diagnostic outcomes were 55% negative for malignancy, 23% insufficient for diagnosis, 11% atypical, 8% suspicious for malignancy, and 3% positive for malignancy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of FNA for detecting malignancy were 76%, 96%, 93%, and 85%, respectively. One false positive case, categorized as atypical due to degenerative changes, was later confirmed as benign apocrine metaplasia. Three false-negative cases, initially categorized as non-diagnostic, were later diagnosed as invasive ductal carcinoma, Hodgkin lymphoma, and papillary carcinoma. An additional false-negative case, categorized under negative for malignancy, was later diagnosed as invasive ductal carcinoma.

Conclusion: Breast FNAs, while less frequently performed than core needle biopsies, provide significant diagnostic insights, particularly for cystic lesions. The study demonstrates high specificity and PPV for FNA in detecting malignancy, underscoring its value as a diagnostic tool when integrated with imaging and clinical assessment. These findings support the continued use of FNA in the diagnostic evaluation of breast lesions.

Background: The efficiency of the cytological test largely depends on the control and quality assurance of laboratory procedures, to avoid false results. The objectives of this descriptive review were to point out and discuss the main mechanisms for controlling and ensuring the quality of cytological diagnosis.

Summary: A critical revision was performed to identify the principal challenges involved in the processes of all the main issues related to the morphological alterations that characterize a true-related lesion in the daily routine of the Pap test examination. Principles of QC and QA are already being implemented worldwide, and the positive aspects and limitations of these are discussed as well as proposing alternatives when pertinent. Most of the articles evaluated highlighted the necessity of implementing audit mechanisms to control the performance of the professionals involved with the cytology evaluation.

Key message: Promising data from the new image-based technological arsenal appear to be a remarkable tool for improving cytological evaluation, reducing errors of interpretation and serving as a powerful arm for cytology teaching.