Acta Cytologica最新文献

Introduction: We aimed to determine the utility of Pipet Curet™ cytology (PCC) and Pipet Curet biopsy (PCB) for diagnosing uterine endometrial endometrioid carcinoma (EEC).

Methods: We divided 77 patients with EEC into two groups per Federation of Gynecology and Obstetrics (FIGO) grades: G1 (n = 44) and G2/3 (n = 33), and compared the diagnostic sensitivity of PCC, PCB, and PCC & PCB combined, retrospectively. Next, we investigated any diagnostic discordance between PCC-based and PCB-based diagnoses per FIGO grade group.

Results: The diagnostic sensitivity of PCC, PCB, and the two modalities combined was significantly higher for G2/3 EECs than for G1 EECs (72.7% vs. 45.5%, p = 0.0209; 84.8% vs. 63.6%, p = 0.0434; and 93.9% vs.65.9%, p = 0.0046, respectively), likely due to more friable cancer cells in higher grade EEC cases. Among our 77 EEC patients, there were four patients (5.19%) with PCC-based concordant but PCB-based discordant results against EEC, in the G2/3 group predominantly. Diagnostic sensitivity of all cases increased from 72.7% (56/77) by PCB alone to 77.9% (60/77) by use of both modalities combined.

Conclusion: Cytologic evaluation can reduce the number of false-negative histologic diagnoses. By providing complementary information, the two modalities combined from the Pipet Curet procedure would be valuable as a diagnostic method for EEC.

Introduction Fine needle aspiration cytology (FNAC) of lymph node is sensitive for detection of metastatic carcinoma but not without a significant false negative rate. This study reviews clinicocytological features of negative node aspirates to identify predictive factors for establishing adequacy criteria. Methods Negative FNAC specimens matched with neck dissection from a primary diagnosis of head and neck squamous cell, or undifferentiated (nasopharyngeal) carcinoma were reviewed for clinical and cytological parameters including lymphoid, inflammatory, and background components. Results Slides from 86 lymph node aspirates including 50 positive for metastasis on follow-up were retrieved. Higher total lymphocyte count, lymphoid fragment count, germinal center fragment count, undifferentiated histology, presence of histiocytes and absence of blood were associated with a true negative cytologic diagnosis (p<0.05), but not node size or location (p>0.05). Undifferentiated histology, small lymphoid and germinal center fragments were independent factors indicative of a true negative diagnosis (p<0.05). Large lymphoid fragments (p=0.052) demonstrated a trend. Assessment of lymphoid components over five hotspots high power fields (HFPs) were more robust in predictive value than only one hotspot. Receiver operating characteristic curve identified >10 small lymphoid, >20 large lymphoid and >2 germinal center fragment per five HPFs as optimal adequacy thresholds. Stricter total lymphocyte count cutoff accompanies increase of diagnostic accuracy, up to 0.67 for ≥5 HPFs with >500 lymphocytes. Conclusion Total counts of lymphoid and germinal center fragments from multiple HPFs are useful in adequacy assessment of lymph node aspirates and improves diagnostic performance of FNAC in exclusion of metastatic carcinoma.

Introduction: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a modern and minimally invasive technique to acquire diagnostic material from within the gastrointestinal tract, as well as from adjacent organs and structures, which can help in the diagnosis and staging of a variety of gastrointestinal malignancies, as well as for non-malignant conditions. Though well described in adults, there is limited literature on the diagnostic utility of EUS-FNA in paediatric patients. The objective of this study is evaluate the diagnostic accuracy and clinical utility of EUS-FNA in paediatric patients performed at our centre over the last 17 years.

Materials and methods: After obtaining IRB approval, 63 cases of paediatric EUS-FNA performed at SKMCH&RC from 2005 to 2022 were retrieved. A 22-gauge EUS-FNA needle was used for obtaining samples with use of suction (when required). The sample was then smeared onto glass slides, with half being stained with RAPI stain while the rest with the Papanicolaou stain. Demographic details, indication for the procedure, results of rapid on-site adequacy status(ROSE), site of lesion and cytological diagnosis were reviewed and analysed.

Results: Of the 63 patients, 55 (87.3%) had an adequate sample (confirmed on ROSE). 42 (66.7%) were male and the mean age was 12.4 years. The most frequent indication of EUS-FNA was sampling of enlarged lymph nodes (74.6%). The most common sites of nodal aspiration were subcarinal (33.3%) and celiac lymph nodes (14.3%). EUS-FNA of a pancreatic lesion accounted for an additional 17.5% of cases. Involvement by Hodgkin's lymphoma was the most common diagnosis (25.4%) followed by granulomatous inflammation (19.1%). Cases of solid pseudo-papillary tumor (4.8%) and recurrent Wilm's tumor (3.2%) were also diagnosed. No patient suffered complications, and none required hospital admission, post procedure. The sensitivity, specificity, PPV and NPV of EUS-FNA were 98.1, 83.3, 96.4 and 90.9% respectively.

Conclusion: EUS-FNA is a safe, well-tolerated, minimally invasive out-patient setting procedure with high sensitivity and significant utility in the diagnosis and staging of disease.

Introduction This study conducts the first meta-analysis to evaluate the diagnostic accuracy and the aggregated risk of malignancy associated with each category of the Papanicolaou Society of Cytopathology (PSC) system for reporting respiratory cytology. Methods A systematic search was conducted in PubMed, Scopus, and Web of Science using the keywords "(Lung, Respiratory specimens) AND (Papanicolaou Society of Cytopathology System)." Articles were assessed for risk of bias using the QUADAS-2 tool. After excluding inadequate samples, sensitivity and specificity for various cut-off points. Summary receiver operating characteristic (sROC) curves and diagnostic odds ratios (DOR) were pooled to assess diagnostic accuracy. Results Five studies, totaling 3489 cases, were included. Sensitivity and specificity for the "Atypical and higher risk categories" considered positive were 60% (95% CI, 51%-68%) and 87% (95% CI, 81%-92%), respectively. For the "Suspicious for malignancy and higher risk categories" considered positive, sensitivity and specificity were 49% (95% CI, 40%-58%) and 95% (95% CI, 92%-97%), respectively. Sensitivity and specificity for the "Malignant" category considered positive for malignancy were 42% (95% CI, 33%-52%) and 97% (95% CI, 92%-99%), respectively. The pooled Area Under the Curve (AUC) ranged from 68% to 75% for each cut-off. Conclusion This meta-analysis underscores the PSC system's accuracy in reporting respiratory cytology. It highlights the diagnostic importance of the "Suspicious" and "Malignant" categories in identifying malignancy, and the utility of the "Atypical" category for initial screening. These findings support the PSC system's role in enhancing diagnostic accuracy and clinical decision-making in respiratory cytology.

Introduction: Xylene (XL) is the most commonly used clearing agent in Papanicolaou staining. XL is hazardous and toxic chemical and prolonged exposure to XL can cause many ill-health effects. The health risk due to XL can be minimized by substituting XL with less hazardous clearing reagents such as Pine Oil (PO), Eucalyptus oil (EO), or Limonene (LM). The objective of this study was to compare the clearing ability, staining quality, preservation of morphology, physical properties, and cost of XL, PO, EO, and LM.

Methods: Four smears were prepared from each of 50 serous effusions and were subjected to Papanicolaou stain. Out of four smears, one each was exposed to clearing specifically with XL (control), PO (test), EO (test), and LM (test). Test smears were compared with control for clearing, staining and morphology; graded as excellent, good or fair and further scored as 3, 2, 1, and the quality index (QI) was calculated. Statistical analysis was performed and the p value was calculated. In addition, the physical properties and cost of all the reagents were compared.

Results: QI was 0.96 for both XL and PO, whereas 0.92 and 0.54 for EO and LM, respectively. Compared to XL, the quality of staining, clearing and morphology of PO and EO were statistically not significant, whereas the difference was statistically significant with LM (p = 0.005). Physical properties such as volatility, flammability, miscibility with alcohol and DPX and the refractive indices of all the reagents were almost similar and all were recyclable. Odor was pungent for XL and EO but was pleasant for PO and LM. The cost was less for PO as compared to others.

Conclusion: PO was a natural, less hazardous, less toxic, and economical clearing agent and can be considered as a substitute for XL.

Introduction: The World Health Organization 2021 lung cancer classification highlights the central role of immunohistochemistry (IHC) in diagnostic pathology. Despite traditional IHC being essential, its limitation to one marker per tissue section brings challenges, particularly when facing cytological limitedly sized samples. To overcome these challenges, multiplex immunocytochemistry (mICC) techniques offer the simultaneous detection of multiple markers from a single section. These advances complement the highly complex imaging techniques that enable additional analyses of cellular interactions.

Methods: The present study outlines a comprehensive mICC methodology of an automated multiplex immunoperoxidase staining method and multiple tissue hybrid controls for ICC/mICC. Protocols are presented in detail and demonstrate a careful approach to optimizing various markers for diagnostic workup including immunotherapy.

Conclusion: Multiplex IHC/ICC emerges as a transformative force in biomedical diagnostics and research. Beyond simultaneous marker detection, it unravels complexities within tissues - unveiling co-localization nuances, deciphering expression patterns, and enhancing understanding of cellular populations. As personalized treatments gain prominence, the study emphasizes the heightened importance of diagnostic tools and sample adequacy. The present methodological study, encapsulating an automated multiplex immunoperoxidase staining method, symbolizes a stride towards precision in pulmonary carcinoma diagnosis. Multi-tissue controls represent a key element in quality assurance in pathology laboratories.

Introduction: Sarcomas presenting as malignant effusions are rare, and diagnosing them on fluid cytology requires expertise and clinicoradiological correlation as cells undergo morphological changes, mimicking carcinoma or mesothelioma.

Case presentation: We present a case of a 70-year-old man with abdominal distention and pain, initially suggestive of carcinoma on peritoneal fluid cytology. However, subsequent analysis with immunohistochemistry on the cell block revealed diffuse nuclear positivity for MDM2, leading to the diagnosis of dedifferentiated liposarcoma.

Conclusion: The cytological diagnosis of dedifferentiated liposarcoma is challenging and requires a high index of suspicion, with clinicoradiological correlation. Utilizing immunohistochemistry on cell block samples enhances diagnostic accuracy and guides appropriate patient management.

Introduction: Standardized basic morphology and the algorithmic approach make the Paris System (TPS) for Reporting Urinary Cytology understandable and applicable. This study examined how well the TPS categories are understood by pathology residents and how well these criteria are enabling them reaching accurate diagnosis.

Materials/methods: A hundred consecutive cases representing all categories were selected. Authors reevaluated slides using TPS regardless of their original diagnosis. In the next step, the TPS was explained to four residents and trained them by five optimal urine cytology samples from each category. Then they were asked to diagnose the selected slides according to the TPS. The diagnoses were compared to authors. The agreement was assessed using kappa. Discordant diagnoses were classified as high and low impact based on potential on clinical practice.

Results: The sensitivity of authors was 62.8%, and residents' were 24-31.8%. The specificity of authors was 98.8%, and residents' were 82.3-92.8%. Reproducibility of TPS was 40-46%. Kappa values were below 0.40 except for one resident. The highest rate of concordance was for negative for high-grade urothelial carcinoma (NHGUC): authors assigned 38 NHGUC (35 biopsy-proven benign cases). Twenty to twenty-six of them were assigned as NHGUC by residents. While authors assigned 42 cases as suspicious for high-grade urothelial carcinoma (SHGUC) or high-grade urothelial carcinoma (HGUC) (35 biopsy-proven malignant cases), residents assigned 22-29 of them. Discordant diagnosis with high clinical implication was 56-63%.

Conclusion: Diagnostic accuracy rates of junior pathology residents using the TPS were unsatisfactory. The best agreement was observed in NHGUC and HGUC categories. Combining HGUC and SHGUC doubled the sensitivity of residents.

Introduction: Multiplex genetic testing (MGT) has become the mainstream method for genetic mutation testing in the field of lung cancer treatment, but the suitability criteria for MGT biopsy specimens are stringent. Although rapid on-site evaluation (ROSE) is considered a useful method for obtaining the suitable biopsy specimens for MGT, no direct comparisons of ROSE and MGT are available. In this study, we first evaluated the accuracy of MGT and ROSE in our hospital. Then, we explored the potential utility of the cytological findings of ROSE for indicating the adequacy of biopsy specimens for MGT.

Methods: These analyses were performed retrospectively using the data of 74 patients with lung cancer who underwent ROSE at our hospital in 2020-2022.

Results: Regarding the accuracy of MGT, the success rate was 97.9% and the frequency of epidermal growth factor receptor mutation in adenocarcinoma cases was 34.6%. The results of ROSE were then compared with histological diagnoses. The sensitivity and positive predictive value were 95.9% and 100.0%, respectively. To analyze the utility of the ROSE results for determining the adequacy of biopsy specimens for MGT, we determined the tumor fraction in the ROSE preparations (ROSE-T%) and the tumor fraction (B-T%)/tumor cell number (B-TN) in the biopsy specimens. When the threshold of the ROSE-T% was set at 80%, there were statistically significant biases of the B-T% ≥20%/B-TN ≥300 cases between the ROSE-T% ≥80% and <80% groups.

Conclusion: This is the first report to suggest the utility of ROSE-T% in assessing the suitability of biopsy specimens for MGT. This predictive ability may add further value to ROSE and help reduce the time required for diagnostic testing, and thereby the patient burden.

Background: Cytological samples play a critical role in diagnosing advanced-stage tumors and those arising in difficult-to-reach anatomical sites such as the pancreatobiliary tract, lung, thyroid, suprarenal, pelvis, and others such as salivary glands. These samples are often the only available material for accurate diagnosis and for performing ancillary studies, such as immunocytochemistry (ICC) or the detection of molecular biomarkers.

Summary: While the use of immunohistochemistry is well established and standardized on formalin-fixed-paraffin-embedded histological tissue, in cytological samples, it presents unique challenges. Methods used for obtaining and processing these specimens are complex and are not standardized among laboratories. Moreover, there is also diversity in the types of cytological samples potentially suitable for ICC.

Key messages: This review explores the current landscape of ICC practices in European and North American laboratories, highlighting variability in methods and the need for standardization to ensure reliable results and reproducibility of ICC on cytological specimens.