Joshua Jing Xi Li, Joanna Ka Man Ng, Christopher Chan, Charlotte Ho Ying Lau, Joyce Ka Ching Ng, Rachel Lai Ping Lo, Wing Ho Yip, Jenny Chun Li Ngai, Ka Pang Chan
Introduction: Bronchoscopy is a useful diagnostic tool capable of performing core biopsy, forceps biopsy, bronchoalveolar lavage, and bronchial brushing. This study compares the cellularity of bronchial cytology including pre- and post-biopsy lavage by digital image analysis, aiming to increase diagnostic and tumor yield by optimizing the sequence and combination of bronchial biopsy and cytology.
Methods: Alveolar macrophage, bronchial epithelium, and tumor cell cellularity from liquid-based cytology preparations of bronchial brushing and pre-biopsy and post-biopsy bronchoalveolar lavage were annotated on digitized whole-slide images and compared. Secondary analysis on the relationship of tumor cell and non-lesional cell yield was performed.
Results: Overall, 118 cytology specimens from 43 patients were retrieved in total. Bronchial epithelium count was higher in pre-biopsy than post-biopsy lavage (p < 0.01) but not for alveolar macrophages nor tumor cell (p > 0.05). Tumor cell count was higher for bronchial brushing cytology samples than lavage (p = 0.018). The alveolar macrophage count was higher in post-biopsy lavage than bronchial brushing (p = 0.033); otherwise, brushing showed consistently higher bronchial epithelium and tumor cell counts. There were 33 false negative (tumor cell absent) specimens, and the combination of bronchial brushing and pre-biopsy lavage yielded the lowest false negative cases. Correlation between bronchial epithelium and alveolar macrophage counts with tumor cell count was weak (correlation coefficient = -0.168-0.203) except for post-biopsy lavage (correlation coefficient = 0.412-0.479, p < 0.05).
Conclusion: Bronchial brushing yields a greater amount of tumor cell than lavage, and timing lavage before or after core biopsy does not affect tumor cell yield. Combining bronchial brushing and pre-biopsy lavage results in the lowest false negative rate.
{"title":"Digital Image Comparison of Cellular Yield in Bronchial Brushing: Pre- and Post-Biopsy Lavage Cytology.","authors":"Joshua Jing Xi Li, Joanna Ka Man Ng, Christopher Chan, Charlotte Ho Ying Lau, Joyce Ka Ching Ng, Rachel Lai Ping Lo, Wing Ho Yip, Jenny Chun Li Ngai, Ka Pang Chan","doi":"10.1159/000539567","DOIUrl":"10.1159/000539567","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchoscopy is a useful diagnostic tool capable of performing core biopsy, forceps biopsy, bronchoalveolar lavage, and bronchial brushing. This study compares the cellularity of bronchial cytology including pre- and post-biopsy lavage by digital image analysis, aiming to increase diagnostic and tumor yield by optimizing the sequence and combination of bronchial biopsy and cytology.</p><p><strong>Methods: </strong>Alveolar macrophage, bronchial epithelium, and tumor cell cellularity from liquid-based cytology preparations of bronchial brushing and pre-biopsy and post-biopsy bronchoalveolar lavage were annotated on digitized whole-slide images and compared. Secondary analysis on the relationship of tumor cell and non-lesional cell yield was performed.</p><p><strong>Results: </strong>Overall, 118 cytology specimens from 43 patients were retrieved in total. Bronchial epithelium count was higher in pre-biopsy than post-biopsy lavage (p < 0.01) but not for alveolar macrophages nor tumor cell (p > 0.05). Tumor cell count was higher for bronchial brushing cytology samples than lavage (p = 0.018). The alveolar macrophage count was higher in post-biopsy lavage than bronchial brushing (p = 0.033); otherwise, brushing showed consistently higher bronchial epithelium and tumor cell counts. There were 33 false negative (tumor cell absent) specimens, and the combination of bronchial brushing and pre-biopsy lavage yielded the lowest false negative cases. Correlation between bronchial epithelium and alveolar macrophage counts with tumor cell count was weak (correlation coefficient = -0.168-0.203) except for post-biopsy lavage (correlation coefficient = 0.412-0.479, p < 0.05).</p><p><strong>Conclusion: </strong>Bronchial brushing yields a greater amount of tumor cell than lavage, and timing lavage before or after core biopsy does not affect tumor cell yield. Combining bronchial brushing and pre-biopsy lavage results in the lowest false negative rate.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The earliest cytotechnologists are largely unknown.
Summary: In 1943, the book "Diagnosis of Uterine Cancer by the Vaginal Smear" by Papanicolaou and Traut recognized several women who have largely faded from memory. While Mary Papanicolaou and Charlotte Street are familiar names, others like Alberta Kuder and Huldah Boerker, who inadvertently laid the groundwork for the field of cytotechnology, remain obscure. There were also women like Christine Rassias and Adele Reboul who did not receive recognition. Notably, Mrs. Lady Mary G. Papanicolaou, despite her significant contributions both in the lab and at home since 1914, was not acknowledged in her husband's work until the publication of his Atlas in 1954.
Key message: These women set the benchmark for future cytotechnologists, unknowingly shaping the profession as we know it today.
{"title":"The Founding Pioneer Cytotechnologists: The Women Who Assisted George N. Papanicolaou, MD, PhD, Develop the Pap Test for Cervical Cancer Prevention.","authors":"Paul A Elgert","doi":"10.1159/000539566","DOIUrl":"10.1159/000539566","url":null,"abstract":"<p><strong>Background: </strong>The earliest cytotechnologists are largely unknown.</p><p><strong>Summary: </strong>In 1943, the book \"Diagnosis of Uterine Cancer by the Vaginal Smear\" by Papanicolaou and Traut recognized several women who have largely faded from memory. While Mary Papanicolaou and Charlotte Street are familiar names, others like Alberta Kuder and Huldah Boerker, who inadvertently laid the groundwork for the field of cytotechnology, remain obscure. There were also women like Christine Rassias and Adele Reboul who did not receive recognition. Notably, Mrs. Lady Mary G. Papanicolaou, despite her significant contributions both in the lab and at home since 1914, was not acknowledged in her husband's work until the publication of his Atlas in 1954.</p><p><strong>Key message: </strong>These women set the benchmark for future cytotechnologists, unknowingly shaping the profession as we know it today.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141178650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wilhelmina Conradie, Karin Baatjes, Thifhelimbilu Luvhengo, Johannes Buitendag, Rubina Razack, John Davies, Fabio Crabbia, Amir Afrogheh, Jeanne Lübbe
Introduction: The 6 categories of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) with associated risk of malignancy (ROM) provide evidence-based clinical management guidelines. This study aimed to determine the ROM and accuracy of FNAB in South Africa (SA).
Methods: Thyroid specimens from 3 pathology laboratories registered between January 2015 and December 2019 were considered for inclusion. ROM was obtained per TBSRTC category by cytohistological correlation and dividing the total number of specimens with malignant histology by the total number of cases operated. Accuracy was calculated based on the Bethesda category and eventual malignant histology.
Results: Seventeen thousand seven hundred and seventy-three histology and 4,791 cytology cases were identified. Of the 4,791 cytology cases, 931 (19%) underwent surgery. More than a third (333, 35.8%) of cases were confirmed as malignant following histological assessment, with the majority being benign (584, 62.7%). The ROM for the nondiagnostic and benign categories was 24.3% and 20.5%. The highest ROM was for category VI (91.5%), followed by categories V (69.5%), IV (51.9%), and III (38.8%). Thyroid FNAB had a sensitivity of 73%, specificity of 74%, and overall accuracy of 74%.
Conclusion: Bethesda categories II and IV have a relatively higher ROM in SA compared to findings from other developed countries. The diagnostic accuracy of thyroid FNAB in SA and the high rate of nondiagnostic diagnoses (38%) require further investigation. A national thyroid registry could provide location-specific data to aid the implementation of appropriate local policies and national guidelines for practicing thyroid surgeons.
{"title":"Performance of Thyroid Fine-Needle Aspiration Biopsy in a Low- and Middle-Income Country.","authors":"Wilhelmina Conradie, Karin Baatjes, Thifhelimbilu Luvhengo, Johannes Buitendag, Rubina Razack, John Davies, Fabio Crabbia, Amir Afrogheh, Jeanne Lübbe","doi":"10.1159/000539153","DOIUrl":"10.1159/000539153","url":null,"abstract":"<p><strong>Introduction: </strong>The 6 categories of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) with associated risk of malignancy (ROM) provide evidence-based clinical management guidelines. This study aimed to determine the ROM and accuracy of FNAB in South Africa (SA).</p><p><strong>Methods: </strong>Thyroid specimens from 3 pathology laboratories registered between January 2015 and December 2019 were considered for inclusion. ROM was obtained per TBSRTC category by cytohistological correlation and dividing the total number of specimens with malignant histology by the total number of cases operated. Accuracy was calculated based on the Bethesda category and eventual malignant histology.</p><p><strong>Results: </strong>Seventeen thousand seven hundred and seventy-three histology and 4,791 cytology cases were identified. Of the 4,791 cytology cases, 931 (19%) underwent surgery. More than a third (333, 35.8%) of cases were confirmed as malignant following histological assessment, with the majority being benign (584, 62.7%). The ROM for the nondiagnostic and benign categories was 24.3% and 20.5%. The highest ROM was for category VI (91.5%), followed by categories V (69.5%), IV (51.9%), and III (38.8%). Thyroid FNAB had a sensitivity of 73%, specificity of 74%, and overall accuracy of 74%.</p><p><strong>Conclusion: </strong>Bethesda categories II and IV have a relatively higher ROM in SA compared to findings from other developed countries. The diagnostic accuracy of thyroid FNAB in SA and the high rate of nondiagnostic diagnoses (38%) require further investigation. A national thyroid registry could provide location-specific data to aid the implementation of appropriate local policies and national guidelines for practicing thyroid surgeons.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The WHO System of Reporting Lung Cytopathology proposed a 5-tiered system in 2023. We report the risk of malignancies (ROMs) of bronchial washing/lavage and percutaneous fine-needle aspiration (FNA) specimens. We also evaluated the change of ROMs when image correlation is required.
Methods: Lung cytology cases in 2021 and 2022 with histologic follow-up were included. CT reports were reviewed to identify cases with a solid nodule/tumor but benign cytological findings. These were reassigned from the "benign" to "non-diagnostic" category, and the ROMs were re-estimated.
Results: A total of 1,031 bronchial washing/lavage and 206 FNAs were identified. The ROMs of bronchial washing/lavage were "non-diagnostic" 56.5% (13/23), "benign" 41.9% (320/764), "atypical" 71.7% (71/99), "suspicious for malignancy" 94.7% (72/76), and "malignant" 100% (70/70). The ROMs of FNAs were "non-diagnostic" 66% (33/50), "benign" 58.2% (39/67), "atypical" 70% (28/40), "suspicious for malignancy" 96.2% (25/26), and "malignant" 100% (70/70). When image finding was considered, cases initially assigned as "benign" were re-classified to "non-diagnostic" with decreases in ROMs for the "benign" category.
Conclusions: Malignancy risks associated with the WHO System of Reporting Lung Cytopathology diagnostic groups were reported. Image correlation for the "benign" category led to a decrease in case number and ROM.
{"title":"Evaluating the Risk of Malignancies of the Diagnostic Categories Proposed by the World Health Organization System for Reporting Lung Cytopathology: A 2-Year Single Institutional Experience.","authors":"Wei-An Lai, Chien-Chin Chen","doi":"10.1159/000539154","DOIUrl":"10.1159/000539154","url":null,"abstract":"<p><strong>Introduction: </strong>The WHO System of Reporting Lung Cytopathology proposed a 5-tiered system in 2023. We report the risk of malignancies (ROMs) of bronchial washing/lavage and percutaneous fine-needle aspiration (FNA) specimens. We also evaluated the change of ROMs when image correlation is required.</p><p><strong>Methods: </strong>Lung cytology cases in 2021 and 2022 with histologic follow-up were included. CT reports were reviewed to identify cases with a solid nodule/tumor but benign cytological findings. These were reassigned from the \"benign\" to \"non-diagnostic\" category, and the ROMs were re-estimated.</p><p><strong>Results: </strong>A total of 1,031 bronchial washing/lavage and 206 FNAs were identified. The ROMs of bronchial washing/lavage were \"non-diagnostic\" 56.5% (13/23), \"benign\" 41.9% (320/764), \"atypical\" 71.7% (71/99), \"suspicious for malignancy\" 94.7% (72/76), and \"malignant\" 100% (70/70). The ROMs of FNAs were \"non-diagnostic\" 66% (33/50), \"benign\" 58.2% (39/67), \"atypical\" 70% (28/40), \"suspicious for malignancy\" 96.2% (25/26), and \"malignant\" 100% (70/70). When image finding was considered, cases initially assigned as \"benign\" were re-classified to \"non-diagnostic\" with decreases in ROMs for the \"benign\" category.</p><p><strong>Conclusions: </strong>Malignancy risks associated with the WHO System of Reporting Lung Cytopathology diagnostic groups were reported. Image correlation for the \"benign\" category led to a decrease in case number and ROM.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Digitizing cytology slides presents challenges because of their three-dimensional features and uneven cell distribution. While multi-Z-plane scan is a prevalent solution, its adoption in clinical digital cytopathology is hindered by prolonged scanning times, increased image file sizes, and the requirement for cytopathologists to review multiple Z-plane images. METHODS This study presents heuristic scan as a novel solution, using an artificial intelligence (AI)-based approach specifically designed for cytology slide scanning as an alternative to the multi-Z-plane scan. Both the 21 Z-plane scan and the heuristic scan simulation methods were used on 52 urine cytology slides from three distinct cytopreparations (Cytospin, ThinPrep, and BD CytoRich™ (SurePath)), generating whole-slide images (WSIs) via the Leica Aperio AT2 digital scanner. The AI algorithm inferred the WSI from 21 Z-planes to quantitate the total number of suspicious for high-grade urothelial carcinoma or more severe cells (SHGUC+) cells. The heuristic scan simulation calculated the total numbers of SHGUC+ cells from the 21 Z-plane scan data. Performance metrics including SHGUC+ cell coverage rates (calculated by dividing the number of SHGUC+ cells identified in multiple Z-planes or heuristic scan simulation by the total SHGUC+ cells in the 21 Z-planes for each WSI), scanning time, and file size were analyzed to compare the performance of each scanning method. The heuristic scan's metrics were linearly estimated from the 21 Z-plane scan data. Additionally, AI-aided interpretations of WSIs with scant SHGUC+ cells followed The Paris System guidelines and were compared with original diagnoses. RESULTS The heuristic scan achieved median SHGUC+ cell coverage rates similar to 5 Z-plane scans across three cytopreparations (0.78-0.91 vs. 0.75-0.88, P=0.451-0.578). Notably, it substantially reduced both scanning time (137.2-635.0 seconds vs. 332.6-1278.8 seconds, P<0.05) and image file size (0.51-2.10 GB vs. 1.16-3.10 GB, P<0.05). Importantly, the heuristic scan yielded higher rates of accurate AI-aided interpretations compared to the single Z-plane scan (62.5% vs. 37.5%). CONCLUSION We demonstrated that the heuristic scan offers a cost-effective alternative to the conventional multi-Z-plane scan in digital cytopathology. It achieves comparable SHGUC+ cell capture rates while reducing both scanning time and image file size, promising to aid digital urine cytology interpretations with a higher accuracy rate compared to the conventional single (optimal) plane scan. Further studies are needed to assess the integration of this new technology into compatible digital scanners for practical cytology slide scanning.
简介由于细胞学切片的三维特征和不均匀的细胞分布,将其数字化是一项挑战。虽然多 Z 平面扫描是一种普遍的解决方案,但其在临床数字细胞病理学中的应用却受到扫描时间延长、图像文件体积增大以及细胞病理学家需要查看多个 Z 平面图像等因素的阻碍。通过徕卡 Aperio AT2 数字扫描仪,对来自三种不同细胞制剂(Cytospin、ThinPrep 和 BD CytoRich™ (SurePath))的 52 张尿液细胞学载玻片使用了 21 Z 平面扫描和启发式扫描模拟方法,生成整张载玻片图像(WSI)。人工智能算法从 21 个 Z 平面推断出 WSI,以量化疑似高级别尿路上皮癌或更严重细胞(SHGUC+)的细胞总数。启发式扫描模拟从 21 个 Z 平面扫描数据中计算出 SHGUC+ 细胞的总数。为了比较每种扫描方法的性能,我们分析了性能指标,包括 SHGUC+ 细胞覆盖率(计算方法是将多个 Z 平面或启发式扫描模拟中发现的 SHGUC+ 细胞数除以每个 WSI 21 个 Z 平面中的 SHGUC+ 细胞总数)、扫描时间和文件大小。启发式扫描的指标是从 21 个 Z 平面扫描数据中线性估算出来的。结果启发式扫描的中位 SHGUC+ 细胞覆盖率与三种细胞制备的 5 Z 平面扫描相似(0.78-0.91 vs. 0.75-0.88,P=0.451-0.578)。值得注意的是,它大大减少了扫描时间(137.2-635.0 秒 vs. 332.6-1278.8 秒,P<0.05)和图像文件大小(0.51-2.10 GB vs. 1.16-3.10 GB,P<0.05)。重要的是,与单 Z 平面扫描相比,启发式扫描的人工智能辅助解释准确率更高(62.5% 对 37.5%)。与传统的单(最佳)平面扫描相比,启发式扫描有望以更高的准确率帮助数字尿液细胞学诊断。还需要进一步研究,以评估将这项新技术整合到兼容的数字扫描仪中,用于实际细胞学玻片扫描的情况。
{"title":"Evaluating Urine Cytology Slide Digitization Efficiency: A Comparative Study Using an Artificial Intelligence-Based Heuristic Scanning Simulation and Multiple-Z-Plane Scanning.","authors":"Jen-Fan Hang, Yen-Chuan Ou, Wei-Lei Yang, Tang-Yi Tsao, Cheng-Hung Yeh, Chi-Bin Li, En-Yu Hsu, Po-Yen Hung, Ming-Yu Lin, Yi-Ting Hwang, Tien-Jen Liu, Min-Che Tung","doi":"10.1159/000538985","DOIUrl":"https://doi.org/10.1159/000538985","url":null,"abstract":"INTRODUCTION\u0000Digitizing cytology slides presents challenges because of their three-dimensional features and uneven cell distribution. While multi-Z-plane scan is a prevalent solution, its adoption in clinical digital cytopathology is hindered by prolonged scanning times, increased image file sizes, and the requirement for cytopathologists to review multiple Z-plane images.\u0000\u0000\u0000METHODS\u0000This study presents heuristic scan as a novel solution, using an artificial intelligence (AI)-based approach specifically designed for cytology slide scanning as an alternative to the multi-Z-plane scan. Both the 21 Z-plane scan and the heuristic scan simulation methods were used on 52 urine cytology slides from three distinct cytopreparations (Cytospin, ThinPrep, and BD CytoRich™ (SurePath)), generating whole-slide images (WSIs) via the Leica Aperio AT2 digital scanner. The AI algorithm inferred the WSI from 21 Z-planes to quantitate the total number of suspicious for high-grade urothelial carcinoma or more severe cells (SHGUC+) cells. The heuristic scan simulation calculated the total numbers of SHGUC+ cells from the 21 Z-plane scan data. Performance metrics including SHGUC+ cell coverage rates (calculated by dividing the number of SHGUC+ cells identified in multiple Z-planes or heuristic scan simulation by the total SHGUC+ cells in the 21 Z-planes for each WSI), scanning time, and file size were analyzed to compare the performance of each scanning method. The heuristic scan's metrics were linearly estimated from the 21 Z-plane scan data. Additionally, AI-aided interpretations of WSIs with scant SHGUC+ cells followed The Paris System guidelines and were compared with original diagnoses.\u0000\u0000\u0000RESULTS\u0000The heuristic scan achieved median SHGUC+ cell coverage rates similar to 5 Z-plane scans across three cytopreparations (0.78-0.91 vs. 0.75-0.88, P=0.451-0.578). Notably, it substantially reduced both scanning time (137.2-635.0 seconds vs. 332.6-1278.8 seconds, P<0.05) and image file size (0.51-2.10 GB vs. 1.16-3.10 GB, P<0.05). Importantly, the heuristic scan yielded higher rates of accurate AI-aided interpretations compared to the single Z-plane scan (62.5% vs. 37.5%).\u0000\u0000\u0000CONCLUSION\u0000We demonstrated that the heuristic scan offers a cost-effective alternative to the conventional multi-Z-plane scan in digital cytopathology. It achieves comparable SHGUC+ cell capture rates while reducing both scanning time and image file size, promising to aid digital urine cytology interpretations with a higher accuracy rate compared to the conventional single (optimal) plane scan. Further studies are needed to assess the integration of this new technology into compatible digital scanners for practical cytology slide scanning.","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND The advances of minimally invasive endoscopy-guided procedures that usually yield limited diagnostic material changed pancreaticobiliary cytopathology into one of the most challenging areas of Cytopathology given the abundance of differential diagnoses to be considered when dealing with limited specimens. SUMMARY We describes a few challenging, examples of potential pitfalls in pancreatobiliary cytopathology evaluation collected from a busy academic hospital (tertiary) center. Case 1 illustrates the challenges in handling paucicellular specimens from pancreatic solid lesions in which, differential diagnoses may include acinar cell carcinoma, neuroendocrine tumors, adenocarcinoma, or even benign pancreatic tissue, among others. Case 2 illustrates the pitfalls in evaluating limited specimens from patients with chronic pancreatitis specially when distinguishing exuberant reactive atypia from dysplastic changes is mandatory. Case 3 illustrates pitfalls in distinguishing malignancy from reactive changes in biliary brushing specimens from patients with Primary Sclerosing Cholangitis. Finally, cases 4 and 5 highlight the importance of including the possibility of pancreatic metastasis in the differential diagnoses of some pancreatic lesions. KEY MESSAGES Over time, there has been an increasing demand for pathologists to render diagnoses on limited specimens obtained through minimally invasive procedures which can be frequently challenging even for the most experienced professionals. In many difficult cases, salvaging additional material for a cell block can turn out to be extremely helpful given the possibility of utilizing additional ancillary tests for diagnostic confirmation.
{"title":"Challenges and pitfalls in pancreatobiliary cytopathology.","authors":"Jose Victor Scarpa-Carniello, M. Siddiqui","doi":"10.1159/000538687","DOIUrl":"https://doi.org/10.1159/000538687","url":null,"abstract":"BACKGROUND\u0000The advances of minimally invasive endoscopy-guided procedures that usually yield limited diagnostic material changed pancreaticobiliary cytopathology into one of the most challenging areas of Cytopathology given the abundance of differential diagnoses to be considered when dealing with limited specimens.\u0000\u0000\u0000SUMMARY\u0000We describes a few challenging, examples of potential pitfalls in pancreatobiliary cytopathology evaluation collected from a busy academic hospital (tertiary) center. Case 1 illustrates the challenges in handling paucicellular specimens from pancreatic solid lesions in which, differential diagnoses may include acinar cell carcinoma, neuroendocrine tumors, adenocarcinoma, or even benign pancreatic tissue, among others. Case 2 illustrates the pitfalls in evaluating limited specimens from patients with chronic pancreatitis specially when distinguishing exuberant reactive atypia from dysplastic changes is mandatory. Case 3 illustrates pitfalls in distinguishing malignancy from reactive changes in biliary brushing specimens from patients with Primary Sclerosing Cholangitis. Finally, cases 4 and 5 highlight the importance of including the possibility of pancreatic metastasis in the differential diagnoses of some pancreatic lesions.\u0000\u0000\u0000KEY MESSAGES\u0000Over time, there has been an increasing demand for pathologists to render diagnoses on limited specimens obtained through minimally invasive procedures which can be frequently challenging even for the most experienced professionals. In many difficult cases, salvaging additional material for a cell block can turn out to be extremely helpful given the possibility of utilizing additional ancillary tests for diagnostic confirmation.","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Rhabdomyosarcoma, though rare in the middle ear, necessitates prompt recognition for optimal management. They are malignant mesenchymal neoplasms arising from the embryonic mesenchymal cells of striated skeletal muscles. Case presentation We present a case of a 5-year-old child with massive right mastoid swelling and bloody ear discharge. Cytological examination via fine needle aspiration biopsy revealed features suggestive of a malignant mesenchymal tumor, confirmed on imaging and subsequent histopathology as embryonal rhabdomyosarcoma (ERMS) FNCLCC grade 2. Characteristic cytological findings included spindle-shaped cells in a myxoid stroma with tigroid background, aiding in early diagnosis. Despite radical mastoidectomy and adjuvant chemotherapy, ERMS in the middle ear remains challenging due to its aggressive nature and potential complications. Conclusion This case underscores the importance of cytological evaluation in identifying rare soft tissue tumors like ERMS, facilitating timely intervention and improved outcomes. Early recognition and multidisciplinary management are crucial in addressing the complexities of ERMS in uncommon sites like the middle ear.
{"title":"Cytomorphological Insights into Embryonal Rhabdomyosarcoma: A Rare Case in the Middle Ear.","authors":"A. Khan, Sana Ahuja, S. Zaheer","doi":"10.1159/000538809","DOIUrl":"https://doi.org/10.1159/000538809","url":null,"abstract":"Introduction Rhabdomyosarcoma, though rare in the middle ear, necessitates prompt recognition for optimal management. They are malignant mesenchymal neoplasms arising from the embryonic mesenchymal cells of striated skeletal muscles. Case presentation We present a case of a 5-year-old child with massive right mastoid swelling and bloody ear discharge. Cytological examination via fine needle aspiration biopsy revealed features suggestive of a malignant mesenchymal tumor, confirmed on imaging and subsequent histopathology as embryonal rhabdomyosarcoma (ERMS) FNCLCC grade 2. Characteristic cytological findings included spindle-shaped cells in a myxoid stroma with tigroid background, aiding in early diagnosis. Despite radical mastoidectomy and adjuvant chemotherapy, ERMS in the middle ear remains challenging due to its aggressive nature and potential complications. Conclusion This case underscores the importance of cytological evaluation in identifying rare soft tissue tumors like ERMS, facilitating timely intervention and improved outcomes. Early recognition and multidisciplinary management are crucial in addressing the complexities of ERMS in uncommon sites like the middle ear.","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Puga, Inês Poças Ferreira, José Ricardo Brandão, Liliana Fonseca, André Couto de Carvalho, Cláudia Freitas
INTRODUCTION Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. METHODS This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. RESULTS A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]). CONCLUSION The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.
{"title":"Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study.","authors":"F. Puga, Inês Poças Ferreira, José Ricardo Brandão, Liliana Fonseca, André Couto de Carvalho, Cláudia Freitas","doi":"10.1159/000538290","DOIUrl":"https://doi.org/10.1159/000538290","url":null,"abstract":"INTRODUCTION\u0000Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles.\u0000\u0000\u0000METHODS\u0000This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups.\u0000\u0000\u0000RESULTS\u0000A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]).\u0000\u0000\u0000CONCLUSION\u0000The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Cytopathology is integral to the investigation and diagnosis of respiratory disease and, in the last decade or so, transbronchial needle aspiration by endobronchial ultrasound has made possible diagnosis and staging of malignant thoracic tumours at a single procedure. In addition, interventional teams increasingly include cytopathologists and cytotechnologists who, by providing rapid onsite evaluation, ensure efficient sampling of intrathoracic targets with the ultimate goal of accurate diagnosis as well as sufficient material for comprehensive predictive testing. Nonetheless, "traditional" cytological investigations such as bronchial washings, brushings and lavages are still carried out for investigation of both suspected neoplastic and non-neoplastic conditions and all these procedures still produce specimens in which florid benign cells mimic malignancy while truly neoplastic cells lurk quietly in the background. Furthermore, even when neoplasia is not suspected, issues in preparation and interpretation may render a final assessment inaccurate and, therefore, clinically unhelpful, or misleading. In this overview, we have tried to adopt a format partly modelled on the passage of a specimen from clinical acquisition to laboratory endpoint and thus taking in potential pitfalls in communication, clinical interaction, transport, and clinic-based preparation as well as in morphology, immunocytochemistry and suitability for predictive testing. It is not exhaustive but highlights areas that may frequently be encountered or are part of our personal experience. Summary The account highlights potential pitfalls in respiratory cytopathology at key stages of the process from acquisition to reporting and presents these in both flow diagram and tabular form. We hope this is useful for the increasingly collaborative roles of cytotechnologist and cytopathologist and their wider involvement in the clinical investigative teams. Key messages Correct clinical and radiological information is crucially important and promotes the correct acquisition and processing of cytopathological specimens. Cross-discipline collaborative working ensures the most efficient use of the specimen such that diagnoses, and predictive tests are performed on optimal material, reducing the potential for misinterpretation. Nonetheless, even with optimal material, morphological mimics and atypical antigen expression may mislead and render accurate diagnosis challenging.
{"title":"Pitfalls in Respiratory Tract Cytopathology.","authors":"Leonie Wheeldon, Anthony Maddox","doi":"10.1159/000538463","DOIUrl":"https://doi.org/10.1159/000538463","url":null,"abstract":"Background Cytopathology is integral to the investigation and diagnosis of respiratory disease and, in the last decade or so, transbronchial needle aspiration by endobronchial ultrasound has made possible diagnosis and staging of malignant thoracic tumours at a single procedure. In addition, interventional teams increasingly include cytopathologists and cytotechnologists who, by providing rapid onsite evaluation, ensure efficient sampling of intrathoracic targets with the ultimate goal of accurate diagnosis as well as sufficient material for comprehensive predictive testing. Nonetheless, \"traditional\" cytological investigations such as bronchial washings, brushings and lavages are still carried out for investigation of both suspected neoplastic and non-neoplastic conditions and all these procedures still produce specimens in which florid benign cells mimic malignancy while truly neoplastic cells lurk quietly in the background. Furthermore, even when neoplasia is not suspected, issues in preparation and interpretation may render a final assessment inaccurate and, therefore, clinically unhelpful, or misleading. In this overview, we have tried to adopt a format partly modelled on the passage of a specimen from clinical acquisition to laboratory endpoint and thus taking in potential pitfalls in communication, clinical interaction, transport, and clinic-based preparation as well as in morphology, immunocytochemistry and suitability for predictive testing. It is not exhaustive but highlights areas that may frequently be encountered or are part of our personal experience. Summary The account highlights potential pitfalls in respiratory cytopathology at key stages of the process from acquisition to reporting and presents these in both flow diagram and tabular form. We hope this is useful for the increasingly collaborative roles of cytotechnologist and cytopathologist and their wider involvement in the clinical investigative teams. Key messages Correct clinical and radiological information is crucially important and promotes the correct acquisition and processing of cytopathological specimens. Cross-discipline collaborative working ensures the most efficient use of the specimen such that diagnoses, and predictive tests are performed on optimal material, reducing the potential for misinterpretation. Nonetheless, even with optimal material, morphological mimics and atypical antigen expression may mislead and render accurate diagnosis challenging.","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140755375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-05-24DOI: 10.1159/000539418
Helen J Trihia, Philippe Vielh
{"title":"Pitfalls in Cytopathology.","authors":"Helen J Trihia, Philippe Vielh","doi":"10.1159/000539418","DOIUrl":"10.1159/000539418","url":null,"abstract":"","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}