Acta Cytologica最新文献

Background: Blastemal tumours are quite frequent malignancies in childhood. In many oncological centres, fine needle aspiration is a part of the specific diagnostic procedure. In this review, the cytological features of the most common entities - i.e., neuroblastic tumours, nephroblastomas, retinoblastomas, and hepatoblastomas - are covered.

Summary: Blastemal tumours are composed of blastemal cells, which are frequently rounded or oval. This morphological similarity among different entities requires detailed clinical and radiological information for accurate diagnosis. Cytological specimens play a crucial role, especially when histological specimens are not available or in cases where a prompt initiation of treatment is needed.

Key messages: Cytological smears are highly cellular and show specific patterns for accurate histological typing. The hypercellularity of cytological specimen allows for the use of high-quality material for ancillary techniques, which are important for assessing several prognostic factors.

Introduction: Paediatric breast lesions are rare and mostly benign. Despite their benign nature, the presence of these lesions in this population often raises concerns. Fine-needle aspiration biopsy (FNAB) offers a minimally invasive, though its application in paediatric populations remains debated due to interpretative challenges. This systematic review aims to assess the utility, limitations, and diagnostic performance of FNAB in the evaluation of paediatric breast lesions.

Methods: A systematic search was performed in PubMed for articles published from January 2014 to February 2025. Non-humans and non-English language reports were excluded. Based on title and abstract screening, 25 articles were selected, and 13 additional articles were retrieved through reference list, yielding a total of 38 studies for qualitative analysis. Data were manually extracted and synthesized.

Results: Benign lesions represented the majority of cases, with fibroadenomas being the most frequent (65%-95%), followed by benign phyllodes tumours, hamartomas, tubular adenomas, pseudoangiomatous stromal hyperplasia (PASH), and cystic lesions. Malignant lesions were rare and included metastatic tumours, malignant phyllodes tumours, secretory carcinoma, and primary breast sarcomas. FNAB demonstrated high diagnostic accuracy for benign lesions but showed limitations in distinguishing benign from malignant tumours. ROSE was identified as a valuable adjunct, improving sample adequacy, reducing the rate of inconclusive results, and enhancing diagnostic reliability.

Conclusion: FNAB is an effective first-line diagnostic modality for paediatric breast lesions, offering high accuracy for benign conditions. However, limitations exist in discriminating borderline and malignant lesions, warranting correlation with clinical, radiological findings, and, in some cases, core biopsy confirmation. The integration of ROSE enhances FNAB diagnostic yield and may further refine management strategies. A multidisciplinary approach remains essential to ensure optimal, minimally invasive care for paediatric patients.

Introduction: Spindle cell lesions in the head and neck often mimic sarcomas but may include a wide range of benign and malignant entities. Fine-needle aspiration (FNA) is a minimally invasive method used to evaluate such lesions, though cytological interpretation can be challenging due to overlapping features.

Methods: This retrospective study included 12 primary spindle cell lesions of the head and neck, selected based on inclusion/exclusion criteria. Papanicolaou and May-Grünwald-Giemsa stains were used for smear evaluation. Cell blocks were prepared, and cytological diagnoses were compared with histopathological outcomes.

Results: The 12 cases were diagnosed as follows: nodular fasciitis (n = 2), schwannoma (n = 2), malignant peripheral nerve sheath tumor (n = 1), leiomyosarcoma (n = 1), liposarcoma (n = 1), rhabdomyosarcoma (n = 1), osteosarcoma (n = 3), and chondroblastoma (n = 1). Cytological features showed moderate correlation with final histology.

Conclusion: FNA is a valuable, cost-effective tool for evaluating spindle cell lesions in the head and neck. While morphological overlap poses diagnostic limitations, ancillary techniques and molecular studies enhance its accuracy and clinical utility.

Introduction: Renal cell carcinoma frequently metastasizes to multiple sites, which often poses significant diagnostic challenges, particularly when the primary tumor is unknown or occult. This retrospective study analyzed 43 fine-needle aspiration (FNA) cases of metastatic ccRCC from a single institution to characterize metastatic patterns and evaluate the diagnostic utility of cytology combined with immunocytochemistry.

Methods: We retrospectively reviewed FNA cases diagnosed as metastatic RCC from January 2003 to December 2024. Cytopathological evaluation included cellularity, architectural patterns, cytoplasmic and nuclear features, background elements, and immunocytochemical analysis when available.

Results: Cytology demonstrated excellent diagnostic performance. The majority of cases were reported as malignant (91%), while the remaining 9% were classified as suspicious for malignancy or atypia of undetermined significance. Notably, in 42% of cases, FNA established the initial diagnosis of RCC, highlighting its value in detecting occult primary tumors. Diagnostic accuracy relied on cytomorphologic evaluation, complemented by immunocytochemical profiling, which was performed on cell blocks in 60.4% of cases.

Conclusion: Key markers such as PAX8, CD10, and RCCma were critical in confirming renal origin and differentiating ccRCC from morphologically similar neoplasms in each organ. FNA cytology, corroborated by focused immunocytochemistry, plays a key role in diagnosing metastatic ccRCC, particularly when the presentation is uncommon or the primary tumor is hidden. This integrated method supports effective clinical management, avoiding unnecessary surgery in cases that may benefit from systemic therapy.

Introduction: Oral squamous cell carcinoma (OSCC) is the most prevalent oral malignant neoplasm. Cytopathology may represent an important tool in the screening of OSCC, and liquid-based oral brush cytology (LBOBC) has been widely studied because of its clearer cell sample results. These cytopathological analyses could be more efficient with the aid of artificial intelligence. The objective of this study was to analyze the effectiveness of two AI models (Papanicolaou and AgNOR Slide Image Examiners) in LBOBC analyses.

Methods: Two human evaluators and the AI models performed cell maturation pattern analysis and mean nucleolar organizer region (NOR) per nucleus count in Papanicolaou and silver-stained nucleolar organizer region (AgNOR) oral cytopathological samples of 20 individuals, respectively. Inter-evaluator agreement was evaluated by kappa and intraclass correlation coefficient. Chi-square and Wilcoxon matched-pairs/Friedman tests analyzed differences between the conventional and LBOBC methods and among evaluators.

Results: Kappa between the Papanicolaou AI model and each human researcher was substantial (k = 0.69) for the conventional method and moderate for the LBOBC (k = 0.55-0.53. There were statistical differences in the cellular type analysis between cytology methods and among evaluators (p < 0.001). The automated AgNOR model showed an excellent/highly good agreement with human evaluators for NOR count in both cytology methods, with and without bounding boxes. There was no statistical difference in the NOR count between methods (p > 0.05). In the conventional method, there were differences among evaluators (p < 0.05); in the LBOBC, there were not (p > 0.05).

Conclusion: The AgNOR automated model is reliable when assessing NOR count in oral samples processed by different cytological methods, when compared to the human analysis. The Papanicolaou model still needs more training with LBOBC samples.

Introduction: Fine-needle aspiration cytology (FNAC) reporting systems for adrenal gland cytology lack global uniformity. Implementing a standardized global reporting system would improve diagnostic accuracy, risk assessment, clinical communication, and uniformity in adrenal gland cytology practices worldwide. The current systematic review and meta-analysis aimed to assess the proposed WHO-standardized reporting categories for adrenal gland cytology and evaluate the role of FNAC in adrenal lesion diagnosis.

Material and methods: A comprehensive search was conducted in PubMed, Scopus, and Embase databases up to June 2024. Studies with more than 15 patients were included. The QUADAS-2 tool was employed for quality assessment of the selected studies. Heterogeneity and publication bias among the studies were also evaluated. Cytological categories were recategorized according to the proposed WHO reporting system. Pooled sensitivity, specificity, and risk of malignancy (ROM) ranges for each cytological category were calculated.

Results: Fifteen studies met the inclusion criteria. Pooled diagnostic performance across studies showed high sensitivity (92.2%) and high specificity (99.5%). Heterogeneity and publication bias were low. Range and pooled ROM across cytology categories were as follows: inadequate/nondiagnostic/unsatisfactory - 0% to 100% (18%), benign - 0% to 14.7% (3.7%), atypical category - 0% to 50% (46.2%), "suspicious for malignancy" - 0% to 100% (76.5%), and malignant category - 94.4% to 100% (99.6%).

Conclusion: High sensitivity and specificity, as well as ROM values across categories, demonstrate that the proposed WHO cytological categories offer reliable risk stratification for adrenal lesions, supporting accurate diagnosis and treatment decisions. The low heterogeneity and minimal publication bias ensure that the findings are applicable across various clinical settings and patient populations.

Introduction: Birefringence analysis is an essential tool in both histological and cytological diagnostics, particularly with stains such as picrosirius red for collagen and Congo red for amyloid. However, polarized light microscopy remains limited in many laboratories due to cost and accessibility barriers. We describe a low-cost "do-it-yourself" (DIY) approach using commercial polarizing films to adapt a standard brightfield microscope for birefringence visualization.

Methods: Thirty gastrocnemius muscle sections stained with picrosirius red were analyzed using both a commercial polarized light system and the DIY setup. Quantitative image analysis was performed with ImageJ, and agreement between methods was assessed with ROC curve analysis.

Results: The DIY method achieved an AUC of 0.6252 (p = 0.0309) and 99% inter-observer concordance, demonstrating fair agreement with the commercial system.

Conclusion: This simple, validated method expands access to birefringence-based diagnostics and has potential applications in cytological contexts, such as amyloid detection in fine-needle aspirates and collagen assessment in cytospin preparations.

Introduction: Bronchoalveolar lavage (BAL) brings an important contribution in diagnosing pulmonary diseases. The analysis of standard cell distribution and the assessment of iron-laden macrophages (the Golde score) are integral to standard medical reports. However, the traditional cytological method of manual cell counting is subject to interobserver variability and staining quality issues.

Methods: To address these issues, we trained AI-based algorithms to enhance the accuracy of differentiated cell counts of macrophages, lymphocytes, neutrophils, eosinophils, ciliated cells, and squamous cells as well as the Golde score, which assesses the hemosiderin content in macrophages. For this purpose, we assembled an internal sample cohort with 16 Hemacolor, 16 Papanicolaou, and 5 iron-stained smears. For validation, we used 10 slides each of Papanicolaou and Hemacolor staining and 5 with iron staining.

Results: The algorithm achieved fair to excellent correlation compared to two cytologists: For Papanicolaou staining, the correlations were macrophages 0.96, lymphocytes 0.98, neutrophil granulocytes 0.99, eosinophils 0.58, ciliated cells 0.61, squamous cells 0.31. In Hemacolor staining the correlations were macrophages 0.97, lymphocytes 0.92, neutrophils 0.99, eosinophils 0.99, ciliated cells 0.58, squamous cells -0.145. The automated Golde score calculation deviated on average by 19 points from the manual evaluation.

Conclusion: The study demonstrates the potential of AI-supported methods for BAL analysis in diagnostic cytology. The high accuracy in recognizing cell types and calculating the Golde score underlines the benefits of expanding the training data for broader clinical applications. Further research is encouraged to support the use of digital cytology on conventional smears in clinical practice.

Cornflake artifacts that appear in cervical cytology are formed by a poorly dehydrated series of Papanicolaou (Pap) stains and dried before mounting. This study focused on the humidity conditions during Pap staining to investigate the cause of the appearance of cornflake artifacts in Pap smears. One SurePath™ liquid-based cytology cell specimen, diagnosed as negative for intraepithelial lesions or malignancy and human papillomavirus using the uniplex E6/E7 PCR method, was used. The draft humidity was adjusted to 30%, 50%, 70%, and 80%. Subsequently, poorly dehydrated series of Pap staining according to the method was performed. After the last xylene immersion, smears that were not dried and dried after 1, 3, and 5 min were mounted. Cornflake artifacts were not observed in smears that had not been dried and dried for 1 min under any humidity condition. In the smear dried for 3 min before mounting, cornflake artifacts were observed at only 80% humidity, and the ratio of cornflake artifacts to normal squamous cells was 0.04 corn/nsc. The ratios when smears were dried for 5 min before mounting at 30%, 50%, 70%, and 80% humidity were 6.44, 6.80, 6.53, and 1.46 corn/nsc, respectively. This study revealed that the appearance of cornflake artifacts in Pap stains under poor dehydration conditions is related to high humidity.