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Accuracy and Reproducibility of Cytology Triage in a HPV-Based Primary Screening Setting: A Revision of 384 Pap Tests. 基于HPV的初筛环境中细胞学分型的准确性和再现性:384项巴氏检测的修订。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-09-26 DOI: 10.1159/000534282
Stefania Cannistrà, Francesca Carozzi, Chiara Di Stefano, Marzia Matucci, Giampaolo Pompeo, Giuseppe Gorini, Donella Puliti, Marco Zappa, Cristina Sani, Massimo Confortini

Introduction: After the transition toward the HPV-based screening protocol, which has led to an increase in sensitivity, and in order to bring the specificity back to acceptable values, cytology underwent a change of approach, becoming a triage test. For these reasons, in the Tuscany region (after the recommendations of the GISCi document), it was decided to reduce, as much as possible, the use of ASC-US category in cytology triage, classifying these morphological cases as negative for intraepithelial lesion or malignancies (NILM) or LSIL, basing on the grade of nuclear atypia. So, in Italy, in a cytology triage context (HPV primary screening), a modified Bethesda system (TBS) is currently used. The aim of this study was to evaluate the performance of the review activity of 384 cytology triage cases and of the cervical cancer screening indicators (sensitivity and specificity for CIN2+ lesions) using the TBS 2014 or the modified TBS.

Materials and methods: 384 HPV positive cases at one-year recall (192 with a cytology result of NILM both at baseline and at one-year recall; 192 with a cytology result of NILM at baseline but abnormal at one-year recall), all with a histologically confirmed result (128 CIN2+, 256 ≤ CIN1), were selected, and their baseline Pap tests were reviewed in blind mode by 5 expert cytologists.

Results: The cytological results of NILM were confirmed for 92.5% and 83.8% of cases using TBS 2014 or modified TBS, respectively. 20/128 CIN2+ cases could have been reported at the baseline cytology triage, causing an anticipatory effect and an improvement in sensitivity of the screening protocol at baseline (+15.6%). Using TBS 2014, the number of false positives more than tripled with respect to the modified TBS 2014, with a significant increase in unnecessary colposcopies (+11.4%).

Conclusion: This work demonstrated that a greater expertise of cytologists, acquired during the following 3 years of experience with cytological triage, and a strong IQC system could lead to the identification of a significant number of lesions reported to baseline rather than at one-year recall (diagnostic anticipation).

引言在向基于HPV的筛查方案过渡后,这导致了灵敏度的提高,为了将特异性恢复到可接受的值,细胞学改变了方法,成为了一种分诊测试。出于这些原因,在托斯卡纳地区(根据GISCi文件的建议),决定在细胞学分型中尽可能减少ASC-US类别的使用,根据细胞核异型性的等级将这些形态学病例分类为NILM或LSIL。因此,在意大利,在细胞学分诊(HPV初级筛查)中,目前使用改良的贝塞斯达系统(TBS)。本研究的目的是评估384例细胞学分诊病例的审查活动以及使用TBS 2014或改良TBS的宫颈癌症筛查指标(CIN2+病变的敏感性和特异性)的表现。材料和方法选择384例一年召回时HPV阳性病例(192例基线和一年召回均为NILM细胞学结果;192例基线为NILM,但一年召回异常),所有病例均具有组织学证实结果(128 CIN2+,256≤CIN1),并由5名专业细胞学家以盲模式审查其基线pap测试。结果使用TBS 2014或改良TBS的NILM细胞学结果分别为92.5%和83.8%。在基线细胞学分型时,本可以报告20/128例CIN2+病例,从而在基线时产生预期效果并提高筛查方案的敏感性(+15.6%)。使用TBS 2014,假阳性数量比改良的TBS 2014增加了两倍多,不必要的阴道镜检查显著增加(+111.4%)。讨论/结论这项工作表明,在接下来的三年细胞学分型经验中,细胞学家获得了更多的专业知识,强大的IQC系统可以识别大量报告到基线的病变,而不是一年的召回(诊断预期)。
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引用次数: 0
The Future Role of Cytology in Cervical Cancer Screening in the Era of HPV Vaccination. HPV疫苗时代细胞学在宫颈癌筛查中的未来作用
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000528964
Julieta E Barroeta

Background: Up until recently, cervical cytology was the mainstay for cervical cancer screening. However, the established association between human papillomavirus (HPV) infection and cervical cancer has led to changes in preventive strategies, with cytology being replaced by the use of high-risk HPV (hrHPV) testing and primary prevention being achieved by HPV vaccination. In this context, the role of cervical cytology is shifting to secondary triage of HPV-positive women. As vaccination is leading to decreased HPV infections and significant cervical abnormalities (CIN2+), data on the impact of HPV vaccination on cervical cytology metrics, including positive predictive value (PPV) and negative predictive value (NPV), are starting to emerge.

Summary: This is a review of updates in cervical cancer screening, including the use of primary HPV testing and the impact of HPV vaccination on cytology as part of cervical cancer screening.

Key messages: Cervical cancer screening and prevention are undergoing significant changes as there is widespread implementation of HPV vaccination and hrHPV testing is becoming the entry point for secondary prevention. Optimal screening approaches and intervals in this setting are currently being analyzed including the use of cytology and other ancillary techniques for triage of positive cases, as well as the effect of vaccination on the PPV and NPV of cytology in the detection of CIN2+.

背景:直到最近,宫颈细胞学是宫颈癌筛查的主要方法。然而,人乳头瘤病毒(HPV)感染与宫颈癌之间的既定联系导致了预防策略的变化,细胞学检查被使用高危HPV (hrHPV)检测所取代,HPV疫苗接种实现了一级预防。在这种情况下,宫颈细胞学的作用正在转移到hpv阳性妇女的二级分诊。由于疫苗接种导致HPV感染减少和明显的宫颈异常(CIN2+),关于HPV疫苗接种对宫颈细胞学指标的影响的数据,包括阳性预测值(PPV)和阴性预测值(NPV),开始出现。摘要:本文回顾了宫颈癌筛查的最新进展,包括使用原发性HPV检测和HPV疫苗接种对细胞学的影响,作为宫颈癌筛查的一部分。关键信息:随着HPV疫苗接种的广泛实施,宫颈癌筛查和预防正在发生重大变化,hrHPV检测正在成为二级预防的切入点。目前正在分析这种情况下的最佳筛查方法和间隔,包括使用细胞学和其他辅助技术对阳性病例进行分诊,以及在检测CIN2+时接种疫苗对细胞学PPV和NPV的影响。
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引用次数: 0
A Practical Approach to Squamous Abnormalities on Cervical Cytology: Overview of Interpretive Criteria and Guidance for Altering Thresholds in Response to Quality Assurance Findings. 宫颈细胞学鳞状异常的实用方法:质量保证结果改变阈值的解释标准和指南概述。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000528531
Michael James Thrall

Background: Squamous intraepithelial lesions observed in Papanicolaou (Pap) test gynecologic cytology arise as a result of infection of the cervicovaginal tract by human papillomavirus (HPV). The viral cytopathic effect of HPV manifests as koilocytosis, also known as low-grade squamous intraepithelial lesion (LSIL) in The Bethesda System (TBS). Integration of HPV genetic material into the genome of squamous cells can, in some women, result in progressive accumulation of mutations and abnormalities of growth and maturation leading to high-grade squamous intraepithelial lesion (HSIL) and possibly invasive squamous cell carcinoma. Due to morphologic overlap between reactive processes and these changes related to HPV, TBS includes equivocal categories that may be applied to Pap tests with uncertain morphology: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot exclude HSIL (ASC-H). Quality assurance (QA) measures in gynecologic cytology laboratories aim to maximize the sensitivity for LSIL and HSIL lesions while simultaneously keeping the use of ASC-US at reasonable levels.

Summary: TBS provides a comprehensive nomenclature for squamous abnormalities encountered in screening, but subjectivity in interpretation remains. QA practices attempt to identify problematic patterns of misinterpretation for correction.

Key message: This review aimed to provide practical recommendations for cytology practitioners seeking to alter their interpretive thresholds for ASC-US, LSIL, and HSIL in response to feedback from QA procedures indicating deviation from desired norms.

背景:在巴氏涂片(Pap)检查中观察到的鳞状上皮内病变是由于人乳头瘤病毒(HPV)感染宫颈阴道道引起的。在贝塞斯达系统(TBS)中,HPV的病毒细胞病变作用表现为koilocylosis,也称为低级别鳞状上皮内病变(LSIL)。在一些女性中,将HPV遗传物质整合到鳞状细胞基因组中可能导致突变的进行性积累和生长和成熟的异常,从而导致高级别鳞状上皮内病变(HSIL)和可能的侵袭性鳞状细胞癌。由于反应过程和这些与HPV相关的变化之间的形态学重叠,TBS包括可用于具有不确定形态的巴氏试验的模糊分类:不确定意义的非典型鳞状细胞(ASC-US)和非典型鳞状细胞不能排除HSIL (ASC-H)。妇科细胞学实验室的质量保证(QA)措施旨在最大限度地提高LSIL和HSIL病变的敏感性,同时使ASC-US的使用保持在合理的水平。总结:TBS为筛查中遇到的鳞状异常提供了一个全面的命名,但在解释上仍然存在主观性。QA实践试图识别有问题的误解模式以进行纠正。关键信息:本综述旨在为寻求改变ASC-US、LSIL和HSIL的解释阈值的细胞学从业者提供实用建议,以响应QA程序表明偏离期望规范的反馈。
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引用次数: 1
The Application of the Proposed Sydney System for Reporting Lymph Node Cytopathology: A Five-Year Experience of an Academic Institution in South India. 建议的悉尼系统报告淋巴结细胞病理学的应用:南印度一个学术机构的五年经验。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000530038
Sakthisankari Shanmugasundaram, Nandhini Bala Balasubramanian, Abinaya Sundari Amirthakatesan

Introduction: Fine needle aspiration biopsy (FNAB) is a routinely used investigation in the evaluation of lymph node pathologies. However, there exists a lack of uniformity in cytopathology reporting owing to the nonavailability of standard guidelines. Recently, a novel system for reporting lymph node cytopathology has been proposed. The present study aimed to analyze the utility of the proposed system in cytopathology reporting in our institution.

Materials: FNABs of lymph nodes performed over a period of 5 years were categorized as per the proposed Sydney system. The diagnoses on cytopathology were correlated with histopathologic diagnoses to assess the diagnostic accuracy. The rate of malignancy (ROM) for each category was calculated.

Results: A total of 747 lymph node FNABs were included in the study. Histopathology was available in 262 cases. ROM in categories I-V was 26.3%, 7.2%, 76.9%, 82.3%, and 100.0%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNAB when considering category L3 to represent benign cytopathology were 84.2%, 97.5%, 97.1%, and 86.2%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNAB when considering category L3 to represent malignant cytopathology were 92.56%, 95.08%, 94.9%, and 92.8%, respectively.

Conclusion: The study substantiates the usefulness of the proposed Sydney system in lymph node cytopathology in enhancing better communication between clinicians and cytopathologists. The use of ancillary techniques like immunocytochemistry and flow cytometry will aid in arriving at a more precise diagnosis.

细针穿刺活检(FNAB)是评估淋巴结病理的常规检查方法。然而,由于缺乏标准指南,细胞病理学报告缺乏统一性。最近,一种新的报告淋巴结细胞病理学的系统被提出。本研究旨在分析该系统在我院细胞病理报告中的应用。资料:5年内进行的淋巴结fnab按照拟议的Sydney系统进行分类。将细胞病理学诊断与组织病理学诊断相比较,评价诊断的准确性。计算每个类别的恶性肿瘤发生率(ROM)。结果:共纳入747例淋巴结fnab。262例进行组织病理学检查。I-V类的ROM分别为26.3%、7.2%、76.9%、82.3%和100.0%。考虑L3分类代表良性细胞病理时,FNAB的敏感性为84.2%,特异性为97.5%,阳性预测值为97.1%,阴性预测值为86.2%。考虑L3类代表恶性细胞病理时,FNAB的敏感性为92.56%,特异性为95.08%,阳性预测值为94.9%,阴性预测值为92.8%。结论:该研究证实了在淋巴结细胞病理学中提出的悉尼系统在加强临床医生和细胞病理学家之间更好的沟通方面的有用性。使用辅助技术,如免疫细胞化学和流式细胞术将有助于达到更精确的诊断。
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引用次数: 0
Deep Learning Neural Network-Guided Detection of Asbestos Bodies in Bronchoalveolar Lavage Samples. 深度学习神经网络引导检测支气管肺泡灌洗样本中的石棉体。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-09-19 DOI: 10.1159/000534149
Antti J Hakkarainen, Reija Randen-Brady, Henrik Wolff, Mikko I Mäyränpää, Antti Sajantila

Introduction: Asbestos is a global occupational health hazard, and exposure to it by inhalation predisposes to interstitial as well as malignant pulmonary morbidity. Over time, asbestos fibers embedded in lung tissue can become coated with iron-rich proteins and mucopolysaccharides, after which they are called asbestos bodies (ABs) and can be detected in light microscopy (LM). Bronchoalveolar lavage, a cytological sample from the lower airways, is one of the methods for diagnosing lung asbestosis and related morbidity. Search for ABs in these samples is generally laborious and time-consuming. We describe a novel diagnostic method, which implements deep learning neural network technology for the detection of ABs in bronchoalveolar lavage samples (BALs).

Methods: BALs with suspicion of asbestos exposure were scanned as whole slide images (WSIs) and uploaded to a cloud-based virtual microscopy platform with a neural network training interface. The images were used for training and testing a neural network model capable of recognizing ABs. To prioritize the model's sensitivity, we allowed it to also make false-positive suggestions. To test the model, we compared its performance to standard LM diagnostic data as well as the ground truth (GT) number of ABs, which we established by a thorough manual search of the WSIs.

Results: We were able to reach overall sensitivity of 93.4% (95% CI: 90.3-95.7%) in the detection of ABs in comparison to their GT number. Compared to standard LM diagnostic data, our model showed equal to or higher sensitivity in most cases.

Conclusion: Our results indicate that deep learning neural network technology offers promising diagnostic tools for routine assessment of BALs. However, at this stage, a human expert is required to confirm the findings.

引言:石棉是一种全球性的职业健康危害,吸入石棉易导致间质性和恶性肺部疾病。随着时间的推移,嵌入肺组织中的石棉纤维可以被富含铁的蛋白质和粘多糖包裹,之后它们被称为石棉体,可以在光学显微镜中检测到。支气管肺泡灌洗是下呼吸道的细胞学样本,是诊断肺石棉肺及其相关发病率的方法之一。在这些样本中寻找石棉尸体通常既费力又耗时。我们描述了一种新的诊断方法,该方法实现了深度学习神经网络技术,用于检测支气管肺泡灌洗样本中的石棉体。方法:将疑似石棉暴露的支气管肺泡灌洗样本扫描为完整的载玻片图像,并上传到具有神经网络训练界面的基于云的虚拟显微镜平台。这些图像被用于训练和测试能够识别石棉尸体的神经网络模型。为了优先考虑模型的敏感性,我们允许它也提出假阳性建议。为了测试该模型,我们将其性能与标准光学显微镜诊断数据以及石棉体的真实数量进行了比较,这是我们通过对整个幻灯片图像进行彻底手动搜索而确定的。结果:与地面真实值相比,我们能够在石棉体检测中达到93.4%(95%CI 90.3-95.7%)的总体灵敏度。与标准的光学显微镜诊断数据相比,我们的模型在大多数情况下显示出同等或更高的灵敏度。结论:我们的研究结果表明,深度学习神经网络技术为支气管肺泡灌洗液样本的常规评估提供了有前景的诊断工具。然而,在这个阶段,需要一位人类专家来确认这些发现。
{"title":"Deep Learning Neural Network-Guided Detection of Asbestos Bodies in Bronchoalveolar Lavage Samples.","authors":"Antti J Hakkarainen, Reija Randen-Brady, Henrik Wolff, Mikko I Mäyränpää, Antti Sajantila","doi":"10.1159/000534149","DOIUrl":"10.1159/000534149","url":null,"abstract":"<p><strong>Introduction: </strong>Asbestos is a global occupational health hazard, and exposure to it by inhalation predisposes to interstitial as well as malignant pulmonary morbidity. Over time, asbestos fibers embedded in lung tissue can become coated with iron-rich proteins and mucopolysaccharides, after which they are called asbestos bodies (ABs) and can be detected in light microscopy (LM). Bronchoalveolar lavage, a cytological sample from the lower airways, is one of the methods for diagnosing lung asbestosis and related morbidity. Search for ABs in these samples is generally laborious and time-consuming. We describe a novel diagnostic method, which implements deep learning neural network technology for the detection of ABs in bronchoalveolar lavage samples (BALs).</p><p><strong>Methods: </strong>BALs with suspicion of asbestos exposure were scanned as whole slide images (WSIs) and uploaded to a cloud-based virtual microscopy platform with a neural network training interface. The images were used for training and testing a neural network model capable of recognizing ABs. To prioritize the model's sensitivity, we allowed it to also make false-positive suggestions. To test the model, we compared its performance to standard LM diagnostic data as well as the ground truth (GT) number of ABs, which we established by a thorough manual search of the WSIs.</p><p><strong>Results: </strong>We were able to reach overall sensitivity of 93.4% (95% CI: 90.3-95.7%) in the detection of ABs in comparison to their GT number. Compared to standard LM diagnostic data, our model showed equal to or higher sensitivity in most cases.</p><p><strong>Conclusion: </strong>Our results indicate that deep learning neural network technology offers promising diagnostic tools for routine assessment of BALs. However, at this stage, a human expert is required to confirm the findings.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41095037","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}
引用次数: 0
Aptima HR-HPV Testing of Cytology Specimens Is an Effective Supplement for p16 Staining to Improve Diagnostic Accuracy for HPV-Related Oropharyngeal Squamous Cell Carcinoma. Aptima HR-HPV细胞学检测是p16染色的有效补充,可提高hpv相关口咽鳞状细胞癌的诊断准确性。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000527951
Xin Yang, Chunfang Hu, Huan Zhao, Zhihui Zhang, Linlin Zhao, Jing Yu, Xiaoguang Ni, Huiqin Guo

Introduction: Regarding a small proportion of oropharyngeal squamous cell carcinoma (OPSCC) patients who tested p16-positive but human papillomavirus (HPV)-negative, we attempted to perform HPV testing to improve the accuracy of HPV detection in OPSCC patients.

Methods: We simultaneously performed Aptima HPV testing of cytological specimens and p16 immunohistochemistry (IHC) staining of histologic biopsies from the same cohort of patients with head and neck SCC (HNSCC). The cytological specimens included fine-needle aspiration specimens from patients with enlarged nodes and endoscopic brushing specimens from the primary lesions of patients without enlarged nodes. Cases with discordant results for p16 IHC staining and Aptima HPV testing were reexamined by a third method, RNAscope testing.

Results: Sixty patients with HNSCC (39 OPSCC and 21 non-OPSCC) were recruited for examination of HPV status. Among these patients, 28 were p16+/HPV+, 29 were p16-/HPV-, 2 were p16+/HPV-, and 1 was p16-/HPV+. The overall concordance rate between Aptima HPV testing and p16 IHC was 95.0%. Three cases with discordant results for these two methods were reexamined by RNAscope testing, and all were confirmed to be HPV negative. The prevalence of HPV in OPSCC and non-OPSCC patients was 61.5% (24/39) and 19.0% (4/21), respectively. The sensitivity and negative predictive values of Aptima HPV testing and p16 IHC were consistent at 100%, while the specificity and positive predictive values were 96.9% and 96.6% versus 93.8% and 93.3%, respectively. Additionally, 30 OPSCCs were simultaneously examined and diagnosed by both brush cytology and biopsy pathology; six of these SCCs were underdiagnosed by histopathology but accurately diagnosed by supplemental brush cytology.

Conclusion: Aptima HPV testing of cytology specimens can be used as an adjuvant examination to identify false-positive OPSCC patients after p16 IHC of biopsies, while brush cytology may be a supplemental method for the histologic diagnosis of malignant oropharyngeal tumors.

引言:针对一小部分p16阳性但人乳头瘤病毒(HPV)阴性的口咽鳞状细胞癌(OPSCC)患者,我们试图进行HPV检测以提高OPSCC患者HPV检测的准确性。方法:我们同时对同一队列头颈部鳞状细胞癌(HNSCC)患者的细胞学标本进行Aptima HPV检测,并对组织活检进行p16免疫组化(IHC)染色。细胞学标本包括淋巴结肿大患者的细针穿刺标本和非淋巴结肿大患者原发病变的内镜下涂刷标本。p16免疫组化染色和Aptima HPV检测结果不一致的病例用第三种方法RNAscope检测重新检查。结果:60例HNSCC患者(39例OPSCC和21例非OPSCC)被招募进行HPV状态检查。其中p16+/HPV+ 28例,p16-/HPV- 29例,p16+/HPV- 2例,p16-/HPV+ 1例。Aptima HPV检测与p16 IHC的总体符合率为95.0%。两种方法检测结果不一致的3例复查RNAscope,均为HPV阴性。HPV在OPSCC和非OPSCC患者中的患病率分别为61.5%(24/39)和19.0%(4/21)。Aptima HPV检测和p16 IHC检测的敏感性和阴性预测值一致,均为100%,特异性和阳性预测值分别为96.9%和96.6%,而特异性和阳性预测值分别为93.8%和93.3%。此外,30例OPSCCs同时接受刷细胞学和活检病理检查和诊断;其中6例SCCs未被组织病理学诊断,但通过补充刷细胞学准确诊断。结论:细胞学标本Aptima HPV检测可作为活检p16免疫组化后鉴别假阳性OPSCC患者的辅助检查,而刷细胞学可作为口咽恶性肿瘤组织学诊断的补充方法。
{"title":"Aptima HR-HPV Testing of Cytology Specimens Is an Effective Supplement for p16 Staining to Improve Diagnostic Accuracy for HPV-Related Oropharyngeal Squamous Cell Carcinoma.","authors":"Xin Yang,&nbsp;Chunfang Hu,&nbsp;Huan Zhao,&nbsp;Zhihui Zhang,&nbsp;Linlin Zhao,&nbsp;Jing Yu,&nbsp;Xiaoguang Ni,&nbsp;Huiqin Guo","doi":"10.1159/000527951","DOIUrl":"https://doi.org/10.1159/000527951","url":null,"abstract":"<p><strong>Introduction: </strong>Regarding a small proportion of oropharyngeal squamous cell carcinoma (OPSCC) patients who tested p16-positive but human papillomavirus (HPV)-negative, we attempted to perform HPV testing to improve the accuracy of HPV detection in OPSCC patients.</p><p><strong>Methods: </strong>We simultaneously performed Aptima HPV testing of cytological specimens and p16 immunohistochemistry (IHC) staining of histologic biopsies from the same cohort of patients with head and neck SCC (HNSCC). The cytological specimens included fine-needle aspiration specimens from patients with enlarged nodes and endoscopic brushing specimens from the primary lesions of patients without enlarged nodes. Cases with discordant results for p16 IHC staining and Aptima HPV testing were reexamined by a third method, RNAscope testing.</p><p><strong>Results: </strong>Sixty patients with HNSCC (39 OPSCC and 21 non-OPSCC) were recruited for examination of HPV status. Among these patients, 28 were p16+/HPV+, 29 were p16-/HPV-, 2 were p16+/HPV-, and 1 was p16-/HPV+. The overall concordance rate between Aptima HPV testing and p16 IHC was 95.0%. Three cases with discordant results for these two methods were reexamined by RNAscope testing, and all were confirmed to be HPV negative. The prevalence of HPV in OPSCC and non-OPSCC patients was 61.5% (24/39) and 19.0% (4/21), respectively. The sensitivity and negative predictive values of Aptima HPV testing and p16 IHC were consistent at 100%, while the specificity and positive predictive values were 96.9% and 96.6% versus 93.8% and 93.3%, respectively. Additionally, 30 OPSCCs were simultaneously examined and diagnosed by both brush cytology and biopsy pathology; six of these SCCs were underdiagnosed by histopathology but accurately diagnosed by supplemental brush cytology.</p><p><strong>Conclusion: </strong>Aptima HPV testing of cytology specimens can be used as an adjuvant examination to identify false-positive OPSCC patients after p16 IHC of biopsies, while brush cytology may be a supplemental method for the histologic diagnosis of malignant oropharyngeal tumors.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9623346","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}
引用次数: 1
A Retrospective Analysis of the Application of the Newly Proposed International System for Reporting Serous Fluid Cytopathology on Serous Effusion Specimens: An Institutional Experience. 回顾性分析新提出的浆液细胞病理报告国际系统在浆液标本上的应用:一个机构的经验。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000527398
Priyadarshini Kumaraswamy Rajeswaran, Vidhyalakshmi Srinivasan, Swaathi Shri Venkatasubramanian Mahesh, Arsha Usha Ashok

Introduction: The International Academy of Cytology and the American Society of Cytopathology recently proposed the International System for Reporting Serous Fluid Cytology (ISRSFC) to standardize serous fluid cytopathology reporting and guide further clinical management. The current study aimed to assess the feasibility of utilizing ISRSFC reporting categories for serous fluids, estimate the risk of malignancy (ROM) of each category, and scrutinize if the management protocols followed in our institution are as per the ISRFSFC recommendations.

Methods: All pleural, peritoneal, and pericardial effusions submitted for evaluation at our institute between January 2021 and December 2021 were retrieved. All these cases were reviewed and re-categorized into one of the five categories proposed by the ISRSFC: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspicious for malignancy (SFM), and malignant (MAL), and ROM was calculated for each category.

Results: The present study examined 596 serous effusions, of which 229 were pleural effusions, 358 were peritoneal effusions, and the remaining nine were pericardial effusions. Among 596 cases, 395 cases had a radiological or histological follow-up. The serous effusion samples were re-categorized as 61 (10.2%) ND, 449 (75.3%) NFM, 47 (7.8%) AUS, 17 (2.9%) SFM, and 22 (3.8%) MAL, and ROM for each above category were 10%, 4.4%, 19%, 83.3%, and 100%, respectively.

Conclusion: Categorizing serous effusion cytology samples per the ISRSFC diagnostic categories reduces reporting variability. The ISRSFC provides a standardized format to predict the ROM and thus improves the quality of clinical care.

简介:国际细胞学学会和美国细胞病理学学会最近提出了国际浆液细胞学报告系统(ISRSFC),以规范浆液细胞病理学报告并指导进一步的临床管理。本研究旨在评估在浆液中使用ISRSFC报告类别的可行性,估计每个类别的恶性风险(ROM),并审查我们机构所遵循的管理方案是否符合ISRFSFC的建议。方法:检索2021年1月至2021年12月期间在我们研究所提交评估的所有胸膜、腹膜和心包积液。对所有病例进行回顾,并将其重新分类为ISRSFC提出的5类:非诊断性(ND)、恶性阴性(NFM)、意义不确定异型(AUS)、可疑恶性(SFM)和恶性(MAL)之一,并计算每一类的ROM。结果:本研究检查了596例浆液积液,其中229例为胸腔积液,358例为腹膜积液,其余9例为心包积液。在596例病例中,395例进行了放射学或组织学随访。浆液积液样本重新分类为ND 61例(10.2%),NFM 449例(75.3%),AUS 47例(7.8%),SFM 17例(2.9%),MAL 22例(3.8%),ROM分别为10%,4.4%,19%,83.3%和100%。结论:根据ISRSFC诊断分类对浆液积液细胞学样本进行分类可以减少报告的可变性。ISRSFC提供了预测ROM的标准化格式,从而提高了临床护理的质量。
{"title":"A Retrospective Analysis of the Application of the Newly Proposed International System for Reporting Serous Fluid Cytopathology on Serous Effusion Specimens: An Institutional Experience.","authors":"Priyadarshini Kumaraswamy Rajeswaran,&nbsp;Vidhyalakshmi Srinivasan,&nbsp;Swaathi Shri Venkatasubramanian Mahesh,&nbsp;Arsha Usha Ashok","doi":"10.1159/000527398","DOIUrl":"https://doi.org/10.1159/000527398","url":null,"abstract":"<p><strong>Introduction: </strong>The International Academy of Cytology and the American Society of Cytopathology recently proposed the International System for Reporting Serous Fluid Cytology (ISRSFC) to standardize serous fluid cytopathology reporting and guide further clinical management. The current study aimed to assess the feasibility of utilizing ISRSFC reporting categories for serous fluids, estimate the risk of malignancy (ROM) of each category, and scrutinize if the management protocols followed in our institution are as per the ISRFSFC recommendations.</p><p><strong>Methods: </strong>All pleural, peritoneal, and pericardial effusions submitted for evaluation at our institute between January 2021 and December 2021 were retrieved. All these cases were reviewed and re-categorized into one of the five categories proposed by the ISRSFC: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspicious for malignancy (SFM), and malignant (MAL), and ROM was calculated for each category.</p><p><strong>Results: </strong>The present study examined 596 serous effusions, of which 229 were pleural effusions, 358 were peritoneal effusions, and the remaining nine were pericardial effusions. Among 596 cases, 395 cases had a radiological or histological follow-up. The serous effusion samples were re-categorized as 61 (10.2%) ND, 449 (75.3%) NFM, 47 (7.8%) AUS, 17 (2.9%) SFM, and 22 (3.8%) MAL, and ROM for each above category were 10%, 4.4%, 19%, 83.3%, and 100%, respectively.</p><p><strong>Conclusion: </strong>Categorizing serous effusion cytology samples per the ISRSFC diagnostic categories reduces reporting variability. The ISRSFC provides a standardized format to predict the ROM and thus improves the quality of clinical care.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10527949","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}
引用次数: 1
A New Cytology Staining Method: A Fast Approach for Rapid On-Site Evaluation on Thyroid Fine-Needle Aspiration Cytology. 一种新的细胞学染色方法:甲状腺细针穿刺细胞学快速现场评价的快速方法。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000527347
Paula de Melo Alves, Fernando Ferreira, Telma Oliveira, Daniela Alves, Sule Canberk, Fernando C Schmitt

Introduction: Thyroid fine-needle aspiration (FNA) is a well-established technique in the cytology literature. Through the introduction of rapid stains in cytology practice, the ever-increasing utility of rapid on-site evaluation (ROSE) has strengthened the place of FNA as a primary diagnostic method in patient management. There are few stain variants available in the market for ROSE, namely Diff-Quik (DQ), Toluidine blue, and ultrafast Papanicolaou stains. Recently, our group developed a new staining variant labeled as original "BlueStain®" technique that was not previously tested in this context.

Methods: 40 FNA thyroid cases were studied. At least two slides were prepared from each patient: one stained by DQ and the other by BlueStain®. Simultaneously, a ROSE diagnosis was performed as the two staining methods were compared, evaluating the parameters of background, cellularity, details of colloid presence, cell morphology, nuclear details, cytoplasmic details, and overall staining, scored on a scale from 1 to 3, representing poor, average, and good, respectively.

Results: The quality index was slightly better for BlueStain® (53% vs. 47%) but not significantly different between the two stains. BlueStain® provides better details in both the presence and type of colloid as well as nuclear details, which are regarded as very important for diagnosis in thyroid cytology. There were eight cases with discordant diagnosis when compared between two stains from the same patient. In five cases of indeterminate cases, BlueStain® allows to bring them to the benign category, probably because this staining method allows a clear observation of the colloid in the background of the smears. However, since we are observing two different slides, we cannot rule out that these differences are a question of sample collecting and/or smearing.

Conclusions: Our data demonstrates that BlueStain® is suitable to provide good-quality slides for primary assessments of thyroid aspirates studied by ROSE. In fact, in some aspects, this new staining method shows better preservation of colloid and cell details, revealing itself as an alternative to the DQ stain variant, upholding performance level while being 10 times cheaper and simpler because it requires just one step of staining.

简介:甲状腺细针穿刺(FNA)在细胞学文献中是一种成熟的技术。通过在细胞学实践中引入快速染色,快速现场评估(ROSE)的不断增加的效用加强了FNA作为患者管理的主要诊断方法的地位。市场上有几种ROSE染色剂可供选择,即diff - quick (DQ)、甲苯胺蓝和超快Papanicolaou染色剂。最近,我们的团队开发了一种新的染色变体,标记为原始的“BlueStain®”技术,以前没有在这种情况下进行过测试。方法:对40例FNA甲状腺病例进行分析。每位患者至少准备两张载玻片:一张用DQ染色,另一张用BlueStain®染色。同时,通过比较两种染色方法,进行ROSE诊断,评估背景、细胞度、胶体存在细节、细胞形态、核细节、细胞质细节和整体染色等参数,分别以1到3分进行评分,分别代表差、平均和良好。结果:BlueStain®的质量指数略好(53%对47%),但两种染色剂之间无显著差异。BlueStain®在胶体的存在和类型以及核细节方面提供了更好的细节,这对于甲状腺细胞学诊断非常重要。对同一患者的两种染色进行比较,有8例诊断不一致。在5例不确定病例中,BlueStain®允许将其带入良性类别,可能是因为这种染色方法可以清楚地观察到涂片背景中的胶体。然而,由于我们观察的是两种不同的载玻片,我们不能排除这些差异是样品收集和/或涂抹的问题。结论:我们的数据表明,BlueStain®适合为ROSE研究的甲状腺吸入物的初步评估提供高质量的载玻片。事实上,在某些方面,这种新的染色方法可以更好地保存胶体和细胞细节,显示出它是DQ染色变体的替代品,在保持性能水平的同时便宜10倍,更简单,因为它只需要一个染色步骤。
{"title":"A New Cytology Staining Method: A Fast Approach for Rapid On-Site Evaluation on Thyroid Fine-Needle Aspiration Cytology.","authors":"Paula de Melo Alves,&nbsp;Fernando Ferreira,&nbsp;Telma Oliveira,&nbsp;Daniela Alves,&nbsp;Sule Canberk,&nbsp;Fernando C Schmitt","doi":"10.1159/000527347","DOIUrl":"https://doi.org/10.1159/000527347","url":null,"abstract":"<p><strong>Introduction: </strong>Thyroid fine-needle aspiration (FNA) is a well-established technique in the cytology literature. Through the introduction of rapid stains in cytology practice, the ever-increasing utility of rapid on-site evaluation (ROSE) has strengthened the place of FNA as a primary diagnostic method in patient management. There are few stain variants available in the market for ROSE, namely Diff-Quik (DQ), Toluidine blue, and ultrafast Papanicolaou stains. Recently, our group developed a new staining variant labeled as original \"BlueStain®\" technique that was not previously tested in this context.</p><p><strong>Methods: </strong>40 FNA thyroid cases were studied. At least two slides were prepared from each patient: one stained by DQ and the other by BlueStain®. Simultaneously, a ROSE diagnosis was performed as the two staining methods were compared, evaluating the parameters of background, cellularity, details of colloid presence, cell morphology, nuclear details, cytoplasmic details, and overall staining, scored on a scale from 1 to 3, representing poor, average, and good, respectively.</p><p><strong>Results: </strong>The quality index was slightly better for BlueStain® (53% vs. 47%) but not significantly different between the two stains. BlueStain® provides better details in both the presence and type of colloid as well as nuclear details, which are regarded as very important for diagnosis in thyroid cytology. There were eight cases with discordant diagnosis when compared between two stains from the same patient. In five cases of indeterminate cases, BlueStain® allows to bring them to the benign category, probably because this staining method allows a clear observation of the colloid in the background of the smears. However, since we are observing two different slides, we cannot rule out that these differences are a question of sample collecting and/or smearing.</p><p><strong>Conclusions: </strong>Our data demonstrates that BlueStain® is suitable to provide good-quality slides for primary assessments of thyroid aspirates studied by ROSE. In fact, in some aspects, this new staining method shows better preservation of colloid and cell details, revealing itself as an alternative to the DQ stain variant, upholding performance level while being 10 times cheaper and simpler because it requires just one step of staining.</p>","PeriodicalId":6959,"journal":{"name":"Acta Cytologica","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925311","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}
引用次数: 0
Utility of BAP1, p16, and Methylthio-Adenosine Phosphorylase Immunohistochemistry in Cytological and Histological Samples of Pleural Mesotheliomas. BAP1, p16和甲基硫代腺苷磷酸化酶免疫组化在胸膜间皮瘤细胞学和组织学样本中的应用。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000530002
Vera Amacher, Peter Karl Bode, Holger Moch, Daniela Lenggenhager, Bart Vrugt

Introduction: In most cases, the diagnostic workup of pleural mesotheliomas (MPMs) starts with cytological examination of pleural effusion, but histology is needed to confirm the diagnosis. The introduction of BAP1 and methylthio-adenosine phosphorylase (MTAP) immunohistochemistry has become a powerful tool to confirm the malignant nature of mesothelial proliferations also in cytological specimens. The objective of this study was to determine the concordance of BAP1, MTAP, and p16 expression between cytological and histological samples of patients with MPM.

Methods: Immunohistochemistry of BAP1, MTAP, and p16 was performed on cytological samples and compared with the corresponding histological specimen of 25 patients with MPM. Inflammatory and stromal cells served as positive internal control for all three markers. In addition, samples of 11 patients with reactive mesothelial proliferations served as an external control group.

Results: Loss of BAP1, MTAP, and p16 expression was found in 68%, 72%, and 92% of MPM, respectively. Loss of MTAP was associated with loss of p16 expression in all cases. Concordance of BAP1 between cytological and corresponding histological samples was 100% (kappa coefficient 1; p = 0.008). For MTAP and p16, kappa coefficient was 0.9 (p = 0.01) and 0.8 (p = 0.7788), respectively.

Conclusions: Concordant BAP1, MTAP, and p16 expression is found between cytological and corresponding histological samples, indicating that a reliable diagnosis of MPM can be made on cytology only. Of the three markers, BAP1 and MTAP are most reliable in distinguishing malignant from reactive mesothelial proliferations.

简介:在大多数情况下,胸膜间皮瘤(MPMs)的诊断工作从胸膜积液细胞学检查开始,但需要组织学来确认诊断。引入BAP1和甲基硫代腺苷磷酸化酶(MTAP)免疫组化已成为细胞学标本中确认间皮增生恶性性质的有力工具。本研究的目的是确定MPM患者细胞学和组织学样本中BAP1、MTAP和p16表达的一致性。方法:对25例MPM患者细胞学标本进行BAP1、MTAP、p16的免疫组化,并与相应的组织学标本进行比较。炎症细胞和基质细胞是这三种标志物的阳性内控。此外,11例反应性间皮增生患者作为外部对照组。结果:BAP1、MTAP和p16的表达分别在68%、72%和92%的MPM中缺失。在所有病例中,MTAP的缺失都与p16表达的缺失相关。细胞学样本与相应的组织学样本BAP1的一致性为100% (kappa系数1;P = 0.008)。MTAP和p16的kappa系数分别为0.9 (p = 0.01)和0.8 (p = 0.7788)。结论:BAP1、MTAP、p16在细胞学和相应的组织学样本中表达一致,提示仅凭细胞学诊断可可靠诊断MPM。在这三种标志物中,BAP1和MTAP在区分恶性和反应性间皮细胞增殖方面是最可靠的。
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引用次数: 0
Transthoracic Fine-Needle Aspiration Cytology of Pulmonary Spindle and Mesenchymal Neoplasms: A Pandora's Box. 肺梭形和间质肿瘤的经胸细针穿刺细胞学:潘多拉的盒子。
IF 1.8 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000528843
Kanwalpreet Kaur, Trupti Patel, Sanjiban Patra, Priti Trivedi

Introduction: Pulmonary spindle cell and mesenchymal lesions are paradox for pathologists due to their rarity, overlapping morphology, and differentials ranging from benign to malignant lesions, and correct diagnosis is essential due to major treatment implications. This study highlights the role of fine-needle aspiration cytology, clot core biopsy, and immunohistochemistry in diagnosis of spindle cell lesions in lung, thus playing a key role in patient management.

Methods: It is a retrospective study of lung FNA with predominantly spindle and mesenchymal cells from 2015-2020 which were classified cytomorphologically into spindle, epithelioid, small round cell, and biphasic, and IHC panels are applied accordingly. FNA from mediastinum and chest wall was excluded.

Results: 60 cases of lung FNA with spindle and mesenchymal cells were identified and included 6 benign and 54 malignancies which included 24 primary pulmonary malignancies and 30 metastases. Most common primary malignancy was sarcomatoid carcinoma, and most common metastasis was malignant peripheral nerve sheath tumour. FNA was paucicellular in 7 cases and was reported as benign in 7 cases and malignant in 46 cases. There were two false-negative cases. One case of pulmonary blastoma was reported as inflammatory pseudotumour on cytology, and other case of chondrosarcoma was reported as chondroid tumour. Sensitivity and specificity of FNA in distinguishing benign lesions and malignancies were 93.8% and 100%, respectively.

Conclusion: FNA along with clot core biopsy/cell block and IHC plays a pivotal role in the subsequent pathway taken for diagnostic or therapeutic management of these patients without the need for second sampling or trucut biopsies in a low resource setting.

简介:肺梭形细胞和间质病变因其罕见、形态重叠、良恶性差异大,对病理学家来说是一个悖论,正确的诊断是重要的治疗意义。本研究强调细针穿刺细胞学、凝块核心活检和免疫组织化学在肺梭形细胞病变诊断中的作用,从而在患者管理中发挥关键作用。方法:对2015-2020年以梭形细胞和间充质细胞为主的肺FNA进行回顾性研究,细胞形态学上分为梭形细胞、上皮样细胞、小圆细胞和双相细胞,并采用免疫组化方法。排除纵隔和胸壁的FNA。结果:60例肺FNA伴梭形细胞和间充质细胞,其中良性6例,恶性54例,其中原发性肺恶性24例,转移性30例。原发肿瘤以肉瘤样癌多见,转移瘤以周围神经鞘恶性肿瘤多见。FNA 7例为少细胞性,7例为良性,46例为恶性。有两个假阴性病例。1例肺母细胞瘤细胞学上报告为炎性假瘤,另1例软骨肉瘤报告为软骨样瘤。FNA鉴别良性病变和恶性病变的敏感性为93.8%,特异性为100%。结论:在资源匮乏的情况下,FNA与凝块核心活检/细胞阻断和免疫组化在这些患者的诊断或治疗管理的后续途径中起着关键作用,而无需进行第二次采样或组织活检。
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