Acta Cytologica最新文献

Introduction: Cervical cancer screening using Pap smears is affected by false-negative results. Liquid-based cytology (LBC) offers the technical advantage of preparing cell blocks from residual fluid to conduct ancillary tests on them. The p16INK4a gene product has been shown to be strongly overexpressed in dysplastic cervical epithelia and serves as surrogate marker for high-risk human papilloma virus infection.

Materials and methods: Microwave-processed cell blocks were prepared from residual material in vials after ThinPrep slide preparation, stained with hematoxylin and eosin and p16INK4a. Nuclear staining with or without cytoplasmic staining on p16 slides was considered positive. Four parameters were evaluated: percentage of positive cells, intensity of staining, number of positively stained cells in close contact, and full-thickness epithelial staining. We compared sensitivity and specificity of ThinPrep smears and p16-stained cell blocks in diagnosing invasive malignancy.

Results: The intensity and percentage of p16-positive cells was found to increase with increasing grade of cervical abnormality. We found good concordance between ThinPrep smear and cell block diagnoses in cases which were negative for intraepithelial lesion or malignancy (97.6%), in low-grade squamous intraepithelial lesions (90%), high-grade squamous intraepithelial lesions (100%), and squamous cell carcinomas (93.5%). Of 16 discrepant cases, 9 were reported unsatisfactory on ThinPrep smears due to abundant necrosis or scant cellularity. All these turned out to have malignancies on follow-up and review of histology. The sensitivity of ThinPrep and p16-stained cell blocks in diagnosing invasive malignancy were 70.2% and 85.1%, respectively, while the specificity of both was 100%.

Conclusions: Cell blocks prepared from residual fluid in LBC vials have the potential to reduce the rates of inadequacy and are feasible in routine practice. While the cost of p16 on cell blocks may be too prohibitive for use in routine cervical screening programs, if used judiciously in combination with clinical suspicion, a lot of valuable material which is usually discarded in the residual LBC vials can prove to be crucial in arriving at the correct diagnosis.

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

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

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

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

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

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

Background: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using larger, next-generation cutting needles is a minimally invasive method for the diagnosis of pancreatic lesions. Rapid on-site evaluation (ROSE) is employed to render preliminary diagnoses, ensure specimen adequacy, and triage tissue for ancillary testing and can be performed on FNB cores. Given the difficulty of pancreatic cytology and the novelty of ROSE with these larger cutting needles, this study was performed to evaluate discrepancies between ROSE and the final diagnosis to uncover challenging diagnostic areas.

Methods: Final reports from pancreatic FNBs with ROSE between January 2019 and December 2021 were reviewed, and the ROSE and final diagnoses were compared. Cases were categorized into nondiagnostic (ND), negative for malignancy (NEG), atypical, neoplastic (NEO), suspicious for malignancy (SFM), and positive for malignant cells (POS). A major discrepancy was defined as an ND/NEG versus NEO/SFM/POS interpretation.

Results: A total of 454 cases were identified. The ROSE versus final diagnosis breakdown was as follows: ND/NEG 18.7% versus 16.3%, atypical 6.4% versus 5.1%, NEO 10.8% versus 11.9%, SFM 4.4% versus 2.0%, and POS 59.7% versus 64.8%. The concordance rate was high at 96.9% with only 14 (3.1%) major discrepancies, which included 6 due to interpretive error, 3 due to sampling error, and 5 due to a combination of both. While the majority of lesions in the cohort were conventional ductal adenocarcinomas (76%), there was an over-representation of non-ductal tumors constituting major discrepancies (6/14; 42.9%).

Conclusions: ROSE using pancreatic EUS-FNB is possible and provides an accurate interpretation in most cases. Diagnostic challenges remain with non-ductal tumors.

Introduction: The use of liquid-based cytology (LBC) in non-gynecological fields has progressively increased. However, studies focusing on the application of LBC in bile cytology are limited, and its efficacy remains uncertain. In this study, we assessed the potential of LBC in bile cytology by evaluating the interobserver agreement.

Methods: Bile cytology specimens were collected between 2015 and 2022 by using endoscopic retrograde cholangiopancreatography. Eleven cytotechnologists participated in the evaluation. Digital images of bile cytology specimens prepared using conventional smear (CS), ThinPrep LBC (TP-LBC), and SurePath LBC (SP-LBC) methods (20 cases per preparation method) were assessed for interobserver agreement on 21 diagnostic criteria. The diagnostic accuracy was evaluated using 50 bile cytology cases per preparation method.

Results: High interobserver agreement (exact kappa > 0.6) was observed for features, including the loss of nuclear polarity, irregular nuclear spacing, nuclear size variation, and increased nuclear-to-cytoplasmic ratio across the CS, TP-LBC, and SP-LBC methods. Malignant cells in TP-LBC appeared smaller and rounder, and formed flat aggregates compared with those in CS. In contrast, the malignant cells in SP-LBC formed three-dimensional clusters that overlapped and exhibited higher cellularity than those in CS. The sensitivity of bile cytology was 76.4%, 84.8%, and 93.2% for CS, TP-LBC, and SP-LBC, respectively.

Conclusion: The observers consistently recognized malignant cell features in bile cytology, irrespective of the preparation method. Understanding common features and method-specific cellular morphology is crucial for enhancing diagnostic accuracy. Our findings suggest that LBC methods can be effectively applied to bile cytology, potentially offering improved diagnostic accuracy compared with conventional methods.

Introduction: The evaluation of lymph nodes (LNs) through fine needle aspiration (FNA) is widely used as the first-line approach in the assessment of unexplained lymphadenopathy due to its minimal invasiveness, speed, and cost-effectiveness and the availability of provide material for various auxiliary techniques. The Sydney Lymph Node Cytology Reporting and Classification System was introduced in 2020. The aim of our study was to classify LN-FNAs according to the Sydney System and to evaluate the concordance with histological diagnoses and the rates of malignancy in the available cases.

Methods: Between 2019 and 2023, FNAs were retrospectively reviewed. A total of 1,000 cases were categorized according to the Sydney System as ND (inadequate/insufficient), benign, AUS/ALUS (atypical lymphoid cells of uncertain significance), suspicious, and malignant. The risk of malignancy was calculated for histopathological follow-up available cases.

Results: Cases were categorized into 5 groups: 58 cases (5.8%) as "ND," 560 cases (56%) as "benign," 24 cases (2.4%) as "AUS/ALUS," 32 cases (3.2%) as "suspicious," and 326 cases (32.6%) as "malignant." In the malignant group, 315 cases were metastatic malignancies and 11 were lymphoid malignancies. Histopathological follow-up was possible in 294 cases (29.4%). Among these, 159 were diagnosed as malignant. Of the malignant cases, 33 were diagnosed as lymphoma and 126 as metastatic malignancies. Based on the available data, the concordance rate between cytological and histological diagnoses was 81.0%. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated as 91.11%, 69.49%, 77.36%, and 87.23%, respectively. The risk of malignancy was 52.9% for the nondiagnostic, 12.7% for the benign, 33.3% for the atypical, 80.0% for the suspicious, and 77.3% for the malignant categories.

Conclusion: The Sydney System is easily applied to LN-FNAs and shows a high cytology-histology diagnosis concordance rate and sensitivity. By simplifying reporting and strengthening communication between cytopathologists and clinicians, it enhances the clinical management of malignancy risk.

Introduction: Sediment cytology, initially applied in urinary diagnostics, has expanded to formalin-fixed biopsy specimens, evaluating exfoliated cells suspended in formalin fixative. Though traditionally discarded, this sediment contains diagnostic material, especially in friable or malignant tissues. It offers a rapid, cost-effective, preliminary diagnostic tool when histopathology is delayed, such as in bone lesions requiring decalcification. This systematic review aimed to comprehensively assess the diagnostic accuracy, applicability, and limitations of sediment cytology across diverse anatomical sites.

Methods: This systematic review followed PRISMA guidelines, and an electronic search was conducted across PubMed, Scopus, and Google Scholar databases until January 1, 2025, without year restrictions. Keywords included "Sediment cytology," "oral neoplasms," "bone lesions," and related terms. Articles in English reporting sediment cytology on formalin-fixed biopsies with cytological-histological correlation were included.

Results: Nine eligible studies were identified, involving various lesions including oral squamous cell carcinoma (OSCC), oral potentially malignant disorders (OPMDs), bone lesions, GIT, and cervical and ovarian neoplasms. Pooled sensitivity and specificity were 73.3% and 92.1%, respectively. Subgroup analysis revealed excellent concordance for OSCC and bone malignancies. Sensitivity was lower in benign lesions and OPMDs, attributed to poor cellularity and exfoliation. Methodological heterogeneity was noted, though overall bias remained low.

Conclusion: Sediment cytology shows valuable diagnostic potential as a preliminary adjunct to histopathology, particularly for malignancies, warranting further standardized multicenter studies.