Acta Cytologica最新文献

Introduction: We aimed to investigate malignancy rates in atypia of undetermined significance (AUS) subcategories and their association with cytomorphologic and ultrasonographic features.

Methods: A total of 201 thyroid nodules with AUS cytology that underwent surgical resection were analyzed, including 169 AUS-nuclear (AUS-N) and 32 AUS-other (AUS-O) nodules. Cytomorphological and ultrasonographic features, along with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classifications, were analyzed to assess the association between malignancy and AUS subcategories.

Results: The overall risk of malignancy (ROM) for AUS nodules was 19.4%, with a significantly higher rate observed in the AUS-N subgroup compared to AUS-O (21.9% vs. 6.3%, p = 0.04). A significantly higher ROM was observed in nodules with irregular margin, taller-than-wide shape, microcalcification, hypoechogenicity, and solid composition (OR = 9.63, 5.81, 3.33, 2.14, and 2.07, respectively). A statistically significant difference in ROM was observed across ACR-TIRADS and EU-TIRADS categories within the AUS nodules (p < 0.001 for both) and the AUS-N group (p = 0.001 and <0.001). A marked increase in ROM was observed with nuclear overlapping, pseudoinclusions, and enlargement (OR: 9.16, 4.47 and 2.80, respectively), while oncocytic atypia was associated with a reduced risk (OR: 0.44). In multivariate analysis, nuclear overlapping, pseudoinclusions, and sonographic irregular margins remained as independent predictors of malignancy (OR = 6.97, 6.09, and 5.79, respectively).

Conclusion: To our knowledge, this is the first study to demonstrate a significant association between ACR-TIRADS classification and malignancy risk in the AUS-N subcategory.

Background: Fine-needle aspiration cytology serves as an important preoperative diagnostic tool for thyroid nodules. Despite its excellent diagnostic accuracy, diagnoses based solely on morphological observation can be challenging. Therefore, various ancillary diagnostic techniques have been applied, including immunocytochemistry (ICC). This review discusses the application and evaluation of ICC in thyroid fine needle aspiration.

Summary: Currently, three immunostaining preparation methods are available for cytological materials: liquid-based cytology, cell block, and cell transfer. ICC proves valuable in scenarios such as tumour diagnosis, assessment of differentiation and grading of carcinomas, estimation of primary organs in metastatic carcinomas, and detection of gene abnormalities. However, ICC, while useful, is not as accurate as immunohistochemistry and is more difficult to evaluate.

Key messages: If the pitfalls and limitations are understood and effectively navigated, ICC could play a significant role in decreasing the non-diagnostic rate, thus leading to more accurate and valuable diagnoses and reductions in the re-aspiration rate.

Background: Fine-needle aspiration cytology serves as an important preoperative diagnostic tool for thyroid nodules. Despite its excellent diagnostic accuracy, diagnoses based solely on morphological observation can be challenging. Therefore, various ancillary diagnostic techniques have been applied, including immunocytochemistry (ICC). This review discusses the application and evaluation of ICC in thyroid fine needle aspiration.

Summary: Currently, three immunostaining preparation methods are available for cytological materials: liquid-based cytology, cell block, and cell transfer. ICC proves valuable in scenarios such as tumour diagnosis, assessment of differentiation and grading of carcinomas, estimation of primary organs in metastatic carcinomas, and detection of gene abnormalities. However, ICC, while useful, is not as accurate as immunohistochemistry and is more difficult to evaluate.

Key messages: If the pitfalls and limitations are understood and effectively navigated, ICC could play a significant role in decreasing the non-diagnostic rate, thus leading to more accurate and valuable diagnoses and reductions in the re-aspiration rate.

Introduction: Non-neoplastic and non-diagnostic cytological findings present a diagnostic and therapeutic challenge in head and neck oncology. Both groups still harbor a risk of malignancy (ROM). Of note, ROM values have been counted from surgically confirmed lesions only. The purpose of this study was to evaluate the clinical course of patients with non-neoplastic or non-diagnostic fine needle aspiration cytology (FNAC) findings from a parotid gland lesion.

Methods: This retrospective cohort study comprises all 184 consecutive patients who visited the Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital (HUS, Helsinki, Finland) and whose first parotid gland FNAC result during 2016-2018 was non-neoplastic or non-diagnostic. The cytology reports were obtained from the HUS Pathological Archives (Q-Pati). Demographics, physical examination findings, and cytopathological and treatment data were reviewed. Two patient groups were formed according to their clinical management: those who had surgery and those who were only followed up. If the parotid gland was operated on, FNAC was compared with histology. If the patient was followed up without surgical treatment, the follow-up data included a review of the patient records supplemented with a questionnaire.

Results: Altogether, there were 186 parotid lesions. Seventy-six (40.9%) tumors in 75 patients were operated on, and 110 (59.1%) were only followed up. Of all parotid gland lesions, 12 (6.5%) turned out to be malignant, and all of them were in the surgically treated group. When only followed up clinically, with repeated needle sampling or imaging during the minimum 4-year follow-up period, none of the other lesions turned out to be malignant.

Conclusion: The ROM for non-diagnostic and non-neoplastic FNAC samples is lower when all FNAC samples, including also those from nonsurgically treated patients, are included in comparison with the series that includes only surgically treated patients with histopathological confirmation. Our results suggest that this patient group can be followed up conservatively in the absence of abnormal symptoms or radiological findings.

Introduction: Although the widespread use of screening tests and HPV vaccines for squamous cell carcinoma has led to early detection and treatment, effectiveness is limited for cervical adenocarcinoma. Lobular endocervical glandular hyperplasia (LEGH) corresponds to gastric metaplasia but is regarded as a pathological condition with subtle morphological abnormalities. LEGH is a benign lesion and a precursor to gastric-type adenocarcinoma. We herein developed an objective and quantitative method by applying an image analysis technique to overcome the difficulties associated with the differential diagnosis of LEGH in uterine cervical cytology. This approach is expected to enable the early detection and accurate diagnosis of LEGH.

Methods: We extracted signal values for the nucleus and cytoplasm from microscopic images of cytological specimens of normal endocervical (EC) and LEGH cells. These values were then converted into CIELAB and sRGB values to create color distribution maps, and color unmixing techniques were applied to assess the spectral absorbance of each pigment.

Results: The CIELAB signal values extracted from the nuclear images of LEGH cells exhibited lower values than those of EC cells. Furthermore, based on color distribution maps, the cytoplasm of EC cells exhibited shades from purple to pink, while LEGH cells showed a distribution toward yellow.

Conclusions: This study reveals that, compared to EC cells, LEGH cells exhibit lower nuclear signal values and increased nuclear chromatin content. Thus, assessing the relative difference in cytoplasmic color tones between them may become an effective indicator for distinguishing between EC and LEGH cells.

Introduction: Cervicovaginal infections continue to be a public health problem for the female population. The aim of this study was to compare the prevalence of infections and coinfections diagnosed by cervical cytology in pregnant and non-pregnant patients at the San Bartolomé Hospital, Lima, Peru.

Methods: An observational and cross-sectional study was conducted. A sample of 284 cervical reports from pregnant and non-pregnant women was included and screened by the Pap test during the period 2021-2023.

Results: The overall prevalence of cervicovaginal infections was 52.8%, for pregnant women 59.2% and for non-pregnant women 46.5%, with statistically significant differences between the groups (p < 0.05). Bacterial vaginosis (43%) and Candida spp. predominated (26.8%), showing significant differences (p < 0.05). No significant differences were observed with other cervicovaginal infections (p > 0.05). The general prevalence of coinfections was 13.4%, for the pregnant group it was 19.7% and for the non-pregnant group it was 7.0%, observing differences with statistical significance between the groups (p < 0.05). The most predominant coinfection was bacterial vaginosis accompanied by Candida spp. (13.4%), finding significant differences (p < 0.05). No significant differences were observed with other cervicovaginal coinfections (p > 0.05).

Conclusion: There is a higher prevalence of cervicovaginal infections and coinfections in pregnant women in contrast to non-pregnant women, observing statistically significant differences by means of the Pap test.

Introduction: The status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) plays a crucial role in the management of patients with metastatic breast cancer. Herein we report our experience on ER, PR, and HER2 immunostains on cell block and core needle biopsy (CNB) specimens of metastatic breast cancers.

Methods: Cytological samples of metastatic breast cancer with associated cell blocks or core needle biopsies were identified, on which ER, PR, or HER2 were ordered from 2019 to 2021. Both fine needle aspiration specimens and body effusion fluids were included. Patients' demographics, cancer histological subtype, biopsy site, specimen type (cell block or CNB) for immunohistochemistry and ER, PR, and HER2 expression were recorded.

Results: 192 specimens from 177 patients were identified. Patients' mean age was 58.5 years (range 24-96). The majority of samples were obtained from patients with invasive ductal carcinoma. Staining was performed on core biopsies (n = 74/192, 38.5%) and on cell blocks (n = 118/192, 61.5%). Pleural fluid (n = 75) was the most commonly sampled site, followed by the liver (n = 48) and lymph nodes (n = 44). ER, PR, and HER2 were positive in 76.3%, 79.3%, and 13.2% of samples, respectively. Concordantly, ER+PR+HER2- was the most common sample phenotype. Seven samples had insufficient tissue to evaluate ER, PR, or HER2 status.

Conclusion: ER, PR, and HER2 immunohistochemical staining can be performed on cell block or CNB specimens of metastatic breast cancer and can provide reliable information to clinicians for optimal patient care.

Background: The application of immunocytochemistry (ICC) as a diagnostic and predictive tool in the workup of head and neck lesions has followed the changes and progresses in the surgical pathology evaluation. The contribution of ICC has shown a significant role in head and neck cytology, demonstrating as its contribution can support the diagnosis of many lesions. Furthermore, its role has been evolving as an important adjuvant tool in targeted therapies. An additional useful role is defined by the recent introduction of ICC markers related to genetic alterations, which has opened the door to the adoption of a surrogate for molecular evaluation also on cytological material.

Summary: The current review article analyzes the role of ICC in the field of head and neck cytology, showing that it might represent a valid diagnostic tool in difficult cases. The review will include all the different head and neck lesions, demonstrating how we could rely on organ-specific ICC markers but also on ICC markers able to discriminate between benign and malignant lesions.

Key messages: The role of ICC represents a valid additional tool in the management of several difficult lesions, especially when morphology alone is not able to make a conclusive diagnosis. The support of ICC is likely to support the morphological findings leading to the definition of the diagnosis and the most appropriate management.