Liquid-based thin-prep cytology study of lacrimal drainage system in primary acquired nasolacrimal duct obstruction.

Abstract

We investigated the cytologic findings of primary acquired nasolacrimal duct obstruction (PANDO) based on the thin-prep cytology method using sheath-guided dacryoendoscopy. A retrospective review was conducted of 66 cases from 50 patients who were diagnosed with PANDO. Slit-lamp examination, the lacrimal irrigation test, and dacryocystography were performed for the evaluation of PANDO. The dacryocystography (DCG) findings were classified into primary and secondary change. Each patient was treated with transcanalicular dacryoplasty using catheter sheath-guided dacryoendoscopy (RUIDO Fiberscope, Fiber Tech Co., Ltd., Tokyo, Japan) and obtained cytologic specimens. The liquid-based thin-prep cytology method was used for the analysis of histopathology. The cellular detection rate was as follows: epithelial cells with 56 cases (84.8%), 33 cases (50.0%) with inflammatory cells, 1 case (1.5%) with mucin, and bacterial colonies with 2 cases (3.0%). In the dacryoendoscopic findings, all cases of a presence of pus were related to the detection of the columnar epithelium (p = 0.026), while there was no statical significance according to the presence of an epithelial cell. In the DCG findings, the PANDOs with the secondary change showed a higher detection rate than those with the primary change (p = 0.005), and columnar epithelial cells were observed (p = 0.011). The detection rate of inflammatory cells was 50.0% (33/66) and all inflammatory cells were lymphocytes but it was not correlated with clinical findings. One case of mucin (1.5%) and 2 cases of bacterial colonies (3.0%) were presented using liquid-based thin-prep cytology analysis. The overall success rate of transcanalicular dacryoplasty and silicone intubation was 86.4%. Liquid based thin prep cytology can be used to analyze histopathological changes of lacrimal passage in PANDO without invasive biopsy. These cytologic findings of lacrimal passage provide a better understanding of the pathogenesis of lacrimal passage in patientswith PANDO.