Conventional Smear Preparations Research Articles

Role of liquid based cytology in detection of human papilloma virus and diagnosing oral premalignant and malignant lesions

BackgroundLiquid based cytology (LBC) is relatively a newer method of exfoliative cytology for diagnosing cervical cancers and detection of Human Papilloma Virus (HPV). Its use in diagnosing oral squamous cell carcinoma (OSCC) is less explored. We aim to compare LBC with conventional cytology in diagnosing oral premalignant and malignant lesions and study the role of LBC in detecting HPV. MethodA cross-sectional observational study done at a tertiary hospital on patients above 18 years clinically suspicious of oral malignant and premalignant lesions. Samples were taken using cytobrush. Conventional and LBC smears were compared using specific cytomorphologic criteria. HPV testing was done using Polymerase Chain Reaction (PCR). Statistical analysis: Data collected was entered in Microsoft Excel and analyzed using MedCalc software Version18.2.1. Numbers and percentages represented the qualitative data and mean and standard deviation represented quantitative data. Wilcoxon Signed Rank test was applied. The accuracy of cytological screening test was presented using sensitivity, specificity and receiver operating characteristic (ROC) curve. ResultBackground, uniform distribution, cellular overlapping and morphology was statistically significant with p value< 0.05. ROC and Youden index showed the sensitivity of conventional method was 56.25% and specificity was 100% where as in case of LBC, sensitivity was 62.5% and specificity was 75%. ConclusionLBC does not significantly outperform conventional smear preparation for routine diagnostic and mass screening procedures. Negative result of HPV DNA in all cases using LBC vials questions the utility of cytology for HPV detection and etiological role of HPV in OSCC.

Guided Needle Aspirations of Intra-Abdominal Masses: Analogy between Liquid-Based and Conventional Smear Preparation Methods

Objective: Image-guided fine needle aspiration cytology with conventional smear (CS) preparation offers onsite cellular adequacy evaluation; however, it still provides false negatives due to faulty smear preparations. Liquid-based cytology (LBC) can be advantageous in these scenarios. Hence, with an aim to investigate utility of LBC in these samples, we carried out the above study with objectives to find diagnostic accuracy of LBC and agreement of LBC with CS methods in guided aspiration samples from intra-abdominal masses. Methods: A prospective observational study, of 113 patients with clinical or radiological diagnosis of intra-abdominal masses, was carried out. SurePath BD™ was used for LBC smear preparation, and the standard protocol was used for CS preparation. Results: LBC alone was diagnostic in 80.8% of the cases, and CS alone was diagnostic in 71.2% cases (agreement was 83.7%, p = 0.03). Cellular morphology was better preserved in LBC; however, interpretation was easier in CS. Conclusion: CS may be complimented with LBC sample collection method to enhance the sensitivity of intra-abdominal FNA.

Comparison of Conventional Smear and Liquid-Based Cytology in Adequacy of Thyroid Fine-Needle Aspiration Biopsies without an Accompanying Cytopathologist.

ObjectivesIn this study, we aimed to compare the adequacy of conventional smear (CS) and liquid-based cytology (LBC) methods in thyroid fine-needle aspiration biopsy (FNAB) samples obtained without an accompanying cytopathologist during the procedure. Furthermore, we aimed to investigate the presence of a significant difference between the rates of nodules classified as Bethesda Category III and malignancy in both techniques and the features of the nodules affecting malignancy.MethodsA total of 625 nodules from 572 patients who were found suitable for biopsy were included in this retrospective study. FNABs were performed by interventional radiologists without an accompanying cytopathologist during the procedures. The specimens were either prepared using CS or LBC preparation methods. Cytopathological diagnostic adequacy and cytopathological results of the specimens were evaluated according to Bethesda category, and the relationship between the morphological findings was evaluated retrospectively.ResultsOf all the biopsy preparations, 338 (54.1%) of them were transferred to pathology in liquid-based solution and 287 (45.9%) were transferred as CS. Malignancy rates of the biopsy samples were found similar in both LBC and CS methods. Considering the nodules classified as Bethesda Category II, III, IV, V, and VI, there was no statistical difference between the results of both methods. Non-diagnostic biopsy rate was higher in the specimens prepared by CS method (p<0.001).ConclusionIn this study, the adequacy rate of FNAB was found significantly higher in LBC method compared to the CS method. LBC was more practical and faster than the CS method. We think that LBC method may be preferred in FNAB of thyroid nodules.

Potential role of mobile rapid on-site evaluation® in thyroid fine-needle aspiration cytology to reduce delayed repeated aspiration.

Rapid on-site evaluation of fine-needle aspiration cytology is time-consuming and requires specialized cytopathology staff. Mobile Rose® is a newly developed device for rapid on-site evaluation of fine-needle aspiration cytology. This study aimed to investigate the potential role of Mobile Rose® in reducing delayed repeated aspiration of the thyroid. A total of 120 cytological samples were collected and observed using Mobile Rose® after fine-needle aspiration cytology between September and October 2020, with immediate assessment of minimal or no cell clusters after conventional smear preparation. After qualifying and scoring, needle washout materials were prepared using the BD CytoRichTM method and correlated with cytology results. The average turn-around time of Mobile Rose® was found to be 1.5 minutes. Sensitivity, specificity, positive predictive value, and negative predictive value were 94.4%, 100%, 100%, and 57.1%, respectively. False-negative results were attributed to small aggregates of cells that were difficult to distinguish from the background and artifacts. Mobile Rose® may represent an important innovation for rapid on-site evaluation that is fast, has high diagnostic performance, does not require the presence of specialized cytology staff, and can reduce delayed repeated aspiration of the thyroid gland. However, further minor improvements and confirmation are required.

Comparative evaluation of centrifuged liquid-based cytology method over conventional brush cytology in normal oral mucosa

Introduction: Liquid-based cytology (LBC) is a new monolayer slide preparation method introduced to overcome the limitations of conventional Papanicolaou (PAP) smears which is used in cancer screening. The study was aimed to compare the efficacy of modified technique, centrifuged LBC (CLBC) with that of conventional brush cytology in normal oral mucosa. Materials and Methods: Two smears were obtained from 100 cases of normal mucosa using a cytobrush. One smear was spread on to the slide by conventional technique, and the other smear was prepared by CLBC. Regular PAP staining was done for both the smears. Both the smears were evaluated for cellularity, cell distribution, cellular overlapping, cell elongation, and cellular background and were graded using the grading criteria. Mann–Whitney U-test was used, and P ≤ 0.05 was considered statistically significant. Results: The mean score of the criterias was found to be more desirable in CLBC than conventional technique, but there was no statistical significance found. Conclusions: LBC offers a significant advantage over conventional smear preparation in most of the criteria to advocate its use for routine diagnostic and mass screening procedures.

Assessment of cytological features of glandular lesions of the cervix on conventional smear preparations-a comprehensive study from a tertiary care hospital.

Atypical glandular cells (AGC) as a diagnostic category in cervicovaginal cytology remains as a challenge to cytopathologists. The aim of the present study is to identify the cytological features helpful in categorizing AGC as reactive or neoplastic upon correlation with histology. The study was a retrospective review of cervical smears, with histopathological follow up, reported as glandular lesions for a period of 9 years. The architectural and nuclear features studied were adapted from The Bethesda System (TBS) to stratify the lesions as AGC, AGC-FN (atypical glandular cells favour neoplasia) and adenocarcinoma. The cytological categories were correlated with histology. A total of 89 cases of which 67 (AGC NOS = 34, AGC FN = 19, adenocarcinoma = 14) with histology were reviewed. Neoplastic lesions were encountered in 14 cases (34.6%). Of the cases diagnosed as AGC-NOS, AGC-FN and adenocarcinoma, 26.5%, 68.4% and 100% respectively were neoplastic on histopathology. Squamous lesions accounted for 14.9% of all the glandular lesions. Rosette or acinar formation and loss of polarity frequently observed in neoplastic lesions as compared to reactive changes (p = 0.0004, p = 0.001). Of the nuclear features, nuclear hyperchromasia or coarse clumping of chromatin along with nuclear membrane irregularity and nuclear pleomorphism was frequently associated with neoplastic lesions as compared to reactive conditions (p = 0.007, p = 0.001, p = 0.0002). A diagnosis of AGC at cytology harbors significant number of malignant lesions when confirmed on biopsy. Architectural features complemented with nuclear characteristics helps in differentiating between reactive and neoplastic conditions. Hence stratifying glandular lesions at cytology according to TBS helps in the management.

Diagnostic Utility of Cell Block Preparation of Fine Needle Aspiration Material

In routine FNAC, 15 to 20% are classified as non-diagnostic due to scanty cellullarity. Cell blocks can be prepared from the residual material of FNA obtained by flushing the needle hub. This ensures maximum utilization of all available material. This work aims to study comparative cytopathology in conventional smears &amp; Cell blocks &amp; the advantages and disadvantages of cell block technique over conventional smears. Present study was cross sectional study carried in a tertiary care hospital. Routine FNAC was done on 270 patients, cell blocks were made from residual material left behind after preparing conventional cytology smears. Conventional FNAC smears were adequate in 221 and Cell blocks in 214 cases. In 199 cases both conventional FNAC smears and Cell blocks were adequate, while in 22 only conventional smears were adequate and in 15 only Cell blocks were adequate. Adequacy of conventional FNAC smears and Cell Blocks were 81.85% and 79.25% respectively. Combined adequacy rate of conventional FNAC smears and Cell blocks was 87.40%. The study concluded that Cell blocks from the FNA material remaining in hub or syringe, after conventional smear preparation increases cellular yield, architectural pattern &amp; add to diagnostic efficacy of smear preparation of same patient without repeating the FNA or incurring an additional procedure.

Comparative Analysis for Diagnostic Yield of Small Cell Lung Cancer by Cytology and Histology During the Same Bronchoscopic Procedure

BackgroundBiopsy, brushing, and transbronchial needle aspiration (TBNA) are the most common methods used for the diagnosis of small cell lung cancer during the same diagnostic bronchoscopic procedure. However, it is not clear which method provides better results. Patients and MethodsA retrospective analysis was performed of 140 patients who had undergone video bronchoscopy for diagnostic purposes. Bronchial brushings were obtained from all subjects. Biopsy specimens were also obtained from all subjects, except for 6 cases that could not be sampled; the TBNA method was used for some special lesions. The results were analyzed separately by histology and cytology. ResultsThe diagnostic yield of cytology was significantly greater than that of histology (P < .01) and that of conventional smear preparations in cytology was obviously greater than that of hematoxylin and eosin stains in histology (P < .01). The false-negative results were significantly lower with cytology than with histology (P < .01). Also, the cases of sampling site restriction with cytology were distinctly less than those with histology (P < .05). Stretch deformation of the tissue structure and cell morphology was the main reason for the false-negative results in the histologic diagnosis. The use of TBNA resolved all 4 cases of hilar adenopathy and 2 cases of lesions outside the bronchus. Multiple brushings of the tissue adjacent to cancer tissue and liquid-based preparations of cancerous necrotic tissue can significantly reduce the false-negative results from biopsy. ConclusionsThe diagnostic yield of cytologic examination of brushings and TBNA for small cell lung cancer was superior to that of histologic examination of hematoxylin and eosin stains and immunohistochemistry.

Su1478 Diagnostic Yield of Surepath (SP) and Conventional Smear Preparations (CSP) for Brush Cytology Obtained From the Common Bile Duct (CBD) in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for Suspected Malignancy

Su1478 Diagnostic Yield of Surepath (SP) and Conventional Smear Preparations (CSP) for Brush Cytology Obtained From the Common Bile Duct (CBD) in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for Suspected Malignancy

Cervical Biopsy, Smear Evaluation and Comparison of Human Papilloma Virus Subtypes Result

Objective: The aim of this study was to investigate the relationship between human papilloma virus (HPV) types which was worked with polymerase chain reaction (PCR) and immunohistochemistry methods and cvtology and biyopsy results. Materials and Methods: A total of 100 cases from hospital between 2010-2013 participitated in this study. Linear Array HPV genotyping test was worked with PCR, tissue biopsies was evaluated with light microscopy, HPV was detected with immunohistochemistry (IHK) method and results were compared evaluating of conventional smear preparations according to Bethesda. Results: While 61 cases included high risk (61%), 39 cases included low risk HPV (39%). HPV types with high risk such as HPV16, HPV6, HPV11, HPV18, HPV31 respectively detected in 24, 19, 9, 7, 2 cases. HPV types with low risk such as HPV66 detected in 7 cases. HPV16 was observed epithelial cell abnormality such as 9 ASCUS, 3 LSIL,1 ASC-H, 1 AGUS in 14/24 ratio (58%) and ILMAN was observed 10/24 ratio (42%). Between cytological diagnosis results and HPV types are significant relationship according to chi-square test (p=0.001). When the results of the biopsy tissue analyzed, 38 patients were diagnosed intraepithelial neoplasia and malignant, 62 cases were diagnosed inflammation and other benign featured. The relationship between tissue diagnosis and HPV types is significant according to chi-square test (p<0.001). HPV in tissue was positive in 44 cases. The relationship between HPV types and tissue HPV results are significant (p<0.001). The cytological tissue diagnosis of 19 patients with ASCUS has been reported as follows; 10 CIN1, 3 CIN2, 2 CIN3 and 4 inflammation. Negative and positive HPV results studied in tissue are not significant results with cytological diagnosis (p=0.02) and tissue diagnosis results (p=0.02). Conclusion: The important of HPV detection is obvious, but tissue changes as well as HPV detection are important. Thus combined use of testing, even in evaluation with the biopsy results may give more realistic results for all types of cancers worldwide.

Utility of manual liquid-based cytology and conventional smears in the evaluation of various fine-needle aspiration samples.

Background:Liquid-based cytology (LBC) preparation is a way to improve and refine the fine-needle aspiration (FNA) samples. There are a few studies comparing LBC with conventional smear (CS).Aim:The present study was undertaken to evaluate the utility of manual LBC (MLBC) and CS preparations in various FNA samples.Materials and Methods:In this cross-sectional study, a total of 100 FNA samples from various anatomical sites were evaluated using MLBC and CS preparations. Cellularity, blood, informative background, monolayers, cell architecture, cytoplasmic, and nuclear preservation were compared with MLBC and CS preparations by Wilcoxon signed rank test. P < 0.05 is considered statistically significant.Results:MLBC preparations were superior to CS preparations in view of absence of blood and debris (P = 0.001), presence of monolayers (P < 0.001), and preservation of cytoplasmic (P = 0.001) and nuclear details (P = 0.001). However, no statistically significant differences were found between MLBC and CS preparations with regard to cellularity (P = 0.157), informative background (P = 0.083), and architecture (P = 0.739).Conclusion:MLBC preparations in FNAC are a safe, easy, and less time-consuming procedure, and it may have promising diagnostic value in the evaluation of FNA samples from various anatomical sites. However, the use of both MLBC and CS preparations is recommended to achieve optimal diagnostic yield.

Atypical glandular cells of undetermined significance in conventional cervical/vaginal smears and thin-layer preparations

Biopsy follow-up of a cervical/vaginal smear interpretation of atypical glandular cells of undetermined significance (AGUS) most often reveals either a benign reactive process or a squamous cervical intraepithelial neoplasia (CIN) rather than a glandular one. The ThinPrep Papanicolaou test (TP) has been shown to increase diagnostic sensitivity for CIN. To the authors' knowledge there are few studies examining its effectiveness in diagnosing uterine glandular lesions, either endocervical or endometrial. The authors compared outcomes after AGUS interpreted in TP specimens and conventional smear preparations (CPs). Follow-up was sought in all cases that were interpreted as AGUS during a 3-year period in which practice groups converted from CPs to TPs. A tissue diagnosis of adenocarcinoma in situ, CIN of Grade 2 or 3, or invasive carcinoma was considered to be a positive follow-up result. Either a benign biopsy finding with a subsequent benign cytologic result or two consecutive benign cytologic results were considered to be negative follow-up results. AGUS was reported in 116 of 75,002 TPs (0.15%) and 151 of 79,322 CPs (0.19%). Follow-up information was available in 91 (78%) and 130 (86%) cases, respectively. The predictive value of AGUS for a positive follow-up result was 22% in the TP group and 15% in the CP group. An AGUS interpretation with a positive follow-up result was found in 0.027% of all cases using TPs and in 0.025% of all cases using CPs. The use of TPs may increase the diagnostic specificity of AGUS for a high-grade precursor lesion or carcinoma.

ThinPrep versus conventional smear cytologic preparations in the analysis of thyroid fine-needle aspiration specimens.

Paired fine-needle aspiration specimens were analyzed from 41 surgically resected thyroid nodules, to compare diagnostic accuracy, amount (absent, mild, moderate, or marked) and pattern (diffuse, droplets, or both) of colloid, nuclear detail (poor, satisfactory, or excellent) and cytoplasmic detail (intact or disrupted) in ThinPrep (TP) (Cytyc, Marlborough, MA) versus conventional smear (CS) cytologic preparations. The 41 surgical specimens included 25 colloid nodules, 6 papillary carcinomas, 4 follicular adenomas, 2 minimally invasive (encapsulated) follicular carcinomas, 3 Hashimoto's thyroiditis, and 1 Grave's disease. Both techniques identified seven of the eight carcinomas with the minimally invasive follicular carcinomas categorized as hypercellular follicular nodule, possibly malignant (HCFN). One papillary carcinoma was classified as a HCFN by both TP and CS techniques. The four follicular adenomas were classified as HCFN based on the TP slides. One oxyphilic follicular adenoma, associated with focal lymphocytic thyroiditis, was misinterpreted as Hashimoto's thyroiditis on a conventional smear. Three colloid nodules were interpreted as HCFN based on the TP slides. Two of these were similarly classified based on the conventional smear. ThinPrep slides contained less colloid and the colloid occurred as droplets rather than a diffuse pattern. TP slides had better nuclear detail but more often disrupted cytoplasm. In conclusion, the TP process does alter some cellular features; however, we experienced similar diagnostic accuracy with the TP and conventional smear preparations.

Immunohistochemical Diagnosis of Central Nervous System Tumours on Smear Preparations

The successful application of immunostaining on smear preparations from 34 tumours of the central nervous system using the peroxidase-antiperoxidase technique and the avidin-biotin-peroxidase complex technique with commercially available antibodies is described. When combined with conventional smear preparations, the technique contributed to a rapid and accurate diagnosis in 79% of cases and is advocated to be a useful adjunct in neurosurgical diagnosis.