Conventional Smear Research Articles

Utility of Cell Block with p53 Immunostain in Diagnosing Urothelial Carcinoma

Background: Urine cytology is an initial noninvasive screening test done in patients with suspected urothelial carcinoma. The objective of this study was to compare the sensitivity of conventional smear cytology with cell block technique for the diagnosis of malignant cells in urine and to assess the efficacy of p53 immuno-marker in the diagnosis and prognosis of urinary bladder cancer.
 Methodology: The study was carried out in the department of Histopathology, Pakistan Institute of Medical Sciences(PIMS), Islamabad. Cell blocks and cytology smears and were prepared from urine samples of 80 patients of urothelial carcinoma and p53 stain was applied. Data was analyzed using version 21. Sensitivity of conventional smear and cell block techniques were calculated for both low and high grade urothelial carcinomas.
 Results:The sensitivity of detecting atypical cells using conventional smear was 31% and 70.6% for low grade and high grade urothelial tumors respectively. The sensitivity increased to 41.4% and 84.3% for low and high grade urothelial carcinomas respectively with cell block technique. Positive p53 stain was seen in 13.8% of cases with low grade tumors and 66.7% cases with high grade tumors. Chi-square test was used to find the association of cytology findings with the histologic grade.
 Conclusion: Sensitivity of urine cell blocks is higher than the conventional smear method for detecting high grade lesions. It can be used as an efficient non-invasive technique and an adjunct tool for the determination of disease relapse and overall survival in patients.
 Keywords: Carcinoma, Cytology, P53 Protein, Urine

Clinical characteristics and a 2-year follow-up of unsatisfactory conventional Pap smears: a retrospective case–control study

The objective of this study was to conduct a 2-year follow-up of individuals having unsatisfactory reports of Pap smears and to analyze the contributing factors. This was a retrospective study at a medical center that performed about 5000–6000 Pap smears annually in Eastern Taiwan. Women who had unsatisfactory results due to scant cellularity between January 1, 2015–December 31, 2016, were included in this study. The control group comprised age-matched women with normal Pap smears at a 1:4 ratio, during the same period. The clinical characteristics and the 2-year outcomes were followed. Patients who were unavailable for follow-up assessments or who had insufficient clinical information were excluded. Student’s t-test and chi-square test were used for continuous and categorical variables, respectively. Statistical significance was defined as a p-value < 0.05. A total of 887 Pap smears were included. A total of 717 and 170 women had normal Pap and unsatisfactory Pap tests, respectively. After excluding women who were unavailable for follow-up, the final analysis included 248 and 67 women with normal and unsatisfactory Pap tests, respectively. The mean age was not significantly different between the two groups (49.97 ± 10.69 and 51.61 ± 11.28 years in the unsatisfactory Pap and control groups, respectively [p > 0.05]). The percentage of menopause and vaginal discharge were significantly different between the two groups. Multivariate analysis revealed that premenopausal status, increased discharge were associated with the risk of unsatisfactory Pap tests. Of the 67 women with unsatisfactory Pap tests, all tested negative for any malignancies at a 2-year follow-up assessment. Women with increased vaginal discharge and without menopause were at an increased risk of having an unsatisfactory Pap test. Our results indicate that an unsatisfactory Pap smear due to scant cellularity might not increase the risk of intraepithelial neoplasia or cancer after 2 years. Further, large-scale studies with longer follow-up periods are required.

DIAGNOSTIC ROLE OF MANUAL METHOD OF LIQUID BASED CERVICAL CYTOLOGY

Background: The introduction of the Pap test as a screening procedure to detect precancerous lesions has helped to reduce both the incidence and mortality of cervical cancer. In order to improve the sensitivity, specicity of the Pap test there has been a shift from conventional cytology to Liquid based cytology. A disadvantage of the Liquid based cytology is the high cost automated processing equipment. On the other hand, Manual Liquid-Based Cytology is a technique that also enables cells to be suspended in a monolayer similar to Liquid based cytology and improves detection of precursor lesions, specimen adequacy and also a cost effective strategy in limited resource setting. To compare the Objective: diagnostic utility of Manual liquid-based cytology versus Conventional pap smear in cervical cancer detection on cervical smears. Materials and Methods: In this prospective comparative study, 210 samples were collected for conventional pap smears and Manual Liquid-Based Cytology to compare the two methods and to correlate with histopathological diagnosis where specimen was available. The Manual Liquid-Based Results: Cytology showed sensitivity of 100% , specicity of 91.7% while conventional smears had sensitivity of 75% and specicity of 85.7%.The diagnostic accuracy of Manual Liquid-Based Cytology was 98% and that of conventional method was 78% The p value was less than 0.005 in Manual Liquid-Based Cytology (0.0001) and CPS (0.0001) methods considering histopathology as gold standard. This study Conclusion: showed that Manual Liquid-Based Cytology has a higher sensitivity and specicity than conventional pap smears.

Cytomorphological spectrum of cervical pap smear reports using the 2014 bethesda system for reporting cervical cytology; A two year study in a tertiary care hospital at Puducherry, India

Background: Cancer cervix is fourth most common cancer in world and second most common in India. It is considered as a preventable disease when identified at an early stage by pap smear screening test. Aim: This study aims to explore the use of conventional pap smear for the diagnosis of various cytomorphological spectrum of cervical pap smear reports using “The Bethesda System for reporting cervical cytology 2014” (TBSRC 2014), to analyze the clinical and demographic data of the patients, and also to characterize the age pattern of various pap smear findings/results and prevalence of abnormal pap smears among various age groups as well. Methods: In this retrospective study, a total of 1650 conventional pap smears of women who attended gynaecology OPD in our tertiary care hospital, Puducherry, India between July 2018 to July 2020 are evaluated and reported as per TBSRC 2014 and the results were tabulated and analysed accordingly. Results: 1376 women had Negative for Intraepithelial lesion/ Malignancy (NILM) and 33(2.3%) had Epithelial cell abnormality (ECA). Organisms (15.3%) is the one of the frequent patterns of NILM in the study involving predominantly 21-40 years age group (11%).

Utility of NR4A3 on FNA cytology smears and liquid-based preparations of salivary gland.

Fine-needle aspiration cytology (FNAC) is generally the initial sampling method for salivary gland neoplasms. The cytomorphologic features of acinic cell carcinoma (AciCC) of salivary gland can overlap with other neoplastic and nonneoplastic entities. AciCCs harbor a recurrent t(4;9) rearrangement with upregulation of nuclear receptor subfamily 4 group A member 3 (NR4A3). NR4A3 protein overexpression has been shown to be highly sensitive and specific for the diagnosis of AciCC in histologic specimens and cell block preparations. However, data on NR4A3 immunocytochemistry (ICC) on conventional smears or liquid-based cytology are limited. The authors identified 18 FNAC of histologically proven AciCC cases between 2013 and 2019. FNAC samples of diagnostic mimickers were likewise retrieved and included in the study cohort for comparison. The NOR1/NR4A3 mouse monoclonal antibody was applied directly to FNAC slides using a standard ICC technique. The cohort included ethanol-fixed Papanicolaou-stained cytologic smears and liquid-based preparations from 18 AciCC, one secretory carcinoma, four mucoepidermoid carcinomas, four salivary duct carcinomas, five pleomorphic adenomas (PA), five Warthin tumors, five oncocytomas, one oncocytic hyperplasia, and five nonneoplastic salivary gland cases. Strong nuclear staining for NR4A3 was present in all AciCC, weak nuclear staining was present in one PA, and all other non-AciCC were negative (sensitivity, 100%; specificity, 97%). NR4A3 ICC can be used directly on FNAC conventional smears and liquid-based cytology to reliably distinguish AciCC from its mimickers. This marker may be useful in cases where a cell block preparation is unavailable or inadequate.

Digital cervical cancer screening: a reliable One-Stop method ?

BackgroundWorldwide, cervical cancer (CC) is considered the fourth most common cancer in women. Globocandata stated 311,365 CC related mortalities in the world in 2018, 90% of them occurred in low-income countries. In Jordan, CC ranks as the 12th most common cancer among women. The primary aim of this report is to be able to decide if digital screening (DS) is reliable and worth using in our one stop gynecology clinics. Materials and MethodsThis study was done for all women who attended one stop out-patient gynecology services for routine CC screening between 1/1/2019 and 31/12/2019. Inclusion criteria requested women to be 18 years of age or more, healthy, and had previously normal cervical smear (conventional Pap smear (CPS) or Liquid based cytology (LBC)) i.e., all previous screening tests results were normal. ResultsA total number of 94 patients agreed to have the DS method done, mean age was 43 years. 25.5% were found to have abnormal screening results on DS. When compared to the national data of 12.5% abnormal smears in Liquid‐based cytology (LBC), there was a statistically significant difference in the numbers of abnormal screening results between both methods (p value of 0.000). LBC is used in most centers for CCS in Jordan ConclusionThe digital cervical screening method saves time and offers a one stop clinic management, therefore minimizing lost to follow up rate, and where colposcopy is indicated. Additionally, DS should be considered in low resource countries.

Importance of Cytological Screening in the Diagnosis of Cervical Diseases

The purpose of the study was to compare the conventional Pap smear with liquid-based cytology in the early diagnosis of cervical diseases. Materials and methods. The study included 150 women between the ages of 18 and 73 with cervical diseases. The comparison was held on the basis of the results of histology of liquid-based and conventional Pap smears taken from cervix. Bethesda classification was used to make the diagnosis. Diagnostic performance was calculated in terms of sensitivity, specificity, positive predictive value and negative predictive value. Results and discussion. During the sensitivity, specificity and prognostic assessment of liquid-based cytology with conventional Pap smears, the sensitivity of liquid-based cytology was higher than the conventional Pap test – 93.1%, and the conventional Pap test was 81.3%. The specificity of liquid-based cytology can be compared with a conventional Pap test (76.2% and 70.6%, respectively). The positive prognostic value was 84.4% in liquid-based cytology and 88.6% in the conventional Pap test. Negative prognostic value was significantly higher in liquid-based cytology than in conventional Pap tests (88.9% and 57.1%, respectively). The total diagnostic value was 86.0% in liquid-based cytology and 78.5% in the conventional Pap test. As a result of the study it has become clear that liquid-based cytology is an appropriate method for the diagnosis of cervical diseases. There are screening programs for cervical, breast, colorectal and prostate cancer in the country, but due to some psycho-social factors, restrictions and barriers, patients only seek medical attention when there is an urgent need. As a result, more than half of all cancers are diagnosed at a late stage. Thus, the study concluded that liquid-based cytology is more convenient than conventional smear screening for cervical cancer screening. As single-layer smears are easier to examine, cells with atypia are not covered by other cells (inflammation, blood, etc.). In addition, the amount of unsatisfactory smears is minimal. In general, many studies have been conducted comparing liquid-based cytology with conventional Pap smears. The results were different in both the initial studies and the meta-analysis. Conclusion. Thus, both screening methods predict the likelihood of disease in the same way, but with liquid-based cytology, the number of false-negative results is less, and the sample quality is improved by reducing the number of unsatisfactory smears. Also, women with liquid-based cytology are more likely to get a positive result than those with cervical disease. Liquid-based cytology is superior and more sensitive than conventional Pap tests in the detection of cervical neoplasms

A retrospective analysis of serous effusions based on the newly proposed international system for reporting serous fluid cytopathology: a report of 3633 cases in an oncological center

BackgroundThe International System for Reporting Serous Fluid Cytopathology (TIS) was recently proposed. We retrospectively applied TIS recommendations for reporting the cytological diagnosis of serous effusions and reported our experience.MethodsAll the serous effusions from January 2018 to September 2021 were retrieved from the database. Recategorization was performed using the TIS classification, the risk of malignancy (ROM) was calculated for each TIS category. In addition, on the basis of the original TIS classification, we further subdivided the TIS category IV (suspicious for malignancy, SFM) into 2 groups (IVa and IVb) according to cytological characteristics (quality and quantity) to explore the necessity of SFM subclassification. The performance evaluation was carried out using different samples (pleural, peritoneal and pericardial effusions) and preparation methods (conventional smears, liquid-based preparations and cell blocks).ResultsA total of 3633 cases were studied: 17 (0.5%) were diagnosed as ‘nondiagnostic’ (I, ND), 1100 (30.3%) as ‘negative for malignancy’ (II, NFM), 101 (2.8%) as ‘atypia of undetermined significance’ (III, AUS), 677 (18.6%) as ‘suspicious for malignancy’ (IV, SFM), and 1738 (47.8%) as ‘malignant’ (V, MAL). The ROMs for the categories were 38.5%, 28.6%, 52.1%, 99.4% and 100%, respectively. The ROM for SFM was significantly higher than that for AUS (P < 0.001), while the difference between the ROMs for IVa and IVb was insignificant. The sensitivity, negative predictive value (NPV) and diagnostic accuracy of liquid-based preparations were all superior to those of conventional smears and cell blocks in detecting abnormalities. Using the three preparation methods simultaneously had the highest sensitivity, NPV and diagnostic accuracy.ConclusionSerous effusion cytology has a high specificity and positive predictive value (PPV), and TIS is a user-friendly reporting system. Liquid-based preparations could improve the sensitivity of diagnosis, and it is best to use three different preparation methods simultaneously for serous effusion cytologic examination.

A STUDY OF PLEURAL EFFUSION BY COMBINED APPROACH OF CONVENTIONAL SMEAR AND CELL BLOCK TECHNIQUE

BACKGROUND: Cytological examination of pleural uid is of paramount importance not only for diagnosis, staging, prognostication and management of malignancy also gives information about various inammatory and non-inammatory conditions. Conventional smear method has some disadvantages which can be overcome by cell block technique. To compare cytomorphological features ofAIMS AND OBJECTIVES: conventional smears versus cell block technique and also to evaluate the diagnostic efcacy of a combined approach of conventional smear study and cell block technique. 150 Sterile uid sample were processed in cytology section, Department of Pathology,MATERIAL AND METHOD: DECCAN COLLEGE OF MEDICAL SCIENCES, HYDERABAD. This study was conducted over a period of one and half years from January 2018 to June 2019. Each sample was divided into two equal parts one part was subjected to conventional smear method and other part was subjected to cell block technique. Statistical analysis was done using Microsoft Excel to calculate sensitivity and specicity of conventional cytosmears and cell block technique.RESULT: Sensitivity and additional yield for malignancy was 50% more by cell block method.

Comparison of ITS-1 and TBR-1/2 primer sensitivity for the detection of Trypanosoma evansi local isolates in experimental rats using a polymerase chain reaction.

Background and Aim:Surra is caused by Trypanosoma evansi. The detection method using conventional parasitological tests has not always shown positive results in blood parasite detection, although the livestock has presented with clinical signs. Therefore, a fast and accurate diagnosis is necessary to prevent the disease predominately in field isolates. This study aimed to investigate the sensitivity of molecular detection method using two different specific primers, namely, Internal Transcribed Spacer 1 (ITS-1) and Trypanosoma brucei repeat 1/2 (TBR-1/2) against T. evansi field isolates from Banten Province, Indonesia.Materials and Methods:The isolates of T. evansi used in this study were collected from Banten Province and cultured and preserved by the National Research Center for Veterinary Science, Indonesia. Eighteen experimental rats were divided into three equal groups, which were categorized as control, 1 × 101, and 1 × 104 infective doses. The isolates were injected into all experimental albino rats intraperitoneally. All samples were tested using conventional blood smear, card agglutination test (CATT), and polymerase chain reaction (PCR) method.Results:The results of the CATT examination in all treatments showed negative results. However, PCR results showed that two different primers, namely, ITS-1 and TBR-1/2 had been successfully detected T. evansi from infected experimental rats, proven by positive PCR band appeared in 480 base pairs (bp) and 164 bp, respectively.Conclusion:Based on the molecular diagnostic test using PCR method, TBR-1/2 primer is more sensitive to detect T. evansi compared to ITS-1 primer. The present finding provides preliminary data for studying the efficiency of different primers if practically applied as a standard diagnostic test for trypanosomiasis, especially in Indonesian livestock.

Diagnostic Utility Of Fluid Cytology By Conventional Smear And Cell Block Method In Pleural Effusion

The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered a definitive diagnosis. The study was planned to determine the diagnostic utility of fluid cytology by conventional smear and cell block method in pleural effusion. This was a hospital-based open cohort observational study conducted on patients diagnosed with pleural effusion. The study period was one year, and patients were recruited using a nonprobability sampling method. The fluid samples were subjected to the conventional smear examination, followed by cell block preparation. The overall morphologic details, cellularity, architecture, and nuclear and cytoplasmic details were studied and compared in conventional smear and cell block techniques. The samples were categorized as unsatisfactory, benign, suspicious for malignancy, or malignancy. The study was conducted on 113 pleural fluid samples. The study demonstrated that the cell block technique improved the cellular yield and established diagnosis in malignant effusions.

High Prevalence of Cervical High-Grade Lesions and High-Risk Human Papillomavirus Infections in Women Living with HIV: A Case for Prioritizing Cervical Screening in This Vulnerable Group

Introduction: Women living with HIV (WLHIV) are at an increased risk of developing cervical precancerous lesions and cervical human papillomavirus (HPV) infection. This study aimed at evaluating the prevalence of cervical lesions and high-risk HPV (HR-HPV) infection in WLHIV in comparison to the HIV-negative women undergoing opportunistic screening. In addition, these findings among WLHIV were correlated with the clinic-demographic factors. Methods: A cross-sectional study was conducted among WLHIVs at a tertiary hospital and linked antiretroviral therapy (ART) center, while HIV-negative women were recruited from the health promotion clinic at our institute. With informed consent, a semi-structured questionnaire was filled on demographic and epidemiological parameters. Conventional cervical smears and samples for HPV DNA detection by HC2 high-risk HPV DNA test were collected in all participants. Cervical smears were reported using the Bethesda system 2014. Appropriate statistical analysis was performed for bivariate and multivariate logistic regression analysis for comparison between WLHIV and HIV-negative women and for correlation of abnormal cervical cytology and HR-HPV infection among WLHIVs. Results: The clinic-demographic characteristics of WLHIVs and HIV-negative women were similar. On cytology, the prevalence of cervical cytological abnormalities were significantly higher (p < 0.001) among WLHIVs (14.1%) compared to HIV-negative women (3.1%). High-grade lesions were seen in 3.7% of WLHIVs, while no high-grade lesions were detected in HIV-negative women. Cervical HR-HPV infection was also significantly higher (p < 0.001) in WLHIVs (28.9%) than HIV-negative women (9.3%). Cervical precancerous lesions in WLHIVs showed positive association with current sexually transmitted infection (STI), multiple sexual partners, tobacco use, and CD4 count less than 200/µL, while cervical HPV was positively associated with current STI, tobacco use, CD4 count less than 200/µL and negatively with ART intake. On multivariate logistic regression, cervical cytological abnormalities showed a significant association with multiple sexual partners (p < 0.001), while cervical HR-HPV infection was positively associated with current STI (p = 0.01), nadir CD4 count <200/µL (p = 0.004), abnormal cervical cytology (p = 0.002) and negatively with ART intake (p = 0.03). Conclusion: Women living with HIV have a significantly higher prevalence of cervical precancerous lesions and HR-HPV infection compared to the general population. Considering the lack of an organized population-based cervical cancer screening program in many low-resource countries like ours, specific focus on screening this highly vulnerable population to reduce the morbidity and mortality due to cervical cancer is imperative.

Cytomorphological evaluation of ascitic and pleural fluid with special reference to cell block method

: The cytological examination of serous effusions helps in diagnosis, staging and prognostication of patients with various malignancies. Combined analysis of Conventional smear and Cell block methods increases the diagnostic value of serous effusions. Of this study is to evaluate the cytomorphological features of ascitic and pleural fluids by the Conventional smear (CS) technique and the Cell block (CB) method, to compare them and also to assess the utility of their combined approach in the diagnosis of malignancy. : It is a cross sectional study, 110 specimens (64 ascitic and 46 pleural fluids) were subjected to evaluation by both CS and CB methods over a period of one year. Cellularity, architecture patterns, morphological features, nuclear &amp; cytoplasmic details and also yield for malignancy were compared. Chi-square and p-value were calculated. Cell block method provided higher cellularity, better architectural patterns and additional yield for malignancy as compared to Conventional smear method. Chi square -19.0275, p- value is 0.000776. The p value is p&amp;#60;0.05, it is statistically significant. The present study shows that it is advisable to routinely make CBs in every cases that were suspicious for malignancy by CS method.

Liquid-based cytology: Technical aspects.

Liquid-based cytology (LBC) is a monolayer slide preparation technology that has outperformed conventional Pap smears because of improved fixation, decreased obscuring factors, and standardized cell transfer. In LBC, samples are collected by completely immersing the sampling device into the company vial containing preservative fluid, whereby the cells are preserved and fixed simultaneously unlike conventional smears where the sample is smeared onto the glass slide and fixed separately. To date, two major liquid-based preparation methods are known – ThinPrep and SurePath. These two methods are different in their principles of cell harvesting but produce similar preparations. SurePath works on the principle of density gradient sedimentation. In this, a sample is vortexed and strained to break the mucus and large cell groups and then is treated through a density gradient centrifugation process to remove blood and debris. The cell pellet is resuspended and is allowed to sediment onto a glass slide. This is followed by staining on the PrepStain instrument. Government Medical College and Hospital, Nagpur, India, uses the SurePath method which was approved by FDA in the USA in 1999. Our institution uses Rovers Cervex-Brush to collect the cells from the transformation zone. This chapter describes the principle of SurePath and the processing of cervicovaginal specimen using the fully automated system in the laboratory.

Diagnostic utility of conventional and liquid-based cytology in the management of thyroid lesions; an institutional experience.

Objectives:Liquid-based cytology (LBC) is becoming a useful method in evaluating both gynecological and nongynecological preparations. Many studies have been conducted these days to see the quality of LBC in diagnosing thyroid lesions and its role is yet to be standardized. This study has been done to pick the cytomorphological features of thyroid lesions on LBC and to compare them with the conventional cytology of these lesions.The objective of the study is to evaluate the efficacy of thyroid fine-needle aspiration cytology processed by LBC as compared to conventional smears.Material and Methods:A prospective study has been done on 53 cases of thyroid lesions using standard conventional and LBC techniques.Results:In most of the cases, the cytological features are similar in conventional cytology smears and LBC, but the colloid film and the lymphocytic component show a clear picture on direct smears, whereas nuclear and cytoplasmic details are better evaluated in LBC slides. The preservative solution used in LBC could be efficiently used for the application of immunocytochemical and molecular techniques.Conclusion:LBC does not represent as a valid alternative to conventional cytology but it can be considered as a diagnostic utility process especially due to the possibility of applying additional techniques which enhance the efficacy of the cytological diagnosis of thyroid lesions.

Small-cell neuroendocrine carcinoma of the cervix accompanied by adenocarcinoma and high-grade squamous intraepithelial lesion.

Few cytological reports have described small-cell neuroendocrine carcinoma (SCNEC) in the female genital tract. In the present study, we describe a cytological case of SCNEC accompanied by adenocarcinoma, as well as high-grade squamous intraepithelial lesion (HSIL). A Japanese woman (42 years old) presented with abnormal genital bleeding. A conventional Papanicolaou smear revealed an inflammatory condition with three neoplastic components: SCNEC as irregular aggregates of neoplastic small round cells with nuclear molding and granular chromatin; adenocarcinoma as columnar cell clusters with peripherally located large nuclei, and HSIL as sheets or clusters of dysplastic basal-type squamous cells with irregular hyperchromatic nuclei. Accordingly, a cytodiagnosis of SCNEC with adenocarcinoma and HSIL was made. Owing to the rarity of cervical SCNEC, cytological diagnosis may be difficult. Due to its aggressive clinical behavior, the presence of an SCNEC component should be verified in any cytodiagnosis of adenocarcinoma or HSIL.

Improved Conventional and New Approaches in the Diagnosis of Tuberculosis.

Tuberculosis (TB) is a life-threatening infectious disease caused by Mycobacterium tuberculosis (M. tuberculosis). Timely diagnosis and effective treatment are essential in the control of TB. Conventional smear microscopy still has low sensitivity and is unable to reveal the drug resistance of this bacterium. The traditional culture-based diagnosis is time-consuming, since usually the results are available after 3–4 weeks. Molecular biology methods fail to differentiate live from dead M. tuberculosis, while diagnostic immunology methods fail to distinguish active from latent TB. In view of these limitations of the existing detection techniques, in addition to the continuous emergence of multidrug-resistant and extensively drug-resistant TB, in recent years there has been an increase in the demand for simple, rapid, accurate and economical point-of-care approaches. This review describes the development, evaluation, and implementation of conventional diagnostic methods for TB and the rapid new approaches for the detection of M. tuberculosis.

High Asymptomatic Cases of Babesiosis in Dogs and Comparison of Diagnostic Performance of Conventional PCR vs Blood Smears.

Babesiosis is one of the most important globally extended and quickly spreading tick-borne infections of dogs. Diagnosis of babesiosis in Sri Lanka is based on clinical signs followed by thin blood smears which could be error-prone due to undetected early infections, absence of clinical signs or low parasitemia. The present study investigated the prevalence of babesiosis in dogs presented to the Veterinary Teaching Hospital (VTH) at the Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, for treatments, vaccinations, and regular check-ups, and compared the diagnosis methods of microscopy and molecular analysis. Blood samples from dogs were collected from January to June 2019. First, Giemsa stained blood smears were prepared, and then the blood samples were subjected to PCR using genus-specific primers to amplify a 411-450bp region in the 18S rRNA gene. Twenty samples from PCR amplified products were sequenced for species identification and phylogenetic analysis. Clinical signs of the dogs were noted down, and ticks were also collected from dogs if any. Results show a very high prevalence of canine babesiosis (78.6%) among the dogs brought to the VTH. The parasite was identified microscopically and genetically as Babesia gibsoni. A large percentage (66.7%) of infections was asymptomatic. Out of 42 blood samples, 19 (45.2%) were microscopically positive for babesiosis while 33 (78.6%) were PCR positive, showing a significant difference in the two methods of diagnosis (chi-square test, χ2 = 9.462, p = 0.002). Three tick species: Rhipicephalus haemaphysaloides, Haemaphysalis bispinosa, and Rhipicephalus sanguineus were found attached to the dogs. This study shows a very high prevalence of canine babesiosis among dogs in the Kandy area. Most of these infections might go undetected if only microscopy was used to diagnose. An improved, rapid diagnostic method such as the novel, PCR-based point-of-care diagnostic method that detects very low parasitemia within 30min is needed. Moreover, as most infected dogs did not show clinical signs, they may act as reservoirs of infection. The ability of asymptomatic dogs to spread babesiosis should be investigated.

Usefulness of Liquid-Based Cytology in Diagnosing Biliary Tract Cancer Compared to Conventional Smear and Forceps Biopsy.

Liquid-based cytology (LBC) has been shown to improve the diagnostic efficacy of brush cytology for thyroid, cervical and pancreatic cancer. To evaluate the diagnostic performance of LBC for biliary tract cancer, we compared it with conventional smears and forceps biopsies. A retrospective study was conducted of all consecutive patients who underwent brush cytology under ERCP from January 2010 to April 2020. The primary outcome was the diagnostic efficacy of conventional smears and LBC. The difference between the two groups was corrected using inverse probability weighting (IPW). The secondary outcome was the sensitivity and specificity of brush cytology and forceps biopsy. The secondary outcome was evaluated in patients who underwent both methods. Among 162 patients, conventional smears were performed in 70 patients and LBC was performed in 92 patients. In the primary analysis using IPW, the sensitivity of conventional smears and LBC was 56.00% and 78.26% respectively (P = 0.009). The specificity was 100% for both methods. The accuracy was 66.15% for conventional smears and 83.33% for LBC (P = 0.012). In the secondary analysis, the sensitivity of conventional smears versus forceps biopsies was 62.16% versus 78.38% (P = 0.034) and 81.16% for both LBC and forceps biopsies. The specificity of both cytological examination and forceps biopsies was 100%. Liquid-based cytology demonstrated better sensitivity and accuracy than conventional smears. Moreover, its diagnostic performance was close to that of forceps biopsies.

Comparison of conventional and liquid-based Pap smear methods in the diagnosis of precancerous cervical lesions

Cervical cancer is one of the five most common cancers among women. The present study aimed to compare conventional and liquid-based Pap smear methods in 2018 in Kerman, Iran. This was a cross-sectional study. Pap smear samples (conventional Pap smear (CN) and liquid-based cytology (LBC)) were collected from five health centres in Kerman. Samples were classified into two groups of liquid and CNs, and each group was classified into normal, abnormal (including, atypical squamous cells of undetermined significance (ASCUS+), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H+), low-grade squamous intraepithelial lesion (LSIL+), high-grade squamous intraepithelial lesion (HSIL+) and cancer+) and unsatisfactory. Descriptive data analysis and chi-square/Fisher's exact test were performed in SPSS 20 (SPSS Inc., Chicago, IL). Totally, 31,513 women were screened by two CN and LBC. The mean age of subjects was 39.73 ± 9.58 years. The unsatisfactory smears (1.4% versus 0.02%; p=.001) and ASCUS+ (45.1% versus 39.4%; p=.007) were more reported by conventional tests, while LSIL+ (33.1% versus 38.9%; p=.005) was reported by the LBC test. Among women who were younger than 40 years, the CIN2+ that was found by LBC was significantly more than the CN method (37.4% versus 31.7, p=.04) and among older women (older than 40 years) the CIN1+ was significantly more as well (18% versus 13.6%, p=.05). The present study showed that, although LBC had many advantages, CN is still useful. Further studies are to be suggested as a clinical trial in another population with a large number of participants to compare the diagnosing methods of cervical cancers. Impact Statement What is already known on this subject? The conventional Pap smear (CN) and liquid-based cytology (LBC) methods are the most common methods for screening cervical cancers. Previously, in some studies, LBC was reported as a better method and in some studies, traditional method was preferred. Conflicting results were found in previous articles. What do the results of this study add? LBC compared to CN could find truer abnormal cases. The superiority of the LBC method is seen in cases such as reducing unsatisfactory cases, etc. LBC compared to CN could find more CIN+. Also, LBC could find more CIN1+ among women older than 40 years and more CIN+ ≥2 among younger women. What are the implications of these findings for clinical practice and/or further research? Although LBC has many advantages and it is easier, CN is still useful and both methods are suitable for cervical abnormality and cancer detection. CN cannot be declared an outdated method.