Cytological Grading Research Articles

Robinson′s cytological grading on aspirates of breast carcinoma: Correlation with Bloom Richardson′s histological grading

Background:Cytological grading (CG) on aspirates of breast carcinoma is a useful tool for surgical maneuver and prognosis.Aims:An endeavor was made to use CG on aspirates of breast carcinoma using Robinson's grade and to correlate it with Bloom Richardsons’ histopathological grading.Materials and Methods:A total of 59 patients of breast carcinoma, aged 28-57 years, were aspirated and the smears were graded using Robinson's criteria. All the cases were correlated with Bloom Richardson's grade on histopathology in mastectomy specimens. Lymphadenopathy in 38 cases was aspirated and stained with Papanicolaou and Romanowsky stain.Results:Robinson's CG correlated well with Bloom Richardson's histopathological grading. For grade I and II tumors, there was substantial strength of agreement between cytology and histopathology, while in grade III, the concordance was nearly perfect. Lymph node metastasis was found in 27 of 32 axillary nodes, three of five cervical nodes and the only palpable supraclavicular node. Lymph node metastasis was observed in three with cytological grade II, 28 of grade III and none of grade I. All grade I had stage A, two of grade II had stage B, while all grade III had either stage B or stage C disease.Conclusions:Thus, CG of breast carcinoma correlates well with histopathological grading and may well be useful as a prognostic marker.

Determination of infiltrative ductal breast carcinoma differentiation grade in biopsy imprints

In patients with breast carcinoma there are many risk factors for assessment of breast carcinoma maturity and prognosis. Besides histological type of differentiation, cytologic criteria for the evaluation grade of the differentiation of infiltrative ductal breast carcinomas are very important for prognosis. The aim of this study was to define cytologic criteria for grading of infiltrative ductal carcinomas of the breast. . The imprints of intraoperative biopsies from 124 patients were studied. They were air-dried and stained by May-Grünwald Giemsa method. The features assessed were: the degree and type of cell clustering, nuclear diameter and pleomorphism, chromatin structure, number and features of nucleoli, the aspect of cytoplasm, noncellular background and the variability of cells and nuclei. According to these morphologic features the infiltrative ductal carcinomas of the breast could be classified into three grades of differentiation. Cytologic and histologic differentation grade revealed disagreement among 34.6% of the imprints. In 9 of total 23 histologicaly well differentiated carcinomas, cytological differentation grade was moderately differentiated. In 63 carcinomas with histologic differentiation grade II, cytologic differentation grade was good in 12 and poor in 16 carcinomas. Cytologic and histologic grading were not identical in 34.6% of the imprints what points out the need to further definition of diagnostic criteria, especially for grade II of differentiation.

Characteristic cytological features of histological grade one (G1) breast carcinomas in fine needle aspirates

To analyse the spectrum of nuclear features as well as dissociation pattern found in fine needle aspirates (FNAC) from histological grade 1 breast carcinomas and evaluate the critical cytological features of these lesions. The material consisted of FNAC smears from 494 histologically confirmed grade 1 breast carcinomas. All smears were revaluated for cell dissociation pattern, nuclear size, cell uniformity, nucleoli, nuclear margin and chromatin pattern. All features were compared with the histological subtype and cytological grading. 73.9% of the cases were cytological grade 1, 24.3% were grade 2 and 1.8% were grade 3. The majority of the cases had a cell dissociation pattern showing both a population of single carcinoma cells and cell clusters (65.9%). Practically all tumours had a granular chromatin pattern (94.7%) and a slightly irregular nuclear margin with folds and grooves (94%) irrespective of histological subtype and cytological grading. Nucleoli were mostly indistinct or small (74%), whereas 24.3% were noticeable and 1.7% abnormal. Practically all cases revealed some degree of pleomorphism with 74.3% showing mild and 22.4% a distinct pleomorphism. A small subgroup of IDC was classified as monomorphic (3.3%). Almost all tumours had nuclear sizes in the range of 2-4 x RBC (96.9%). Not all histological grade 1 carcinomas are cytological grade 1. About 25% were grade 2, and a small subpopulation reached grade 3. The typical/average findings in FNAC from grade 1 breast carcinomas were a population of both groups and single cells showing mild pleomorphism, granular chromatin, slightly irregular nuclear margin, indistinct nucleolus and nuclear size 2-4 x RBC.

Quantitative classification of breast fine needle aspirates using the AxioHOME system

Fine needle aspiration cytology is useful in the pre-operative assessment of patients with breast lumps. Lesions are reported as benign, suspicious or malignant. The number of suspicious categories is high in inexperienced hands thus limiting this useful diagnostic tool. The aim was to evaluate quantitative methods of classifying breast fine needle aspirates using the Highly Optimized Microscope Environment system. May- Grumwald Giemsa-stained archived slides were retrieved and smear quality assessed. Fifty epithelial cells corresponding to the cytological grading on each slide were measured using the system\'s general morphometry program. Generated data was exported to Microsoft Excel for analysis. A significant difference in the mean nuclear area, mean nuclear perimeter, mean largest nuclear diameter was found between the slides graded as benign, suspicious malignant and malignant. C2 & C4, D 1, P < 0.004. C4 & C5, Area P < 0.001. The means of the number count of nucleoli was able to distinguish between FNAC Benign and Malignant category C2/C5, P = 00440 and suspicious benign and malignant C3/C5 P = 0.00486. Morphometry could be useful in situations where experienced cytopathologists are unavailable especially when this program can also measure the degree of dispersion between cells Keywords: Morphometric image analysis, aspiration cytology, breast. International Journal of Biological and Chemical Sciences Vol. 2 (2) 2008: pp. 139-145

Pattern of breast cancer presentation at first diagnosis in 2,246 patients from a single Italian institution

22182 Background: The aim of this study is to evaluate the pattern of female breast cancer presentation at first diagnosis in a single institution case series in Milan, Italy. Methods: Stage at diagnosis, histology and biological characterization of the disease were retrospectively evaluated in 2,246 consecutives cases of female breast cancer observed in our outpatient department, from January 1985 to December 2007. Results: patients' median age was 58.7 (± 12) years. Most patients were postmenopausal (74%), whereas premenopausal were 25.5% (not evaluated 0.5%). Tumor size and lymph nodal involvement: Tis in 97 pts. (4.3%); T1 in 1.341 pts. (59,7%); T2 in 584 pts (26%); T3 in 74 pts (3,2%); T4 117 pts (5,2%). Out of 825 (36,7%) node positive pts., 346 (41.9%) were T1 and 317 (38.4%) T2. Distant metastases were detected at first diagnosis in 83 pts. (3,7%). Histology showed a prevalence of invasive ductal carcinoma (74.4%), followed by invasive lobular carcinoma (8.7%), invasive tubular carcinoma (2.6%), mucinous (1.2%), invasive medullar carcinoma (1%), intraductal (3.2%), lobular in situ carcinoma (0.3%). Cytological grading: G1 15.4% of the 2,092 tested, G2 35% and G3 25%. (24,5% not evaluated). Angioinvasivity 12.4% of the 2,233 tested. Ki67 was <10% in 33% of the 1.532 tested, 10–20% in 30% and >20% in 33%. HER-2 was positive in 90.3% and negative 9.7% of the 1.440 tested. Hormonal receptor status: Er + and PgR + in 53.8%, Er - and PgR- in 15.8%, Er+ and PgR- in 14% or PgR + and Er - in 2%. In 13.3% hormonal status was not assessed. In 680 pts. (30,3%) there was family history of breast cancer. Among them 55.4% had first degree relative with breast cancer, 29.3% pts. had second degree relatives with breast cancer, 15.3% pts. out of them had third degree relatives with breast cancer. Conclusions: The collected data represent the breast cancer pattern of presentation in a general hospital based in the urban area of Milan, Italy. Interestingly, 48,6% of pts were diagnosed in early stage (pTis-pT1, N0) and in 64% of all pts. tumor size was < 2 cm. No significant financial relationships to disclose.

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Purpose: To compare the subjective symptoms, conjunctival hyperemia, tearing response and conjunctival cytological changes secondary to topical administration of bimatoprost and travoprost for 6 months. Methods: Newly diagnosed primary open-angle glaucoma patients were randomly prescribed bimatoprost (35 cases) or travoprost (42 cases). Two patients in each group were excluded because they did not appear at their appointments regularly. Thus, 33 and 40 patients completed the study in the bimatoprost and travoprost groups, respectively. Redness, itching, foreign-body sensation, pain and discomfort were assessed by a questionnaire, and patients were examined for conjunctival hyperemia. Schirmer’s I and break-up time tests were performed, and impression cytology of conjunctiva was evaluated. Results: Subjective symptoms were similar in both groups. The only subjective symptom that changed significantly was redness. The change in conjunctival hyperemia along the study period correlated with the patient-reported redness in both groups, being highest on day 30. Schirmer’s test I and break-up time did not change with time and were similar in both groups. The impression cytology grade increased with time in both groups with the only significant difference between groups on day 90 (higher in the bimatoprost group). Conclusion: We observed conjunctival hyperemia as the most common side effect of bimatoprost and travoprost. Tear film functions were not affected by these drugs while cytological alterations were.

Prevalence of type-specific HPV infection by age and grade of cervical cytology: data from the ARTISTIC trial

Human papillomavirus (HPV) infection causes cervical cancer and premalignant dysplasia. Type-specific HPV prevalence data provide a basis for assessing the impact of HPV vaccination programmes on cervical cytology. We report high-risk HPV (HR-HPV) type-specific prevalence data in relation to cervical cytology for 24 510 women (age range: 20–64; mean age 40.2 years) recruited into the ARTISTIC trial, which is being conducted within the routine NHS Cervical Screening Programme in Greater Manchester. The most common HR-HPV types were HPV16, 18, 31, 51 and 52, which accounted for 60% of all HR-HPV types detected. There was a marked decline in the prevalence of HR-HPV infection with age, but the proportion due to each HPV type did not vary greatly with age. Multiple infections were common below the age of 30 years but less so between age 30 and 64 years. Catch-up vaccination of this sexually active cohort would be expected to reduce the number of women with moderate or worse cytology by 45%, but the number with borderline or mild cytology would fall by only 7%, giving an overall reduction of 12% in the number of women with abnormal cytology and 27% in the number with any HR-HPV infection. In the absence of broader cross-protection, the large majority of low-grade and many high-grade abnormalities may still occur in sexually active vaccinated women.

Correlations between sonographic and clinical findings in breast cancer

We recorded the sonographic findings of 108 cases of carcinoma of the breast and compared the different criteria with the respective histological and clinical parameters. When scanned, carcinomas of the breast usually presented as irregular carcinomas with good sound conduction, few internal echoes and rarely with a lateral or dorsal ultrasonic shadow. Sonography showed a smaller diameter of the tumours than measured histologically. Medium-size and solid carcinomas with a smooth surface could be distinguished mos easily. Histological and cytological grading classified these tumours in the high risk group. Tubular and scirrhous tumours were significantly less easy to identify and delineate. This applies also to bigger and smaller tumours. In most cases small carcinomas were smooth, were likely to show sound intensification, and rarely had a dorsal ultrasonic shadow. The bigger they became, the more often we could observe branches; sound intensification decreased, and the dorsal ultrasonic shadow increased. Carcinomas of young women had the same sonographic characteristics as small tumours, whereas carcinomas in elderly women had those of big tumours, although there was no correlation between age and the size of the tumours. We emphasise the importance of sonography in determining tumours dynamics.

Predictive testing of early cervical pre-cancer by detecting human papillomavirus E6/E7 mRNA in cervical cytologies up to high-grade squamous intraepithelial lesions: Diagnostic and prognostic implications

The type-specific persistence of oncogenic human papillomavirus (HPV) is considered to be the true precursor of cervical cancer at which the transcription of the viral oncogenes E6 and E7 is necessary for the malignant transformation and maintenance of the neoplastic state. In the present pilot study, a cohort of 66 women was investigated from a routine office-based screening population who had an index cytological result from normal to high-grade squamous intraepithelial lesions and who were also HPV-DNA positive for at least one of the following high-risk HPV types: HPV 16, 18, 31, 33 and 45 detected by MY09/MY11 consensus and GP5+/6+ general primers, followed by sequencing. The expression of E6/E7 transcripts from the same HPV types was detected by the PreTect HPV-Proofer. Cervical status was checked 18 months after the mRNA test. The expression of E6/E7 mRNA was found in 58% of the cases showing a 97% concordance with the HPV-DNA types and a positive correlation with increasing cytological and histological grade. All HPV-mRNA positive cases were also positive for HPV DNA whereas 25 (38%) of the HPV-DNA positive cases did not express the respective mRNA. The diagnostic validity of the PreTect assay for detecting histologically-proven prevalent CIN3 lesions were: sensitivity 95%, specificity 55%, positive predictive value (PPV) 81% and negative predictive value (NPV) 86%. The prognostic power of the PreTect test for predicting cytological disease progression was as follows: 78% sensitivity, 60% specificity, 37% PPV and 90% NPV. In conclusion, our results showed that the detection of oncogenic HPV E6/E7 mRNA in cervical smears in a routine screening setting identifies prevalent CIN3 lesions with nearly 100% sensitivity and has a very high negative predictive value for disease progression during the natural course of HPV infection. Thus, testing for HPV oncogenic activity may be used as a clinically predictive marker to enhance the net effectiveness of screening and enable the prognostication of prevalent cervical lesions.

Critical appraisal of cytological nuclear grading in carcinoma of the breast and its correlation with ER/PR expression

<b>Background:</b> Cytological nuclear grading is one of the several key prognostic factors that should be addressed in cytological analysis of breast carcinomas. <br><b> Aims:</b> To evaluate different cytological nuclear grading methods on fine needle aspirates of breast carcinomas and its correlation with histopathological nuclear grading as well as with the immunocytochemical expression of estrogen receptor (ER) and progesterone receptor (PR). <br><b> Materials and Methods:</b> The smears from 30 cytologically proven cases of breast carcinoma were graded by - Nottingham's modification of Scarff Bloom Richardson, Fisher's modification of Black's nuclear grading and Robinson's cytological grading methods. 18 cases were available for correlation with histology grading. <br><b> Results:</b> Robbinson's cytological grading system was found to have the best correlation with histopathology grades (<i>P</i> < 0.001) as well as ER (<i>P</i> = 0.003) and PR (<i>P</i> = 0.001) expression on smears.<br><b> Conclusions:</b> The Richardson's cytology grading method is recommended for cytological nuclear grading along with ER / PR expression, without which the cytological diagnosis of breast carcinoma is incomplete.

Correlation of Upper-Tract Cytology, Retrograde Pyelography, Ureteroscopic Appearance, and Ureteroscopic Biopsy with Histologic Examination of Upper-Tract Transitional Cell Carcinoma

To determine the accuracy of radiographic studies, ureteroscopy, biopsy, and cytology in predicting the histopathology of upper-tract transitional cell carcinoma (TCC). From 1998 to 2006, 46 upper-tract lesions were diagnosed ureteroscopically and underwent nephroureterectomy, and 30 of them were subjected to direct ureteroscopic inspection and biopsy. Fresh samples were delivered to the cytopathology laboratory and histology samples were prepared whenever visible tissue was present. Radiological, ureteroscopic, cytology, and biopsy data were compared to the actual grades and stages of these 30 surgical specimens. Retrograde ureteropyelography was suggestive of malignancy in 29 of 30 cases, but did not predict the grade or stage accurately. Cytology was positive for malignancy in 21 of 30 cases (70%). Grading of ureteroscopic specimens was possible in all cases. At nephroureterectomy two cases were found to have no tumor (T(0)). Of the remaining 28 cases, the biopsy grade proved to be identical in 21 (75%). Grade 1 or 2 ureteroscopic specimens had a low-stage (T(0), T(a), or T(1)) tumor in 17 of 25 (68%); in contrast, 3 of 5 (60%) high-grade specimens had invasive tumor (T(2) or T(3)). For patients with grade 2 ureteroscopic specimens, combining exfoliated cell cytology and biopsy grade improved the accuracy in predicting high-stage and high-grade disease. This study confirms previous findings that ureteroscopic inspection and biopsy provides accurate information regarding the grade and stage of upper-tract TCC. Combining exfoliated cell cytology improves the predictive power of biopsy grade 2 disease for high-risk specimen grade and stage. Our data suggest that ureteroscopic findings may predict muscle invasion.

Routinely assessed morphological features correlate with microsatellite instability status in endometrial cancer

Microsatellite instability (MSI) has been shown to be important in the molecular pathogenesis of both sporadic and inherited endometrial carcinomas of endometrioid type. It is likely prognostically significant as well. The aim of this study was to determine whether MSI phenotype in endometrial carcinoma was associated with specific morphologic patterns and therefore predictable by tumor morphology. The study subjects consisted of 102 patients with nearly equal representation of MSI high (MSI-H; n = 52) and non-MSI-H (n = 50) endometrial tumors. Microsatellite instability was determined by the standard polymerase chain reaction method using the National Cancer Institute-recommended set of 5 markers. The MSI-H and non-MSI-H groups were matched for patient age, race, histologic type (all endometrioid), International Federation of Gynecology and Obstetrics grade, and disease stage. Assessed morphological features included host inflammatory response (tumor infiltrating lymphocytes [TILs], peritumoral lymphocytes, peritumoral lymphoid follicles, and neutrophilic infiltration), tumor characteristics (cytologic grade, growth pattern, tumor heterogeneity, invasion pattern, metaplastic changes, necrosis, and lymphovascular invasion), and background endometrium (hyperplasia, atrophy, and polyp). Of all the features examined, TIL counts and peritumoral lymphocytes correlated significantly with MSI-H status. Their statistical relationship was strengthened in the presence of a nonpapillary growth pattern and endometrial hyperplasia. On multivariate analysis, TIL counts and peritumoral lymphocytes remained independent predictors for MSI-H status. At a cutoff point of 40 TILs/10 high power fields, TIL counts had a sensitivity of 85% in predicting MSI status in endometrioid endometrial carcinoma, with a specificity of 46%. This specificity increased as higher cutoff points were selected, but sensitivity decreased. Given that analogous features have been encountered in MSI-H colorectal cancers, our findings suggest a similar relationship between tumor phenotype and DNA mismatch repair abnormalities in both endometrial and colorectal tumors. Therefore, morphological patterns encountered in endometrial carcinoma may prove useful in screening tumors under consideration for MSI testing and identifying appropriate patients for referral to a genetic counseling service.

Comparison of Two Preparation Methods for Endocervical Evaluation

To assess the validity of SurePath liquid-based preparation method for examination of endocervical brush specimens as a substitute for conventionally prepared cytology methods for evaluating the endocervical canal during colposcopic examination and biopsy.Paired SurePath liquid-based test slides and conventional smears were obtained using an endocervical brush in a split sample protocol before biopsy at the time of colposcopy. The level of agreement between cytologic results obtained was assessed. Accuracy and operating characteristics were evaluated compared to histologic follow-up.Agreement between cytology results for the methods was excellent. The overall kappa was 0.924 (p = 0.0000). There was exact agreement on interpretation between the methods in 283 of 299 cases (94.6%). Cytohistologic follow-up results correlation were: SurePath liquid-based Pap test results and conventional smear results agreed with histology results in 47.8% and 49.2% of cases, respectively. Allowing for a discrepancy within 1 level of severity of cytologic grade, agreements were 76.6% and 77.2%, respectively.This study demonstrates that the SurePath method is equivalent to conventional endocervical brush cytology preparation and performs well for detection of cervical intraepithelial lesions and cancer. SurePath is acceptable for endocervical evaluation as a substitute for endocervical curettage at colposcopic biopsy.

‘See and treat’ regime by LEEP conisation is a safe and time saving procedure among women with cytological high‐grade squamous intraepithelial lesion

Assess the value of colposcopic evaluation preceding loop electrosurgical excision procedure (LEEP) conisation of cytological high grade squamous intraepithelial lesion (HSIL), and study risk factors for recurrence. Consecutive follow-up among women undergoing LEEP conisation from January 2001 to December 2004. Some 528 LEEP conisations were performed because of suspected or verified cervical dysplasia. On classified samples, cytology, punch biopsy and histopathology of the cone specimen showed cervical intraepithelial neoplasia (CIN)2 or a higher degree in 48.5, 36.2 and 58.6%, respectively. Sensitivity for HSIL out of cytology and colposcopically directed punch biopsy was 74.4 and 73.3%, respectively. Likewise, among 286 women with all 3 samples, positive and negative predictive value for HSIL in Papanicolaou (Pap) smear and punch biopsy was 78.5, 73.2% and 60.3, 63.6%, respectively. Positive cone margins were found in 16.8%. Residual/recurrent disease, defined as any grade of dysplasia at cytological follow-up, was found among 9.4%. Significant risk for recurrent/residual disease was found among those with positive marginal status. Median time from colposcopy to conisation was 2 months. An immediate colposcopically-guided LEEP conisation after HSIL Pap smear may be a safe and time saving strategy. Positive cone margins are a risk factor for residual/recurrent disease.

Silver-Stained Nucleolar Organizer Regions in Normal and Dysplastic Cervical Lesions: Correlation with DNA Ploidy and S-Phase Fraction by Flow Cytometry

Objectives: To investigate the prognostic significance of DNA ploidy and silver-stained nucleolar organizer regions (AgNOR), their relation to the cytological grades of cervical dysplasia and correlation of cells in the S-phase of the cell cycle and DNA ploidy with AgNOR count. Methods: Multiparametric DNA flow-cytometric analysis and AgNOR count were performed on cervical smear samples, cytologically diagnosed as normal (n = 196), atypical squamous cells of unknown significance (ASCUS, n = 98) and various grades of cervical dysplasia (n = 127). Results: Among the cytological grade, aneuploid cases from low-grade squamous intraepithelial lesion (mild) and high-grade squamous intraepithelial lesion (moderate and severe) groups were showing high AgNOR counts (ranges 4.33–5.86 and 5.91–7.42, respectively). Aneuploid cases from the ASCUS group also presented high AgNOR (range 3.72–4.93). The high percentage of cells in the S-phase (>12%) correlated with these 2 parameters in the ASCUS and dysplasia groups. After grouping the cases into those with high (>4.0) and low (<4.0) AgNOR counts, significant correlations in the group with high AgNOR count with DNA ploidy, S-phase and cytological grade were recorded (p < 0.001). Results obtained from follow-up study revealed that cases with aneuploidy, high AgNOR count and S-phase fraction presented with a progressive trend of disease. Conclusions: Thus, the study shows that high AgNOR count, S-phase fraction and aneuploid DNA have prognostic significance in the early detection of cervical cancer.

MUC1 (EMA) expressing plasma cells in bone marrow infiltrated by plasma cell myeloma.

MUC1 (also called: epithelial membrane antigen, EMA) represents a mucin molecule strongly expressed in various epithelia and epithelial neoplasms. Its expression correlates with clinical and pathological factors as well as prognosis in some tumor types. Additionally, MUC1 was detected in normal haematopoietic cell lines and neoplasms, especially subgroups of human lymphomas including plasma cell myeloma. Therefore, the expression of MUC1 in trephine biopsies exhibiting infiltrates of plasma cell myeloma were investigated immunohistochemically. An immunoreactivity of two monoclonal antibodies (EMA and HMFG-2) was observed in about 50% of the cases. In cases exhibiting a so-called packed marrow, EMA immunoreactivity was reduced. However, MUC1 positivity did not correlate with the cytologic grade of differentiation, the fibre content of the marrow, or survival probability of the patients. However, its strong expression in a certain percentage of cases of plasma cell myeloma may be of therapeutic impact, since new therapeutic strategies include the enrichment of MUC1-specific T cells or MUC1 vaccination.

Relevance of modified prognostic score for breast carcinoma on fine needle aspiration cytology in a resource-poor setting

21177 Background: Breast cancer is the commonest malignancy in premenopausal Nigerian women in whom it is almost uniformly fatal probably due to lack of access to early diagnosis and treatment. To enhance the value of fine needle aspiration cytology, a rapid and comparatively new technique in our center, we sought to verify if it is also a cost-effective test to predict biological behavior in breast carcinoma. We developed a modified grading system to compare the cytologic features of the cases in our series with known prognostic factors (tumours size, histologic grade and axillary lymph node status) in subsequently excised tissues. Methods: Fine needle aspirates obtained in 42 patients diagnosed as ductal cell carcinoma not otherwise specified (NOS) at the UDUTH Hospital, Sokoto, Nigeria were investigated. The three cytologic features used were nuclear grade (score 1–3), cellular dyscohesion (score 1–3), and bare atypical nuclei (score 0, 1). A cytological score of 3 and below was considered a low score, and a score of 4–7 was considered a high score. We also categorized each patient according to the Nottingham Prognostic Index (NPI) into: good prognostic group (GPG), moderate prognostic group (MPG) and poor prognostic group (PPG). The cases in GPG and MPG were considered to belong to a more favourable category. Results of cytoprognostic scores were compared with the respective pathological information calculated by the NPI. Results: Eighteen of the 20 cases that had a cytologically high score were confirmed to be PPG while 2 correlated with MPG. Among the 22 cases that had cytologically low scores 14 cases were not correlated with favourable NPI index (belonged to PPG category) while the remaining 8 correlated well (MPG = 4 and GPG = 4). The overall accuracy for cytologic grading was 62% (26 out of 42 cases). Conclusion: Tumour typing on FNA material correlates with the NPI in the poor prognostic group. However, this modified cytoprognostic score seems to have doubtful promise as a prognostic factor in our group of patients with favourable NPI. The importance of each cytological feature used in this grading system will be determined by regression analysis in a larger sample size. No significant financial relationships to disclose.

Risk of high‐grade cervical intra‐epithelial neoplasia based on cytology and high‐risk HPV testing at baseline and at 6‐months

Adding a test for high-risk human papillomavirus (hrHPV) to cytological screening enhances the detection of high-grade cervical intraepithelial neoplasia (>or=CIN2), but data are required that enable long-term evaluation of screening. We investigated the >or=CIN2 risk for women participating in population-based screening as a function of hrHPV and cytology testing results at baseline and at 6 months. We included 2,193 women aged 30-60 years participating in a population-based screening trial who received colposcopy or a repeat testing advice at baseline. The main endpoint was histologically confirmed >or=CIN2 diagnosed within 36 months. hrHPV testing was more sensitive than cytology for >or=CIN2 (relative sensitivity 1.4, 95%CI: 1.3-1.5; absolute sensitivity 94.1 and 68.0%, respectively). The 18-month >or=CIN2 risks in women with a hrHPV-positive smear and in women with abnormal cytology were similar (relative risk 0.9, 95%CI: 0.8-1.1). Women with HPV16 and/or HPV18 had a higher >or=CIN2 risk than other hrHPV-positive women irrespective of the cytological grade. Repeat testing showed that both cytological regression and viral clearance were strongly associated with a decrease in >or=CIN2 risk. Notably, women who had a double negative repeat test at 6 months had a >or=CIN2 risk of only 0.2% (95%CI: 0.0-1.1) and hrHPV-negative women with baseline borderline or mild dyskaryosis and normal cytology at 6 months had a >or=CIN2 risk of 0% (95%CI: 0.0-0.8). Using hrHPV and/or cytology testing, risk of >or=CIN2 can be assessed more accurately by repeat testing than single visit testing. Hence, when hrHPV testing is implemented, patient management with repeat testing is a promising strategy to control the number of referrals for colposcopy.

The Expression of Interleukin-10 in Patients with Primary Ovarian Epithelial Carcinoma and in Ovarian Carcinoma Cell Lines

This study determined interleukin-10 (IL-10) expression in patients with ovarian carcinoma and in ovarian carcinoma cell lines, and investigated its clinical significance in the development and progression of ovarian carcinoma. Expression of IL-10 in ovarian carcinoma, benign ovarian tumour, normal control tissues and ovarian carcinoma cell lines was detected by immunohistochemistry and Western blot analysis. IL-10 concentrations in sera and ascites from patients with ovarian carcinoma, in sera from patients with benign ovarian tumour and normal controls, and in supernatants of ovarian carcinoma cell line cultures were measured by enzyme-linked immunosorbent assay. The tissue level of IL-10 in ovarian carcinoma was significantly higher than in benign ovarian tumour and normal controls. IL-10 expression was detectable in cell lysate and supernatant from ovarian carcinoma cell lines. In patients with ovarian carcinoma the IL-10 level in ascitic fluid was significantly higher than in sera, and the serum IL-10 level in ovarian carcinoma was significantly higher than in benign ovarian tumour and normal controls. Ascitic IL-10 levels in ovarian carcinoma were significantly correlated with disease stage but not cytological grade. These results suggest that ovarian carcinoma cells are able to synthesize and secrete IL-10, which probably assists in promoting the development and progression of ovarian carcinoma.

Lymphocytic thyroiditis – is cytological grading significant? A correlation of grades with clinical, biochemical, ultrasonographic and radionuclide parameters

BackgroundClinical, biochemical, ultrasonographic, radionuclide and cytomorphological observations in Lymphocytic thyroiditis (LT), to define the cytological grading criteria on smears and correlation of grades with above parameters.MethodsThis prospective study was conducted on 76 patients attending the Fine needle aspiration cytology clinic of a tertiary care institute in North India. The various parameters like patients' clinical presentation, thyroid antimicrosomal antibodies, hormonal profiles, radionuclide thyroid scan and thyroid ultrasound were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically.ResultsMost of the patients were females (70, 92.11%) who presented with a diffuse goiter (68, 89.47%). Hypothyroid features (56, 73.68%) and elevated TSH (75, 98.68%) were common, but radioiodide uptake was low or normal in majority of patients. Thyroid antimicrosomal antibody was elevated in 46/70 (65.71%) patients. Cytomorphology in fine needle aspirates was diagnostic of lymphocytic thyroiditis in 75 (98.68%) patients. Most of them had grade I/II disease by cytology. No correlation was observed between grades of cytomorphology and clinical, biochemical, ultrasonographic and radionuclide parameters.ConclusionDespite the availability of several tests for diagnosis of LT, FNAC remains the gold standard. The grades of thyroiditis at cytology however do not correlate with clinical, biochemical, radionuclide and ultrasonographic parameters.