Cytology Results Research Articles

Multi-center evaluation of the Alinity m HR HPV assay with liquid-based cytology cervical specimens in the United States.

Incorporating molecular testing for human papillomavirus (HPV) into the screening of cervical specimens can improve risk stratification and, in turn, patient management. Infection with a high-risk (HR) HPV genotype is associated with greater risk for persistent infection, viral integration, and progression of cervical neoplasia. Current guidelines consider HPV 16 or HPV 18 clinically actionable with referral to colposcopy; however, 12 Other HR HPV genotypes have been associated with cervical cancer risk, suggesting a benefit of extended genotyping. In this multi-center study, we evaluated the performance of the Alinity m HR HPV assay, which reports HPV 16, 18, and 45 individually and aggregates of HPV 31/33/52/58 and HPV 35/39/51/56/59/66, compared with cobas HPV and Aptima HPV assays, across a variety of cytology result categories. A total of 746 de-identified residual cervical specimens, collected as part of routine cervical cancer screening programs, were tested using Alinity m HR HPV and at least one comparator assay. The overall percent agreement was ≥90.7% for results from the Alinity m HR HPV assay and cobas HPV assays and 90.5% for results from the Alinity m HR HPV and Aptima HPV assay. In patients with any abnormal cytology result, Alinity m identified 78 specimens with non-HPV 16/18 results, underscoring the benefit of detecting additional HR HPV genotypes to guide patient management more accurately. Among specimens with normal cytology, Alinity m detected 14 additional specimens with non-HPV 16/18 genotypes. Extended HR HPV testing can provide additional information to triage patients for appropriate testing and follow-up.IMPORTANCEExtended genotyping for high-risk human papillomavirus (HPV) types enhances diagnostic precision by identifying additional oncogenic HPV types beyond 16 and 18 therefore offering a more nuanced risk profile. This more comprehensive detection may aid in identifying persistent infections that are more likely to progress, thereby supporting future risk-based patient management strategies.

A case of intrascrotal fibrous pseudotumor caused by scrotal puncture

IntroductionIntrascrotal tumors are relatively rare. Differentiating benign intrascrotal tumors from malignant tumors is frequently difficult. Here, we report a case of benign fibrous pseudotumor following puncture of a hydrocele and loss of the left testis.Case presentationA 65‐year‐old man complained of a left hydrocele and underwent scrotal puncture three times. The patient had painful enlargement of the left scrotum and was diagnosed with a malignant tumor in his scrotum based on cytological results and imaging test findings, including ultrasonography, computed tomography, and magnetic resonance imaging. The patient underwent high inguinal orchiectomy; the patient was finally diagnosed with fibrous pseudotumor.ConclusionPuncture of the scrotum may be considered a cause of fibrous pseudotumors.

Risk scoring system for evaluating pathological upstaging after radical nephroureterectomy for upper tract urothelial carcinoma: A multicenter study in Japan.

Accurate preoperative staging of upper tract urothelial carcinoma is often difficult. Therefore, we aimed to investigate the preoperative factors associated with pathological upstaging in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy and to develop a risk-scoring system to assess pathological upstaging. This retrospective study enrolled 386 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinical tumor stage 4, clinical node +, and those who received neoadjuvant chemotherapy were excluded from the study. The association between preoperative patient factors and pathological upstaging was analyzed. Statistical analyses included the t-test, chi-squared test, and logistic regression analysis. Of the 386 patients, 32 were excluded. Finally, 354 patients were included in this study, of whom 87 (24.6%) were pathologically upstaged. Hydronephrosis, positive urine cytology result, and maximum tumor diameter <30 mm were associated with upstaging. We developed a risk scoring system in which the score was the sum of the number of applicable items for three factors: hydronephrosis, positive urine cytology result, and maximum tumor size <30 mm. The probabilities of ureteral cancer upstaging were 0%, 8.3%, 29.5%, and 50.0% for scores of 0, 1, 2, and 3, respectively. Hydronephrosis, urine cytology, and maximum tumor diameter were associated with pathological upstaging. Our risk-scoring system may be useful in predicting pathological upstaging, especially in patients with ureteral cancer.

Cervical screening during pregnancy - a review of recommendations.

Cervical cytology is a vital screening tool used to detect precancerous and cancerous cells in the cervix. The procedure is crucial in preventing cervical cancer by enabling the early detection and treatment of abnormal cells. In the context of pregnancy, cytology remains an essential component of prenatal care. Numerous studies confirmed that cytology was safe for both the mother and the fetus when performed correctly. The interpretation of cytological results during pregnancy requires careful consideration due to physiological changes in the cervix, which may mimic or obscure pathological findings. The review describes physiological changes in cervical cytology during pregnancy, interpretation challenges and the guidelines of international societies in this topic.

Applying Results of Extended Genotyping to Management of Positive Cervicovaginal Human Papillomavirus Test Results: Enduring Guidelines.

The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for the use of extended genotyping results in cervical cancer prevention programs. Risks of cervical intraepithelial neoplasia grade 3 or worse were calculated using data obtained with the Onclarity HPV Assay from large cohorts. Management recommendations were based on clinical action thresholds developed for the 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines. Risk estimates were reviewed in relation to clinical action thresholds and used as the basis for draft recommendations. After an open comment period, recommendations were finalized and ratified through a vote by the Consensus Stakeholder Group. Colposcopy is recommended after positive tests for human papillomavirus (HPV) types 16 and 18. For those positive for HPV 45, 33/58, 31, 52, 35/39/68, or 51 but negative for 16 or 18, triage with cytology or dual stain testing is recommended. When screening with primary HPV testing, for patients who test positive for HPV types 56/59/66 and no other carcinogenic types, repeat HPV testing in 1 year is recommended. When screening with cotesting, for those who test positive for HPV types 56/59/66 and no other carcinogenic types, 1-year return is recommended for negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and low-grade squamous intraepithelial lesion, and colposcopy is recommended for atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), atypical glandular cells, high-grade squamous intraepithelial lesion, or carcinoma. When patients without prior high-grade cytology (atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion, atypical glandular cells, high-grade squamous intraepithelial lesion, or carcinoma) or histology (cervical intraepithelial neoplasia [CIN]2, CIN3, or adenocarcinoma in situ) are being followed, use of extended genotyping results is acceptable. When high-grade cytology or histology results are present, or when patients are being followed after treatment of CIN2+, management using the 2019 guidelines is recommended. Human papillomavirus extended genotyping can guide clinical management in the setting of a positive HPV test result.

PAP Smear in Pregnant Women: A Hospital Based Study

Introduction: Pregnancy provides an important opportunity to screen the cervix for neoplastic and infectious diseases and to spread awareness. A Papanicolaou(Pap) smear is simple, cost effective and safe during pregnancy. In low resource countries, this may be the only opportunity when woman visits a health care centre. Objective of this study is to use Pap smear as a cervical cancer screening test in pregnant women and to determine the prevalence of abnormal Pap smear among pregnant women attending the antenatal outpatient department. Methods: A prospective study conducted in the department of Obstetrics and Gynaecology of Shree Birendra Hospital for a period of 12 months from September 2020 to August 2021. Inclusion criteria was pregnant women in the first trimester. Exclusion criteria were pregnancy greater than 12 weeks, symptoms of vaginal infection, history of sexual intercourse or vaginal medication or bleeding in the last 48 hours or normal Pap smear in last 3 years. Ayre’s spatula was used to conduct smear test in this study. All the smears were immediately fixatived in 95% ethanol and sent to the department of pathology. The cytological result were reported on the Bethesteda classification system 2014. Results: Out of 300 pregnant women enrolled in the study, the Pap smear report revealed that 28.3% of the study subjects had inflammatory smear 65.7% of the subjects showed negative for intraepithelial lesion or malignancy and only 0.3% of subjects had Atypical Squamous Cells of Undetermined Significance (ASCUS). No satisfactory sample was reported in 5.7% of the subjects. Conclusions: The antenatal period should be utilized as an opportunity to screen women for cancer cervix. Pap smear during pregnancy not only gives the opportunity to screen but also helps to create awareness.

Diagnostic Efficacy of Staging Laparoscopy Compared to CT and PET-CT in Gastric Cancer: A Retrospective Cohort Analysis.

Background and Objectives: This study aimed to assess the diagnostic accuracy and prognostic significance of staging laparoscopy (SL) compared to computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) in gastric cancer staging. We evaluated the ability of SL to detect occult peritoneal metastases and influence of SL on survival outcomes across cancer stages and treatment approaches. Materials and Methods: In this retrospective cohort study, 95 patients with gastric cancer underwent preoperative assessment using CT, PET-CT, and SL between 2018 and 2024. Diagnostic performance metrics were calculated for SL, CT, and PET/CT across the local, locally advanced, and metastatic stages. Survival outcomes were analyzed using Kaplan-Meier curves, and comparisons were made using log-rank tests. A multivariable Cox proportional hazards model incorporating interaction terms was used to determine the independent prognostic factors affecting survival, focusing on SL findings and cytology results. Results: The cohort comprised 75 males (78.9%) and 20 females (21.1%), with a mean age of 57.4 ± 10.1 years. The tumor location distribution was predominant in the corpus (31.1%) and cardia. Tumor staging revealed that 48.1% were classified as T3 and 28.8% as T4, respectively. Diagnostic accuracy analysis showed that SL outperformed CT and PET-CT in detecting peritoneal metastasis across all stages. Specifically, SL demonstrated a sensitivity and specificity of 85% and 95% for local disease, 92% and 80% for locally advanced disease, and 95% and 99% for metastatic disease, significantly exceeding those of CT and PET-CT. Patients with SL findings had a median overall survival (OS) of 30 months compared with 20 months for those assessed only with CT and PET-CT (p < 0.05). The stage-specific median OS for SL patients was 40 months in the local, 25 months in the locally advanced (p < 0.05), and 15 months in the metastatic disease (p < 0.01) groups, indicating significant survival benefits. Multivariable Cox regression identified SL findings as an independent factor associated with reduced mortality risk (HR: 0.70, 95% CI: 0.50-0.90, p < 0.01), while positive cytology findings predicted poorer survival (HR: 1.80, 95% CI: 1.25-2.60, p < 0.01). Interaction terms revealed that SL yielded greater survival benefits in patients with metastatic disease (hazard ratio [HR]: 0.60, p < 0.01) and those undergoing systemic therapy (HR: 0.75, p = 0.04). Conclusions: SL provides superior diagnostic accuracy and prognostic information for advanced gastric cancer staging compared with CT and PET-CT. By accurately detecting peritoneal metastasis, SL aids in optimizing treatment plans, particularly in advanced stages, thus potentially improving patient outcomes.

Evaluation of primary HPV-based cervical screening among older women: Long-term follow-up of a randomized healthcare policy trial in Sweden.

Evidence on invasive cervical cancer prevention among older women is limited, especially with the introduction of human papillomavirus (HPV)-based screening and longer interval. We conducted a long-term follow-up of the first phase of a randomized healthcare policy trial in cervical screening, targeting women aged 56 to 61 years old, to investigate the effectiveness of primary HPV-based screening in preventing invasive cervical cancer (ICC) and the safety of extending screening interval. The randomized healthcare policy trial of primary HPV-based cervical screening targeted women residing in Stockholm-Gotland region during 2012 to 2016, aged 30 to 64 years. The trial aimed to investigate the detection rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) within 24 months and long-term protection against invasive cervical cancer, comparing primary HPV-based screening to primary cytology-based screening. The initial phase of the trial, which was the focus of this study, targeted women aged 56 to 61 years old in 2012 to 2014 who were randomized to primary cytology arm (n = 7,401) or primary HPV arm (n = 7,318). We used national registries to identify the subsequent cervical tests and all histopathological diagnoses including ICC before December 31, 2022. We calculated cumulative incidence, incidence rate (IR) and IR ratio (IRR) of ICC, by baseline test result. Furthermore, we calculated longitudinal sensitivity and specificity for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by receipt of primary cytology or primary HPV test for the recommended screening intervals in this age group. We found that the IR of ICC among women in the primary HPV arm was 7.2/100,000 person-years (py) and 3.0 for women who tested HPV negative, compared to 18.4/100,000 py among women in the primary cytology arm and 18.8 for women who tested cytology negative. We further found that the overall point estimate for the risk of ICC over 10 years of follow-up among women in the primary HPV arm was 0.39 compared to women in the primary cytology arm, but this was not statistically significant (IRR: 0.39; 95% confidence interval, CI [0.14, 1.09]; p = 0.0726). However, among women with a negative test result at baseline, women in the primary HPV arm had an 84% lower risk of ICC compared to women in the primary cytology arm (IRR: 0.16; 95% CI [0.04, 0.72]; p = 0.0163). Moreover, primary HPV testing had a higher sensitivity for detecting CIN2+ within a 7-year interval than primary cytology testing within a 5-year interval (89.6% versus 50.9%, p < 0.0001). We were limited by a partial imbalance of invitations during the follow-up between the 2 arms which may have led to an underestimation of the effectiveness of primary HPV-based screening. In this study, we observed that women over 55 years of age who received a primary negative HPV test result had substantially lower risk of CIN2+, and ICC, compared to women who received a primary negative cytology result. This should apply even if the screening interval were prolonged to 7 years. NCT01511328.

Significance and limitations of routine p16/Ki-67 immunohistochemistry as a diagnostic tool for high-grade squamous intraepithelial lesions of the uterine cervix.

To evaluate the diagnostic utility and limitations of routine p16 and Ki-67 immunohistochemistry (IHC) in detecting high-grade squamous intraepithelial lesions (HSILs) in the uterine cervix. We reviewed 2,061 cervical biopsy records, including 271 morphologically indeterminate squamous lesions, evaluated using p16/Ki-67 IHC for HSIL detection or exclusion. HSIL was diagnosed based on p16 positivity and a high Ki-67 labeling index (Ki-LI). In cases that remained inconclusive after IHC, follow-up histological and/or cytological outcomes were assessed. p16/Ki-67 IHC established a definitive diagnosis of either HSIL or non-HSIL in 74.2% (201/271) of morphologically indeterminate cases, whereas 25.8% (70/271) remained inconclusive. p16/Ki-67 IHC contributed to the diagnosis of HSIL in 120 cases, representing 11.9% (120/1,011) of all HSILs cases and 44.3% (120/271) of morphologically indeterminate cases. Among the 70 inconclusive cases, 58 had available follow-up data, of which 22 were subsequently diagnosed with HSIL, including 12 within 1 month of the initial biopsy. HSIL outcomes were more frequent in cases with suspicious HSIL on the initial biopsy (66.7 [12/18]). Based on the p16/Ki-LI status, patients with HSIL outcomes were categorized into three groups: p16-positive/low Ki-LI (54.2 [13/24]), p16-negative/high Ki-LI (50.0 [5/10]), and p16-negative/low Ki-LI (16.7 [4/24]). Multiple comparisons revealed a significant difference between the p16-positive/low Ki-LI and p16-negative/low Ki-LI groups (Benjamini-Yekutieli adjusted P=0.0435), whereas no significant difference was found between other groups. IHC using p16/Ki-67 significantly improved the diagnostic performance for HSIL. In cases that remain inconclusive after IHC, IHC-based risk stratification offers a valuable approach for surveillance, thus mitigating delays in HSIL diagnosis.

Evaluating the Benefits of Endocervical Curettage in Women Infected With HPV16/18.

This study evaluates the effectiveness of endocervical curettage (ECC) in detecting additional high-grade squamous intraepithelial lesions or worse (HSIL+) in women infected with human papillomavirus (HPV) types 16 and 18, which may be missed by biopsy alone. A retrospective cohort study analyzed the medical records of 4,811 women referred for colposcopy due to HPV16/18 infection from January 2019 to December 2023. Patients underwent both biopsy and ECC. Statistical comparisons of various clinical factors between HSIL+ and low-grade or normal lesions were performed using χ2 tests and logistic regression analyses, with stratified analysis to determine ECC's additional detection rate under different clinical conditions. Endocervical curettage detected an additional 6.46% of HSIL+ lesions missed by biopsy alone, with the highest rates in women with normal colposcopic impressions (23.1%), those aged 50 or older (12%), type 3 transformation zones (9.5%), and postmenopausal women (11.9%). In contrast, younger women under 30 and those with type 1 or 2 transformation zones had significantly lower detection rates (2.9%). Logistic regression indicated that older age, type 3 transformation zone, higher grade cytological results, and abnormal colposcopic impressions are significant risk factors for HSIL+ detection via ECC (p < .001). Data from this study indicate that ECC would be beneficial for women over 30 with HPV16/18 infections, particularly those with type 3 transformation zones or normal colposcopy, as it enhances HSIL+ detection. However, it offers minimal benefit for younger women or those with type 1 or 2 transformation zones.

Gastric Cytology: A Supplement to Early Diagnosis of Gastric Malignancies.

Gastric malignancies are one of the leading causes of morbidity and mortality globally. Rapid accurate interpretation of gastric cytology aids in early diagnosis and management. This study evaluates the utility of gastric cytology in diagnosing gastric malignancies. This retrospective, cross-sectional study was conducted in the Department of Pathology for a period of 3.5 years. The cases with clinical suspicion of gastric malignancy and those who have had both cytology and histopathology examinations were included. Cytology results were reported as positive for malignancy, suspicious for malignancy, atypical cells-favor reactive, and negative for malignancy. The cytology and histopathology results were correlated, and descriptive statistics were used to analyze data. Among 118 patients included in the study, 103 cases were malignant and 15 were nonmalignant. Out of 103 malignant cases, 89 cases were detected in cytology. False positive cases consisted of four gastritis cases with florid reactive atypia and one with moderate dysplasia. False negative cases were of diffuse and intestinal subtypes of adenocarcinoma, followed by non-Hodgkin lymphoma. Sensitivity and specificity were found to be 86.41% and 66.67%, respectively. The positive predictive value is 94.68% with 41.67% negative predictive value and a diagnostic accuracy of 83.90%. Gastric cytology is a reliable screening and diagnostic tool with a high positive predictive value and acceptable sensitivity. Negative cytology in suspected cases of gastric malignancy should always be correlated with biopsy reports. Diffuse type, intestinal type gastric adenocarcinoma and non-Hodgkin lymphoma were the major pitfall on cytology. The cells in the background must be meticulously observed for the malignant features. Gastric cytology is cost-effective and yields rapid diagnosis with a high positive predictive value, sensitivity, and diagnostic accuracy.

2024 Hong Kong College of Obstetricians and Gynaecologists Guidelines for cervical cancer prevention and screening.

Primary prevention of cervical cancer is best achieved by vaccinating girls with a prophylactic human papillomavirus (HPV) vaccine. Despite the high efficacy of such vaccines, cervical cancer screening remains necessary because current vaccines do not offer full protection. Secondary prevention via cervical screening should target all women from age 25 years or at the onset of sexual activity, whichever occurs later, until age 64 years. Screening is recommended at 3-year intervals after two consecutive normal annual cytology results, or at 5-year intervals using HPV-based testing (either HPV co-test with cytology or HPV stand-alone). Women who have undergone hysterectomy with cervix removal for benign disease and have no prior history of cervical dysplasia can discontinue screening. Women with HPV-positive, cytology-negative co-test results should either undergo repeat co-testing in 12 months or immediate HPV16/18 genotyping. Immediate referral of women with positive stand-alone HPV test results for colposcopy without further triage is not recommended. A second triage test using cytology, genotyping for HPV16/18, or p16/Ki-67 dual-stain should be conducted to accurately identify women at high risk for high-grade lesions who thus require colposcopy referral. Women with HPV-positive, cytology-positive co-test results, or high-grade abnormal cytology results should be referred for colposcopy. Treatment with a loop electrosurgical excision procedure is recommended for women with high-grade squamous intraepithelial lesions (HSILs). After HSIL treatment, long-term follow-up with HPV-based testing over 25 years is preferred. When cytology results show atypical glandular cells, colposcopy and sampling of the endocervix and endometrium are recommended.

Pericardial effusion cytology: malignancy rates, patterns of metastasis, comparison with pericardial window, and genomic correlates.

Cytologic evaluation of pericardial fluid is essential for diagnosing malignant pericardial effusions secondary to metastatic disease and for guiding appropriate clinical management; however, large cohort and up-to-date studies on malignancy rates and distribution of primary tumor sites is lacking. A retrospective analysis of pericardial fluid specimens from 2 large academic medical centers over a 10-year period was conducted. Clinical and specimen characteristics were correlated with cytologic diagnoses, and compared with surgical pathology pericardial specimens when available. In addition, genomic testing results were examined in a subset of malignant cases. A total of 1667 pericardial fluid specimens were evaluated, with 15.3% diagnosed as malignant. Lung cancer (50.6%) was by far the most common primary tumor causing malignant pericardial effusions, followed by breast (13.0%), hematolymphoid (12.6%), and gastrointestinal (6.1%) cancers. A subset of patients with paired cytology and surgical pathology pericardial specimens showed concordance in 84.2% of cases, with discordant cases more frequently presenting with a positive cytology but negative surgical pathology result. Genomic analysis of a subset of malignant pericardial effusions revealed the most frequently mutated genes to be TP53, KRAS, CDKN2A/B, and PIK3CA, with a larger proportion of high tumor mutational burden (≥10 muts/Mb) in pericardial fluid samples compared to primary or metastatic sites. While lung cancer is the most frequent cause of a cytology-confirmed malignant pericardial effusion, familiarity with relative frequencies of metastases from other sites can be particularly helpful, especially in the diagnostic work-up of an occult malignant pericardial effusion.

Impact of endoscopic ultrasound-guided fine needle aspiration on positive peritoneal lavage cytology in patients with resectable pancreatic body and tail cancer.

A recent study has demonstrated that the timing of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) significantly influences the peritoneal lavage cytology (CY) outcomes in pancreatic body-tail cancer. The aim of this study was to clarify the impact of EUS-FNA on CY positivity in patients with resectable pancreatic body-tail cancer. Patients with anatomically resectable pancreatic body-tail cancer surgically resected at Hiroshima University Hospital were enrolled, and elated clinicopathological factors, including EUS-FNA variables and CY positivity rate, were analyzed. Of the 129 eligible patients, 16 (12%) had positive CY. The EUS-FNA rates of the CY-positive and CY-negative groups were not significantly different (63% vs. 52%, p = .440). Multivariate analysis revealed that lymph node metastasis was the only independent risk factor for CY positivity (odds ratio: 5.734, p = .031). A total of 10 (14%) of the 69 patients who underwent EUS-FNA had positive CY; however, needle specifications and the interval between EUS-FNA and CY examination did not differ between the CY-positive and CY-negative groups. CY positivity rates were comparable for intervals ≤14 days and ≥15 days (17% vs. 14%, p = 1.000). EUS-FNA may not affect CY positivity in patients with resectable pancreatic body-tail cancer, regardless of the timing.

Adiposity is associated with a higher number of thyroid nodules and worse fine-needle aspiration outcomes.

Adiposity may be associated with thyroid nodularity. However, its impact on the number of nodules and the risk of malignancy is unclear. To evaluate the impact of adiposity on thyroid nodules using body mass index (BMI), ultrasonographic (US) data and cytological data. A retrospective cohort study of 310 patients with thyroid nodules was performed. Patients were categorized based on their BMI, and grayscale US data and fine-needle aspiration cytology results were evaluated. Patients with BMI ≥ 25 kg/m2 were found to have a higher number of thyroid nodules compared to those with BMI < 25 kg/m2 (4.25 ± 2.42 vs 3.66 ± 1.93) (P value = 0.05). Patients with BMI ≥ 25 kg/m2 had more suspicious and malignant cytology than those with BMI < 25 kg/m2 (P value = 0.029). Patients with BMI ≥ 25 kg/m2 had more nodules with intermediate and high suspicion sonographic patterns. However, this did not reach statistical significance. Overweight and obese patients have a trend for more thyroid nodules and have a higher risk of being diagnosed with thyroid malignancy.

CareHPV, Papanicolaou Positivity Status, and Their Association With Behavioral Risk Factors in Rural Womenof Kamrup District, Assam, India.

Screening of rural women of Assam by careHPV test for high-risk HPV (hr-HPV) DNA and Papanicolaou (PAP) test for abnormal cytology. This prospective cross-sectional study included 480 non-pregnant women participants aged 20-70 years from Kamrup District, Assam. Two cervical scrap samples were obtained from eligible enrolled women. The Hr-HPV DNA test by CareHPV was performed with one cervical scrap, and a second cervical scrap sample was used for the Papanicolaou (PAP) test. The statistical analysis was done using RStudio for variables. A p-value < 0.05 was considered to be statistically significant. Women having positive hr-HPV DNA outcomes were 3.33% (16/480) and 7.7% (37/480) women had positive PAP. Tobacco chewing was significantly associated with positive hr-HPV DNA (p = 0.04) and positive PAP (p = 0.03) status. Alcohol-consuming women have a significantly higher risk of positive hr-HPV DNA (p < 0.00001) and positive PAP (p-0.04) outcomes. Irregular menstruation (p = 0.004) and urogenital tract infection (p = 0.008) also have significant risk for a positive hr-HPV DNA status. The positive hr-HPV DNA status was also significant in women having > 3 numbers of children birth (p = 0.003). We found that the positive hr-HPV DNA status among rural women in Kamrup, Assam, was significantly associated with alcohol consumption, tobacco chewing, irregular menstruation, urogenital tract infection, and more than three children birth. The abnormal cytology outcome was also substantially associated with tobacco chewing and alcohol consumption.

&amp;#1052;odern methods of diagnosis of endometrial carcinoma

The main methods of histological diagnosis of endometrial carcinoma are dilatation and curettage, fractional curettage, and diagnostic hysteroscopy with endometrial biopsy. This retrospective study aims to compare the preoperative histological results obtained by different diagnostic methods with the postoperative ones in patients with endometrial carcinoma and determine the most accurate and safest method for diagnosing the disease. From 06.2020 to 09.2023, a retrospective study was conducted on 80 patients with histologically proven carcinoma of the endometrium, treated at University Hospital Saint Marina-Pleven. The mean age of the patients was 58.04 &amp;plusmn; 10.46, ranging from 28 to 78. The comparative analysis of the discrepancies of the histological verification methods in the evaluation of the preoperative and postoperative histological result showed that a statistically significantly higher percentage of discrepancies (19.5%) had the dilatation and curettage compared to the zero discrepancy of the hysteroscopy (0.0%). The relative proportion of discrepancies of the fractional curettage is 14.3%. The cytological result was negative for tumor cells in 97.5% and positive in 2.5%. In all patients with a positive cytological result for tumor cells, the method of histological verification was dilatation and curettage. Performing diagnostic hysteroscopy and observing safety principles such as creating low intrauterine pressure and short operative time is a safe and reliable method for diagnosing endometrial carcinoma.

Value of laser therapy, photodynamic therapy, and follow-up observation in the management of cervical low-grade squamous intraepithelial lesions: a prospective cohort study

Objective: To explore the value of CO2 laser therapy, photodynamic therapy, and follow-up observation in the management of cervical low-grade squamous intraepithelial lesion (LSIL). Methods: Women diagnosed with cervical LSIL and high risk human papillomavirus (HR-HPV) infection through colposcopy-guided biopsy from January 1, 2021 to December 31, 2023 were collected. According to a 1∶1 ratio, 107 cases were included in each of the laser treatment, photodynamic therapy, and follow-up groups. The complete remission rate and HR-HPV clearance rate were compared during the 6-12 months follow-up period. Results: (1) Comparison of clinical data among the three groups before treatment: the median age of the 321 patients was (34.9±8.1) years. Before treatment, cytological abnormalities were present in 51.7% (166/321) of patients, and 35.2% (113/321) had human papillomavirus (HPV) 16/18 infections. The accuracy rate of colposcopic diagnosis was 69.2% (222/321). Age, cytology results, HPV 16/18 infection, and colposcopy diagnosis in the laser group, photodynamic group, and follow-up group were compared, and there were not statistically significant differences (all P>0.05). (2) During the 6-12 months follow-up period, the complete remission rate was 89.7% (96/107) in the laser group, slightly higher than the 86.9% (93/107) in the photodynamic group, with no statistical difference between the two groups (χ2=0.41, P=0.523). However, both were significantly higher than the 64.5% (69/107) in the follow-up group (χ2=19.30, P<0.001; χ2=14.63, P<0.001). The HR-HPV clearance rates in the laser and photodynamic groups were 73.8% (79/107) and 68.2% (73/107), respectively, both significantly higher than the 32.7% (35/107) in the follow-up group (χ2=36.34, P<0.001; χ2=26.99, P<0.001), but with no statistical difference between the laser and photodynamic groups (χ2=0.82, P=0.366). Conclusions: CO2 laser therapy and photodynamic therapy are effective treatments for cervical LSIL, significantly superior to follow-up observation in terms of lesion remission and HR-HPV clearance rates. Individualized treatment plans could be developed based on the patient's age, duration of HR-HPV infection, colposcopic impression, and economic conditions.

Retrospective Study of Fine Needle Aspiration Cytology of Patients with Thyroid Nodule in Benghazi in the Period of (2021-2023)

Background: Thyroid nodules constitute a common endocrine disorder, these nodules could be solitary, multiple, cystic, or solid. Increasing age, female gender, iodine deficiency, and history of thyroid radiation all are high risk for thyroid nodules. FNAC representing the most cost-effective diagnostic tool used in the assessment of nodules of the thyroid. Objective of the study: The aim of this study is to evaluate the result of fine needle aspiration cytology (FNAC) and assess thyroid status using of thyroid hormone obtained from patients with thyroid nodules. Materials and methods: this is a retrospective study, includes collection of data from available cases of thyroid nodules underwent fine needle aspiration between 2021 to 2023, data regarding age, sex, TFT, USS, FNAC was collected from the archive of endocrine out patients clinic of Benghazi Medical Center and from endocrine clinic of Benghazi diabetic center. The analysis was done using the SPSS program. Result: A total of 60 cases were studied, Data was collected from 60 patient’s files for years between 2021 and 2023. The mean age of the patients with FNAC selected for this study was 49.65, and ranged from 21-80 years. The gender distribution shows female predominance in which female cases were 53 (98.33%) while only one case (1.67%) was reported among men. The size of nodules in our cases range from 1cm to 4.5 cm. The mean size of nodules is 1.89cm. In this study the largest group of nodules located in right lobe (21) cases then left lobe (20) cases then both (17) cases and in isthmus only 2 cases. Most of the cases thyroid function test result shows an euthyroid status (38) cases. FNAC of thyroid nodule showed that most of patient’s result diagnosed as benign nodules (47) cases. Conclusion: FNAC is a key tool in diagnosis of thyroid nodule as it has safe, minimally invasive and cost effective diagnostic role.

Abstract A049: Peritoneal tumor DNA as a prognostic biomarker in locally advanced gastroesophageal cancer: A pilot prospective cohort study

Abstract Background: Gastroesophageal cancers commonly spread to the peritoneum. Peritoneal disease significantly alters patient prognosis and treatment-intent. Currently, peritoneal lavage cytology (PLC) is the method of choice for detecting peritoneal micro-metastasis within the peritoneum. Despite its pervasive use, PLC has a variable sensitivity of 10% - 80% in detecting peritoneal micro-metastasis in gastroesophageal cancers. Peritoneal tumor DNA (ptDNA) is tumor-derived DNA detectable in peritoneal lavage fluid. ptDNA-positivity may indicate peritoneal micro- metastasis and may be more sensitive than PLC in staging the peritoneum and predicting disease- free survival (DFS) and overall survival (OS). We aimed to develop and test a tumor-informed platform for ptDNA detection and validate its sensitivity and specificity against PLC. Methods: For this pilot study, peritoneal lavage fluid were collected at staging laparoscopy from 15 patients with gastroesophageal cancer. Cytology and peritoneal metastases (where clinically detectable) were confirmed by histopathology. A tumor-informed ptDNA testing was performed via whole-genome sequencing of tumor tissue and buffy coat to identify somatic variants for each patients, followed by tracking of up to 96 variants in each patient’s peritoneal fluid. Results: 5 out of 15 patients were either cytology positive or had macroscopic peritoneal disease and ptDNA was detectable in all 5 cases. Additionally, out of the 10 cytology-negative patients without macroscopic peritoneal disease, ptDNA positivity was detected in 6 patients prior to commencing neoadjuvant chemotherapy or surgery. Two of these 6 patients demonstrated radiological evidence of recurrence at 15- and 18-months follow-up respectively. Interestingly, one patient with macroscopic peritoneal disease tested negative for cytology. In this case, peritoneal lavage was carried out to the upper two abdominal quadrants only, and the pelvic deposit of disease was detected after the lavage had been completed. Despite a negative cytology result, ptDNA was detected using the same fluid sample, suggesting a higher sensitivity compared to PLC. Conclusions: This pilot study demonstrates that a tumor-informed ptDNA detection platform is feasible and potentially more sensitive than PLC in gastroesophageal cancer. To further validate the clinical utility of ptDNA we are proceeding to a multi-center prospective cohort study. Citation Format: Zexi Allan, Yuxuan Wang, Jeanne Tie, Niall Tebbutt, Nicholas Clemons, Nickolas Papadopoulos, Kenneth Kinzler, Bert Vogelstein, David SH Liu. Peritoneal tumor DNA as a prognostic biomarker in locally advanced gastroesophageal cancer: A pilot prospective cohort study [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A049.