Diagnostic Accuracy Of Cytology Research Articles

Fine Needle Aspiration Cytology of Ovarian Tumors With Histopathological Correlation: A Revisit to Borderline Category.

Borderline ovarian tumors (BOTs) comprise 15%-20% of all ovarian epithelial malignancies. The majority of them are serous tumors followed by mucinous tumors. Pre-operative cytological diagnosis plays an important role with histopathology being the gold standard. The present study aimed to assess the sensitivity, specificity, and diagnostic accuracy of cytology in the diagnosis of epithelial ovarian tumors with special emphasis on the cytologically borderline category. The present study was conducted in our institute over five years from January 2017 to December 2022. This was a retrospective study and included 92 patients with ovarian masses who were subjected to ultrasound-guided fine needle aspiration (FNA) as a preliminary diagnostic procedure. Cytology smears were examined and categorized as benign, borderline, and malignant. The sensitivity, specificity, and diagnostic accuracy were assessed considering histopathology as the gold standard. In the present study, 92 ovarian FNA cytology were performed. Aspirates were adequate in all but 10 cases. Out of 82 cases, 75 were epithelial tumors. Twelve cases of BOTs were compiled and cytological findings were assessed. To conclude, diagnosis of BOTs on cytology is difficult, however, aspiration from multiple sites from the lesion, critical cytomorphological assessment, and cell-block preparation with immunocytochemistry/immunohistochemistry can overcome the pitfalls.

Inter- and Intra-observer Reproducibility of Thyroid Fine Needle Aspiration Cytology: An investigation of Bethesda 2023 Using Immunohistochemical BRAFV600E Antibody.

The Bethesda System for Reporting Thyroid Cytology (TBSRTC) recommended for the interpretation of needle aspiration cytology of the thyroid, is the most widely used worldwide. Studies have shown that the disagreement between observers, especially in the Bethesda III and IV diagnostic categories, is not insignificant at 10%-40%. In the TBSRTC 2023 version, some definitions were removed and simplified, and molecular pathology was proposed as a complement to cytopathology. The current availability of molecular tests is limited because they can be performed in a few centers and are expensive. Therefore, our study investigated intra- and inter-observer agreement according to TBSRTC 2023 using only immunohistochemically BRAFV600E antibodies. The study included 173 cases with aspiration cytology evaluated between 2019 and 2022. The immunohistochemical procedure applied BRAFV600E (RM8) monoclonal antibody to cell block sections. All slides were assessed and categorized by three different observers. Data were interpreted using Cohen's kappa and Fleiss's kappa test in the Statistical Package for Social Sciences Windows 2021 program. For the applied RM8 antibody, sensitivity was 64.71% and specificity was 87.27%. In terms of diagnostic categories, inter-observer agreement was good for Bethesda II (K = 0.606) and moderate for Bethesda III (K = 0.429), Bethesda IV (K = 0.523), Bethesda V (K = 0,464), and Bethesda VI (K = 0.544), respectively. In conclusion, the study reveals that the 2023 version of TBSRTC provides improvement, especially in the categories of uncertain diagnosis, but is still insufficient to improve cytological diagnostic accuracy, at which point molecular analyses become even more important.

Diagnostic accuracy of cytology and urine methylation test in patients with non-muscle invasive bladder cancer: a systematic review and meta-analysis.

Multiple clinical studies have demonstrated the numerous advantages of urine methylation test over cytology for monitoring patients with non-muscle invasive bladder cancer (NMIBC) following surgery. This research aims to provide a systematic review and meta-analysis to evaluate the efficacy and limits of urine methylation test in the clinical management of NMIBC. This research was carried out by conducting a comprehensive search of clinical trials comparing cytology and urine methylation test for NMIBC follow-up using databases such as PubMed, Embase, Web of Science, and the Cochrane Library up until May 2023, including references from relevant articles. The study is registered on PROSPERO with ID CRD42023398969. This study comprised six studies with a total of 1676 patients. The analysis revealed that the AUC of urine methylation test had a greater AUC than that of the cytology examination (0.89 vs 0.71). In post-operative follow-up of patients with NMIBC, the urine methylation test demonstrated a significant sensitivity (0.69 vs 0.52), but with lower specificity (0.87 vs 0.93) than cytology examination. The urine methylation test and cytology examination have both shown strong diagnostic performance in screening for NMIBC patients. However, urine methylation test outperforms cytology examination in terms of accuracy and sensitivity. PROSPERO, identifier CRD42023398969.

Verifying a novel bile cytology scoring system.

The scoring system for bile cytology (SSBC) aims to improve bile cytology diagnostic accuracy. Here, the practicality of SSBC was verified by multiple cytotechnologists. Bile cytological specimens were evaluated by 24 cytotechnologists using SSBC. The samples were assessed before using the SSBC (first-time assessment) according to three categories: benign, indeterminate, and malignant. A first scoring evaluation (FSE) was then performed using SSBC; each item in the scoring system was classified as present or absent. After distributing an instruction sheet with diagnostic criteria, a second scoring evaluation (SSE) was performed using SSBC. Each method was evaluated using diagnostic accuracy and interobserver and intraobserver agreement. Several samples were assessed as indeterminate in the first-time assessment. Although the specificity of the SSE improved, the sensitivity and accuracy decreased compared with those of the FSE. The overall interobserver agreement was fair for all parameters, including abnormal chromatin, irregular internuclear distances, irregularly overlapped nuclei, irregular cluster margins, and final evaluation in the FSE and SSE. The final evaluation by histological type exhibited slight agreement for well-differentiated tubular adenocarcinoma and almost perfect agreement for poorly differentiated tubular adenocarcinoma in the FSE and SSE. For moderately differentiated tubular adenocarcinoma, agreement was moderate in the FSE and fair in the SSE. For cholangitis, a slight agreement was observed in the FSE, which improved to fair in the SSE. Although the SSBC is expected to improve specificity, there exists ambiguity regarding SSBC criteria and interindividual assessment differences. Therefore, the objective assessment method should be revised.

The International System for Reporting Serous Fluid Cytopathology: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies.

This is the first systematic review and meta-analysis of The International System (TIS) for reporting serous fluid cytopathology. Our aims were to present the pooled malignancy rate of each TIS reporting category and the diagnostic accuracy of cytology using this system. Database search using a predefined strategy was followed by study selection, data extraction, study quality assessment, and statistical analysis. Data derived from 16 eligible studies were pooled. The pooled rates of malignancy were as follows: 27% (95% CI; 16%-41%) for "nondiagnostic" (ND), 11% (95% CI; 7%-18%) for negative for malignancy" (NFM), 49% (95% CI; 37%-61%) for "atypia of undetermined significance" (AUS), 90% (95% CI; 81%-95%) for "suspicious for malignancy" (SFM), and 100% (95% CI; 98%-100%) for "positive for malignancy" (MAL). Studies performed exclusively in cancer hospitals showed higher pooled malignancy rates, compared with academic and community hospitals serving the general population, in the ND [40% (95% CI; 21%-62%) vs. 22% (95% CI; 11%-39%)], NFM [20% (95% CI; 13%-30%) vs. 9% (95% CI; 5%-17%)], and AUS categories [55% (95% CI; 47%-63%) vs. 46% (95% CI; 31%-62%)]. Notably, the difference was significant in the NFM category ( P =0.04). When both SFM and MAL cytology interpretations were considered as malignant outcomes, the pooled sensitivity and specificity were 68.74% (95% CI; 59.90%-76.39%) and 98.81% (95% CI; 98.18%-99.22%), respectively. In addition, the diagnostic odds ratio (DOR) was found to be 170.7 (95% CI; 96.2-303.3). Despite its strengths, our study also had some limitations. Therefore, future large-scale longitudinal studies could strengthen the findings of this review.

Comparation of 5ml and 10ml Negative Pressures with Wet-suction Techniques for EUS-FNA of Solid Lesions: A Single-center Randomized Controlled Trial.

The negative pressure selectable for the wet-suction technique remains uncertain. The aim was to investigate the quality of sampling and diagnostic accuracy with solid lesions by 5mL and 10mL negative pressure with wet-suction techniques. This is a single-center, crossover, randomized controlled trial conducted with a random sampling technique. In all, 160 patients consecutively undergoing EUS-FNA for solid lesions were randomized in a ratio of 1:1 into 2 groups, the 5mL and 10mL negative pressure wet-suction group. The main outcome was to compare the sample quality between the 2 groups. The secondary outcome was to compare the histologic and cytologic diagnostic accuracy of solid lesions. Pancreatic (n=129) and nonpancreatic (n=27) lesions from 156 lesions were examined. The sample quality concluding cellularity, adequacy, integrity, and blood contamination were comparable between the 2 groups. However, in subgroup analysis, we found 19G FNA provided more integrity of specimen in 5mL than in 10mL group (100% vs. 82.9%, P =0.025). In contrast, this benefit was not noteworthy in the 22G FNA subgroup. And there was no statistically significant in histologic (87.82% vs. 87.18%, P =1.000) and cytologic (78.85% vs. 80.77%, P =0.778) accuracy between 5mL and 10mL groups. When using the wet-suction technique, 5mL and 10mL negative pressure offer equivalent sample quality and diagnostic accuracy. However, the 19G FNA can obtain better sample quality with 5mL negative pressure than 10mL negative pressure.

The Cytologic Diagnostic Accuracy of NUT Midline Carcinoma in Relation to the Overall Survival Rate, in Comparison to Immunohistochemistry and Molecular Ancillary Testing: A Systematic Review

The Cytologic Diagnostic Accuracy of NUT Midline Carcinoma in Relation to the Overall Survival Rate, in Comparison to Immunohistochemistry and Molecular Ancillary Testing: A Systematic Review

Screening of Endometrial Cancer Related to Lynch Syndrome in China by Suction Curettage-Based Cytology and Histology: A Retrospective Study.

To explore the feasibility of sampling Chinese patients by suction curettage for cytological and histological screening of endometrial cancer related to Lynch syndrome. This retrospective study enrolled patients who underwent endometrial biopsy at our hospital between May 2018 and January 2019. Endometrial sampling (cytological and micro-histological specimens) was conducted by suction curettage. The gold standard for diagnosis was traditional sharp dilation and curettage (D&C). The sensitivity, specificity, and diagnostic accuracy of cytology, micro-histology, and the combination of cytology and micro-histology were calculated. Additionally, receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficiency of three screening methods. Mismatch repair proteins were further detected using immunohistochemistry (IHC) in endometrial cancer. This retrospective finally enrolled 100 patients, which satisfactory samples were obtained from 96 patients for liquid-based cytology and 93 patients for microtissue histology. The concordance rates with D&C, sensitivity, and specificity were 94.8%, 76.9%, and 97.5% for liquid-based cytology, 96.8%, 84.6%, and 98.8% for microtissue histology, and 99.0%, 92.3%, and 100.0% for liquid-based cytology and microtissue histology combined, respectively. The AUC of ROC curves in liquid-based cytology, microtissue histology, and the combined methods for diagnostic ability were 0.873, 0.917, and 0.962, respectively. Absence rates of MLHl, MSH2, MSH6, and PMS2 proteins were 15.3% (2/13), 0% (0/13), 7.7% (1/13), and 15.3% (2/13) in the 13 endometrial cancer samples. Liquid-based cytology and microtissue histology samples from suction curettage combined IHC are useful for endometrial cancer screening.

Analysis of Cytological Misdiagnosis and Oversight of Adenoid Cystic Carcinoma of Salivary Gland.

In this article on adenoid cystic carcinoma (ACC) of salivary gland, we intend to summarize the causes of misdiagnosis and oversight of ACC hoping to improve cytological diagnostic accuracy, clinical management and patient treatment. The study retrospectively reviewed 32 patients with ACC of salivary gland, registered at the Affiliated Hospital of Southwest Medical University from July 2014 to June 2021. These cases were diagnosed by FNA and surgical excision biopsy. All cytopathological results were retrospectively categorized according to Milan system for reporting salivary gland cytopathology (MSRSGC). The accuracy of FNA was verified by surgical excision biopsy. Of these 32 patients, 16 (50.0%) cases were male, and 16 (50.0%) were female. Their age ranged from 21 to 79 years, with an average age of 50.32 years. The highest incidence (15/32, 46.9%) of ACC was observed in patients between 41 and 50 years of age. 10 cases (31.3%) occurred in the parotid gland, 9 cases (28.1%) in the submandibular gland, 9 cases (28.1%) in the sublingual gland, 3 cases (9.4%) in the palate, and 1 case (3.1%) in the lip. Among the 32 cases of ACC, 23 cases (71.9%) were classified to VI, 4 cases (12.5%) to IVa, and 5 cases (15.6%) to II by MSRSGC. A comparison of the FNA results with biopsy showed that the accuracy of FNA in ACC of salivary gland is 71.9%. Being able to identify the cytomorphological features is the key factor for accurate diagnosis of ACC of the salivary gland. Our results confirm that FNA is an important initial screening in the diagnosis of ACC of salivary gland. Increased study of the cytomorphology of ACC is beneficial for more accurate diagnosis of ACC, to reduce misdiagnosis and oversight.

THE CORRELATION BETWEEN CYTOLOGICAL ASSESSMENT OF HEAD AND NECK SWELLING AND HISTOPATHOLOGY

Head and also the neck swellings can come from lymph nodes, the thyroid, or the salivary glands. The FNAC is used for prognostic as well as the therapeutic purposes, helping surgeons decide on treatment. This study compared sensitivity, diagnostic accuracy and also the specificity of cytological diagnoses of head and the neck swellings with histopathology. This 2-year retrospective study included 500 pathology cases from Fakir Mohan Medical College and Hospital, Balasore, Odissa. The FNAC of head and neck tumors that were palpable corresponded with histopathological results. Descriptive statistics were used to evaluate the specificity, sensitivity and also the diagnostic accuracy of cytology. Lymph nodes (56.23%) had the most aspirates, followed by the thyroid (27.54%) and salivary gland (9.1%). Overall diagnostic accuracy, specificity, sensitivity of FNAC were 73.8%, 99.3%, and 94.5%, respectively. FNAC is considered as a reliable, accurate and also a cost-effective method for diagnosing palpable head and neck lesions, allowing the surgeon to monitor or modify his surgical approach.

S79 EUS-Guided FNA Cytology and EUS-Guided FNB Histology Comparison for Solid Pancreatic Lesions: Single Tertiary Care Center Retrospective Study

Introduction: Endoscopic Ultrasound (EUS)-guided fine needle aspiration (FNA) and fine needle biopsy (FNB) are the current standard of care for making a diagnosis in solid pancreatic lesions (SPLs). There is conflicting data on the diagnostic utility of cytology and histology for diagnosing SPLs. The aim of this study was to evaluate the diagnostic utility of cytology and histology for diagnosing SPLs. Methods: A retrospective chart review was performed and all patients greater than 18 years with solid pancreatic lesions who underwent EUS between October 2019 and June 2021 were included. All the procedures were performed by a single advanced endoscopist and same needle (Acquire 22G, Boston Scientific) was used for all the procedures. Primary outcomes assessed were diagnostic advantage of cytology and histology in terms of providing a final diagnosis and diagnostic accuracy of cytology and histology with surgery specimen being the gold standard. Secondary outcomes assessed were relation of diagnostic accuracy to specimen length, no. of passes and size of lesion using t-test. Results: A total of 59 patients were included in our study with majority of them being males (52.4%). Mean needle passes per patient were 4.25 and average size of lesion on EUS was 3.7 cm. Turnaround time of histology was superior (2.7 days) as compared to cytology (3.3 days). In 39 cases, there was agreement between histology and cytology and 36/39 (92%) of those were malignant. Of the remaining 20 patients, histology was found to be more advantageous for 17 (85%) patients while cytology was more advantageous for the other 3 patients (15%). All 3 cases where cytology was advantageous were malignant. Of the 17 histologically advantageous cases, 15 (88%) were malignant. The histological diagnosis and cytological diagnosis were accurate in 7/8 (88%) and 3/8 (38%) respectively. T-test did not show any significant difference between two groups in relation to diagnostic accuracy to specimen length, no. of passes and size of lesion using t-test. Conclusion: Histology provided more accurate diagnosis for discordant cases and had faster turnaround times. However, there were malignant cases diagnosed on cytology which could have been missed if only histology was performed. Histology and cytology are important in conjunction with each other for maximizing the diagnostic accuracy for SPLs.

Cytological and Histopathological Correlation of Salivary Gland Tumours

Background: Tumours of the salivary gland comprise 3-6% of all tumours of head and neck region. Fine Needle Aspiration Cytology (FNAC) is a widely recognized practical and non-expensive technique to differentiate between the benign and malignant lesions. The objectives of the study are, 1. To study the histopathology of benign and malignant tumours of salivary glands. 2.To correlate cytological and histopathological diagnosis of salivary gland tumours.Method: FNAC was done under strict aseptic precautions with 18–22-gauge needles with 10cc syringe after getting informed and written consent. Slides were fixed in alcohol and stained with Haematoxylin and Eosin. The fixed surgical specimens were processed and sections of 5-micron thickness were cut and stained with Haematoxylin and EosinResult: Out of the 50 cases studied 39(78%) were benign and 11(22%) were malignant. In the present study out of 41 cases reported as benign in cytology, 38 were proved to be benign and three cases turned into malignant in histopathology. The sensitivity, specificity and accuracy of cytological diagnosis to diagnose benign lesions are 92.8%, 100% and 94% respectively. In the present study out of eight cases reported as malignant tumour, all were later proved in histopathology as malignant. The sensitivity, specificity and diagnostic accuracy of cytology to diagnose malignant tumours are 75.4%, 100% and 94% respectively.Conclusion: Thus FNAC is the safe, reliable, quick, convenient and accurate method of diagnosis and should be considered as one of the first line investigations in the evaluation of salivary gland lesions.

Accuracy of Endoscopic Transpapillary Gallbladder Drainage with Liquid-Based Cytology for Gallbladder Disease

Introduction: Gallbladder carcinoma is often difficult to distinguish from benign gallbladder diseases. While the diagnostic accuracy of endoscopic transpapillary gallbladder drainage (ETGD) has been reported, these results were obtained retrospectively. This prospective study aimed to evaluate the cytological diagnostic accuracy of ETGD in patients with gallbladder disease. Methods: This single-arm prospective clinical trial included a total of 35 patients scheduled to undergo ETGD between March 2017 and September 2019. A 5F pigtail nasobiliary drainage tube was inserted into the gallbladder, and bile was collected over 5 times; if ETGD failed, a drainage tube was placed into the bile duct. The endpoints were, first, the cytological diagnostic accuracy of ETGD and, second, technical success rates and adverse events. Results: Of the 35 patients, 19 were finally diagnosed with gallbladder cancer. The success rate of ETGD tube insertion was 85.7%, and the morphological pattern of the cystic duct with the angle down and located on the right side had a significantly lower success rate for ETGD than that of other cystic duct patterns (odds ratio, 13.5; 95% confidence interval, 1.7–143.7; p = 0.02). Cytological samples were collected 5 times on median. The sensitivity, specificity, and accuracy in all patients were 78.9%, 100%, and 88.6%, respectively, while those in 30 patients with successful ETGD were 87.5%, 100%, and 93.3%, respectively. Adverse events occurred in 3 patients: mild pancreatitis in 1 patient and obstructive jaundice in 2 patients; all complications were resolved with conservative therapy. Discussion/Conclusions: Cytology using an ETGD tube is useful in differentiating benign and malignant gallbladder diseases (Clinical Trial Registry No. UMIN000026929).

DIAGNOSTIC ACCURACY OF SQUASH CYTOLOGY OF ASTROCYTOMA

BACKGROUND: Primary Central nervous system tumours occupies less than 2% of overall human cancers in adults. The accurate diagnosis of intracranial tumour is necessary for therapeutic and prognostic purpose. Intraoperative smear cytology provides a rapid diagnosis which helps the neurosurgeon for immediate decision regarding the extent of surgery. To Objectives: determine the accuracy of squash preparation, by comparing it with histopathological sections and analysing the cytomorphological features of astrocytoma This was both retrospective and prospective study. We receive Methods: d nineteen radiologically and clinically suspected Astrocytoma in saline with xatives. Crush smear were made and stained with rapid Haematoxylin and Eosin. The corresponding biopsy materials were xed in 10% neutral buffered formalin and submitted for tissue processing. Staining was done with routine Haematoxylin and Eosin stain. The cytomorphologicalfeatures of these tumours were correlated with histopathological sections. In our study, we received Results: nineteen radiologically and clinically suspected Astrocytoma , tissue of all the tumours were soft and easy to smear . Glioblastomamultiforme was the most commonly encounterd tumor amomgneuroepithelial tumor constituting about 42.1% followed by diffuse astrocytoma (36.8%), WHOgrade II and IV tumors of astrocytoma were commonly encountered in ourstudy. Astrocytoma was common in males than females with majority of them fall in 5 th decade. we got 94.7% correlation between squash cytology and histopathology. Squash cytology is Conclusion: simple,rapid, accurate and cost effective diagnostic tool for Astrocytoma

Diagnostic accuracy of cytology for canine osteosarcoma compared to histopathology

PICO question
 What is the sensitivity and specificity of cytology as a test for canine osteosarcoma when compared to histopathology as a gold standard?
 
 Clinical bottom line
 Category of research question
 Diagnosis
 The number and type of study designs reviewed
 Overall, four diagnostic validity studies (two prospective and two retrospective) were critically appraised
 Strength of evidence
 Weak to moderate
 Outcomes reported
 There is evidence of moderate strength to support that cytology is highly sensitive and specific for diagnosing histologically confirmed osteosarcomas as mesenchymal malignant neoplasms (cytological diagnosis of sarcoma). Evidence of weak strength suggests that the sensitivity and specificity of cytology for identifying the exact histotype (cytological diagnosis of osteosarcoma) are low and high, respectively. Finally, there is currently evidence of weak strength indicating that the sensitivity and specificity of cytology are comparable to that of preoperative histopathology after incisional biopsy for the diagnosis of canine osteosarcoma
 Conclusion
 Based on the available evidence, the diagnostic accuracy of cytology in diagnosing histologically confirmed osteosarcomas as sarcomas is high, whereas a confident conclusion cannot be drawn regarding the diagnostic accuracy of cytology for the identification of the exact histotype (cytological diagnosis of osteosarcoma). There is currently scant evidence suggesting that cytology has comparable diagnostic accuracy to preoperative histopathology (i.e. after incisional biopsy) for the diagnosis of canine osteosarcomas, however, more studies are warranted to confirm these results
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

Prospective study of EUS-guided tissue acquisition with a 20G core biopsy needle with a forward bevel for solid pancreatic mass.

There is a growing need for tissue collection for immunostaining and genetic testing. Recently, several fine-needle biopsy needles are commercially available for endoscopic ultrasound-guided tissue acquisition.This prospective historical controlled study evaluates a 20G core biopsy needle with a forward bevel for solid pancreatic masses larger than 15 mm in diameter. The primary endpoint was the accuracy of histological diagnosis. The secondary endpoints included technical success rate, sample adequacy for histology, cytological diagnostic accuracy, and adverse events.Seventy consecutive patients were enrolled between January and October 2017. We achieved technical success in all cases regardless of the puncture sites or the endosonographer's experience. The final diagnoses were neoplasms in 67 patients (95.7%; pancreatic cancer in 65 patients, neuroendocrine neoplasm in 1, and malignant lymphoma in 1) and benign lesions in 3 patients (4.3%; autoimmune pancreatitis in 2 patients and mass-forming pancreatitis in 1). The obtained specimens were adequate for histological evaluation in all cases and the histological accuracy was 91.4% (95% confidence interval, 82.3–96.8%, P < .05) with the sensitivity and specificity of 91.0% and 100%, respectively. The cytological diagnostic accuracy was 95.7% and all patients were accurately diagnosed by combining cytological and histological examinations. As for adverse events, an asymptomatic needle fracture occurred in 1 case (1.4%).This 20G core biopsy needle with a forward bevel showed a high accuracy of histological diagnosis for solid pancreatic masses.

Non-human papilloma virus associated adenocarcinomas of the cervix uteri. Cytologic features and diagnostic agreement using whole slide digital cytology imaging.

Non-Human Papilloma Virus associated adenocarcinomas (NHPVAs) are uncommon tumors of the cervix uteri which often show a deceptive morphology. Therefore, their diagnostic assessment may be challenging. Slide digital cytology imaging may be an useful tool to improve cytological diagnostic accuracy. However, this novel technology has not been applied to NHPVAs associated cytologies yet. The study included 31 whole slide digital cytology cases from 10 women with a proven histological diagnosis of NHPVA. As a control group, three further digital slides, from two women with a histological diagnosis of squamous intraepithelial lesion (SIL), were included. The digitally scanned cytological slides were revised to assess the concordance rate among three observers and to find out the most relevant NHPVA cytological criteria. Overall diagnostic agreement between observers was 67.60% (K = 0.50; P < 0.0001). At the consensus diagnosis 34 cases were re-classified as at least suspicious for glandular lesion (n = 24), SIL (n = 2) and negative (n = 8). The most relevant cytologic features for atypical glandular cells or adenocarcinoma at consensus were evident nucleoli, nuclear overlapping and atypical enlarged nuclei. The diagnosis of NHPVA in digital cytology is feasible using criteria which are also used in conventional microscopy. Our study shows a moderate agreement for the cytological diagnosis of NHPVAs using whole slide digital cytology approach. These results are discussed taking into account the most relevant differential diagnostic issues.

Fine needle aspiration cytology diagnostic accuracy corelation to histopathology of head and neck swelling in Manipal teaching hospital

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Palpable neck swelling is a common clinical manifestation in otolaryngology. Rapid, inexpensive and simple method of examination for the diagnosis of such superficial masses is fine needle aspiration cytology (FNAC). Objectives were to evaluate the usage of fine needle aspiration cytology as a first-line tool for diagnosis, accuracy compared with histopathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method&lt;/strong&gt;: A hospital based prospective cross sectional was conducted by taking 65 patients with neck swelling presentation thyroid swelling were highest in number followed by lymph node and salivary, in which female were 43 (66.15%) and male were 22 (33.85%), the age group ranged from 6 to 75 years in ear, nose, throat (ENT) OPD of Manipal teaching hospital between 15&lt;sup&gt;th &lt;/sup&gt;November 2015 to 15&lt;sup&gt;th&lt;/sup&gt; May 2017. FNAC along with histopathological examination (HPE) were done and compared. For data analysis SPSS 20 version was used. The sensitivity, specificity and accuracy rates were calculated. The Cohen’s Kappa statistical test was employed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;The overall sensitivity and specificity of FNAC was 90.76% and 98.075% respectively in determining the various pathologies. The diagnostic accuracy of FNAC in comparison to histopathology was 92.25%. This study showed almost perfect correlation (measure of agreement) between FNAC and final histopathology diagnosis of neck swellings from Cohen’s Kappa test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FNAC is a safe, simple and rapid method with a high sensitivity and specificity that can be done in diagnosing wide range of neck swellings.&lt;/p&gt;

Diagnostic utility of fine needle aspiration cytology in the evaluation of neoplastic cutaneous nodular skin lesions: Experience from tertiary care institute

Aim: to find out sensitivity, specificity and diagnostic accuracy of cytology in neoplastic cutaneous nodules. Material and Methods: This prospective study was conducted for a period of one year from August, 2017 to August, 2018. Nodular skin lesions diagnosed clinically as neoplastic were assessed by FNAC and correlated with histopathology. The sensitivity, specificity and accuracy of FNAC were determined using histopathology as a gold standard. Results: 82 cases with nodular skin lesions were subjected to cytological examination and biopsy. Aspiration was inadequate in 03 cases. For diagnosing neoplastic lesions, FNAC had a sensitivity of 98.7%, specificity of 94.6% and diagnostic accuracy of 97.4%. Conclusion: FNAC is safe, rapid, cost effective, highly sensitive and specific for the diagnosis of neoplastic nodular skin lesions with high diagnostic accuracy.

694P - Diagnostic value of digital multiplexed detection of single nucleotide variants in pancreatic cancer specimens collected by endoscopic ultrasound fine-needle aspiration

BackgroundCurrent diagnostic approaches for pancreatic cancer (PC) mostly rely on cytologic examination of endoscopic ultrasound fine-needle aspiration (EUS-FNA) samples. However, in a subset of cases, PC diagnosis remains inconclusive due to low tumour cellularity. Molecular analysis of EUS-FNAs might be used as an auxiliary tool to strengthen diagnosis in samples with suboptimal cytology. This study aimed to evaluate the diagnostic utility of a single nucleotide variants (SNV) assay using molecular barcode technology performed on EUS-FNAs. Methods28 EUS-FNA samples of pancreatic masses (19PC, 9 non-malignant lesions) were analyzed. FNAs were collected in RNAlater and stored at -80 C. Mutational status was evaluated using the Nanostring Vantage 3D™ DNA SNV Solid Tumor Panel, utilizing digital enumeration of unique barcoded probes to detect 104 SNV from 24 genes of clinical significance. 5ng of tumor-derived DNA was subjected to multiplexed preamplification and hybridization of variant-specific probes to unique fluorescent barcodes. A multiplex KRAS assay (G12/13) droplet digital PCR (ddPCR) was used to confirm SNVs. ResultsThe SNV assay detected at least one variant in 18/19 (95%) PC samples. One PC case harbored 3 SNVs. Among the PC samples, KRAS variants (G12D, G12V, G12R, Q61H, Q61L) were detected in 17 (90%) cases, EGFR in 1 (5%), and PIK3CA in 1 (5%). All KRAS mutations were also detected by ddPCR. Diagnostic accuracy of cytology alone for PC was 68% (19/28). 32% of the FNAs were inconclusive; at least one SNV was detected in 5/6 inconclusive FNAs with a final diagnosis of PC. No SNV was identified in the remaining 3 inconclusive cases diagnosed as chronic pancreatitis. Combining cytology and SNV analysis for inconclusive cases increased the diagnostic accuracy to 96% (27/28). ConclusionsNanostring SNV assay combined with cytology can enhance the diagnostic power of EUS-FNA, especially in inconclusive cases, preventing repeat biopsies, unnecessary resections for benign disease or delay in PC patients care. Given the low DNA input, digital data output and rapid turn-around time, this novel technology may be instrumental for the preoperative molecular diagnosis of PC. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.