Cytological Grading Research Articles

Cytological grading of lymphocytic thyroiditis and its correlation with thyroid hormonal status

Lymphocytic thyroiditis is the second most common thyroid lesion diagnosed on FNAC after goitre. Clinical features, thyroid antibody titres, thyroid hormonal profile, and ultrasonography also aid in its diagnosis besides FNAC. The present study was carried out to evaluate thyroid fine needle aspirates for cytological features of lymphocytic thyroiditis; to grade lymphocytic thyroiditis cases based on predefined cytological criteria and to correlate cytological grades with thyroid hormonal status. It was a three year retrospective study conducted in the Department of Pathology, Government Medical College, Jammu. Lymphocytic thyroiditis cases reported as per Bethesda system were further graded based on predefined cytological criteria as per Bhatia et al. Cytological grades were correlated with thyroid hormonal status wherever available. A total of 162 cases of lymphocytic thyroiditis were reported as per Bethesda system in our study. On further grading, majority cases were of grade II thyroiditis (104, 64.2%) followed by grade I (48, 29.6%) and grade III (10, 6.2%). Of the 78 cases with available thyroid hormonal profile, maximum patients were hypothyroid (42; 53.85%) followed by euthyroid (21; 26.92%) and hyperthyroid (15; 19.23%). There was no statistically significant association of grades with hormonal status with P value > 0.05. FNAC remains the "gold standard" investigation for diagnosis of Lymphocytic thyroiditis. However, the cytological grades show no statistically significant correlation with thyroid hormonal status in our study.

Comparative study of Robinson’s cytologial grading with Bloom Richardson’s histologic grading for breast carcinoma

Comparative study of Robinson’s cytologial grading with Bloom Richardson’s histologic grading for breast carcinoma - JSAS- Print ISSN No: - Online ISSN No:- 2582-6387 Article DOI No:- 10.18231/j.jsas.2020.005, IP Journal of Surgery and Allied Sciences-IP J Surg Allied Sci

A Comparison Between Cytological and Histopathological Grading System in Cases of Breast Malignancy

Background
 Treatment of breast malignancies depends on its types and grades. Classification of breast lesion is usually based on the histological appearance of tissue in the tumor. Like histopathology, the diagnostic cytology is also a useful tool for the oncologist and surgeons. It is possible to grade breast cancer on fine-needle aspirates.
 Material and methods: 
 A prospective study of FNAC of breast lesions was carried out along with its histopathological correlation. Malignant breast lesion diagnosed on FNAC were graded using Robinson's grading system and correlated with Elstons modified Bloom Richardson histological grading system.
 Results: 
 The sensitivity, specificity and accuracy of the fine needle aspiration cytology to diagnose breast malignancy were 84.84%, 100.00% and 93.75% respectively. Out of 17 cases of Robinson gradeing on FNAC, 12(70.59%) cases were well correlated with Bloom-Richardson histological grade.
 Conclusion: 
 Cytological grading is simple, less time consuming and with rare exceptions correlates precisely with the histological grade. It helps to know prognostic evaluation of breast carcinoma along with diagnosis.

Grade I, II and III Follicular Lymphomas Express Ig VH Genes with Different Patterns of Somatic Mutation

Follicular lymphoma (FL) is an indolent, B-cell, non-Hodgkin’s lymphoma with varying cytological appearance and clinical behavior. The genetic hallmark of FL is the t(14;18) translocation, and as a germinal center derived entity it is also characterized by somatic hypermutation of the immunoglobulin heavy chain (IgH) gene. In an attempt to correlate this molecular signature with the cytological grading of FL, we have analyzed the IgH variable (IgVH), regions in all cytological grades of FL. Four FL cases showing t(14;18) translocation were classified into grade I-III categories according to the current WHO guidelines. The IgVH gene segments were PCR-amplified, sequenced, and compared to their respective germline IgVH sequences. The neoplastic cells of grade I and II FLs revealed clonally related, but highly divergent IgVH gene sequences indicating the ongoing nature of somatic hypermutation. Grade III FL also showed extensive presence of somatic hypermutation, but these mutations were not associated with intraclonal divergence. Thus, these results suggest that grade I-II and grade III FL may represent different biological entities. The presence of ongoing somatic hypermutation of IgVH sequences in grade I and II FLs is compatible with direct follicular origin of these tumor cells, contrasting the homogenous, stable clones of grade III FL resembling a post-follicular stage of B-cell development. Our findings demonstrate that contrary to the three tiered cytological grading, molecular features of IgH genes classify FL into two distinct subcategories. These studies also suggest that with progression FL gains post-follicular–like molecular features and becomes independent of the germinal center microenvironment.

Cytologic grading of canine and feline spindle-cell sarcomas of soft tissues and its correlation with histologic grading

In humans, soft tissue spindle cell sarcomas (STSCS) grading is considered a useful parameter in determining prognosis and therapy, and it is recognized as an important prognostic factor in canine STSCS. The purpose of this study was to assess the utility and the accuracy of a cytologic grading system on fine needle aspiration cytology (FNAC) smears of canine and feline cutaneous and subcutaneous STSCS .Thirty-three cases of cytologically diagnosed STSCS were included. The smears and their tumour sections were cytologically and histologically graded, according to established methods in human oncology.Canine STSCS showed a cyto/histologic concordance in 12/20 cases (60%). Concordance was observed in 4/8 (50%) of grade 1, in 8/12 (67%) of grade 2, and in 0 cases of grade 3. Feline STSCS showed concordance in 11/13 cases (85%). Concordance was observed in 5/6 (83%) of grade 1, in 4/4 (100%) of grade 2, and in 2/3 (66.6%) of grade 3 cases. The overall concordance in the entire canine and feline population was 70%. The gradewise concordance was 65% in grade 1, 75% in grade 2, and 66% in grade 3 cases. The overall concordance is similar to that reported in humans. Although a wider population is required to strengthen our findings, these results suggest that cytologic grading of STSCSs may be a useful tool for therapeutic and prognostic evaluations in dogs and cats.

Clinicopathological study of intraductal carcinoma of the salivary gland, with emphasis on the apocrine type

Intraductal carcinoma (IC) is a rare salivary gland tumor with low- to intermediate-grade cytological features. It is further classified into intercalated duct type and apocrine type based on its distinct histologic and immunohistochemical expression. Conventional salivary duct carcinoma (SDC) is an aggressive carcinoma with high-grade features and is usually associated with poor prognosis. In this study, immunohistochemistry and mutation analyses (including HRAS/PIK3CA mutations, RET rearrangement, and human epidermal growth factor receptor 2 [HER2] amplification) of 9 ICs (including 3 pure ICs, 6 ICs with invasive carcinoma) and 24 conventional SDCs were performed and the results were compared. Four intercalated duct-type cases were positive for SOX10 and S100 and negative for AR; five apocrine-type cases showed opposite results. All five apocrine-type cases had cysts with relatively circumscribed tumor borders and morphologically mimicking breast low-grade ductal carcinoma in situ or papillary carcinoma. RET fusion is detected in half of the 4 intercalated duct-type IC but not in the apocrine-type or conventional SDC. HER2 amplification was only observed in conventional SDC. The monoclonal antibody (clone RBT-NRAS) against NRAS Q61R is a sensitive and specific marker used for detecting HRAS Q61R mutation in the salivary gland tumors. The apocrine-type IC had different cytological grades, distinct tumor growth patterns, and no evidence of low- to high-grade transition, suggesting that apocrine-type IC should be distinguished from apocrine SDC with an in situ component.

An economical Nanopore sequencing assay for human papillomavirus (HPV) genotyping

BackgroundHuman papillomavirus (HPV) testing has been employed by several European countries to augment cytology-based cervical screening programs. A number of research groups have demonstrated potential utility of next-generation sequencing (NGS) for HPV genotyping, with comparable performance and broader detection spectrum than current gold standards. Nevertheless, most of these NGS platforms may not be the best choice for medium sample throughput and laboratories with less resources and space. In light of this, we developed a Nanopore sequencing assay for HPV genotyping and compared its performance with cobas HPV Test and Roche Linear Array HPV Genotyping Test (LA).MethodsTwo hundred and one cervicovaginal swabs were routinely tested for Papanicolaou smear, cobas HPV Test and LA. Residual DNA was used for Nanopore protocol after routine testing. Briefly, HPV L1 region was amplified using PGMY and MGP primers, and PCR-positive specimens were sequenced on MinION flow cells (R9.4.1). Data generated in first 2 h were aligned with reference sequences from Papillomavirus Episteme database for genotyping.ResultsNanopore detected 96 HPV-positive (47.76%) and 95 HPV-negative (47.26%) specimens, with 10 lacking β-globin band and not further analyzed (4.98%). Substantial agreement was achieved with cobas HPV Test and LA (κ: 0.83–0.93). In particular, Nanopore appeared to be more sensitive than cobas HPV Test for HPV 52 (n = 7). For LA, Nanopore revealed higher concordance for high-risk (κ: 0.93) than non-high risk types (κ: 0.83), and with similar high-risk positivity in each cytology grading. Nanopore also provided better resolution for HPV 52 in 3 specimens co-infected with HPV 33 or 58, and for HPV 87 which was identified as HPV 84 by LA. Interestingly, Nanopore identified 5 additional HPV types, with an unexpected high incidence of HPV 90 (n = 12) which was reported in North America and Belgium but not in Hong Kong.ConclusionsWe developed a Nanopore workflow for HPV genotyping which was economical (about USD 50.77 per patient specimen for 24-plex runs), and with comparable or better performance than 2 reference methods in the market. Future prospective study with larger sample size is warranted to further evaluate test performance and streamline the protocol.

Interobserver Agreement in Assessing Dysplasia in Colorectal Adenomatous Polyps: A Multicentric Iranian Study.

Background & Objective:Most colorectal cancers (CRCs) arise from adenomatous polyps, and clinical management of this type of polyp is highly dependent on the reliability and validity of the pathological diagnosis. The aim of this study was to examine the interobserver agreement of five pathologists in assessing dysplasia in adenomatous polyps. Methods:In this study, a total of 146 adenomatous polyps of patients undergoing colonoscopy were selected from hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2018. Five pathologists independently classified adenomatous polyps according to histologic type, nuclear pseudostratification, mitotic activity, nuclear polarity, nuclear pleomorphism, nuclear shape, nucleolus, chromatin pattern, cytology grade, architectural features, dysplasia, and final diagnosis. The overall kappa statistic (k) was used to assess agreement among pathologists.Results:The mean age of the patients was 62.06 ± 13.06 (mean ± SD) with a male-to-female ratio of 2.2:1. The most common site of resection was the sigmoid colon (28.1%). The highest agreement was found for dysplasia grade (k=0.415) and histologic type (k=0.401), whereas the lowest agreement was found for mitotic activity (k=0.185), nuclear shape (k=0.187), and nucleolus (k=0.196).Conclusion:Our findings indicate that agreement among pathologists in assessing dysplasia in adenomatous polyps is within fair to moderate levels of agreement. Therefore, there is a vital need to better clarify the current diagnostic criteria.

Abstract A17: Human papillomavirus type 16 and 18 viral loads as predictors associated with abnormal cervical cytology among women in Saudi Arabia

Abstract The present study aimed to screen for and genotype HPV among Saudi women; develop sensitive quantitative polymerase chain reaction (qPCR) assays to detect the viral load for the two most common HPV types, namely 16 and 18; and assess whether HPV viral load could be used as a marker for cervical abnormality and disease progression. This study examined 733 specimens (both formalin-fixed, paraffin-embedded specimens and PAP smear samples) from women who underwent cervical screening. The specimens and samples were processed for DNA extraction and then tested for HPV DNA. Approximately 165 specimens (18%) were positive for HPV. Those specimens were genotyped using a reverse line blotting hybridization assay. The results indicated that the most common HPV types detected were a single infection with HPV 16 (51%) or with HPV 18 (28%) followed by infections with multiple HPV types (~7%). A qPCR TaqMan assay developed in-house was used to determine the viral load for HPV genotypes 16 (n=80) and 18 (n=45). Viral loads for both HPV types were significantly associated with cervical cytology grade (P < 0.05). The odds ratio (OR) for the HPV 16 viral load was high for specimens with cervical cancer (OR, 18.8; 95% CI, 4.3–82.9) or for those with high-grade squamous intraepithelial lesions (OR, 14.7; 95% Cl, 2.43–88.49). For the HPV 18 viral load, the OR was significant only for specimens with cervical cancer (OR, 11.1; 95% Cl, 2.2–54.9). Logistic regression models for HPV 16 and for HPV 18 viral load levels were significant, with higher viral load associated with cervical abnormalities. These findings indicate that viral load is a predictor significantly associated with cytology abnormality in women who are positive for high-risk HPVs and suggest integrating a viral load test into current clinical screening practices for HPV-positive women. Citation Format: Dalia Obeid, Shihana Almatrrouk, Hadeel Khayat, Turfah Al-Muammer, Asma Tullbah, Ismail Albadawi, Mohammed Alahdal, Fatimah Alhamlan. Human papillomavirus type 16 and 18 viral loads as predictors associated with abnormal cervical cytology among women in Saudi Arabia [abstract]. In: Proceedings of the AACR Special Conference on the Microbiome, Viruses, and Cancer; 2020 Feb 21-24; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2020;80(8 Suppl):Abstract nr A17.

Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel.

Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors. Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low- and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low- or high-grade. However, caution should be exercised when a grade cannot be confidently assigned.

A Sensitive and Simplified Classifier of Cervical Lesions Based on a Methylation-Specific PCR Assay: A Chinese Cohort Study.

ObjectiveThe aim of this study is to assess the diagnostic and screening performance of a standardized methylation-specific real-time PCR assay targeting SOX1 and PAX1 genes for cervical cancer in a Chinese cohort.MethodsGenomic DNA was extracted from cervical exfoliated cells and converted by sodium bisulfite and then analyzed by qMSP assay. Ct values were collected for PAX1 and SOX1 as target genes and β-actin as an endogenous reference gene. The samples included 295 cervicitis, 111 LSIL (low-grade squamous intraepithelial lesion), 51 HSIL (high-grade squamous intraepithelial lesion) and 30 cervical cancer.ResultsThe Ct values decreased with the progression of cervical cancer from cervicitis, through LSIL and HSIL to cancer. The difference in Ct values between cytological grades was highly significant (p≤0.01) between grades either for PAX1 or for SOX1 except the difference between cervicitis and LSIL of SOX1. With the Ct cut-off values of PAX1 gene and SOX1 gene 38.6 and 38 and with the PAX1/SOX1 in combination, the positive rate of methylation in invasive cancer tissues was 100%, in contrast to 11.5% (95% CI: 8.67%–14.33%) in cervicitis tissues, 45.1% (95% CI: 40.68%–49.52%) in LSIL tissues, and 68.5% (95% CI: 64.37%–72.63%) in HSIL tissues. The specificity and sensitivity of differentiating tumors from cervicitis were 0.957 (95% CI: 0.939–0.975) and 1.00, respectively. The specificity and sensitivity of differentiation between cervicitis+LSIL and HSIL+cervical cancer were 0.881 (95% CI: 0.852–0.91) and 0.748 (95% CI: 0.709–0.787), respectively.ConclusionPAX1/SOX1 methylation could be translated into clinical practice for cervical neoplasia detection.

Cell cannibalism: a diagnostic and prognostic marker of breast cancer

Background: Cell cannibalism (cytophagocytosis) is defined as a tumor cell within a tumor cell, such that smaller tumor cells are found in the cytoplasm of larger tumor cells with crescent shaped nuclei. Aims and Objectives were to study the cytomorphological characters of cell cannibalism in primary and metastatic breast cancer, to correlate the histologic type and grade of tumors with positive rate of cannibalism and to study the role of Cannibalism as an independent prognostic factor in breast cancer.Methods: The study was conducted during the period of July 2003 to June 2005 in the Department of Surgery and Pathology, JNMCH, Aligarh. A total of 42 cases were included in the study. A minimum of 3 FNAC smears per case were assessed for cytophagocytosis. Presence of metastasis was also noted to establish the cytological grade and aggressiveness of the tumor.Results: Out of 42 cases, significant cannibalistic activity was noted in 30 (71.42%) cases. All grade III (33.4%) breast tumors were found positive for cytophagocytosis (4.28/smear), while the rate was much lower (2.33/smear) in grade II and (1.63/smear) in grade I tumors. LN metastasis was confirmed by histopathological examination in all high grade tumors showing significant cannibalistic activity.Conclusions: Cannibalism in breast carcinoma is an indicator of both the anaplastic grade and invasiveness. The rate of cytophagocytosis may have a prognostic significance.

Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management.

Patients undergoing endoscopic management for upper tract urothelial carcinoma often progress to definitive therapy with radical nephroureterectomy. This study examined the rate of progression as well as risk factors for transitions in treatment over time. Retrospective review at two institutions identified patients undergoing endoscopic management for upper tract urothelial carcinoma. Patients were assessed for progression to radical nephroureterectomy. Baseline characteristics were compared using Chi square analysis. Kaplan-Meier method analyzed the probability of patients not progressing to radical nephroureterectomy. Cox proportional hazards identified factors associated with progression to radical nephroureterectomy. Eighty-one patients had endoscopic management alone and 89 progressed to radical nephroureterectomy. The two groups had similar age, histories of bladder cancer, and Charlson comorbidity index. Positive urinary cytology, ureteroscopic visualization, and biopsy grade were higher in those progressing to RNU (p < 0.001). Hazard modeling demonstrated higher rates of progression to radical nephroureterectomy with positive biopsy (HR 11.8, 95% CI 2.4-59.5, p = 0.003) or visible lesion on ureteroscopy (HR 8.4, 95% CI 3.0-23.9, p < 0.001). Patients with a higher Charlson comorbidity index were less likely to have radical nephroureterectomy. On Kaplan-Meier modeling, the probability of not undergoing radical nephroureterectomy at 2years and 5years was 50% and 20%, respectively. Patients who progress to radical nephroureterectomy after endoscopic management have fewer comorbid conditions and changes in disease status including visible lesions on ureteroscopy and positive biopsies. The high rate of progression to radical nephroureterectomy reinforces the need for long-term follow-up of these patients.

Human papillomavirus genotype profiles and cytological grades interlinkages in coinfection with HIV.

IntroductionThe study aimed to examine and characterize human papilloma virus (HPV) cytological grade trends and genotypes among HPV/HIV co-infected/cases and HPV monoinfected/control women attending Kisii Teaching and Referral Hospital, Kenya.MethodsHIV positive co-infected with HPV (HPV/HIV) and HIV negative women monoinfected with HPV profiled as co-infected/cases and monoinfected/control arms respectively were enrolled. HPV subtypes were assayed by Xpert® HPV system (GXHPV-CE-10) alongside pathological cytology analysis of cervical tissue samples.ResultsLow grade intraepithelial lesion (LSIL) was the most predominant cytological grade across cases and controls with a prevalence of 32 (38.1%) while high grade squamous intraepithelial lesion (HSIL) was highest among HPV/HIV co-infected with a prevalence of 23 (27.38%). Among the monoinfected (controls) the predominant lesion was low grade intraepithelial lesions (LSIL) with a prevalence of 23 (27.38%). HPV type 16 had the highest prevalence 26 (30.8%) among the VIA positive women in the overall study participants followed by combinations of HPV types (16, 18/45) at 19 (22.6%).ConclusionHigh risk HPV types 16 and 18/45 were the most predominant in the established cytological grades and among the co-infected women. Routine screening using both cytological and HPV testing should be embraced and/or reinforced as early screening and preventive strategies in the covered geographical region population. Provision of the currently available vaccines to these women at an early age would provide effective protection since the HPV type profiles in this population are covered by such vaccines.

Human papillomavirus type 16 and 18 viral loads as predictors associated with abnormal cervical cytology among women in Saudi Arabia

The detection of HPV viral DNA is regularly conducted with cervical screening. However, using a molecular marker such as the viral load may serve as a predictor associated with disease detection and progression. The present study aimed to screen for and genotype HPV among women in Saudi Arabia, develop and validate sensitive quantitative polymerase chain reaction (qPCR) assays to detect viral load for the two most common HPV types, namely 16 and 18, and assess whether HPV viral load could be used as a marker for cervical abnormality and disease progression. This study examined 733 specimens (both formalin-fixed paraffin embedded specimens and PAP smear samples) from women who underwent cervical screening. The specimens and samples were processed for DNA extraction and then tested for HPV DNA using nested PCR. Approximately 165 specimens (18%) were positive for HPV. Those specimens were genotyped using a reverse line blotting hybridization assay. The results indicated that the most common HPV types detected were a single infection with HPV 16 (51%) or with HPV 18 (28%) followed by infections with multiple HPV types (~7%). A qPCR TaqMan assay developed and validated in-house was used to determine viral load for HPV genotypes 16 (n = 80) and 18 (n = 45). Viral loads for both HPV types were significantly associated with cervical cytology grade (P < 0.05). The odds ratio (OR) for the HPV 16 viral load was high for specimens with cervical cancer (OR, 18.8; 95% CI, 4.3–82.9) or for those with high-grade squamous intraepithelial lesions (OR, 14.7; 95% Cl, 2.43–88.49). For the HPV 18 viral load, the OR was significant only for specimens with cervical cancer (OR, 11.1; 95% Cl, 2.2–54.9). Logistic regression models for HPV 16 and for HPV 18 viral load levels were significant, with higher viral load associated with cervical abnormalities. These findings indicate that viral load is a predictor significantly associated with cytology abnormality in women who are positive for high-risk HPVs and suggest that integrating a viral load test into current clinical screening practices for HPV-positive women is warranted in Saudi Arabia.

TO GRADE BREAST CARCINOMAS ACCORDING TO MODIFIED BLOOM RICHARDSON GRADING SYSTEM IN LUMPECTOMY AND MASTECTOMY SPECIMENS.

The study was conducted in the Department of Surgical Pathology, Patliputra Medical College and Hospital, Dhanbad. Cytological study of breast lumps was done. All patients who were clinically suspected of having breast carcinoma were subjected to FNAC of breast lump under aseptic precautions after explaining the procedure, its potential complications and taking written consent. Local examination was done and details were recorded as per proforma. FNAC was performed by following technique.&#x0D; It is a useful parameter to be taken into consideration when selecting mode of therapy for breast carcinoma and to predict the tumor behavior. Cytological grading is especially useful in low resource settings, where core biopsy is not routinely performed for diagnosis of breast carcinoma. The cyto-prognostic grading helps in identifying fast growing tumors (Grade III&amp; II). Such tumors are more likely to respond to chemotherapy than the low grade, slow growing tumors, which are better suited to pre-treatment with tamoxifen. Therefore, assessment of biological aggressiveness by cytological grading without removing the tumor is valuable approach.&#x0D; Keywords: Robinson’s Grade, Breast, Carcinoma &amp; Cytological Aspirates.

Comparative study of female hypothyroid patients having autoimmune thyroiditis with the clinico-pathological parameters

Introduction: Hypothyroidism during reproductive age group is responsible for menstrual irregularities, infertility along with miscarriages and congenital malformation s during pregnancy. It has a prevalence of 5-20% in child bearing age. Autoimmune thyroiditis is the common cause of subclinical hypothyroidism in adult female population. Presence of thyroid autoantibodies is high in subclinical hypothyroidism. American Thyroid Association (ATA) & American Association of Clinical Endocrinologist (AACE) recommends for treatment of these patients. Lack of obvious signs and symptoms in subclinical hypothyroidism creates dilemma and challenge for diagnosis. Hypothesis: This was a retrospective study conducted in Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar during the period from January 2017 to January 2019. Women of reproductive age group having thyroid swellings were subjected to Fine needle aspiration cytology (FNAC), Thyroid function test and Anti TPO Ab levels in serum. Cytological grading was done and it was correlated with clinical presentation and serological parameters. Results: Out of 120 cases, 56.7% patients were hypothyroid. Increased titre of Anti- TPO Ab levels in serum was observed in 91.4%, 95.3% and 95% cases of Grade I, Grade II & Grade III categories of autoimmune thyroiditis respectively. Conclusion: Autoimmune thyroiditis is the common cause of hypothyroidism in adult females. Early detection and management with low dose of thyroxine will prevent the complications during reproductive period. Keywords: Autoimmune thyroiditis, Hypothyroidism, Anti-TPO Antibody, TFT.

Improvement of conjunctival cytological grade and tear production in Ankylosing Spondylitis patients under TNF inhibitors: a long-term follow-up

Dry eye disease can compromise the patient’s quality of life. Few studies assessed the ocular surface (OS) in Ankylosing Spondylitis (AS) patients. This study aimed to evaluate the clinical and cytological findings of the OS in patients with AS, classify dry eye disease (DED) severity grade and conjunctival impression cytology (IC), and the effects of TNF inhibitors (TNFi) in a one-year follow-up. A baseline (BL) evaluation included 36 AS patients and 39 healthy controls. They fulfilled the Ocular Surface Index Disease questionnaire and underwent the Schirmer I test, break-up time, vital staining, and conjunctival IC. A DED severity grade, as well as IC rating, was applied. Fourteen of these patients received TNFi and analysis of ocular and systemic AS disease parameters occurred at BL and three months (3 M), and 12 months (12 M) after treatment. The AS patients presented a higher frequency of DED (p = 0.01), a worse score of severity (p = 0.001), and a higher frequency of altered IC (p = 0.007) when compared to controls. The 14 patients under TNFi presented an improvement in all the clinical disease activity parameters throughout the one-year treatment (p < 0.05) even as a concomitant increase in the Schirmer test (p = 0.04), and a significant amelioration in the altered IC to a normal IC (p = 0.006). DED is a frequent and under-diagnosed ocular disease in AS patients. The long-term parallel improvement of disease activity and OS parameters in AS patients receiving TNFi suggests that the OS can be an additional target of systemic inflammation in AS.

Robinson’s cytological grading on fine needle aspirates (FNAC) of breast cancers and its correlation with histopathological grading

Background: Breast cancer is one of the most common cancers in females. Fine needle aspiration cytology plays an important role in the management of these patients.Aims and objectives: 1) To study Robinson’s cytological grading on preoperative FNAC smears in cases of breast carcinoma. 2) To correlate Robinson’s cytological grading with modified Scarff Bloom Richardson histopathological grading.Methods: A retrospective study was done on 50 patients of breast carcinoma over the period of 2 years from 1st January 2018 to 31st December 2019 at a tertiary care center. Results: Groups II and group III cases of breast carcinomas were correlated very well on cytological and histopathological grading. The sensitivity of cytological grading in the present study were 66.66%, 75% and 85.71 respectively. Specificity were 85%, 76.92% and 90.90% respectively i.e. maximum in grade III. The k value for present study showed 0.62 i.e substantial agreement. Conclusion: Cytological grading of breast carcinomas is a useful prognostic marker in the management of breast carcinoma. It is helpful in selecting the patients for modified radical mastectomy with axillary dissection and neoadjuvant chemotherapy.

Well-armed is well started: A population-based study to assess risk stratification in potentially premalignant oral epithelial lesions.

Background:The association between potentially premalignant oral epithelial lesions (PPOEL), oral squamous cell carcinoma and its higher incidence in South-East Asian population due to the use of arecanut, pan, slaked lime and tobacco is well known. The study was carried out in urban and rural population of Bengaluru, Karnataka, to assess and correlate the pattern of habit, clinical presentation and cytological grading of PPOELs, attempting at identifying the main arms associated with risk of malignant transformation.Aims:Assessment of history, clinical presentation of PPOELs, co-relate with cytological grades and escalate to binary risk assessment.Materials and Methods:One hundred and fourteen cytological smears received at the Department from screening camps were stained with Papanicolaou and hematoxylin-eosin stains and correlated with the clinical data.Results/Statistics:Descriptive and inferential statistics were performed. 38% lie between 21 and 30 years, 76.3% males, 81 cases involved buccal mucosa with 51.1% Grade II cytosmear, 53.5% chewing tobacco habit, 10 cases involved multiple sites with 60% Grade II cytosmear and 6 cases showed Grade III cytosmear. Based on clinical risk factors and cytological grading, 15.3% were grouped under high risk lesions as against 5.4% when only cytological grading was considered.Conclusion:The incidence of PPOELs is increasing in young males with chewing tobacco mainly in buccal mucosa associated with habit. Biopsy and definitive treatment is necessary when the lesions are red, nonhomogeneous, seen in multiple sites and concomitant lesions with higher grades of dysplasia. The use of cytosmears in screening camps helps to assess, affirm and stress on biopsy on higher dysplasia grades as biopsy is not an acceptable norm in camps.