Cytological Grading Research Articles

The Novel Role of Cytomorphology from Ultrasound-Guided Fine Needle Aspiration Cytology in Evaluating the Status of Prognostic Factors including Estrogen Receptor, Progesterone Receptor and HER2 in Breast Cancer.

It is well established that estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2) could be regarded as prognostic factors in breast cancer. Ultrasound-guided fine needle aspiration cytology (FNAC) has revolutionized the management of cancers, providing less invasive and quick diagnostic method. There are hardly any studies on the correlation between cytomorphology and prognostic biomarkers. We retrospectively analyzed the immunohistochemistry and the fluorescence in situ hybridization of breast cancer specimens from 252 patients, who have been diagnosed as breast cancer at our hospital. Morphological features of cytology smears were scored. The relationship between cytological features and three biomarkers were analyzed. Based on this, we developed a system to predict the status of biomarkers. The results indicated that some cytological parameters, especially the features of nucleoli, were distinctively related to the makers' expression. In the novel scoring system, a cutoff of 12.0 provided a statistical discrimination for cytological grading. We concluded that cytomorphological features were associated with prognostic factors. The HR+ neoplasms showed scattered micronucleoli, while HER2+ neoplasms demonstrated centered macronucleoli. We summarized a scoring system to predict the status of three factors. This may help us to broaden the application of breast cancer cytology.

Efficacy of Modified Masood Scoring System (MMSS) in Cytological Diagnosis of Breast Lesions.

Introduction: Fine-needle aspiration cytology (FNAC) breast is generally considered a reliable diagnostic tool to distinguish non-proliferative from proliferative breast lesions. Nevertheless, differentiating these breast lesions on FNAC poses a diagnostic challenge. Modified Masood Scoring System (MMSS) based on cytomorphological examination has been used to help in differentiating these lesions.Material and methods: A total of 67 patients were included in this prospective study done from November 2012 to May 2014 and the breast lesions were cytologically categorized by conventional and as per MMSS criteria, followed by comparison to a histopathological examination, which was taken as a gold standard. Relevant frequencies and proportions were calculated along with the sensitivity and specificity of the MMSS.Results: The age of the patients ranged from 15 to 85 years with a mean age of 44.3 ± 14.8 years. Females predominated in the study and right-sided breast lesions were more common compared to the left side. Overall diagnostic specificity (100%) and accuracy (97%) were higher using MMSS as compared to conventional cytology in which case specificity was 83.6% and accuracy was 82.1%.Conclusions: Cytological grading system based on MMSS allowed accurate and reproducible diagnosis compared to the standard histopathological diagnosis. It is essential to differentiate non-proliferative lesions from proliferative lesions as the line of treatment and prognosis varies.

Association Between Cytological and Histological Grading of Breast Cancer and its Usefulness in Patient Treatment

Introduction: Breast cancer is the most common cancer in women throughout the globe, and the modern therapeutic available options have been widely researched currently. For a developing nation with limited resources, such as Pakistan, a quick, affordable, and least invasive technique like FNAC may give useful information. Aim: The aim of this study was; 1 Perform and evaluate cytomorphological classification of all breast cancer patients using the Robinson's three-tier grading system. 2 Histopathological evaluation and classification of all samples of MRM by using a modified BR classification system. 3 Correlation of histo-morphological and cytomorphological classification systems. Place and Duration: In the Pathology department of Khyber Teaching Hospital Peshawar for six months duration from February 2018 to July 2018. Material and methods: A prospective study was conducted in which two independent observers classified all breast cancer patients on the basis of cytology and histology of the tissue and cyto-histological correlation. Results: This study provided good individual correlation and inter-observer agreement in the cytopathological classification of breast cancer aspirates. Conclusion: Cytopathological classification may be useful for these patients and should therefore be included in routine reports. Keywords: Breast carcinoma; Cytopathology; Robinson classification system

Lymphocytic Thyroiditis- Association between Cytology and Biochemical Findings

Introduction: Hashimoto’s thyroiditis otherwise called as chronic lymphocytic thyroiditis is the most common cause of hypothyroidism and one of the most common thyroid lesions in Fine Needle Aspiration Cytology (FNAC). Diagnosis depends on clinical findings, ultrasonographic findings, thyroid profile and antithyroid antibody levels along with the FNAC findings. Not much studies are there which have assessed the association of the clinical and biochemical parameters with the cytological findings. Aim: To grade the cytological features of lymphocytic thyroiditis and to study the association of the grades with Thyroid Function Test (TFT) and antithyroid antibody levels. Materials and Methods: A prospective time bound analytical observational study of one year was carried out in the Department of Pathology at Government Medical College, Palakkad, Kerala, India after obtaining approval from the Institutional Ethics Committee (IEC). Out of the total of 462 cases of thyroid lesions who underwent Fine Needle Aspiration (FNA), 147 cases were lymphocytic thyroiditis as per cytology. Of these, 40 cases had Thyroid Stimulating Hormone (TSH), Antithyroglobulin Antibody (ATG) and Antithyroid Peroxidase Antibody (ATPO) levels known which were included in the study. Cytological grading of those were done and the association of the same with the above mentioned parameters was studied. Data was analysed using Statistical Package for the Social Sciences (SPSS) software. Descriptive statistics were calculated and presented as percentages, mean and Standard Deviation (SD). Chi-square test was used to find the association between the categorical variables. The p-value <0.05 was taken as statistically significant. Results: Cytomorphology was diagnostic of thyroiditis in all the cases. Out of the 40 cases, 32 were females.The most common age group affected was 31-40 years, though it ranged from 18-68 years. Most common clinical presentation was diffusely enlarged thyroid, though a few presented as nodular disease. Most of the patients had grade 1 thyroiditis (23 cases) followed by grade 2 (13 cases). Elevated antithyroid antibody levels - ATPO elevated in 32 cases and ATG in 20 cases. TSH was seen elevated in 28 cases of thyroiditis. No association was observed with the antithyroid antibody levels and the cytological grade. Conclusion: Lymphocytic infiltration into the follicles is the diagnostic cytological feature of chronic lymphocytic thyroiditis. TSH elevation and positive ATPO levels strongly suggest Hashimoto’s thyroiditis. No association was found between the cytological grade and TSH and antibody levels.

Serum vitamin D level and micro-ribonucleic acid-146a expression pattern in dry eye disease associated with rheumatoid arthritis in an Egyptian population

Aim The aim of this research was to study serum vitamin D and micro-ribonucleic acid-146a (miRNA-146a) expression in dry eye disease (DED) associated with rheumatoid arthritis (RA) and their clinical correlations to DED parameters. Setting and design This is an observational cross-sectional study that was conducted at Cairo University, Cairo, Egypt. Patients and methods The study participants were divided into three groups: group A, DED/RA (n=35); group B, non-DED/RA (n=36); and group C, non-DED/non-RA (n=35). All participants were assessed for ocular surface disease index, tear breakup time (TBUT), serum level of vitamin D, and miRNA-146a expression. In the DED group (with TBUT˂10 s), DED evaluation was performed, including Schirmer I test, corneal and conjunctival scoring, and impression cytology. Results The mean serum vitamin D level was 17.1±16.2 ng/ml in group A, 35.1±13.4 ng/ml in group B, and 38.1±8.7 ng/ml in group C, with a statistically significant difference (P˂0.001). The mean miRNA-146a expression was 4.7±1.5 in group A compared with 4.8±1.8 in group B (P=0.959) and 1.0±0.1 in group C (P˂0.001, compared with each of groups A and B). In group A, serum vitamin D level showed a significant moderate negative correlation to each of impression cytology grading (r=−0.456, P=0.019) and miRNA-146a expression (r=−0.387, P=0.041). Both serum vitamin D and miRNA-146a expression showed nonsignificant correlations to ocular surface disease index, TBUT, Schirmer I test, and corneal and conjunctival scoring. Conclusion DED associated with RA showed a statistically significantly lower serum level of vitamin D, which was negatively correlated to impression cytology grading and miRNA-146a expression. Expression of miRNA-146a did not differ between the dry eye and non-dry eye RA groups.

Correlation of Nuclear Morphometry with Clinicopathologic Parameters in Malignant Breast Aspirates.

Shilpa GargBackground Nuclear size, shape, chromatin pattern, and nucleolar size and number have all been reported to change in breast cancer. Aim The aim of the study was to quantify nuclear changes on malignant breast aspirates using morphometry and to correlate the morphometric parameters with clinicopathologic features such as cytologic grade, tumor size, lymph node status, mitotic index, and histopathologic grade. Materials and Methods Forty-five cases of carcinoma breast diagnosed on cytology were included in this study. Cytologic grading was performed as per the Robinson's cytologic grading system. Nuclear morphometry was done on Papanicolaou stained smears. One hundred nonoverlapping cells per case were evaluated. Both geometrical and textural parameters were evaluated. Results Comparison of cytologic grades with most morphometric features (nuclear area, perimeter, shape, long axis, short axis, intensity, total run length, and TI homogeneity) was highly significant on statistical analysis. Correlation with tumor size yielded significant results for nuclear area, perimeter, long and short axes, and intensity with p < 0.05. The study of lymph node status and morphometry showed a highly significant statistical association with all the parameters. Mitotic count was significantly associated with all the geometric parameters and one textural parameter (total run length). On correlation of ductal carcinoma in situ and histopathological Grades 1 to 3 with morphometry, it was found that all the parameters except long–run emphasis were highly significant with p < 0.001. Conclusion Morphometry as a technique holds immense promise in prognostication in breast carcinoma.

Efficacy of a recombinant bovine basic fibroblast growth factor gel for the treatment of moderate dry eye: a multicenter randomized double-blind parallel controlled clinical trial

Efficacy of a recombinant bovine basic fibroblast growth factor gel for the treatment of moderate dry eye: a multicenter randomized double-blind parallel controlled clinical trial

Cytomorphological study of chronic lymphocytic thyroiditis: A correlation between cytological grade with lymphoid: Epithelial ratio, thyroid status and anti-thyroid antibodies

Chronic lymphocytic thyroiditis /Hashimoto’s thyroiditis (HT) is an autoimmune disorder whose diagnosis is based on cytology and raised levels of anti-thyroid antibodies. The aim of the present study was to analyse its varied cytological spectrum along with grading and correlation with lymphoid: epithelial (L:E) ratio and serological parameters. Hundred patients diagnosed as HT on cytology were included in the study. Triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone(TSH) and antithyroid antibody levels were estimated. There was a female preponderance comprising 92% cases with majority cases presenting in the third decade. There were 63% cases with grade 2, 24% with grade 1 and 13% with grade 3 thyroiditis. Antithyroperoxidase levels were raised in 87% cases and anti-thyroglobulin antibodies were positive in 78% cases. A statistically significant correlation was found between grading and L:E ratio but not with serological parameters. The present study highlights the cytological spectrum seen in HT which is useful for its diagnosis for prompt patient management.

A retrospective study to evaluate the frequency of various breast lesions diagnosed with the help of FNAC

Background: Fine Needle Aspiration Cytology is the fundamental technique to explore the type and malignant prospects of several palpable lesions such as salivary glands, thyroid and enlarged lymph nodes. Among these palpable lesions, breast pathology is one of the most encountered entity in routine practice that can be diagnosed with FNAC. Aim: To evaluate the frequency of various lesions of breast diagnosed with the help of Fine Needle Aspiration Cytology. Methods: 100 patients of breast lump were referred from surgical departments of Arif Memorial Hospital, Lahore to histopathology laboratory of Rashid Latif Medical College, Lahore, on which Fine Needle Aspiration was performed, during a period of 2 years (2018-2019). Results: In this study, out of 100 cases, the most frequently found lesion was fibroadenoma in the 2nd and 3rd decade of life followed by various other benign lesions. The percentage of malignant lesions was very small and all the patients with malignant lesions were above 40. Conclusion: FNAC has become the most important component for early management of various breast lesions preoperatively. There are various factors that enhance the popularity of FNAC like its affordability, simple and easy to use. Keywords: Fine needle aspiration, Breast carcinoma, cytological grading, International Academy of Cytology.

Applicability of Cytological Grading of Carcinoma Breast

Background: In India breast cancer incidence is on rise and large number of cases occur before 50 years of age. Early diagnosis and proper treatment are known to increase the survival of the patients. As fine needle aspiration cytology is widely used as a preliminary mode for the diagnosis of breast malignancies, adding a reliable grading system in reporting shall aid in planning the management options.&#x0D; Methods: It’s a prospective study done on 100 cases of breast malignancies from June 2018 to May 2020 in department of Pathology JLNMC, Ajmer. Cytology smears were stained with H&amp;E and Geimsa and graded according to Robinson’s cytological grading system while their corresponding histopathological sections were stained with H&amp;E and graded as per Elston and Ellis modification of Scarff Bloom &amp; Richardson grading system and the results were compared.&#x0D; Result: Out of 100 cases of breast cancer evaluated in cytology 29% were grade I, 56% were grade II and 15% were grade III. On histopathological evaluation 25% were grade I, 54% were grade II while 21% were grade III. A highly significant association between the two grading systems was observed with coefficient of correlation 0.831, p value of &lt;0.001 and concordance rate 80%.&#x0D; Conclusion: There is high degree of concordance between the Robinson’s and Elston and Ellis modification of Scarff Bloom &amp; Richardson grading system. Robinson’s method is an easy and quick and reliable method to grade carcinomas of breast, hence it should be included in cytology reporting of breast carcinomas.

English

BACKGROUND Thyroid diseases are the most common endocrine disorders throughout the world. Hashimoto’s thyroiditis is an autoimmune thyroid disorder and it is the second most common thyroid lesion diagnosed on fine needle aspiration cytology (FNAC), only after goiter. FNAC is a quick, easy, safe, cost-effective and highly sensitive investigation for diagnosing Hashimoto’s thyroiditis. The cytomorphological grading of Hashimoto’s thyroiditis was 1st done by Bhatia et al. in 1912. The purpose of this study was to grade Hashimoto’s thyroiditis cytomorphologically according to lymphocytic infiltration and correlating it with thyroid hormone profile. METHODS This is a descriptive study of 87 cases which were diagnosed with Hashimoto’s thyroiditis from January 2019 to December 2019 at the Cytopathology, Department of Pathology, MIMS, Mandya. The slides were collected, reviewed and graded according to Bhatia et al.’s grading system. Thyroid hormone values were collected from the department of biochemistry. The association between cytological grades and thyroid hormone parameters such as T3, T4, TSH and antithyroid peroxidase (anti-TPO) antibody were evaluated. RESULTS In our study, female preponderance was noted. The age range in our study was 10 - 64 years and the majority of cases were in the age group of 21 - 40 years. Grade II was the most common cytological grade, followed by grade III. Based on thyroid function values, majority of the cases were hypothyroid, followed by euthyroid and remaining were hyperthyroid. Anti-TPO levels was raised in 80.6 %, most of them had hypothyroidism. CONCLUSIONS In our study, there was no statistical association between cytological grades and thyroid hormone status. KEYWORDS Hashimoto’s Thyroiditis, FNAC, Bhatia et al.’s Grading, Anti-TPO Antibodies, fT3, fT4, Immunoassay Analyzer

Evaluation of HPV-Related Biomarkers in Anal Cytological Samples from HIV-Uninfected and HIV-Infected MSM.

Men who have sex with men (MSM) harbor the highest risk for anal carcinoma, mainly caused by Human Papillomavirus (HPV). The use of HPV-related biomarkers in the screening for this neoplasia is still debated. We assessed the association between high-risk (hr)HPV DNA, HPV16/18 DNA, hrHPV E6/E7 mRNA, and p16/Ki-67 with cytological abnormalities (any grade) and high-grade intraepithelial lesions (HSIL) in HIV-uninfected and HIV-infected MSM. Overall, 150 cytological samples in PreservCyt (Hologic), with a negative to HSIL report, were analyzed for hrHPV DNA, hrHPV E6/E7 mRNA, and p16/Ki-67 using the Linear Array (Roche), Aptima (Hologic), and CINtec® PLUS (Roche) assays. In HIV-infected MSM, positivity for all the biomarkers significantly increased with the cytological grade. In both populations, the association of hrHPV E6/E7 mRNA and p16/Ki-67 positivity with HPV16 did not differ significantly compared to hrHPVs other than HPV16. In HIV-uninfected MSM, the odds of having an HSIL increased approximately six times for the p16/Ki-67 positive cases. In HIV-infected individuals, all the biomarkers showed a significant association with HSIL, except for hrHPV DNA, with the strongest association observed for p16/Ki-67. The odds of HSIL increased almost 21 times in those positive for this biomarker. Our results encourage further investigation on the use of p16/Ki-67 dual staining in anal cancer screening for HIV-uninfected and HIV-infected MSM.

Comparison of Alinity m HPV and cobas HPV assays on cervical specimens in diverse storage media

ObjectiveTo assess the concordance of high-risk HPV (HR-HPV) testing with the Alinity assay on cervical samples collected with diverse collection/storage protocols (ThinPrep, SurePath, Cervicollect) and to assess inter-assay concordance of HR-HPV testing of cervical cell specimens with Alinity m HR HPV assay (Alinity) vs cobas® 4800 HPV assay (cobas). MethodsSpecimens were obtained from 560 women attending a Women's Health clinic. Two specimens were obtained from each woman with combinations of two of the three collection devices and aliquots were tested by the two assays. ResultsAlinity showed an agreement of 93.9%, Kappa = 0.89 (263/280) between ThinPrep and SurePath specimens; 97.5%, Kappa = 0.95 (347/356) and 92.9%, Kappa = 0.85 (104/112) between ThinPrep and SurePath aliquots taken before or after cytology processing, respectively. Cervi-Collect specimens showed an agreement of 94.6%, Kappa = 0.89 (265/280) with ThinPrep specimens. Compared to cobas, Alinity showed agreements of 94.3%, Kappa = 0.88 (395/419) and 91.8%, Kappa = 0.82 (257/280) between ThinPrep and SurePath specimens, respectively. Alinity and cobas detected genotypes 16/18 and other high-risk HPV types at similar rates and showed similar correlations with cytology grades. ConclusionsCompared to cobas, Alinity performed equally well for detecting HPV in cervical specimens obtained with ThinPrep and SurePath. The Cervi-Collect device compared well to the other collection methods. Alinity is a reliable assay for simultaneous detection of HPV-16/18 and other high-risk genotypes in cervical specimens.

English

BACKGROUND Fine needle aspiration cytology (FNAC) has become the standard primary diagnostic method in carcinoma breast. It is also a useful tool for surgical treatment and prognosis. The present study is designed to correlate cytological grading using Mouriquand’s grading method with histological grading using modified Bloom-Richardson grading method. METHODS This was an observational study. A total of 45 cases of breast carcinoma, aged 30 to 80 years, underwent FNAC and the smears were graded using Mouriquand’s criteria. All the cases were correlated with Bloom-Richardson grade on histopathology in mastectomy specimens. RESULTS There were a total of 44 cases of infiltrating ductal carcinoma and 1 case of mucinous carcinoma on cytology. Patients’ age ranged from 30 to 80 years with a mean of 53.27 years. In terms of cytology, 15 were (33.3 %) grade I cases, 27 (60 %) grade II and 3 (6.7 %) grade III. In histopathology, 19 (42.2 %) were grade I, 21 (46.7 %) were grade II and 5 (11.1 %) were grade III. Grade I showed a sensitivity of 52.6 % and specificity of 84.6 % with positive predictive value of 71.4 % and negative predictive value of 71 %. Grade II showed a sensitivity of 76.2 % and specificity of 50.0 % with positive predictive value of 57.1 % and negative predictive value of 70.6 %. Grade III showed a sensitivity of 20 % and specificity of 95 % with positive predictive value of 33.3 % and negative predictive value of 90.5 %. Concordance rate between cytology and histology of grade I, grade II and grade III tumours was 73.3 %, 59.25 % and 33.3 % respectively. The absolute concordance rate was 62.2 %. CONCLUSIONS Thus, cytological grading of breast carcinoma correlates well with histopathological grading. In the era of multiple treatment modalities and neoadjuvant therapy, cytological grading can be used as a prognostic factor for better management of patients. KEYWORDS Breast Carcinoma, Mouriquand’s Grading, Bloom-Richardson Grading

Can Morphological Markers of Chromosomal Instability in Fine-Needle Aspiration Cytology Aid in Cytological Grading of Breast Cancer

Can Morphological Markers of Chromosomal Instability in Fine-Needle Aspiration Cytology Aid in Cytological Grading of Breast Cancer

Cytological Grading of Prostate Carcinoma

Introduction: The Gleason grading system is one of the most powerful prognostic predictors of carcinoma prostate. In 2014, a newer grading system, the International Society of Urologic Pathology (ISUP) grading system was proposed. The present study is a retrospective study conducted to compare the cytological grading of prostate carcinoma with the newly proposed ISUP grading system for prostate carcinoma. Materials and Methods: The present study is a retrospective study that included 42 cases of carcinoma prostate. The clinical data of the cases, fine-needle aspiration cytology slides, and histological slides were retrieved and reviewed. The cases were regraded using the ISUP grading system for prostate carcinoma. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS). Data were statistically analyzed and Chi-square testing was used to compare the two grading systems. Results: A total of 42 cases were studied. The preoperative grade was assigned to the smears and 26.19% (11 cases) were categorized as grade 1, 40.47% (17 cases) as grade 2, and 33.3% (14 cases) as grade 3. Histological sections were also graded according to the ISUP/grade groups (GG) system and 26.19% (11 cases) were graded as GG 1, 33.3% (14 cases) as GG2, 19.04% (8 cases) as GG3, 16.67% (7 cases) as GG4, and 4.47% (2 cases) as GG5. Conclusion: In the present study, it was concluded that there is a direct concordance between the histologic grade as proposed in the ISUP grading system and the cytologic grade on FNA.

Screening with Anal Cytology in Colombia: Initial Experience and Need for High-Resolution Anoscopy

BackgroundMen who have sex with men (MSM) living with human immunodeficiency virus (HIV) are at increased risk of anal cancer. Anal cytology can be used to screen for dysplasia, with high-resolution anoscopy (HRA) required for diagnostic confirmation. We describe the impact lack of HRA had on management of abnormal screening results in Bogotá, Colombia. Material and MethodsThis retrospective cohort study includes MSM with HIV who underwent anal cytology screening between January 2019February 2020, with colorectal surgery (CRS) follow-up through July 2020. Cytology results included atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). Categorical and continuous variables were compared via Fisher's exact test and Wilcoxon rank-sum, respectively. ResultsOf 211 MSM screened, 68 had abnormal cytology: ASC-US (n = 23), LSIL (n = 41), HSIL (n = 4). Sixty (88.2%) were referred to CRS, and 51 (75.0%) attended ≥ 1 appointment. At initial assessment, 17 were referred for anal exam under anesthesia (EUA) for tissue resection, and 21 for rectosigmoidoscopy. Having perianal condyloma was associated with recommendation for EUA (P < 0.001), while cytology grade of dysplasia was not (P = 0.308). Eleven (16.2%) underwent EUA for condyloma resection. ConclusionsFew studies have described anal cancer screening in settings without HRA. We found lack of HRA limited management of abnormal cytology in Colombia. Those with condyloma underwent resection, but HRA remains necessary to localize and treat microscopic disease. Next steps include implementation of HRA in order to further develop the anal cancer screening program for MSM with HIV in Bogotá.

Correlations between clinical signs and corneal cytology in feline eosinophilic keratoconjunctivitis

ObjectiveTo assess correlations between clinical and cytological features of feline eosinophilic keratoconjunctivitis at the time of cytological diagnosis.Animals StudiedFifteen client‐owned, domestic breed cats (18 eyes) examined between 2007 and 2019.ProceduresAn electronic search and medical record review of cats diagnosed with feline eosinophilic keratitis or keratoconjunctivitis (FEK) based on clinical examination findings and eosinophils detected on corneal cytology were conducted. Clinical severity was graded using a modified version of a previously validated semiquantitative preclinical ocular toxicology scoring (SPOTS) system. Clinical grades were assigned following review of clinical images and medical record descriptions, and cytological grades were assigned following review of archived corneal cytology slides. Correlations were analyzed for significance using Spearman's rank correlation coefficient.ResultsHigher total corneal scores correlated with higher total conjunctival scores, but not with total fluorescein scores. Small lymphocyte scores correlated negatively with scores for collagen degeneration or mineralization. Globule leukocytes, a unique cell type not previously described in ocular cytology, were identified in 4 of 18 cytological samples. Higher globule leukocyte scores were correlated with higher scores for mast cells or plasma cells. Specimens with lower eosinophil scores had higher globule leukocyte scores.ConclusionsLarge variability was detected in the cytological characteristics and clinical features of FEK‐affected cats. This is the first report of globule leukocytes being identified in ocular cytology from any species. The role of globule leukocytes in the etiopathogenesis and progression of FEK remains unknown and warrants further investigation.

Rituximab-Bendamustine in First Line Treatment of Patients with Follicular Lymphoma. Results of Prospective Multicenter Study

BACKGROUND. Follicular lymphoma (FL) is lymphoid tumor that occurs in 22% of all non-Hodgkin's lymphomas (NHL) in Russia with median age 65 years. FL has a high chemosensitivity and often recurs: five-year progression-free survival (PFS) with R-CHOP - 40%. Due to high risk of recurrence and median age of FL pts 65 years, we need to reduce toxicity. Rituximab-bendamustine (R-B) versus R-CHOP in common group (without dividing on cytological grade) increases PFS and has lower toxicity, so it is possible to apply it to patients with concomitant pathology.AIM. To study R-B efficiency in different cytological grade of FL.PATIENTS AND METHODS. We performed a prospective, multicenter, open-label trial in Russia since 1 of June 2013 till 1 of June 2017. The study included 65 patients with FL. Median age of patients was 59 years (from 30 to 78 years). Treatment was completed in 60 patients, so this group of patients was analyzed. Ratio between men and women was 1: 2. 29/60 of patients (48%) were older than 60 y.o. Patients received rituximab 375 mg / m2 on day 1 and bendamustine 90 mg / m2 on days 1 and 2 of a 4-week cycle (6 cycles).47/60 (78%) of pts were diagnosed with FL grade 1, 6/60 (10%) -2 grade, 7/60 (12%) - grade 3A. 55/60(91%) pts had nodular tumor growth type, 6/60(10%) - nodular-diffuse, 4/60 (7%) - diffuse. High risk according to FLIPI had 21/53 (39%) of patients with 1-2 cytologic grade of FL and 7/7 (100%) of pts with FL grade 3A.Extranodal lesions were revealed in 23/60 (38%) of cases: in 4/60 of cases - orbit, in 2/60 - parotid gland, in 3/60 - lungs, in 3/60 - intestines, in 1 / 60 - stomach, 2/60 - pancreas, 2/60 - uterus, 2/60 - skin, 1/60 - subcutaneous tissue, 3/60 - vertebrae, in 1/60 - latticed maze and nasal passages. In 20/23 of cases extranodal lesion was revealed in generalized stage of FL (including lymph nodes and bone marrow).Extranodal lesions were found in 35% of pts with FL grade 1-2, and 57% of pts with FL - grade 3A. Bulky also was observed more frequently in pts with FL grade 3 3/7 (43%) than in pts with FL grade 1-2 19/53 (36%).Results. Complete remission (CR) of disease was achieved in 34/60 (55%) pts, partial remission (PR) - 13/60 (21%) pts. Tumor progression observed in 11/60 (18%) cases, pts were withdrawn from the protocol. In 2/60 (6%) pts had stable disease after 4 courses of R-B. Consequently we performed high-dose chemotherapy with autologous stem cell transplantation for patients with stable disease.Frequency of CR and PR was higher in pts with FL grade 1-2 than in FL grade 3: 87% versus 28%. Progressive disease observed more frequently in FL grade 3A - 71% vs pts with FL grade 1-2 (13%). Median follow up was 42 (4-56) months. Bone marrow was sanitized in all cases of its lesion - 33/60 (55%).Conclusions. 3A cytological grade of FL is associated with high FLIPI score, presence of bulky and extranodal lesions. These parameters are predictive unfavorable factors of poor response to R-B induction therapy. The R-B allows performing stem cells mobilization and autoSCT that is actual in FL pts with bone marrow involvement. DisclosuresNo relevant conflicts of interest to declare.

English

BACKGROUND Breast cancer is increasing in developing countries and the management options are wide; therefore, providing the surgeon with accurate prognostic information on which mode of therapy will be chosen becomes important. Fine needle aspiration cytology (FNAC) is a routinely used initial investigation of choice for rapid diagnosis of breast cancer. Apart from diagnosis of cancer, it also has the ability to predict the grade on smears which will add its diagnostic value without any additional morbidity or expense for the patients. Among various cytological grading systems, Robinson grading is most commonly used for breast carcinoma in fine needle aspirates. The purpose of this study is to evaluate the correlation between Robinson’s cytological grading and Bloom Richardson’s histological grading. METHODS This is a 3 - year retrospective analytical study. 40 cases of infiltrating duct carcinoma (IDC) of breast diagnosed on cytology were included in the study. Cytological grading was done using Robinson’s grading and corresponding histopathology slides were taken, and histological grading using Bloom Richardson’s system was done. Finally, correlation between cytological and histological grading was done using statistical package for social sciences (SPSS) software. RESULTS Age of the patients varied between 32 and 70 yrs. Cytologically, 32.5 % cases were grade I, 40 % were grade II and 27.5 % cases were grade III respectively. Histologically 22.5 %, 47.5 % and 30 % cases were grade I, grade II, and grade III, respectively. Concordance rate between grade I tumours in cytology and histology was 53.84 %, for grade II tumours it was 75 %, and for grade III tumours it was 63.63 %. The absolute concordance rate was 65 %. CONCLUSIONS Robinson’s cytological grading (RCG) of breast carcinoma correlates well with Bloom - Richardson’s histological grading system and could be a helpful parameter in selecting a neoadjuvant treatment for the breast cancer patients on fine needle aspiration cytology alone. KEYWORDS Breast Carcinoma, Robinson’s Cytological Grading, Bloom Richardson’s Histological Grading