Effusion Fluid Research Articles

Liquid biopsy in CNS tumors: Current status & future perspectives.

Precise classification of central nervous system (CNS) malignancies is vital for the treatment and prognostication. Identification of noninvasive markers can be of importance to guide treatment decisions and in monitoring treatment response. CNS tumors are classified based on morphology with an essential complement of molecular changes, including mutations, amplifications, and methylation. Neuroimaging is the mainstay for initial diagnosis and monitoring tumor response with obvious limitations of imprecise tumor typing and no information on diagnostic, predictive and prognostic markers. Liquid biopsy has evolved as a diagnostic tool in body fluids and is being investigated as a surrogate for tissue biopsy in managing primary and metastatic brain tumors. Liquid biopsy refers to analyzing biological fluids such as peripheral blood, urine, pleural effusion, ascites, and cerebrospinal fluid (CSF); however, peripheral blood remains the primary source of fluid biopsy. The analytes include cell-free DNA (cfDNA) circulating tumor cells (CTCs), circulating micro RNAs (miRNAs), circulating proteins and extracellular vesicles (EVs). Analysis of these components is actively used for early cancer detection, auxiliary staging, prognosis assessment, detection of minimal residual disease (MRD), and monitoring drug resistance in various solid tumors. In recent years, liquid biopsy has been studied in CNS tumors, and analysis of CTCs and cfDNA have become relevant research topics. In the current review, we have explained the clinical potential of liquid biopsy in CNS tumors to assist in diagnosing and predicting prognosis and response to treatment.

Mediastinal Lymphoma in a Cat with Feline Leukemia Virus Mediastinal Lymphoma in a Cat with Feline Leukemia Virus

Background: Mediastinal lymphoma occurs at a high incidence in cats positive for feline leukemia virus (FeLV). It is a malignant lymphocytic neoplasm that may trigger clinical signs such as dyspnea, apathy, regurgitation, and weight loss. The objective of this work is to report a case of mediastinal lymphoma associated with FeLV in a cat, and describe the clinical, pathological, diagnostic, and therapeutic aspects that can help the diagnosis and treatment of this disease. Case: A 3-year-old male neutered cat weighing 4.6 kg, positive for FeLV, and with a history of dyspnea and hyporexia was referred to a private veterinary clinic in the city of Caxias do Sul, RS, Brazil. The only alteration found at the clinical examination was a muffled sound during lung auscultation. Radiographs of the thorax revealed the presence of pleural effusion; after drainage of the fluid, a mass located in the mediastinal area became radiographically observable. An analysis of the effusion fluid showed high cellularity characterized by a markedly pleomorphic population of individual round cells consistent with lymphocytes. Small lymphocytes with a high nucleus:cytoplasm ratio, round nucleus, condensed chromatin, and inconspicuous nucleoli were observed, along with medium and large lymphocytes. The medium and large lymphocytes were characterized by a variably increased nucleus:cytoplasm ratio and a scant to moderate cytoplasm exhibiting moderate to intense basophilia and, occasionally, vacuoles. The nuclei were round, idented, or irregular; most of them were located eccentrically and contained coarse to finely granular chromatin. Nucleoli varied from single to multiple, round to angular, and central to peripheral and prominent. Macronucleoli and marked anisonucleosis were also observed, as well as binucleated cells and rare multinucleated cells. The conclusion was that it was a case of neoplastic effusion caused by a lymphoma. After an appointment with an oncologist, a chemotherapy protocol was established. The treatment of choice was CHOP, a combination of cyclophosphamide (20 mg/kg orally), doxorubicin (1 mg/kg intravenously), vincristine (0.5 mg/m2 intravenously), and prednisolone with a regressive dose starting at 2 mg/kg. The patient underwent 4 rounds of chemotherapy, and received a maintenance treatment thereafter. The patient’s condition remained stable for 390 days without relevant clinical or hematological alterations. Discussion: The diagnosis of mediastinal lymphoma was established by associating clinical finings, laboratory exams, and radiographic findings. Exams of utmost importance to reach this diagnosis were the thoracic radiography, which revealed the presence of a mass in the thorax, and the cytopathological analysis of the effusion fluid, as round cell neoplasms are easily dissociated. Young cats are the group most affected by FeLV, and mediastinal lymphoma is considered the most prevalent type of lymphoma in this species. The most common clinical sign is dyspnea; however, other signs such as apathy, weight loss, regurgitation (due to pressure on the esophagus), and Horner’s syndrome (owing to pressure on the thoracic sympathetic innervation) may also occur. This disease is treated with chemotherapy, with CHOP frequently used as the chemotherapeutic protocol. The good therapeutic response for a longer time than the average estimated by studies on the prognostic of this disease indicates that a correct diagnosis along with an assertive approach and the cooperation of the tutor are essential in cases of mediastinal lymphoma. Keywords: cat, neoplasm, virus, mediastinum, effusion. Título: Linfoma mediastinal em gato cm vírus da leucemia felina Descritores: gato, neoplasia, vírus, mediastino, efusão.

Contribution of immature granulocyte level to diagnosis in pleural effusion.

Background In this study, we aimed to evaluate the diagnostic value of neutrophil and immature granulocyte levels in peripheral blood in cases with pleural effusion. Methods Between May 2019 and May 2020, a total of 117 patients (43 males, 74 females; mean age: 63.1±18.1 years; range, 18 to 93 years) who had pleural effusion and analysis of pleural fluid were retrospectively analyzed. All patients were evaluated in terms of age, sex, presence of comorbid diseases, approach to the pleural fluid, biochemical values of peripheral blood and pleural fluid, hemogram series of peripheral blood, diagnosis of pleural fluid, and mortality. Results Of the patients, 66 (54.5%) were diagnosed with benign pleural effusion and 51 (43.5%) were diagnosed with malignant pleural effusion. Number of cases with known primary malignancy was 54 (46.1%). Immature granulocyte count number and percentage of venous blood in the malignant pleural effusion group was significantly higher than the group with benign pleural effusion (p<0.05). Conclusion As a hemogram parameter, immature granulocyte level is an easily applicable, cheap, and a non-invasive method in the outpatient settings.

Role of CRP as a marker for discrimination of exudative and transudative pleural effusion.

Differentiation between exudative and transudative pleural effusion is sometime problematic. This study aimed to evaluate the diagnostic value of C-reactive protein (CRP) in differentiation of exudative and transudative pleural effusion. This is an analytical epidemiologic cross-sectional study that evaluates the role of CRP in differentiating transudative and exudative pleural effusion. Patients were divided into two groups of exudates and transudates, based on Light's criteria. The pleural effusion CRP levels were compared between the two groups. SPSS software version 16 was used for statistical analysis. The significance level was considered p<0.05. A total of 169 patients with pleural effusion enrolled in the study. Based on Light's criteria, 108 patients (63.9%) had exudative pleural effusion and 61 (36.1%) had transudative pleural effusion. The level of CRP in the pleural fluid of patients in the exudative and transudative groups was 13.3±37.1 and 3.5±4.3mg/dl, respectively (p=0.008). The 3.31 mg/dl cut-off point of CRP level of pleural effusion had the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 96.3%, 72.1%, 86% and 91.7% respectively. The results obtained in our study shows that the level of CRP in the effusion fluid can be helpful in differentiating exudative from transudative pleural effusions.

Can measurement of glucose levels in blood and peritoneal fluid be used to diagnose septic peritonitis in dogs?

PICO question&#x0D; Can the measurement of blood and peritoneal fluid effusion glucose levels be used to accurately diagnose septic peritonitis in dogs when compared to cytology and bacterial culture?&#x0D; &#x0D; Clinical bottom line&#x0D; Category of research question&#x0D; Diagnosis&#x0D; The number and type of study designs reviewed&#x0D; Three papers were critically reviewed, all of which were diagnostic test evaluation studies&#x0D; Strength of evidence&#x0D; Moderate&#x0D; Outcomes reported&#x0D; Glucose measurements can be used to diagnose septic peritonitis when the blood plasma glucose level is &gt;2.1 mmol/L higher than that of the peritoneal fluid glucose when using a veterinary point of care (POC) glucometer. If using a biochemistry analyser, a whole blood glucose &gt;1.1 mmol/L higher than that of the peritoneal fluid can be used to diagnose septic peritonitis. This is only relevant when the peritoneal fluid is collected by abdominocentesis and not in a postoperative period&#x0D; Conclusion&#x0D; At present, there is moderate evidence that glucose measurements are useful as a patient side test for the diagnosis of septic peritonitis and are especially useful in cases where intracellular bacteria cannot be identified on cytology. However, despite the so far promising accuracy results, the cut-offs reported are quite variable and overall, there is not a single diagnostic test that is 100% sensitive and specific in repeated studies. Therefore, the results of the glucose measurements should be evaluated alongside other biomarker testing, imaging modalities and the clinical presentation of the patient. Glucose measurements cannot currently replace culture / sensitivity and cytology as the gold standard for the diagnosis of septic peritonitis&#x0D; &#x0D; How to apply this evidence in practice&#x0D; 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.&#x0D; 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.&#x0D; &#x0D;

Relationship between facet joint opening on CT and facet joint effusion on MRI in patients with lumbar spinal stenosis: analysis of a less invasive decompression procedure.

Both facet joint opening (FJO) on CT and facet joint effusion (FJE) on MRI are reportedly indicators of segmental instability in the lumbar facet joints of patients with lumbar spinal stenosis (LSS). However, no study has investigated both parameters simultaneously. Therefore, the association between these findings and which parameter is better for predicting clinical outcomes after surgical treatment remains unclear. The purpose of this study was to investigate the relationship between FJO and FJE in patients who underwent less invasive decompression procedures for LSS and to investigate the impact of these findings on clinical outcomes. This study included 1465 lumbar levels (L1-2 to L5-S1) in 293 patients who underwent less invasive surgery for LSS and had ≥ 5 years of follow-up. FJO was defined as joint space widening ≥ 2 mm on preoperative axial CT images. FJE was defined as fluid effusion in the facet joint on preoperative axial T2-weighted MR images. The characteristics and distributions of FJO and FJE were investigated with other preoperative radiological findings. The association between need for further surgery and FJO/FJE was analyzed according to intervertebral level. FJO was observed at 402 levels (27%), and FJE was found at 306 levels (21%). The correspondence rate between FJO and FJE was 70% (kappa 0.195, p < 0.01). One hundred thirty-seven levels (9%) had both FJO and FJE. Levels with both FJO and FJE more commonly had lateral olisthesis, lateral wedging, and axial intervertebral rotation than other levels (p < 0.001). Levels with both FJO and FJE were more likely than other levels to need further surgery (OR 2.42, p = 0.027). The correspondence rate between FJO and FJE was not high. However, multivariate analysis showed that levels with both FJO and FJE had a higher risk of requiring further surgery than those with other radiological findings, such as lateral olisthesis, lateral wedging, and axial intervertebral rotation. Patients with levels with both FJO and FJE need careful long-term follow-up after undergoing a less invasive decompression procedure.

Cardiac mass revealing an infiltrating bronchogenic carcinoma reaching the controlateral upper lobe: A case report

A malignant tumor can invade all organs of the body by different ways, cardiac metastases of bronchial origin are generally less frequent, and there are few cases in the literature. We report a case of an intra-cardiac tumor revealing a bronchial carcinoma. We report the case of a 64-year-old man who was a smoker at 40PA. He presented with a 3 months evolving symptomatology made of dyspnea associated to a productive cough with whitish sputum sometimes streaked with blood. The patient also complained of a retrosternal pain irradiating to the interscapular region. The patient was apyretic but presented anorexia and weight loss. On physical examination, the patient had a tachycardia at 100 beats per minute, a right basal fluid effusion syndrome, with a WHO performance status at 1.The electrocardiogram showed sinus tachycardia at 100 bpm with the presence of some ventricular extrasystoles. The cardiac echocardiography showed a hypoechoic mass in the left atrium attached to the upper wall, The thoracic CT scan showed a locally invasive heterogeneous tumor, localized in the right lower pulmonary lobe and the mediastinum with intracardiac extension to the left atrium. the bronchoscopy showed a friable whitish tumor bud obstructing the right stump bronchus bleeding on contact, with another bud obstructing the segmental bronchus of the left upper lobar bronchus bleeding easily on contact, biopsies of the bud and aspirations for cytodiagnosis were performed.

A Machine Vision-Based Pipe Leakage Detection System for Automated Power Plant Maintenance.

Industrial pipework maintenance inspection can be automated through machine vision-based effusion monitoring. However, colorless effusions such as water can be difficult to detect in a complex industrial environment due to weak illumination and poor visibility of the background. This paper deploys the reflective characteristics of effusion and its lower temperature compared to the environment in order to develop an automatic inspection system for power plant pipeworks’ maintenance. Such a system is aimed at detecting the colorless fluid effusion based on dual source images and a contour features algorithm. In this respect, a visible light source unit highlights the reflective features of the effusion edge. Meanwhile, high-definition images of the potential effusion are acquired under both visible and infrared lights. A customized image processing procedure extracts the potential effusion features from the infrared image to retrieve the region of interest for segmentation purposes and transfer such information to the visible light image to determine the effusion contour. Finally, a decision-making support tool based on the image contour closure is enabled for classification purposes. The implementation of the proposed system is tested on a real industrial environment. Experimental results show a classification accuracy up to 99%, demonstrating excellent suitability in meeting industrial requirements.

Malignant Serous Effusions among Hospital In-patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Cell block technique is an adjunct to conventional smears in the diagnosis of malignancy in effusion fluid. It aims at retrieving cellular material and concentrating cells in a small field, with preservation of cytomorphologic details. The objective of this study was to find the proportion of malignant serous effusions using cell block technique among hospital in-patients in a tertiary care centre. This was a descriptive cross-sectional study conducted among patients visiting a tertiary care centre between 1st June 2020 to 30th November 2020. Ethical approval was taken from the Institutional Review Committee (Reference number: 305202001). Using a convenience sampling method, 96 hospital in-patients were included in the study. Serous effusions were evaluated by conventional smears and cell block sections. Data was analysed using the Statistical Package for the Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean and standard deviation. Among 96 hospital in-patients, 15 (15.62%) (8.35-22.88 at 95% Confidence Interval) were diagnosed as positive for malignancy by using cell block technique. By conventional smears, 80 (83.33%) cases turned out to be negative for malignancy, 13 (13.54%) were positive for malignancy and three (3.12%) were suspicious for malignancy. Of the three (3.12%) cases suspected for malignancy, two turned out to be positive for malignancy and one was found to be negative for malignancy on cell block technology. The proportion of malignant serous effusions was similar in comparison to other studies. Cell block technique could be routinely incorporated along with conventional smears for a more accurate diagnosis of malignancy on serous effusion.

Immunocytochemistry of effusion fluids: Introduction to SCIP approach.

Due to the remarkably wide morphologic spectrum of reactive mesothelial cells, some of the effusion fluids may be difficult to interpret with objective certainty by cytomorphology alone. Cytomorphology of well to moderately differentiated adenocarcinomas (responsible for the bulk of malignant effusions) may overlap with floridly reactive mesothelial cells. Even mesotheliomas including diffuse malignant epithelioid mesothelioma, are usually cytomorphologically bland without unequivocal features of malignancy.The intensity of challenge depends on the interpreter’s training or experience level, institutional demographics of patients (such as type of prevalent diseases, predominant sex and age group), technical support, and quality of cytopreparatory processing. In general immunocytochemistry is valuable adjunct to facilitate objective interpretation with or without other ancillary techniques as indicated. An increasing number of immunomarkers is further refining the contribution of immunohistochemistry to this field.However, application of immunohistochemistry to effusion fluids is relatively challenging because of many variables. Multiple factors such as delay after specimen collection, specimen processing related factors including fixation and storage; ambient conditions under which paraffin blocks are archived (for retrospective testing); antigen retrieval method; duration of antigen retrieval step; antibody clone and dilution; and antibody application time are identical to application of immunohistochemistry in other areas. The significant challenge related to the potential compromization of the immunoreactivity pattern due to exposure to non-formalin fixatives / reagents is also applicable to effusion fluid specimens.The immunoreactivity results would be compared and corelated with cumulative metadata based on the reported studies performed and validated on formalin-fixed paraffin-embedded tissue sections. Deviating from such protocols may lead to suboptimal results, which is not uncommon in clinical practice with potential compromization of patient care and related liability. Because of this, it is critical to perform immunocytochemistry on formalin-fixed cell-block sections only.In addition, unless the interpretation criteria for immunohistochemical evaluation of effusion fluids are not modified specifically, it may not be productive in resolving some challenging cases. However, this aspect is not well elaborated in the literature. A basic and critical challenge is finding and locating the cells of interest in cell-block sections of effusion fluids. A unique approach is to choose a fundamental immunopanel which highlight the mesothelial and inflammatory cells in reactive effusion fluids to create the basic map. This allows detection of a ‘second-foreign’ population which can be immunocharacterized further with the help of subtractive coordinate immunoreactivity pattern (SCIP) approach elaborated here.

Metastatic Carcinoma in Effusions.

Serous cavity may be involved by any neoplasm, including very rare examples of involvement by central nervous system tumors leading to a malignant effusion. The serous cavity lining is rich in lymphatics with lymphatic lacunae opening directly through narrow gaps (stoma) in the lining. Carcinomas mainly metastasize to serosa via the lymphatic vessels, which may be blocked leading to effusion. Primary carcinomas of organs such as lung, intestines, liver, ovary, etc., lined by serosal membranes may spread by direct extension, resulting in malignant effusions. As standard of practice, unless specified, cytopathologic examination of serous effusions implies detection of malignant cells.As compared to a surgical biopsy from a small focal area of an extensive serosal surface, effusion fluid from respective cavity exfoliates the cells from the entire serosal surface with minimal chance of sampling artifact. Because of this, effusion fluid cytology generally provides a higher diagnostic yield as compared to biopsy of the serous lining, as demonstrated by some studies. However, various challenges related to effusion fluid cytology makes the interpretation of effusion fluid cytology a field with potential misinterpretations, especially for those without proper experience or training.Developing and following a methodical approach is important for appropriate cytologic examination of effusion fluids. Proper approach may achieve definitive interpretation even without ancillary tests. However, lack of appropriate approach and processing may introduce a significant variation in interpretation due to combination of well-recognized diagnostic pitfalls, which may lead to lower reproducibility and even serious misinterpretations.Current review discusses in brief appropriate approach to processing and evaluating effusion fluid cytology for metastatic carcinoma. At general level, this is comparable to that of other specimens; however, it is critical to modify with reference to the limitations associated with effusion cytology.

Immunocytochemistry of effusions: Processing and commonly used immunomarkers.

Definitive cytopathological interpretation of some of the effusion fluids may not be possible based on cytomorphological evaluation alone. As discussed in other reviews, this is due to various reasons specifically applicable to effusion fluids including remarkably wide morphologic spectrum of reactive mesothelial cells overlapping with some well to moderately differentiated metastatic carcinoma. The challenge is subject to various factors including level of interpreter training or experience, institutional demographics (such as type of prevalent diseases, predominant sex and age group), technical advances in ancillary support, and expertise in cytopreparatory processing. In such cases immunohistochemistry performed on cell-block sections is simple objective adjunct with or without other ancillary techniques. Ongoing increase in number of immunomarkers along with rabbit monoclonal antibodies with relatively higher affinity is further refining this field. SCIP (subtractive coordinate immunoreactivity pattern) approach, discussed as separate dedicated review article, facilitates refined interpretation of immunoreactivity pattern in coordinate manner on various serial sections of cell-blocks. However, many variables such as delay after specimen collection, specimen processing related factors including fixation and storage; ambient conditions under which paraffin blocks are archived (for retrospective testing); antigen retrieval method; duration of antigen retrieval step; antibody clone and dilution; and antibody application time are common with application of immunohistochemistry in other areas. This review is dedicated to highlight technical aspects including processing of effusion specimens for optimum immunocytochemical evaluation along with commonly used immunomarkers in effusion cytopathology. This review focuses on the technical and general information about various immunomarkers.

Collection and processing of effusion fluids for cytopathologic evaluation.

Accumulation of fluid in serous cavities as effusions may have to be drained for therapeutic and diagnostic indications. As compared to many other procedures, the technicality of paracentesis procedures is relatively easy. As a result, effusion fluids comprise a significant proportion of specimens in most of the laboratories, including those in community settings.Because of relative complexities in the cytopathologic evaluation of effusion fluids, application of appropriately standardized protocol is critical for achieving optimum results by applying standardized steps from handling of specimens during the initial stages of collection to the final interpretation phase. Understanding various limitations and challenges during collection and processing phases by all the personnel involved, including clinicians, pathologists, and technologists is critical for optimum diagnostic yield.This review highlights various cytopreparatory techniques applicable to effusion cytology in one place. It is organized by projecting the details predominantly in the form of different tables and figures including summary of the recommended protocols with reagents and stains used. Also included is a sample of cytopathology report based on the approach discussed in this series.

Acute cerebral infarction due to severe COVID-19, bacterial meningitis due to Pseudomonas stutzeri, mild loculated pericardial effusion due to MIS-C

Neurological involvement was common in children and adolescents with Coronavirus disease-2019 (COVID-19) related hospitalization and is mostly transient. A spectrum of life-threatening neurologic involvement infrequently occurred and was associated with more extreme inflammation and severe sequel. We reported a patient male, seven months old with chief complaint of fever since 1 month before admission. The patient was diagnosed by confirmed case COVID-19 with a positive RT-PCR SARS-CoV-2 swab. He had some contact with his parents that had confirmed with COVID-19 before. The patient also complained with focal seizures in the left extremity with decreased of consciousness. The seizure always repeated every day for 1 week with the same pattern. Patient also complain of nausea and vomiting every time he has been breastfed. There is no changes of the lips and oral cavity, no cutaneous rash, no red eyes, no swelling or edema on extremities. Non-contrast head CT-Scan revealed large area of acute cerebral infarction. Echocardiography revealed mild loculated pericardial effusion and cerebrospinal fluid cultured result revealed Pseudomonas stutzeri. After 3 weeks discharged from the hospital, the patient underwent a head MRI examination and the results revealed chronic ischemic cerebral infarction and communicating hydrocephalus. The patient was planned to undergo a VP shunt as a treatment for hydrocephalus. The neurological involvement can occur in children and adolescents with COVID-19. The range of severe neurologic complications including peripheral nerve disorders, focal CNS disease and diffuse CNS involvement, make it likely that multiple mechanisms underlie this wide spectrum of disease.

Exosomes in Pathogenesis, Diagnosis, and Treatment of Hepatocellular Carcinoma.

Exosomes are extracellular vesicles with a diameter of 30-150 nm that are released by most types of cells and have been confirmed to be involved in many physical and pathological processes, especially in cell to cell communication. Compared with other vesicles, exosomes have a unique double-layer saclike structure that allows them to be present stably in various body fluids, including blood, cerebrospinal fluid, urine, saliva, and serous cavity effusion. The cargoes of exosomes reflect the characteristics of host cells. Due to the nature of hepatocellular carcinoma (HCC) cells, heterogeneity in the bioactive substances usually exist in exosomes. In addition, exosomes can efficiently deliver cargoes to the target cells to exert pathological functions, playing important role in tumor occurrence, development, metastasis, immune regulation, and drug resistance. Previous studies have been shown that exosomes have wide applications in diagnosis and treatment of HCC. In this review, we discuss these recent findings and highlight the significant roles of exosomes in HCC, focusing on the effect and underlying mechanisms of exosomes to regulate HCC progression and the potential clinical value of exosomes as biomarkers and therapeutic targets.

Assessment of Anti-tumor Efficacy of Osimertinib in Non-Small Cell Lung Cancer Patients by Liquid Biopsy Using Bronchoalveolar Lavage Fluid, Plasma, or Pleural Effusion.

PurposeThis study was to evaluate anti-tumor efficacy of osimertinib in patients positive for acquired epidermal growth factor receptor (EGFR) T790M mutation in liquid biopsy using plasma, bronchoalveolar lavage fluid (BALF) or bronchial washing fluid (BWF), and pleural effusion.Materials and MethodsAmong patients benefited from previous EGFR–tyrosine kinase inhibitor (TKI) treatment followed by treatment failure, patients in whom T790M mutations are detected in at least one of the samples including tumor tissues, BALF/BWF, plasma, and pleural effusion were enrolled. T790M mutation was detected by extracting cell free DNA from liquid biopsy samples, using PANA Mutyper. Objective response rate (ORR) and progression-free survival (PFS) with osimertinib treatment were evaluated.ResultsBetween January 2018 and December 2019, 63 patients were enrolled and received osimertinib. Mean age was 63 years, and 38 (60.3%) were female. Twenty-six patients had T790M mutation in both liquid and tissue samples (group A), 19 patients had only in tissue biopsy samples (group B), and 18 patients had T790M mutation only in liquid biopsy samples (group C). ORR in overall population was 63.5%, and was 61.5% in group A, 68.4% in group B, and 61.1% in group C, respectively. Median PFS in overall patients was 15.6 months (95% confidence interval, 10.7 to 24.2). There was no significant difference in ORR or PFS between groups.ConclusionOsimertinib showed favorable efficacy in lung cancer patients with acquired resistance to prior EGFR-TKI therapies, who screened positive for harboring T790M mutation detected from cell free DNA extracted from plasma, BALF/BWF, and pleural effusion.

Diagnostic utility of measuring lactate dehydrogenase levels and its isoenzyme activities for the evaluation of malignancy in feline pleural effusion and ascitic fluid.

Lactate dehydrogenase (LDH) isoenzymes may be useful in the differential diagnosis of pleural effusion (PE) and ascitic fluid (AF) etiologies in cats since tissue damage induces their release, changing the pattern of their activity. This study aimed to determine the diagnostic utility of measuring LDH levels and isoenzyme activities in PE or AF in cats with malignancy. LDH levels and isoenzyme activities in the serum, PE, and AF were compared among cats in the malignant, infectious, and non-malignant, non-infectious groups. A receiver operating characteristic (ROC) analysis was performed to assess the accuracy in diagnosing feline malignancy. Significant differences in LDH level and LDH isoenzyme activities in the PE and AF were observed among the three groups. The combination of LDH level and LDH-1 activity in PE or AF had the highest area under the ROC (AUC) values for discriminating malignant effusion from non-malignant effusion. The AUC of the combination of LDH level and LDH-1 activity in PE or AF was 0.874. The sensitivity and specificity of using the combination of LDH level (cut-off: <2,269 U/l) and LDH-1 activity (cut-off: <4.8%) in PE or AF for predicting malignancy with the highest AUC value were 94.4% and 72.7%, respectively. Our results suggest that the combination of LDH level and LDH-1 activity in PE or AF is a potential factor for diagnosing malignancy. Considering that LDH isoenzymes can be measured inexpensively and easily, LDH tests can be readily accommodated in veterinary clinical practice.

The Indian Academy of Cytologists Guidelines for Reporting Serous Effusion (IACGRSE): An Interobserver Agreement Analysis.

Context:The Indian Academy of Cytologists published Guidelines and categories for Reporting Serous Effusions (IACGRSE) in 2020 to improve consistency and reproducibility of fluid cytology reporting and to guide patient management.Aims:To evaluate category-wise agreement while using IACGRSE 2020 categories. To analyze interobserver agreement among participants with different level of training and years of experience.Settings and Design:A retrospective interobserver variability study.Methods and Material:Study was done with four participants: an expert cytopathologist and three cytopathology fellows with varying experience. Fluid smears from 60 cases with clinical and/or radiological evidence of malignancy were categorized into one of the five IACGRSE 2020 categories. The interpretations of expert cytopathologist were taken as standard.Statistical Analysis Used:Interobserver agreement was analyzed using Kappa statistics.Results:Previous cases without definitive category got classified into “Atypical cells NOS” (3.33%) and “Atypical cells, Suspicious of Malignancy” (15%). Agreement analysis for IACGRSE 2020 categories showed better concordance for inadequate (I), malignant (V), and benign (II) categories. The range of Kappa for interobserver agreement of fellows was fair to substantial (range 0.1692–0.7249). The participant with substantial diagnostic agreement with expert (κ = 0.729, 88.3%) had the most experience. Causes of major discordance were pertaining to paucity and distribution of cells, and to misinterpretation of reactive mesothelial cells.Conclusions:IACGRSE 2020 categories and participants’ experience were important determinants in classifying the effusion fluid cytology smears and interobserver agreement; emphasizing the need to use IACGRSE2020, and sufficient time and training required for accurate diagnosis of fluid specimens.

Application of the Indian Academy of Cytologists Recommendations for Reporting Serous Fluid Cytopathology in Routine Reporting of Ascitic Fluid Specimen and Assessment of the Risk of Malignancy.

Background:A five-tiered reporting system for effusion fluid cytology has been published by the Indian Academy of Cytologists (IAC). Only a single study has evaluated the applicability of this system in routine reporting.Aims:We intend to evaluate the practical utility of this system in routine reporting of ascitic fluid cytology.Materials And Methods:Nine hundred and sixty-one cases of ascitic fluid cytology were included in this study. The clinical, radiological, cytomorphological, and follow-up data of these cases were reviewed. All cases were recategorized according to the proposed IAC system, and the risk of malignancy (ROM) for each category was estimated.Results:Age of the patients ranged from 1 to 92 years, and fluid volume ranged from 10 ml to 3 l. The number of cases included in each category and their respective ROM were as follows: category 1: 41, 21.42%; category 2: 805, 14.9%; category 3: 5, 33.3%; category 4: 31, 90%; and category 5:79, 96.4%.Conclusions:The new IAC guidelines for the serous fluid is representative, informative, and could be easily applied at our institutional level. We used the recommended diagnostic categories for reclassifying the ascitic fluid samples based on their cytosmear findings and conclude that the system has enormous utility at each level starting from the collection of fluid samples till the delivery of the report.

Study of Serum Adenosine Deaminase (ADA) Activity in Pulmonary Tuberculosis Patients of Indian Subpopulation

Background Adenosine deaminase ADA activity has largely been studied using sputum and effusion fluids for diagnosing tuberculosis TB in the affected patients. However it is not feasible to access these specimens for continuous monitoring. The purpose of this study was to monitor the activity of ADA using serum in pulmonary TB PTB patients.Objectives The study was proposed to estimate the levels of serum ADA in PTB patients and to correlate these levels with normal healthy individuals.Methodology A total of 60 participants comprising of thirty subjects with PTB and thirty healthy subjects with age ge18 years were included in the study. Blood samples were collected from the antecubital vein from each participant and serum samples were used for the estimation of ADA levels using enzymatic method.Result Mean serum level of ADA in PTB patients was 12.6plusmn5.1 UL and control group was 3.2plusmn2.2 UL. PTB patients showed significant elevated levels of serum ADA p lt0.001.Conclusion Serum ADA levels significantly increased in PTB patients compared to healthy individuals. The biological reference interval obtained in the study was different from the one provided by the manufacturer.nbsp