False-negative Cytology Research Articles

Pap tests in the diagnosis of cervical cancer: Help or hinder?

ObjectiveTo evaluate the impact of pap tests on the time to diagnosis of cervical cancer. MethodsIn this population-based retrospective cohort study, Ontario women ≥21 years diagnosed with cervical cancer between 2011 and 2014 were identified and database data collected. The presence or absence of a pap test 0–2 years preceding cancer diagnosis was identified. Descriptive and modelling analyses were performed to determine the effect of pap results on cancer diagnosis. Results2002 patients were identified, 75% received a pap test. 1250 patients had known cytology - 13% normal, 8% low-grade and 7.5% suspicious for cancer. Across all FIGO stages at diagnosis, 5–10% of cytology was low grade, 3–11.5% was positive for carcinoma and 4–41% was normal, which increased with advancing stage. For all cytology and FIGO stages (except stage 1A), OBGYNs had a significantly shorter time to diagnosis compared to family physicians. Factors increasing the odds of low-grade cytology were advanced stage (OR 4.5 (2.4–8.0), p < 0.01) and adenocarcinoma (OR 1.5 (1.1–2.1), p < 0.01). Low grade cytology resulted in the longest delay to diagnosis (p < 0.001). ConclusionPap tests are performed frequently in the 0–2 years prior to the diagnosis of cervical cancer which can result in false negative cytology and diagnostic delay in patients with advanced cancers.

Large (≥3cm) thyroid nodules with benign cytology: Can Thyroid Imaging Reporting and Data System (TIRADS) help predict false-negative cytology?

BackgroundThere is controversy about the accuracy of the fine-needle aspiration (FNA) cytology results in large sized thyroid nodules. Our aim was to evaluate the false-negative rate of FNA for large thyroid nodules and the usefulness of the Thyroid Imaging Reporting and Data System (TIRADS) in predicting false-negative cytology for large thyroid nodules with benign cytology.Methods632 thyroid nodules larger than or equal to 3cm in size with subsequent benign cytology on US-guided FNA were included. US features of internal composition, echogenicity, margin, calcifications, and shape were evaluated, and nodules were classified according to TIRADS. TIRADS category 3 included nodules without any of the following suspicious features:solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape. Category 4a, 4b, 4c, and 5 were assigned to nodules showing one, two, three or four, or five suspicious US features, respectively. US features associated with malignancy for these lesions were analyzed and malignancy risk according to TIRADS was calculated.ResultsOf the 632 lesions, 23 lesions(3.6%) were malignant and 609(96.4%) were benign, suggesting a 3.6% false-negative rate for FNA cytology. Of the 23 malignant lesions, final pathology was mainly follicular carcinoma minimally invasive(65.2%, 15/23) and the follicular variant of papillary carcinoma(26.1%, 6/23). The malignancy risks of categories 3, 4a, 4b, and 4c nodules were 0.9%, 4.6%, 10.0%, and 11.8%, respectively.ConclusionLarge thyroid nodules with benign cytology had a relatively high false-negative risk of 3.6% and TIRADS was helpful in predicting false-negative cytology for these lesions.

False negative fine needle aspiration thyroid cytology: an institutional experience

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Pancreatic juice cytology as sensitive test for detecting pancreatic malignancy in intraductal papillary mucinous neoplasm of the pancreas without mural nodule

ObjectiveRecent studies reported that mural nodule (MN) was the most associated with malignant intraductal papillary mucinous neoplasms (IPMNs). However, IPMNs without MN cannot be diagnosed as malignant if only MN is determined to be indicator of malignancy. This study aimed to investigate role of pancreatic juice cytology for IPMNs without MN. MethodsMedical records of 50 patients with histologically proven malignant IPMNs were reviewed. Exclusively for non-invasive cancer, extent of high-grade dysplasia along the main pancreatic duct (MPD) was determined microscopically. ResultsThirty-six percent IPMNs had no MN. Cyst and main MPD diameter were significantly smaller in IPMN without MN compared to those in IPMN with MN (23 ± 14.1 vs 35 ± 13.2 mm, p = 0.010; 6.6 ± 4.3 vs 10.9 ± 6.1 mm, p = 0.006). Sensitivity of pancreatic juice cytology was higher in IPMN without MN compared to that in IPMN with MN (94% vs 53%, p = 0.004) although it could be affected by selection bias of study patients. Absence of MN was determined to be an independent factor associated with true positive cytology (OR = 24.3, p = 0.005). Extent of high-grade dysplasia was significantly longer in IPMN with true positive cytology compared to that in IPMN with false negative cytology (46.8 ± 20.5 vs 26.4 ± 11.0 mm, p = 0.005), and tended to be longer in IPMN without MN compared to that in IPMN with MN (47.0 ± 19.0 vs 36.0 ± 20.1 mm, p = 0.16). ConclusionsSensitivity of pancreatic juice cytology was excellent in IPMN without MN. Pancreatic juice cytology may be a sensitive test for detection of pancreatic malignancy in IPMN without MN compared to high-risk imaging features.

A prospective study of anal cancer screening in HIV-positive and negative MSM.

The study sought to establish the feasibility and acceptability of anal screening among men MSM. Prospective cohort study. Sexual health clinics in tertiary care. Known HIV-positive and negative MSM who have anoreceptive intercourse. Anal screening with human papilloma virus (HPV) testing, liquid-based cytology and high-resolution anoscopy with biopsy of anoscopic abnormalities. Participants completed questionnaires at baseline and at 6 months. Anal HPV was highly prevalent in MSM (HIV-positive, 88% and HIV-negative, 78%). Despite the high prevalence of cytological abnormality in both HIV-positive (46.2%) and negative (35.0%) MSM, almost half of anal intraepithelial neoplasia (AIN) of all grades were associated with negative cytology. Anoscopically directed biopsies detected AIN3 or worse (AIN3+) in 14 of 203 (6.9%) of HIV-positive MSM and three of 81 (3.7%) HIV-negative MSM. The corresponding prevalence of AIN2+ was 26.6 and 20.9%, respectively. One case of AIN3 was detected at the second visit. Screening was considered to be highly acceptable by participants. The high prevalence of high-risk-HPV and frequency of false negative cytology in this study suggest that high-resolution anoscopy would have most clinical utility, as a primary screening tool for anal cancer in a high-risk group. The prevalence of AIN3+ in HIV-positive MSM lends support for a policy of screening this group, but the high prevalence of lower grade lesions which do not warrant immediate treatment and the limitations of treating high-grade lesions requires careful consideration in terms of a screening policy.

The value of a transformation zone component in anal cytology to detect HSIL.

In a cytology-based screening program intended to prevent anal cancer, the anal transformation zone (TZ) should be adequately sampled because it is the site most susceptible to the development of the cancer precursor, high-grade squamous intraepithelial lesion (HSIL). An adequate TZ component is defined as comprising at least 10 rectal columnar or squamous metaplastic cells. In the current study, the authors examined whether the presence of a TZ component in anal cytology correlated with the detection of histological HSIL. In a natural history study of anal human papillomavirus infection in homosexual men, all participants underwent liquid-based cytology and high-resolution anoscopy (HRA) with or without biopsy at each visit. True-negative cytology (negative cytology with non-HSIL biopsy or negative HRA), false-negative cytology (negative cytology with HSIL biopsy), and true-positive cytology (abnormal cytology with HSIL biopsy) were compared with regard to the presence or absence of a TZ component. Of 617 participants, baseline results included 155 true-positive results, 191 true-negative results, and 31 false-negative results. The absence of an adequate TZ component was found to be significantly higher for false-negative (32.3%) than for either true-positive (11.0%; P = .0034) or true-negative (13.1%; P = .0089) results. Significantly more false-negative cases lacked a TZ component compared with either true-positive or true-negative cases. TZ cells may be an important indicator of sample quality for anal cytology because, unlike cervical sampling, the anal canal is not visualized during cytology sampling. Cancer Cytopathol 2016;124:596-601. © 2016 American Cancer Society.

Long- versus short-interval follow-up of cytologically benign thyroid nodules: a prospective cohort study.

BackgroundThyroid nodules are common, and most are benign. Given the risk of false-negative cytology (i.e. malignancy), follow-up is recommended after 1–2 years, though this recommendation is based solely on expert opinion. Sonographic appearance may assist with planning, but is limited by large inter-observer variability. We therefore compared the safety and efficacy of long- versus short-interval follow-up after a benign initial aspiration, regardless of sonographic appearance.MethodsThis study evaluated all patients referred to the Brigham and Women’s Hospital Thyroid Nodule Clinic, between 1999 and 2010, with a cytologically benign nodule >1 cm and who had returned for follow-up sonographic evaluation. Despite standard clinical recommendations, variation in patient compliance resulted in variable follow-up intervals from time of initial aspiration to the first repeat evaluation. Main outcome measures included nodule growth, repeat fine needle aspiration (FNA), thyroidectomy, malignancy, and disease-specific mortality.ResultsWe evaluated 1,254 patients with 1,819 cytologically benign nodules, with a median time to first follow-up of 1.4 years (range, 0.5–14.1 years). The longer the follow-up interval, the more nodules grew and the more repeat FNAs were performed (P <0.001). The most clinical meaningful endpoints of malignancy or mortality, however, did not differ between the various follow-up intervals. The risk of a thyroidectomy (usually because of compressive symptoms) increased when time to first follow-up exceeded >3 years (4.9 % vs. 1.2 %, P = 0.0001), though no difference in malignancy risk was identified (0.2–0.8 %, P = 0.77). No (0 %) thyroid cancer-specific deaths were identified in either cohort.ConclusionsWhile expert opinion currently recommends repeat evaluation of a cytologically benign nodule at 1–2 years, these are the first data to demonstrate that this interval can be safely extended to 3 years without increased mortality or patient harm. Nodule growth can be expected, though detection of malignancies is unchanged. While replication of these data in large prospective multicenter studies is needed, this extension in follow-up interval would reduce unnecessary visits and medical interventions for millions of affected patients worldwide, leading to healthcare savings.Please see related commentary article: http://dx.doi.org/10.1186/s12916-016-0559-9 and research article: http://dx.doi.org/10.1186/s12916-015-0419-z.

Sensitivity of Urine Cytology for High Grade Urothelial Carcinoma and Explanations for False-Negative Cytologies

Sensitivity of Urine Cytology for High Grade Urothelial Carcinoma and Explanations for False-Negative Cytologies

Papiloma virus humano y su asociación a lesiones preneoplásicas y neoplásicas de cuello uterino

Las lesiones preneoplásicas y neoplásicas de cuello uterino se asocian en elevado porcentaje a infección por papiloma virus humano (H.P.V.). Para su detección es necesario el uso conjunto de citología, colposcopia y biopsia dirigida. En el período comprendido entre febrero de 1994 a setiembre 1995, se evaluó en el departamento académico de la Universidad de San Agustin y Hospital Honorio Delgado de Arequipa, 438 pacientes, siguiendo la metodología diagnóstica antes mencionada. En 73 pacientes (90,14%) se encontró histológicamente: 20 (30,30%) lesiones intraepiteliales escamosas de grado bajo; 35 (53,03%) de grado alto y en 11 pacientes (16,16%) cáncer invasor. El I.R.S. antes de los 18 años, tener 3 ó más parejas sexuales y antecedente de enfermedades de transmisión sexual, constituyeron factores de riesgo. En cambio la paridad, uso de anticonceptivos, tabaquismo y nivel socioeconómico bajo no lo fueron. En 22 pacientes (33,33%) se encontró signos histomorfológicos de infección por H.P.V. En 12 pacientes (18,18%) la biopsia de vulva reveló lo mismo. 27 pacientes tuvieron una citología negativa. Los falsos negativos de la citología ascienden al 40,90% en este trabajo.

Investigación citológica del cáncer cervicouterino en portadora de dispositivos intrauterinos (d.i.u.)

El hecho de haber podido estudiar en 33 meses de trabajo la citología exfoliativa cervicovaginal de 13,062 mujeres portadoras de d.i.u.. en una limitada Area de Santiago, señala la real posibilidad de efectuar detección de cáncer genital en un grupo de mujeres aparentemente sanas aunque cargadas de condiciones etiopatogénicas predisponentes a la cancerización del cuello. En este grupo hemos encontrado 2.2% de citologías anormales (2%. Pap III y 0.2 % Pap. IV y V). En este lapso hemos tenido una sola citología falsa negativa y se han comprobado histológicamente, 15 displosias, 20 Ca. in situ y 9 Ca. invasores del cuello uterino. La mujer que es protegida de embarazo no deseado debe serlo simultáneamente de la evolución de una cervicopatía crónica benigna en un carcinoma del cuello, máxime cuando reuna en sí una o más de las condiciones etiopatogénicas contribuyentes a tal proceso.

Evidence-based adequacy criteria for urinary bladder barbotage cytology

Adequacy criteria are well established in some areas of cytopathology to prevent false negative diagnoses. To date, no such criteria have been proposed and validated for urinary tract specimens. Our aim was to determine a cellularity cutoff point that significantly affects the sensitivity of detecting high-grade or in situ urothelial carcinoma (HGUC or UCIS) in bladder barbotage/washing specimens. Bladder barbotage specimens collected in liquid-based media were selected. Specimens diagnosed as "positive for HGUC" (with histologic confirmation) composed the study group, with negative cases as control specimens. Samples were serially diluted and ThinPrep slides of decreasing cellularity were made and reviewed for diagnosis and cellularity. In a retrospective validation study, we identified cases with a "negative for malignancy" bladder barbotage/washing and a surgical pathology diagnosis of UCIS or HGUC (ie, false negative cytology). Cellularity was assessed. A distinct difference in sensitivity was noted at a cutoff point of 2644 (20 per 10 high-power fields) urothelial cells. Sensitivities increased for atypical or higher (68.3% versus 100%) and HGUC (43.3% versus 88.0%) after application of this cutoff point with high statistical significance (P = 0.001 and 0.0001, respectively). For the retrospective review, cases below the cutoff point were reclassified as unsatisfactory, and sensitivity rose from 76.3% to 84.8% (P = 0.0027). Our results indicate that, in the absence of atypical or malignant cells, an adequate bladder barbotage specimen should have a minimum of 2644 (20 per 10 high-power fields) well-visualized, well-preserved urothelial cells to increase the positive predictive value of this test.

English

AIM: Aim of our study to analyze the prevalence of premalignant lesion based on Pap smear and liquid based cytology in patients of bad cervix. OBJECTIVE: To compare sensitivity and specificity of two methods for screening of bad cervix and to know IDR (increase detection rate) of cervical cancer by conventional Pap smear and liquid based cytology. MATERIAL AND METHOD: 200 women attending Gynaecology OPD were random selection on the basis of inclusion criteria. All 200 selected women were subjected for down staging through per speculum examination for identification of bad cervix. Pap smears of all 200 selected women were taken and ensured that no local douche, antiseptic cream and no local internal examination was done on the day of test. The prepared smears were then stained according to Papanicolaou's technique. Liquid based cytology smears preparing by using cervical brush 1-1.5cm were inserted into the cervical os until the large outer bristles of the brush touch ectocervix. Data collected for sociodemographic, parity, down staging clinical examination Pap smear and LBC was organised, interpreted and analysis on appropriate statistical software. P value < 0.05 is considered significant RESULT: Analysis revealed that the maximum number of women in our study are from middle age group(31-40yrs), low socioeconomic status, married before 18 yrs, multipara, do not use any contraceptive, uneducated, urban, Muslim population.in this study more abnormal smear is seen in LBC as compared to pap smear. Sensitivity and specificity for LBC is more as compare to pap smear. CONCLUSION: In low resource setting like ours were facilities for radiology, chemo- radiotherapy and supportive care are limited or unavailable. It is important to identify which resources fill healthcare need most effectively and to consider alternative approaches, LBC is strongly advocated in the best interest of public health, by improving the quality of the sample and reducing the likelihood of false negative cytology result. Thus it will significantly improve early detection and treatment of cervical lesions and

Lower Endoscopic Ultrasound-Guided Fine-Needle Aspiration: A Useful Diagnostic Tool for Perirectal and Intraluminal Lesions: A Large Series in a Single Tertiary Referral Hospital

Introduction: Lower Endoscopic Ultrasound-Guided Fine-Needle Aspiration (LEUS-FNA) of perirectal lesions is a safe, minimally invasive, and well tolerated procedure that provides valuable information which affects patient management. Herein, we presented our experience of LEUS -FNA to evaluate perirectal lesions. Materials and Methods: LEUS-FNAs were retrieved from the cytopathology archives of our University Hospital, from 2001February, 2014. The cytopathology reports, corresponding histology, immunohistochemistry when available, and clinical data were collected. The sensitivity and specificity of EUS-FNA were calculated in a subset of patients with available surgical pathology. Results: 114 specimens were retrieved. Masses measured 5e100 mm (mean: 27.5 mm) in diameter. Recurrent cancer was clinically suspected in 46% of cases (nZ53). For 37 cases histopatholgic material was available. The aspirated material showed malignant (n Z 48), benign (n Z 41), atypical/suspicious (nZ6) and nondiagnostic cytology (nZ 19). Malignant cases were adenocarcinoma (24), neuroendocrine tumor (3), squamous cell carcinoma (5), urothelial carcinoma (2), positive for malignant cells (12), gastrointestinal stromal tumor (1) and non Hodgkin lymphoma (1). The primary site of the tumors included colorectal, anal, urinary bladder, prostate, pancreas, ovary, and female lower genital tract. The benign cytology cases were negative for malignant cells (32), schwannoma (1), and 8 non neoplastic lesions including: abscess (3), endometriosis (2), hematoma (1), malacoplakia (1) and mucinous cyst (1). Histology confirmed 11/12 negative cytology; one false negative cytology of lymph node. Statistical analysis for LEUS-FNA showed 91% sensitivity, 100% specificity, diagnostic accuracy of 95%, and a positive predictive value of 100% and a negative predictive value of 88%. Discrepancies were likely due to cytology sampling errors. Conclusion: Lower EUS-FNA allows cytological examination and ancillary studies (immunohistochemistry, flow cytometry) of suspicious pelvic lesions in the gut wall and surrounding tissues. LEUS-FNA can detect local recurrences and also improve the staging accuracy of colorectal adenocarcinoma by proving nodal metastasis.

The added value of using mutational profiling in addition to cytology in diagnosing aggressive pancreaticobiliary disease: review of clinical cases at a single center.

BackgroundThis study aimed to better understand the supporting role that mutational profiling (MP) of DNA from microdissected cytology slides and supernatant specimens may play in the diagnosis of malignancy in fine-needle aspirates (FNA) and biliary brushing specimens from patients with pancreaticobiliary masses.MethodsCytology results were examined in a total of 30 patients with associated surgical (10) or clinical (20) outcomes. MP of DNA from microdissected cytology slides and from discarded supernatant fluid was analyzed in 26 patients with atypical, negative or indeterminate cytology.ResultsCytology correctly diagnosed aggressive disease in 4 patients. Cytological diagnoses for the remaining 26 were as follows: 16 negative (9 false negative), 9 atypical, 1 indeterminate. MP correctly determined aggressive disease in 1 false negative cytology case and confirmed a negative cytology diagnosis in 7 of 7 cases of non-aggressive disease. Of the 9 atypical cytology cases, MP correctly diagnosed 7 as positive and 1 as negative for aggressive disease. One specimen that was indeterminate by cytology was correctly diagnosed as non-aggressive by MP. When first line malignant (positive) cytology results were combined with positive second line MP results, 12/21 cases of aggressive disease were identified, compared to 4/21 cases identified by positive cytology alone.ConclusionsWhen first line cytology results were uncertain (atypical), questionable (negative), or not possible (non-diagnostic/indeterminate), MP provided additional information regarding the presence of aggressive disease. When used in conjunction with first line cytology, MP increased detection of aggressive disease without compromising specificity in patients that were difficult to diagnose by cytology alone.

False negative cytology in large thyroid nodules.

Controversy exists regarding the accuracy of fine-needle aspiration (FNA) in large thyroid nodules. Recent surgical series have documented false-negative rates ranging from 0.7 to 13 %. We examined the accuracy of benign FNA cytology in patients with thyroid nodules ≥3 cm who underwent surgical resection and identified features characteristic of false-negative results. We retrospectively studied all thyroidectomy specimens between January 2009 and October 2011 and identified nodules ≥3 cm with corresponding benign preoperative FNA cytology. We collected clinical information regarding patient demographics, nodule size, symptoms, sonographic features, FNA results, and final surgical pathology. For comparison, we analyzed nodules <3 cm from this cohort also with benign FNA cytology. A total of 323 nodules with benign preoperative cytology were identified. Eighty-three nodules were <3 cm, 94 nodules were 3-3.9 cm, and 146 nodules were ≥4 cm in size. The false-negative rate was 11.7 % for all nodules ≥3 cm and 4.8 % for nodules <3 cm (p = 0.03). Subgroup analysis of nodules ≥3 cm revealed a false-negative rate of 12.8 % for nodules 3-3.9 cm and 11 % for nodules ≥4 cm. Age ≥55 years and asymptomatic clinical status were the only patient characteristics that reached statistical significance as risk factors. Final pathology of the false-negative specimens consisted mainly of follicular variant of papillary thyroid cancer and follicular thyroid cancer. When referred for thyroidectomy, patients with large thyroid nodules demonstrate a modest, yet significant, false-negative rate despite initial benign aspiration cytology. Therefore, thyroid nodules ≥3 cm may be considered for removal even when referred with benign preoperative cytology.

False negative touch imprint cytology – Does it matter?

Introduction: Sentinel node biopsy (SNB) with intra-operative analysis using touch imprint cytology (TIC) is standard practice in our unit. We sought to assess the accuracy of TIC and determine the risk of residual disease following false negative TIC in our patient population.

Diagnostic utility of VEGF mRNA and SP1 mRNA expression in bronchial cells of patients with lung cancer

Bronchial brushing is important for cytological diagnosis of lung carcinoma; however, cytological evaluation alone remains relatively insensitive. The aim of this study was to assess the diagnostic utility of vascular endothelial growth factor (VEGF) messenger ribonucleic acid (mRNA) and specificity protein 1 (SP1) mRNA in bronchial brushings in patients with or without lung cancer. VEGF mRNA and SP1 mRNA were measured in liquid-based cells from bronchial brushings in patients with verified lung cancer (n = 93) and with benign lung disease that included tuberculosis (n = 51). This was done using the reverse-transcription polymerase chain reaction. Both VEGF mRNA and SP1 mRNA were significantly more likely to be expressed in the cancer group than in the control (benign) group, whatever their cell type. It was also more often found in the tuberculosis group than in the inflammation group (P < 0.01). In the cancer group, VEGF mRNA was significantly correlated with SP1 mRNA (P < 0.01). Of the 36 false negative cytology results, 30 gave positive results for VEGF mRNA and 34 for SP1 mRNA. The four false positive VEGF results were all diagnosed as tuberculosis. VEGF mRNA gave the highest diagnostic performance with serial use: sensitivity 89.2% and accuracy 90.3%. This was significantly better than cytology (P < 0.01). Detection of VEGF mRNA and SP1 mRNA in bronchial brushing cells may be used as an ancillary tool to cytological diagnosis for detection of early-stage lung cancer. It may also help distinguish tuberculosis from other causes of lung inflammation.

False‐negative rate of endoscopic ultrasound‐guided fine‐needle aspiration for pancreatic solid and cystic lesions with matched surgical resections as the gold standard

The diagnosis of pancreatic tumors is often complicated because of sampling and interpretive challenges. The current study was performed to determine the rates, types, and causes of diagnostic discrepancies. The authors retrospectively reviewed cytology cases from 2004 to 2010 using matched surgical resection cases as the gold standard. A total of 733 cases were divided into 3 categories: 1) positive or suspicious (290 cases); 2) negative or atypical (403 cases); and 3) unsatisfactory (40 cases). Of these cases, 101 fine-needle aspiration (FNA) cases had matched surgical resections including 58 positive diagnoses, 39 negative diagnoses, and 4 unsatisfactory diagnoses. All 19 discrepant cases represented false-negative diagnoses without any false-positive cases noted, which included 2 cases with interpretive errors (10%) and 17 cases with sampling errors (90%). All matched cytology cases were divided into 5 subgroups based on the type of lesion or type of error and were analyzed for sensitivity and specificity. The sampling error rate in cystic lesions (8 of 24; 33%) was significantly higher than that in solid lesions (9 of 73; 12%). The false-negative rate in the interpretive error group (3%) was significantly lower than that in the sampling error group (23%). The results of the current study confirm that pancreatic endoscopic ultrasound-guided FNA diagnosis has a very low false-positive rate but a relatively high false-negative rate using matched surgical resections as the gold standard. The major cause of a false-negative cytology diagnosis is sampling error and the rate of sampling error in cystic lesions is significantly higher than that in solid lesions.

Diagnostic value of fine needle aspirates processed by ThinPrep® for the assessment of axillary lymph node status in patients with invasive carcinoma of the breast

To evaluate the utility of ThinPrep® as an optional specimen processing method for the detection of axillary lymph node metastasis of invasive breast carcinoma. A computer SNOMED search from the file at our institution between January 2003 and August 2011 retrieved a total of 209 fine needle aspiration (FNA) specimens of axillary lymph nodes prepared by ThinPrep and followed by axillary lymph node biopsy and/or dissection. Original cytological diagnoses and corresponding histological diagnoses were documented. Using the histological diagnoses as the gold standard, the diagnostic parameters including sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and diagnostic accuracy were calculated. Both cytology and histology slides from cyto-histologically discrepant cases were reviewed. Out of a total of 209 specimens, 193 (92%) had adequate diagnostic material while the remaining 16 specimens (8%) were inadequate for cytological assessment. The diagnostic specimens included 168 invasive ductal carcinomas (IDC), 15 invasive lobular carcinomas (ILC) and 10 mixed carcinomas (IDC and ILC). Excluding 19 cases with malignant cells on FNA in which no residual tumour was found in fibrotic lymph nodes after neoadjuvant therapy (cytology and histology confirmed on review) ThinPrep detected nodal metastasis with an overall sensitivity of 77.5%, specificity of 100%, PPV of 100% and NPV of 53.7%. Diagnostic accuracy was 82.2%. There was no difference in Bloom-Richardson grade or the number or size of metastases between tumours with true-positive and false-negative cytology. Sampling error was the sole factor contributing to cyto-histological discrepancy. ThinPrep is a good alternative to the conventional smear for cytological assessment of axillary lymph node status in patients with invasive breast carcinoma, particularly when specimens are collected at remote sites or when cytologists are not available for assistance during FNA.

The importance of fine needle aspiration cytology in the management of recurrent and metastatic melanoma

Fine needle aspiration cytology is a widely accepted, reliable diagnostic modality for the early detection of metastases. Quality assurance analysis of fine needle aspiration cytology in melanoma patients. A total of 194 biopsies performed in 142 melanoma patients were analyzed retrospectively. 138 (71.13%) cutaneous or subcutaneous nodules and 56 (28.87%) palpable lymph nodes were studied. 87 (44.85%) true positive, 92 (47.42%) true negative, 3 (1.55%) false positive and 12 (6.19%) false negative cytology results were found. High sensitivity (87.89%), specificity (96.84%) and diagnostic accuracy (93.72%) were confirmed. The quality assurance of fine needle aspiration biopsy in these patients with recurrent and metastatic melanoma meets the international requirements.