Fine Needle Aspiration Cytology Samples Research Articles

Parotid squamous cell carcinoma metastases: Application of human papillomavirus -DNA test on liquid-based cytology to recognize oropharyngeal origin of the neoplasm.

Malignancies of the parotid gland are relatively uncommon and in most cases are primary neoplasms; intraparotid metastases are rare. Oral and oropharyngeal squamous cell carcinoma (O- and OP-SCC) can potentially metastasize to the parotid gland or intraparotid lymph nodes. Fine-needle aspiration cytology (FNAC) serves as the initial diagnostic approach for this purpose. HPV status in FNAC specimens is relevant and can guide the diagnostic workup, indicating a potential oropharyngeal origin of the primary tumor. A small series of occult SCC metastases is presented below, in which HPV-DNA testing of FNAC specimens helped identify primary neoplasms located in the oropharynx. US-guided FNAC of parotid nodules was conducted by an experienced interventional cytopathologist in three cases. Each patient underwent assessment of direct smears, cell blocks, and liquid-based samples for HPV testing. The morphological and immunocytochemical features of SCC were documented, and real-time PCR was employed for the detection and genotyping of HPV. The role of HPV testing on FNAC specimens in pinpointing the primary neoplasms in the oropharynx is highlighted. Consequently, FNAC samples emerge as valuable diagnostic and prognostic tools in this context, providing essential insights for patient management.

Clinical decision making when cytology indicates a Warthin tumor

Warthin tumor (WT) is a benign tumor usually affecting the parotid gland. The main diagnostic tool remains ultrasound combined with fine-needle aspiration cytology (FNAC). This study aims to examine how reliably FNAC indicates WT for clinical decision making regarding surgical versus conservative management. We included all patients who underwent FNAC from a parotid gland lesion between 2016 and 2018 at our institution, and whose FNAC revealed WT suspicion. The FNACs were divided into three groups based on the cytology report: certain, likely, and possible WT. The patients were divided into two groups based on having had either surgery or follow-up. We sent a questionnaire to patients who had not undergone surgery in order to obtain follow-up for a minimum of four years. Altogether, 135 FNAC samples, from 133 tumors and 125 patients, showed signs of WT. Of the 125 patients, 44 (35%) underwent surgery, and 81 (65%) were managed conservatively. Preoperative misdiagnosis in FNAC occurred in three (7%) surgically treated tumors. Their FNACs were reported as possible WTs, but histopathology revealed another benign lesion. In the conservatively treated group, two patients underwent surgery later during the follow-up. Cytological statements of WT were seldom false, and none were malignant. The majority of the patients were only followed-up and rarely required further treatment. A certain or likely diagnosis of WT in the FNAC report by an experienced head and neck pathologist is highly reliable in selecting patients for conservative surveillance.

Rapid on-site evaluation and cell blocks: getting the most from the least invasive method in cytopathology

Fine needle aspiration cytology (FNAC) sampling is a minimally invasive procedure done to identify the pathology behind superficial and deep-seated lesions. Rapid on-site evaluation (ROSE) can be an adjunct to the FNACs. Our study aimed to identify the role of ROSE in diagnostic adequacy and to check the benefit of cell block (CB)/cell buttons prepared from the ROSE samples. A prospective study was conducted where all patients referred for FNAC were included. ROSE using 1% aqueous toluidine blue stain and CB/cell button preparations were done for the identification of various cytological lesions. Among 600 cases included in the study most common age group was third and fourth decades with a mean age of 41.6 years and M: F ratio of 1:1.7. Ultrasound-guided procedures were done in 20% of cases. CB preparation was available in 14% of cases. Most CBs were from the cases wherein ROSE was performed 81% (77 out of 86), with CB helping in making an accurate diagnosis in 17% of cases. Lymph nodes 26%, and thyroid 23% were the most common sites for sampling with the highest number of repeat procedures from non-ROSE cases (14%). The non-diagnostic rate for non-ROSE cases was 7.7% (23/300) even after the repeat procedures as compared to 1.3% (4/300) for ROSE. Three slides on average were consumed in ROSE-performed procedures, as compared to an average of 5 slides in non-ROSE. The average turnaround time was 1.7 days for non-ROSE cases and 1.05 for ROSE cases respectively. Cyto-histopathological correlation was available in 40% of cases with a sensitivity of 98.1%, specificity of 96.7%, positive predictive value of 90%, negative predictive value of 99.4%, and diagnostic accuracy of 97%. The correlation of CB, number of slides consumed, and turnaround time among the 2 groups were statistically significant (P value < 0.001). ROSE is a method used to assess material aspirated at the time of FNAC procedures to determine the adequacy and to an extent to identify whether the lesion is neoplastic or non-neoplastic. CBs have helped in increasing diagnostic accuracy apart from the fact that the paraffin-embedded tissue material can be used for further studies.

Mucormycosis: Cytomorphological Spectrum in Fine-Needle Aspiration Cytology.

Mucormycosis is a fungal infection that can affect multiple organs. The role of fine-needle aspiration cytology (FNAC) in its diagnosis is not well documented. The objective of this study was to describe the detailed cytomorphologic features of mucormycosis on FNAC samples. A retrospective analysis of all cases diagnosed as mucormycosis on FNAC between January 2014 and July 2021 was performed for detailed cytomorphological evaluation and correlation to clinical data and microbiological studies wherever available. FNA was computed tomography-guided (n = 38), ultrasonography-guided (n = 31) or palpation-guided (n = 12), and slides were reviewed in two cases. A total of 83 cases of mucormycosis were evaluated. An immunocompromised setting was observed in 48 cases. The most common site of FNA was the lung (n = 57) followed by liver, soft tissue, palate, mediastinum, orbital/ocular region, and lymph node. Isolated renal involvement, a unique feature, was seen in seven cases. The aspirates were necrotic to pus-like or blood-mixed particulate. Broad, nonseptate, foldable, ribbon-like fungal hyphae showing right-angled branching were seen. The tissue reaction was predominantly necro-inflammatory (n = 36), bland necrotic (n = 22), mixed inflammatory (n = 16), suppurative (n = 5), necrotizing granulomatous (n = 3), and granulomatous (n = 1). Immunocompromised patients showed mixed inflammatory responses more frequently. Fungal culture was positive for Rhizopus species in 2/13 cases and molecular testing in two additional cases corresponding to Rhizopus and Syncephalastrum spp. FNA provides quick and conclusive diagnosis of mucormycosis from varied anatomic sites enabling prompt institution of therapy. The tissue response is variable and to some extent dependent on the immune status of the patient.

EphB3 protein is a potential ancillary diagnostic biomarker for thyroid cancers

ObjectiveTo investigate the expression of ephrin type B receptor 3 (EphB3) in thyroid tumors and its usage as an ancillary diagnostic biomarker for thyroid tumors. MethodsFormalin-fixed and paraffin-embedded (FFPE) tissue samples (78 cases) and FNAC samples (57 cases) were assessed with the EphB3 antibody using immunohistochemistry. PTC and other thyroid follicular tumors were compared regarding their EphB3 expression. Sanger sequencing was used to assess for the presence of a BRAF V600E mutation. ResultsEphB3 was positive in 81.8 % (27/33) of papillary thyroid carcinoma (PTC), 83.3 % (5/6) of medullary thyroid carcinoma (MTC), 25 % (1/4) of hyperplastic/adenomatoid nodule (HN), 14.3 % (1/7) of follicular adenoma (FA), and negative in follicular tumors of uncertain malignant potential (FT-UMP) (0/13), noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) (0/7), thyroid follicular carcinoma (TFC) (0/4), Hashimoto's thyroiditis (0/4), and normal thyroid follicular tissues (0/33). In cellular blocks, EphB3 was positive in 87.1 % (20/23) of PTC, 75 % (3/4) of MTC, 20 % (2/10) of HN, and negative in atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (0/20) and normal thyroid follicular cells (0/10). ConclusionEphB3 is expressed in the majority of PTC, but less so in benign follicular nodules. EphB3 expression in fine needle aspiration cytology (FNAC) specimens can be used as a diagnostic tool to differentiate thyroid cancer from other follicular lesions in its differential diagnosis, especially AUS/FLUS and PTC.

Immunocytochemistry on frozen-embedded cell block for the diagnosis of hematolymphoid cytology specimen: a straightforward alternative to the conventional cell block.

Agarose-based cell block (CB) technique can be modified to be combined with the frozen section technique for the preparation of a high-quality frozen-embedded CB (F-CB) from an effusion or fine-needle aspiration (FNA) cytology sample. This combined technique can be effectively used for the immunocharacterization of the hematolymphoid cells on F-CB. To demonstrate the applicability of performing diagnostic ICC on F-CB, we have analyzed the immunophenotype of the hematolymphoid cells in a series of eight cases of effusions and eight cases of FNA cytology specimens by using CB-ICC on sections cut from frozen-embedded CBs. The SurePathTM residue or cytologic material scraped off from the FNA cytology smear that was diagnostic for or suspicious of hematolymphoid malignancy was pelleted and pre-embedded in agarose. Half of the agarose-embedded pellet was frozen-embedded in OCT compound for the preparation of F-CB, while the other half was processed for the preparation of paraffin-embedded CB. Sections cut from the F-CB and P-CB were used for CB-ICC. Panels of ICC on the F-CBs could enable the immunocytochemical differential diagnosis of large cell hematologic malignancies that encompass anaplastic large cell lymphoma and other forms of large-cell hematolymphoid malignancies such as large B-cell lymphomas, anaplastic plasma cell myeloma, myeloid sarcoma, and T-lymphoblastic lymphoma. It also appeared that the small B-cell lymphomas in the effusions or FNAs could be differentially diagnosed with the aid of CB-ICC on the F-CB. A modified agarose-based CB technique can be combined with the frozen-embedded CB method for the preparation of F-CB that can be directly used for the immunocytochemical differential diagnosis of hematolymphoid cytology samples.

Comparison of CBNAAT and AFB screening using Ziehl Neelsen stain and fluorescent stain on FNAC sample for rapid diagnosis of tubercular lymphadenitis

: Tuberculous lymphadenitis is the most common etiology of cervical lymphadenopathy in endemic countries. Fine needle aspiration of palpable lymph nodes is done for rapid diagnosis of tuberculous lymphadenitis This study presents a comparative evaluation of fine needle aspiration cytology (FNAC) with acid fast bacilli screening using Ziehl Neelsen stain, Fluorescent stain with Cartridge based nucleic acid amplification test (CBNAAT) for the rapid diagnosis of tubercular lymphadenitis.: An observational cross sectional study was done over a period of 15 months from January 2020 to March 2021. All newly diagnosed cases of tubercular lymphadenitis irrespective of age and sex were included. Fine needle aspiration was performed from the palpable lymph node. Smears were prepared using Giemsa, Papanicolaou, Ziehl Neelsen and Auramine O stain.Rest of the sample was used for Mycobacterial growth indicator test (MGIT) and CBNAAT. Statistical Analysis was performed using McNemar test. For gold standard, MGIT as well as a composite reference standard on parameters that included MGIT, radiological findings of tuberculosis, Positive Mantoux test and Positive response to ATT seen in the form of complete resolution of clinical and radiological findings.: The diagnostic value of CBNAAT differed with respect to the chosen gold standard. With MGIT as gold standard, CBNAAT had the highest sensitivity, specificity, positive predictive value and negative predictive value. The diagnostic accuracy of CBNAAT was also the highest. Using CRS (Composite Reference standard) as gold standard, CBNAAT showed the highest specificity and positive predictive value.: With CBNAAT showing statistically significant data of a higher diagnostic value in our study as well as showing rapid result, being automated and not subjected to observer interpretation, we conclude that CBNAAT is more efficient in the diagnosis of tubercular lymphadenitis as compared to AFB screening methods. The only limitation of CBNAAT in our study was its ability to show positive results for three atypical mycobacteria due to possible cross contamination.

Diagnostic Value and Challenges of BRAF V600E Molecular Testing and Thyroid Fine-Needle Aspiration Cytology: A Retrospective Study from a Tertiary Institution in Southern Hunan Province, China

Introduction: Combined thyroid fine-needle aspiration (FNA) cytology and valine-to-glutamate substitution at codon 600 of B-Raf proto-oncogene, serine/threonine kinase (BRAF V600E) mutation detection are procedures used for diagnosing thyroid nodules in many Chinese tertiary institutions. This retrospective study at our institution aimed to explore the effectiveness and challenges of the combined approach in diagnosing thyroid nodules and the correlation between BRAF V600E mutation status and behavior of papillary thyroid carcinoma. Methods: Thyroid FNA cytology and BRAF V600E mutation detection results were reviewed between November 2020 and July 2022. A total of 623 patients, each of whom underwent thyroidectomy and final pathological examination after FNA cytology diagnosis, were included in the study. The relationship between the BRAF V600E mutational status and pathological parameters was analyzed using the χ² test. The effectiveness and challenges of FNA cytology alone and the combined procedure were also evaluated based on the final pathology. Results: Of 623 patients, 591 were diagnosed with papillary thyroid carcinoma (PTC), of which 456 were positive for the BRAF V600E mutation. It demonstrated near-perfect specificity for identifying PTC, and its incidence rate showed an age-specific curve with an inverted U-shaped distribution. The final pathological examination showed that the combined procedure had a higher sensitivity (83.91%) than FNA cytology alone (63.45%) for distinguishing PTC from other lesions (p < 0.001). Mutational status was associated with a larger maximum tumor diameter (p = 0.003) and a tendency of capsular invasion (p = 0.0542) but possibly unrelated to central lymph node metastasis (p = 0.1846). Nodular goiters accounted for most benign entities initially designated as Bethesda categories III–V. Conclusion: BRAF V600E mutational analysis complements cytopathology and improves the PTC detection rate in FNA cytology samples due to the high prevalence of the mutation in China. BRAF V600E mutation does not show a statistical correlation with tumor aggressiveness. Morphological pitfalls such as histocyte aggregation, cystic-lining cells in nodular goiters, and oncocytes in Hashimoto’s thyroiditis, were overwhelmingly found in BRAF V600E-negative specimens.

The Utility of Fine Needle Aspiration (FNA) Biopsy in the Diagnosis of Mediastinal Lesions.

Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections.

A Prospective Study Comparing Diagnosis of Neck Swellings by Fine Needle Aspiration Cytology with Histopathology

Aim: To to correlate the fine needle aspiration cytology findings with histopathology findings of specimens from neck swellings. Study Design; Cross-Sectional Observational Setting: Pathology Department, Chandka Medical College, Larkana Period: June 2021 to June 2023 Methods: This study consisted of neck swelling samples received in the Department of Pathology by FNAC or excision. Both Cytology and Histopathology were evaluated by an experienced pathologist. Diagnoses of cytology were compared with the histopathological examination and the data was recorded into groups that comprised of lymph nodes, thyroid gland, and salivary glands. Lesions that did not fit into these groups were classified into as “others”. Data was entered and analyzed using SPSS Version-22. Results: There were a total of 261 cases of neck swelling samples received in our department. Most of the cases were due to lymph node (n=104) pathologies notably due to reactive hyperplasia and tuberculosis. The thyroid gland (n=95) was the second most common region for FNAC and most samples showed the diagnosis of colloid goiter followed by follicular adenomas. There were n=30 samples of salivary glands whereas n=32 were classified into others. Overall sensitivity and specificity were variable among the regions of FNAC with the highest being (100%) in the salivary glands and lesions classified into others category. Practical Implication: Comparing neck swelling diagnosis via Fine Needle Aspiration Cytology (FNAC) with Histopathology is vital to validate FNAC's accuracy before definitive treatment. It ensures informed decision-making, avoiding unnecessary surgeries and minimizing risks. Conclusion: FNAC of the neck swellings is a highly accurate technique and provides the first line of diagnosis. However, FNAC does have its own limitations and this technique should always be complemented by a confirmatory histopathology. Keywords: Fine needle Aspiration Cytology, Neck Swellings, Lymph node, Salivary Glands, Thyroid Glands

Pilot Study on the Use of Untargeted Metabolomic Fingerprinting of Liquid-Cytology Fluids as a Diagnostic Tool of Malignancy for Thyroid Nodules.

Although it is the gold standard for assessing the malignancy of thyroid nodules (TNs) preoperatively, the cytological analysis of fine-needle aspiration cytology (FNAC) samples results in 20-30% of cases in indeterminate lesions (ITNs). As two-thirds of these lesions will appear benign after diagnostic surgery, improved preoperative diagnostic methods need to be developed. In this pilot study, we evaluate if the metabolomic profiles of liquid-based (CytoRich®) FNAC samples of benign and malignant nodules can allow the molecular diagnosis of TNs. We performed untargeted metabolomic analyses with CytoRich® FNAC in a monocentric retrospective study. The cohort was composed of cytologically benign TNs, histologically benign or papillary thyroid carcinomas (PTCs) cytologically ITNs, and suspicious/malignant TNs histologically confirmed as PTCs. The diagnostic performance of the identified metabolomic signature was assessed using several supervised classification methods. Seventy-eight patients were enrolled in the study. We identified 7690 peaks, of which 2697 ions were included for further analysis. We selected a metabolomic signature composed of the top 15 metabolites. Among all the supervised classification methods, the supervised autoencoder deep neural network exhibited the best performance, with an accuracy of 0.957 (0.842-1), an AUC of 0.945 (0.833-1), and an F1 score of 0.947 (0.842-1). Here, we report a promising new ancillary molecular technique to differentiate PTCs from benign TNs (including among ITNs) based on the metabolomic signature of FNAC sample fluids. Further studies with larger cohorts are now needed to identify a larger number of biomarkers and obtain more robust signatures.

HER2/ERBB2 overexpression in advanced gallbladder carcinoma: comprehensive evaluation by immunocytochemistry and fluorescence in situ hybridisation on fine-needle aspiration cytology samples

AimsAdvanced gallbladder carcinoma (AGBC) carries a poor prognosis with dismal survival. There are no data regarding HER2/ERBB2 expression in AGBC. This study evaluated the overexpression of HER2/ERBB2 in cytological aspirates...

Significance of non-granulomatous cytomorphology on fine needle aspirate in lymphadenitis cases classified as tuberculous by using a composite reference standard.

Fine needle aspiration cytology (FNAC) is established as a first line investigation for tuberculous lymphadenitis (TBLA). We aimed to describe the various cytomorphologic features of tuberculosis (TB) on FNAC and their contribution in the diagnostic decision-making in suspected TBLA cases. Patients with presumptive TBLA were prospectively enrolled (n = 266) and subjected to routine diagnostic work-up for TB, including FNAC samples, and followed until the end of treatment. Patients were categorized as TB or non-TB cases based on a composite reference standard of which the various cytomorphologic patterns were compared. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy was calculated using cross-tabulation. Fifty-six patients were categorized as bacteriologically confirmed TB, 102 as clinically confirmed TB and 108 as non-TB. The most common cytomorphologic pattern among TB cases (59%) was granulomatous inflammation with necrosis, however, about one-third of tuberculous lymphadenitis patients presented with non-granulomatous inflammation, with 21% showing only necrosis and 13% presenting with a reactive pattern. The overall sensitivity and specificity of FNAC was 85% and 66%, respectively. We found that about one-third of TBLA patients presented without granulomas on FNA, highlighting the importance of considering TB in a wide spectrum of cytomorphology in a high TB burden setting. Our study supports the use of FNAC as a first-line investigation tool for diagnosing TBLA in a low-resource setting due to its relative simplicity and good sensitivity. However, the low specificity of FNAC, emphasizes the need for a second-tier confirmatory test with improved specificity.

Accuracy of Ultrasound Scans as Compared to Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules.

Thyroid nodules (TNs) are among the more common findings on physical examinations. Due to the fear of the TN harboring malignancy and with the increasing incidence of thyroid cancer, ultrasound (US) scanning is used as an important diagnostic tool in the assessment of a TN. The American College of Radiology's Thyroid Imaging Reporting and Data System (TI-RADS) was established based on specific patterns composed of two or more features. According to the TI-RADS guidelines, a suspicious nodule by US findings should undergo fine-needle aspiration cytology (FNAC), in which results would guide further management. This study was carried out to assess the accuracy ofUS as compared to FNACin the diagnosis of a thyroid nodule. This retrospective study involved 213 cases that were sent for FNAC after having done a US scan of the thyroid. Data was gathered from all patient files that were referred for FNAC thyroid between 01/02/2018 and 30/06/2021 in Al-Ahli Hospital in the state of Qatar. The US scans were interpreted and reported according to the TI-RADS criteria. The FNAC samples were interpreted and reported according to the Bethesda System for Reporting Thyroid Cytopathology. Data were tabulated and analyzed with Excel (Microsoft, Redmond, WA, USA) and SPSS version 25 (IBM Corp., Armonk, NY, USA). The study showed that US had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 73.9%, 72.6%, 24.6% and 95.8%, respectively, with a significant association between the results of US and the results of FNAC (X2 (1, n = 213) = 20.295, p < .001) and a significant positive correlation (phi coefficient = .309, p < .001). In addition, the data showed that the odds for having a positive FNAC were 7.519 (95% CI: 2.811, 20.112) times greater for cases with positive US compared with cases with negative US. The relative risk of having a positive FNAC when the US was positive was 5.913 (95% CI: 2.440, 14.332) times greater compared to when the US was negative. While our results showed that US cannot be solely relied on in diagnosing TNs, they did show that US can reliably rule out a malignancy in TNs. Recent studies have been showing increasing accuracy of US in diagnosing TNs and more studies are needed to explore this topic.

Utility and Limitations of Fine-Needle Aspiration Cytology in the Diagnosis of Lymphadenopathy.

Fine needle aspiration cytology (FNAC) is a valuable tool for evaluating lymphadenopathy. The purpose of this study was to assess the reliability and effectiveness of FNAC in the diagnosis of lymphadenopathy. Cytological characteristics were evaluated in 432 patients who underwent lymph node FNAC and follow-up biopsy at the Korea Cancer Center Hospital from January 2015 to December 2019. Fifteen (3.5%) of the four hundred and thirty-two patients were diagnosed as inadequate by FNAC, with five (33.3%) of these diagnosed as metastatic carcinoma on histological examination. Of the 432 patients, 155 (35.9%) were diagnosed as benign by FNAC, with seven (4.5%) of these diagnosed histologically as metastatic carcinoma. A review of the FNAC slides, however, showed no evidence of cancer cells, suggesting that the negative results may have been due to FNAC sampling errors. An additional five samples regarded as benign on FNAC were diagnosed as non-Hodgkin lymphoma (NHL) by histological examination. Of the 432 patients, 223 (51.6%) were cytologically diagnosed as malignant, with 20 (9.0%) of these diagnosed as tissue insufficient for diagnosis (TIFD) or benign on histological examination. A review of the FNAC slides of these 20 patients, however, showed that 17 (85.0%) were positive for malignant cells. The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and accuracy of FNAC were 97.8%, 97.5%, 98.7%, 96.0%, and 97.7%, respectively. Preoperative FNAC was safe, practical, and effective in the early diagnosis of lymphadenopathy. This method, however, had limitations in some diagnoses, suggesting that additional attempts may be required according to the clinical situation.

Diagnostic utility of special stains in defining the spectrum of maxillofacial pathologies.

The Fine needle aspiration cytology (FNAC) is considered as a valuable and distinguished diagnostic test in the initial assessment of the patients presenting with a mass in the head and neck region or when a recurrence is suspected after previous treatment. This study was therefore designed to elucidate the efficacy of FNAC as an alternate diagnostic tool to histopathology in head and neck swellings and evaluation of staining efficacy of PAP and MGG stain over Haematoxylin and eosin (H and E) in routine cytopathological smears. The study was conducted in the Department of Oral and Maxillofacial Pathology, where FNAC samples were collected from 150 patients with head and neck swellings. All the slides were stained with H and E, Papanicolaou (PAP), and May Grunewald Giemsa (MGG) stains. The cytopathological diagnosis was compared with histopathological diagnosis based on H and E stained sections obtained from paraffin-embedded formalin-fixed biopsy specimen of benign and malignant neoplasms. The resulting data were analyzed using SPSS software version 19. Differences between the variables were analyzed using Pearson Chi-square test and Kruskal-Wallis test wherever applicable. The FNAC as a diagnostic tool has sensitivity of 84.8%, 72.72%, and 78.78%, specificity of 62.5%, 75%, and 75%, and accuracy of 80.48%, 73.14%, and 78.04% in H and E, MGG, and PAP stain, respectively. PAP stain was the most efficient stain when all qualitative parameters are taken into consideration with maximum sensitivity and specificity for achieving definitive cytodiagnosis. The FNAC is an inexpensive and minimally invasive technique to diagnose different types of head and neck swellings and complement histopathological diagnosis.

Evaluation of Fine Needle Aspiration Cytology versus Culture for Laboratory Diagnosis of Subcutaneous Mycosis

Introduction: Subcutaneous swellings are commonly seen in clinical practice having varied pathology from epidermal inclusion cyst to malignancy. Subcutaneous mycosis is a fungal infection of subcutaneous tissue and dermis which is more prevalent in workers of rural, tropical, and subtropical regions. The subcutaneous infection mostly occurs due to minor trauma which goes unnoticed. Fine Needle Aspiration Cytology (FNAC) followed by microbiological analysis is a cost-effective and simple procedure and can be considered as one of the main modalities for early diagnosis. Moreover, it gives an early presumptive identification of fungus, which helps the clinician in a timely therapeutic approach. Aim: To study the efficacy of FNAC in the diagnosis of subcutaneous mycosis in comparison with culture method. Materials and Methods: A cross-sectional study, including clinically diagnosed cases of subcutaneous mycosis was evaluated between the periods of March 2019 to February 2021 in a tertiary care hospital in Northern Odisha. FNAC samples from all the cases of subcutaneous mycosis were studied cytologically and microbiologically. Cases were analysed and further evaluated on the basis of their age, sex, detailed clinical history, and presentation. FNAC showed the presence of fungal elements in 20 cases. Microbiological evaluation of these samples was carried out. Results: Out of the total 50 cases of subcutaneous mycoses, male (16): female (4) ratio was 4:1 and the commonest age group affected was 20-60 years of age (75%). The most common site of involvement was the lower limb (60%) followed by upper limb (30%). Almost all the cases were from rural areas with a history of trauma present in 11 cases (55%). Out of 50 clinically diagnosed cases, cytological examination revealed fungal element in 20 (40%) cases. The most common cytological diagnosis was abscess with neutrophilic infiltration seen in 13 cases (65%) followed by granuloma in 7 cases (35%). All the 20 samples were further evaluated in conventional methods like KOH mount and culture. Fungal agents were isolated in 13 (65%) cases. Cladosporium spp. was the commonest isolate in 5 cases (25%). Conclusion: Subcutaneous mycosis is a rare disease. FNAC can be used as a rapid and cost-effective screening tool in the diagnosis of such cases as it is more sensitive. Though culture is the gold standard test, it is less specific.

Evaluation of Breast, Lymph Node, and Thyroid Fine Needle Aspiration Cytology by Liquid Based Smears and Conventional Smears

Introduction: Fine needle aspiration cytology (FNAC) is a first-line investigation for palpable lumps and is a highly cost-effective and accurate investigative technique. It is a safe, simple, rapid, minimally invasive technique. Liquid-based cytology (LBC) has been used in gynecologic-cytology for over three decades. Many laboratories have adopted LBC technique for exfoliative and FNA samples. We undertook the present study to compare the advantages and disadvantages of conventional and liquid based cytology preparations. Aim of the study: To evaluate the diagnostic accuracy of LBC and Conventional smears in fine needle aspiration cytology samples from breast, lymph nodes, and thyroid tissue. Materials and methods: FNA material from accessible sites such as palpable breast lumps, thyroid, and lymph nodes were collected from 100 patients and was processed by two different methods, i.e., Conventional smears and by LBC. Various parameters on the slides were considered and compared for both the preparations. Out of 100 FNA samples, 51% were of Thyroid, 34% were of lymph node and 15% were of breast lumps. Observations and results: Adequate cellularity and better architecture was present in conventional smears than LBC preparations. Background material was less, and monolayers were better in the LBC preparations. Informative background material (i.e. Colloid, lymphoglandular bodies, etc) was more in cases of Conventional smears. The nuclear and cytoplasmic details were nearly equally good in both the preparations. Conclusion: Both these methods have their own advantages and disadvantages. Before incorporating LBC as a routine method, pathologists should familiarize themselves with all the aspects of LBC.

Programmed Death Ligand-1 Testing in Adenocarcinoma Lung: A Comparative Study of Cell Block versus Biopsy.

Immunotherapy currently stands as a novel treatment option, specifically in cases of advanced non-small cell lung carcinoma (NSCLC). Expression of programmed death ligand-1 (PD-L1) in tumor cells forms the mainstay for the use of anti-PD-L1 monoclonal antibodies in the treatment of NSCLC. The objectives of the study were to assess utility of cell blocks for testing of PD-L1 in adenocarcinoma lung and to compare the expression of PD-L1 in cell blocks and the corresponding biopsy specimens. The current study was a prospective case series that included 20 cases of NSCLC-adenocarcinoma lung. Cases included in the study had biopsies performed from lung masses, along with which cell blocks were prepared from fine needle aspiration cytology (FNAC) samples. Testing for PD-L1 was done using the monoclonal PD-L1 antibody, SP-263 clone on the Ventana Benchmark XT system. PD-L1 expression was assessed only in the tumor cells, and cases with >1% expression, cytoplasmic or membranous, in tumor cells were categorized as positive. PD-L1 expression was identified in the biopsy samples of tumor cells of 20% of cases (n = 4/20). In the corresponding cell blocks, PD-L1 expression was identified in the tumor cells of 15% of cases (n = 3/20). Sensitivity and specificity of cell blocks were 75% and 100%, respectively. Positive and negative predictive values were 100% and 94.12%, respectively. PD-L1 testing has both predictive and prognostic implications. PD-L1 testing in cell block samples is a potential alternative, specifically in cases where biopsy tissue is minimal or unavailable.

HER2/ERBB2 Overexpression in Advanced Gallbladder Cancer: Evaluation by Immunocytochemistry and Fluorescence in Situ Hybridization on Fine-Needle Aspiration Cytology Samples

HER2/ERBB2 Overexpression in Advanced Gallbladder Cancer: Evaluation by Immunocytochemistry and Fluorescence in Situ Hybridization on Fine-Needle Aspiration Cytology Samples