Fine Needle Aspiration Smears Research Articles

The indeterminate categories of the Milan system for reporting salivary gland cytopathology (MRSGC): A minireview

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), first published in 2018, attempted to develop a standardized and objective system of reporting salivary gland fine needle aspiration smears. It was widely accepted by the cytopathologists who started using it in their day-to-day practice. With the publication of new literature, the Milan system was updated and the 2 edition was released in 2023. The 5 WHO classification of salivary neoplasms, ancillary tests, and imaging characteristics of various salivary neoplasms have also been highlighted in the new edition. The 3 indeterminate categories of the Milan system of reporting are the atypia of undetermined significance (AUS), salivary gland tumor of undetermined malignant potential (SUMP), and suspicious for malignancy (SM) that create major dilemmas for the reporting cytopathologists. The present minireview highlights the criteria of diagnosis and further workup of the various lesions in these categories.

Reporting Pancreatic FNAC using the Papanicolaou System: Still a Diagnostic Challenge

Introduction: The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) is a reliable method to classify pancreatic fine needle aspiration cytology (FNAC) smears. However, it is not without practical problems which can diminish the diagnostic accuracy of the cytological diagnosis. Aims and Objectives: To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. Materials and Methods: Retrospective analysis of pancreatic FNAC smears received in the Department of Pathology of our tertiary care institute over a period of 2 years was done. The cytological diagnoses were classified according to the Papanicolaou Society of Cytopathology system of reporting pancreaticobiliary cytology and correlated with histopathology. The reasons of cyto-histological discordance were analyzed. Results: Out of 50 cases in which both FNAC and biopsy of pancreatic lesions were done, 34 cases were positive/malignant (Category VI), eight cases were suspicious for malignancy (Category V), three cases were neoplastic (Category IV), two cases were atypical (Category III), two cases were negative for malignancy (Category II), and one case was non-diagnostic (Category I). Out of 50 cases, histopathology was non-diagnostic due to inadequate material in six cases. The cytological diagnoses were compared with histopathology in the remaining 44 cases. Categories III, IV V, and VI were considered as positive for neoplastic pathology. The sensitivity of FNAC to predict neoplastic pathology was 97.5%, while the specificity was 25%. The positive predictive value was 92.9%. Two cases reported as atypical (Category III) turned out to be adenocarcinoma on histopathology. One case reported as neuroendocrine tumor and two cases reported as adenocarcinoma on cytology displayed features of chronic pancreatitis on histology. One case reported as neoplastic mucinous cyst (Category IV) turned out to be adenocarcinoma on histology (limited concordance). Conclusion: The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs.

Cytological, Histopathological and Immunohistochemical Studies on Naturally Occurring Cutaneous Melanomas in Cattle in and Around Namakkal, Tamil Nadu, India

Background: Melanomas are tumours that originate from melanoblasts. The studies on bovine tumours are of clinical concern since some melanocytic tumours are congenital and occur in young animals. The present work was carried out to study the pathomorphological characteristics of melanomas in cattle for early diagnosis and intervention. Methods: Tumour samples were collected from suspected cases of neoplasia from four animals during the study period. Data pertaining to the animals were collected. Fine needle aspiration cytology and impression smear were stained with Giemsa stain. Tissue samples were collected in 10 per cent neutral buffered formalin for histopathological examination. Special staining with Fontana silver stain and immunohistochemistry with Melan- A and S- 100 markers for confirmatory diagnosis of melanin pigment was done. Result: Cytology revealed neoplastic cells with vacuolation and pleomorphism. Cytoplasm contained abundant melanin pigments. Microscopically, the cytoplasm contained abundant brown, black coloured melanin pigment granules. Tissue sections stained with Fontana silver impregnation method revealed the presence of black coloured granules. Immunohistochemistry with Melan-A and S-100 revealed strong expression of brown coloured reaction in the cytoplasm of the neoplastic cells.

Study of diagnostic accuracy of non-aspiration cytology in solid tumors

Fine needle aspiration cytology (FNAC) is widely accepted as a primary method for the diagnosis of thyroid lesions. An alternative to FNAC is fine-needle sampling without aspiration (FNNAC). FNAC is easy to perform, quickly and has a high degree of sensitivity and specificity and avoid unnecessary surgery. Hence the present study was performed to study the diagnostic accuracy of FNNAC with FNAC technique in solid tumors.: An observational study was carried out on 325 patients with swellings in the breast, thyroid, and soft tissues and enlarged lymph nodes in the Department of surgical oncology, Regional Cancer Centre, Government Coimbatore Medical college hospital, Coimbatore, India. A single pathologist was responsible for all cytological and histological reports. Slides of both approaches were analysed and compared using Mair et al grading methodology, which depends on five factors. The number of smears with superior quality and diagnostic accuracy is compared and analysed statistically using the 'z' test for two proportions.: FNNAC produced better smears with less haemorrhage in vascular organs like the thyroid. FNAC performed better in breast fibrous lesions such as fibroadenoma and phyllodes tumour. For malignant lumps of breast and lymph nodes, FNAC yields better material than FNNAC.: The current research shows that FNNAC is the superior approach for highly vascular organs such as the thyroid because it yields high-quality smears with less blood admixtures. Although FNAC smears were more often diagnostic, they typically yielded acceptable rather than excellent grade smears.

Comparison of liquid based cytology and conventional smears on lymph node aspirates: A cytomorphological study.

In an era of minimally invasive and rapid diagnostic technologies, fine-needle aspiration cytology (FNAC) is most useful when it comes to patients with lymphadenopathies especially of the cervical region. Liquid-based cytology (LBC) is an alternative processing method which is used for both gynecological and non-gynecological samples. Because of the remarkable advantages of LBC smears in gynecological samples, nowadays, many studies have been done to assess its utility in various other lesions. Hereby, with the help of this study, we would like to evaluate the efficiency of LBC smears in comparison to conventional FNAC smears conventional smears (CS) on lymph node aspirates. A retrospective study was done over a 1-year period in which 253 cases of lymph node aspirates were included in the study. The slides were prepared using standard conventional and LBC techniques and compared for adequacy, cellularity, cell architecture, necrosis, background debris, presence of cells in monolayer sheets, and nuclear/cytoplasmic details. Of the total 253 cases, 171 (67.6%) were and 67 (26.5%) were diagnosed as non-neoplastic and malignant, respectively. Although the LBC smears were useful in the diagnosis of malignant cases, they did pose some challenges especially in the non-neoplastic lymph node aspirates due to loss of the background necrosis. In addition, the cellular yield in LBC smears was low in comparison to CS. LBC smears from lymph node aspirates results in better diagnostic accuracy for malignant cases due to better cellular and nuclear details. However, for non-neoplastic etiology, it should not be considered better than CS as loss of the background necrosis and inflammation may result in an incorrect diagnosis.

Fine needle aspiration biopsy of parathyroid; is it meaningful? A cytologic study of 81 cases with histological and clinical correlations.

Recognizing the parathyroid gland and distinguishing the parathyroid from thyroid lesions in fine needle aspiration (FNA) is challenging. This study aimed to identify cytomorphologic features suggestive of parathyroid origin and to assess the utility of cytopathology in conjunction with ancillary tests in the identification of parathyroid glands. Ultrasound (US) guided FNA of parathyroid gland and lesions in 81 patients were reviewed concerning clinical history and correlated to histopathologic findings in available cases. FNA smears were evaluated for cellularity, architectural patterns, cellular and nuclear features, and background of the smears. In 78 cases, FNA was supplemented by a measurement of parathormone (PTH) levels in the needle washout fluid (FNA-PTH assay) and/or GATA3/PTH/chromogranin-A immunostainings. Sixty-four cases were diagnosed cytologically as parathyroid lesions in conjunction with FNA-PTH assay and/or immunocytochemical examinations. In an additional nine cases, a diagnosis of parathyroid lesions was rendered after repeated FNA with FNA-PTH assay. The histolopathologic diagnosis of surgically excised cases (n = 75) included parathyroid adenoma (60 cases), atypical parathyroid adenoma (4 cases), parathyroid hyperplasia (10 cases), and parathyroid carcinoma (1 case). Major cytological findings of parathyroid tissue included high cellularity, scattered naked nuclei, cribriform and three-dimensional clusters, stippled chromatin, and oxyphilic cytoplasm while papillary pattern or colloid-like material was identified in three cases respectively. No nuclear grooves or inclusions were seen in any case. High cellularity scattered naked nuclei, cribriform and three-dimensional patterns, stippled chromatin and oxyphilic cytoplasm are cytomorphologic features that favour parathyroid origin. A combination of these features with FNA-PTH assay and/or GATA3, PTH, and chromogranin-A immunostainings on cytologic specimens aid in the identification of parathyroid glands and the distinguishing of parathyroid from thyroid lesions.

Gross Appearance of Fine Needle Aspiration Smears: Can Adequacy of the Sample be Assessed and Correlated with their Microscopic Cytological Yield.

Fine needle aspiration cytology (FNAC) is a simple procedure that is widely accepted as a first-line investigation. It should ideally be performed near the patient with microscopic assessment for evaluation of adequacy of aspirate. Since this is not always possible, a worthwhile substitute is to assess the gross appearance of the material obtained. This study was aimed to determine the value of this alternative rapid, bed-side approach. This study was carried out in a tertiary care hospital for a duration of 1 year, where 50 cases undergoing FNAC in the out-patient department (OPD) were included. Unstained smears of commonly encountered lesions were photographed and assessed by three independent observers, who graded them into four grades, viz. Grade 1: unlikely to contain diagnostic material. Grade 2: possibly contains diagnostic material. Grade 3: probably contains diagnostic material. Grade 4: material suggesting a specific diagnosis. Results were subsequently compared with the microscopic findings of stained smears. Distribution of the 50 cases between grades 1, 2, 3, and 4 were 5, 6, 17, and 22, respectively. Gross appearances of FNA smears are helpful in predicting the adequacy of the sample and sometimes the final microscopic diagnosis. The cellularity of a sample can be gauged by inspection and sometimes a likely diagnosis can be made. Some lesions show typical gross appearance easily detected by the experienced eye so a likely diagnosis can be predicted prior to microscopic examination. However, near-patient microscopic assessment of FNA specimens for rapid onsite evaluation, if available, should be the preferred mode.

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.

To study the diagnostic role of fine needle aspiration biopsy cytopathology in lymph node lesions and to find out the pattern of lymphadenopathy among patients visiting Tertiary care hospital: A cross-sectional study

Fine needle aspiration cytology (FNAC) can be a valuable tool for the evaluation of lymphadenopathies. The purpose of this study was to study the diagnostic role of FNAC in lymph node lesions and to find out the pattern of lymphadenopathy among patients visiting Tertiary care hospital. Fine needle aspiration biopsy cytopathology was carried out. Giemsa staining of all FNAC smears was done and Ziehl-Neelsen staining (ZN Stain) was done to confirm the diagnosis if required. Lymph nodes were evaluated for location, consistency, size, mobility. Commonest site involved was cervical region (91.38%), most frequently encountered size was 1 - 2 cm (35.64%), majority of lesions were firm (87.35%), and most of the lymph nodes (95.40%) were mobile. Out of 166 diagnosed cases by FNAC, 95.78% were diagnosed as benign lesions and 4.22% as malignant lesions. 30.72% benign lesions were of reactive hyperplasia and 27.11% were of granulomatous lymphadenitis. All malignant lesions were the secondary lesions. We conclude that FNAC of lymph nodes is a very common, simple, safe, economical, and quick diagnostic technique that eliminates the need for an open biopsy, anesthetic, surgical complications, and hospital stays.

Case Report: Cytodiagnosis of pigmented villonodular synovitis involving carpal bones of right wrist

Background Pigmented Villonodular Synovitis (PVNS) is a rare disease of osteoskeletal tissue. Cytodiagnosis of PVNS on fine needle aspiration (FNA) smears is therefore rarely reported. The PVNS usually affects the larger joints. The involvement of the smaller joints and bones are uncommon. Case presentation The reported case is one such rarity wherein the diagnosis of PVNS was carried out on the FNAC. The case showed the involvement of all carpal bones except for the pisiform. The 2nd- 5th metacarpal bases were also found to be involved in the disease process. The presence of sheets of synoviocytes with brown altered hue to the cytoplasm along with multinucleate giant cells and pigmented macrophages were characteristically present in the smears of FNA. The diagnosis was confirmed on the tissue biopsy. The present case is reported for its unusual multiosteotic involvement of wrist joint bones and the metacarpal bones simultaneously with radiological evidence. The cytomorphology of the lesion in the present case were noteworthy as a learning experience in reporting of PVNS of wrist joint on FNA smears.

Grading of Hashimoto’s thyroiditis in cytology and its association with ultrasonographic and biochemical parameters

Introduction and Aim: In the post-iodization period, Hashimoto's thyroiditis (HT) is most likely the most prevalent cause of goitre and hypothyroidism, particularly in women of reproductive years. This study was undertaken to grade HT on Fine Needle Aspiration Cytology smears and determine their usefulness in predicting thyroid damage in association with clinical history, radiological and biochemical findings. Materials and Methods: Total of 151 cases were diagnosed cytologically in duration of over 2 years as Hashimoto’s thyroiditis/lymphocytic thyroiditis. Cytology scoring technique was used to analyse smears and were correlated with radiological, biochemical findings and were evaluated statistically by ANOVA and Kruskal Wallis tests. Results: In the current study, the most frequent group of individuals with Hashimoto's thyroiditis were between the ages of 40 and 50. Females (145 cases, 96%) were commonly affected and the commonest presentation was a diffuse (125 cases ,82.8%) thyroid enlargement. Cytological grading of Hashimoto’s thyroiditis were as follows,54 (35.8%) patients were Grade I, 81(53.6%) patients were Grade II thyroiditis and 16 (10.6%) patients were Grade III thyroiditis. Biochemically, 78 (56.5%) of the cases were hypothyroid, 51 (37%), euthyroid, and 9 (6.5%) were hyperthyroid. Ultrasonography revealed 76 (50.3%) patients with hypoechoic micronodules, 71 (47%) with echogenic septae, 101 (66.9%) with increased vascularity, and 6 (4%) with normal findings. The grades of lymphocytic thyroiditis and the biochemical data were found to be statistically significant (p=0.001). Furthermore, there was a strong correlation between the grades and specific ultrasound findings, such as echogenic septae (p=0.042) and diffuse hypoechogenicity (p=0.046). Conclusion: Cytological scoring system in Hashimoto’s thyroiditis can predict thyroid functional status and aid in determining the severity of the disease.

Application of the Milan System for Reporting Salivary Gland Lesions and Its Cytohistological Correlation for Risk Stratification: A Single-Institution Experience.

Salivary gland tumors are known to have a heterogeneous profile with variable clinical presentation and a wide variety of histological subgroups of prognostic significance. Immunocytochemical markers that aid in the diagnosis and characterization of the cell type of origin are critical for this heterogeneous group of malignancies. To study the application of The 'Milan System' for Reporting Salivary Gland Cytology and the diagnostic utility of a panel of immunocytochemical markers in the diagnosis of salivary gland neoplasms and their cytohistological correlation for their risk stratification. This was a prospective study carried out in which a total of 60 patients were enrolled in the study. Fine-needle aspiration cytology (FNAC) smears and cell blocks were prepared with standard techniques and staining procedures. Immunocytochemistry (ICC) was performed on cell block sections by immunoperoxidase procedure. Immunocytochemical (ICC) stains were used for the differentiation of the lesions in cell blocks. Histopathology was also studied if the patient underwent excision of salivary gland lesions. Almost 60 cases were studied under FNAC and cell block evaluation, as well as ICC, among those five (8.33%) samples were inadequate, eight (13.3%) were non-neoplastic, 27 (45%) were benign, one (1.7%) was neoplasmwith uncertain malignancy potential, one (1.7%) was suspected of malignancy, and 19 (31.7%) were malignant.The histopathological diagnosis was confirmed in 47 cases. Of these, 24 (51.1%) were benign and 23 (48.9%) were malignant. The malignancy rate for Milan Categories I, II, III, IVa, IVb, V, and VI was 0%, 0%, 100%, 24%, 50%, 80%, and 84.6%, respectively. The study showed that malignancy risk stratification could be further improved by using cell block with immunocytochemistryas a complementary diagnostic modality. The present study was carried out to assess the usefulness of the Milan system to report salivary gland cytology results. Thus, the findings of the present study showthat the Milan system is helpful in stratifying the risk of malignancy in salivary gland tumors.

Cytomorphology of skin adnexal tumors and its correlation with histopathology in a tertiary care center

Objectives: Even though fine-needle aspiration cytology (FNAC) can be successfully used for describing the cytomorphology of skin adnexal tumors and can help in identification of them as benign or malignant, histopathology remains the gold standard in confirmation of diagnosis. Skin adnexal tumors are a large and diverse group and are relatively less commonly encountered in routine practice; hence, knowledge of cytological features of these lesions is crucial for their appropriate management. The present study aims to evaluate the cytomorphological features of skin adnexal tumors on FNAC smears and their correlation with the histopathology. Material and Methods: This is a retrospective study of FNAC of 60 cases of subcutaneous and dermal swellings over a period of 4 years from August 2018 to August 2022 in a tertiary care center. Results: In the 60 cases of skin adnexal tumors evaluated, most cases were within the 2nd to 4th decade with male predominance. The FNA smears were helpful in picking up the nature of skin adnexal tumors, as in our case series, malignant lesions were 8.3% and benign were 91.7%. Majority adnexal lesions were of follicular or sebaceous differentiation. Histological diagnosis was available in 38 cases. Cytological diagnosis in 34 cases was concordant with histopathology. There was discrepancy observed in two cases which were reported as benign skin adnexal tumor but later turned out to be sebaceous carcinoma on histopathology. Conclusion: Even though histopathology being the gold standard for confirmation of diagnosis, in the current era of minimally invasive procedures, FNAC stands out as a valuable modality and can be a promising alternative to diagnose skin adnexal tumors and understand their cytomorphology as the data are limited about it.

B-200 Preoperative Classification of Thyroid Nodules by Desorption Electrospray Ionization Mass Spectrometry Imaging of Fine Needle Aspiration Biopsies

Abstract Background Preoperative diagnosis of thyroid lesions by fine-needle aspiration (FNA) biopsy cytology can be challenging, and in up to 20% of cases is unachievable. Patients with an indeterminate preoperative diagnosis are often recommended for diagnostic surgery, with the majority receiving a benign diagnosis, rendering the surgery unnecessary. Consequently, new technologies that can provide accurate preoperative diagnosis of thyroid lesions are needed. Here, we have employed DESI-MS imaging along with statistical modeling to determine molecular signatures of benign and malignant thyroid lesions using banked thyroid tissue samples with known histopathology diagnosis. We then applied this methodology for analysis and classification of preoperatively collected FNA smears. Methods A total of 199 fresh-frozen thyroid tissues including 50 normal, 55 follicular adenoma (FTA), 58 follicular carcinoma (FTC), and 36 papillary carcinoma (PTC) were sectioned at a thickness of 10 µm and stored at −80 °C until analysis. FNA biopsies were prospectively collected at Baylor College of Medicine. DESI-MS imaging was performed in the negative ion mode using a Waters Xevo G2-XS mass spectrometer fitted with a DESI-XS source. Samples were H&E stained and pathologically evaluated after analysis. Molecular profiles from tissue regions of clear histology were used to build classification models. For the FNA smears, mass spectra corresponding to clusters of thyroid cells were extracted for statistical prediction, and the predictive performance of the models on FNA smears was assessed in correlation with pathology. Results DESI-MS analysis of thyroid tissue sections generated 151 317 individual mass spectra, comprised of hundreds of lipid and metabolite features, that were used to build and validate two classification models: PTC vs benign thyroid, comprised of normal thyroid and FTA, and FTC vs benign thyroid. For each of these models, the data was randomly split with two-thirds used as a training set to generate the model and one-third used as an independent validation set to assess the performance of the model. For the PTC vs benign thyroid model, a prediction accuracy of 97.7% was achieved for the training set with an accuracy of 96.6% for the withheld validation dataset. For the FTC vs benign model, an accuracy of 78.4% was achieved for both the training and validation datasets. We are currently refining statistical workflows to improve the performance of the FTC model and to generate a model discriminating benign thyroid from thyroid cancer (FTC and PTC combined). When testing the prediction of the classifiers built from tissue imaging data on an initial sample set of 19 FNAs, overall per-sample prediction accuracies of 79% and 89% were obtained using the PTC vs benign thyroid model and the FTC vs benign thyroid model, respectively. We are currently working to collect, analyze, and validate the performance of the classification models on additional FNA biopsies, with a focus on samples with indeterminate cytology. Conclusions Overall prediction accuracies of 79% and 89% were achieved for the benign vs PTC model and benign vs FTC model, respectively, for thyroid FNA classification. With the addition of DESI-MS, unnecessary diagnostic surgeries could be prevented by providing improved preoperative specificity.

Rapid, Economic, Acetic acid, Papanicolaou (REAP) staining technique analogous to the routine Papanicolaou staining (PAP) technique

The current research compared classical Papanicolaou stain with REAP (Rapid, Economic, Acetic Acid Papanicolaou) stain to evaluate staining character, range, charge virtue, and sustaining of stain. The PAP Stain is the standard dye in support of shielding cell study for any cell study and is used in various research centers with several reductions. In certainty, PAP Stain has lowered squamous cell carcinoma incidence by 70%, particularly within wealthy provinces with effectively-designed broadcasting systems. But the stain has gone through several changes, moving from the uncreative formal mechanism -> gradual REAP PAP staining in which staining duration level is decreased, it improves the quality, it is cost-effective, easily available, and ethyl alcohol is temporarily superseded with 1% ethanoic acid in advanced nations with guarding programs with careful planning. It has been used to access FNAC (fine needle aspiration cytology). Because of its precise nuclear and nucleoli staining, PAP staining of FNAC and fluid smears is a trustworthy stain. FNAC is a straightforward, speedy, and reliable pre-operative assessment and diagnosis process that has sparked advancements in dyeing technology which utilizes minimal coloring count with a clear cell framework. Around 40 minutes are needed for the standard methodology for traditional PAP Stain. REAP Stain was developed to address this, improving quality while cutting staining time to about one minute. This study's objective was to evaluate the value of the Rapid-Pap stain utilizing quantifiable investigation. The effectiveness of cytoplasmic and nuclear staining, stain preservation, value, and overall course of action for the two techniques—conventional PAP stain and REAP stain—were collated. When compared to traditional Papanicolaou, REAP stain offers a good, quick, and affordable replacement for the screening of cells. The REAP technique also does a superb job for the maintenance of stains.

A Cytohistopathological Correlation Study of Skin Lesions in Leprosy: An Experience in a Tertiary Care Hospital in South India

Abstract Background Leprosy is a granulomatous disease caused by Mycobacterium leprae. Early detection and clinical diagnosis remain a challenge, especially in paucibacillary cases and initial lesions during early phases of leprosy. Use of cytological methods can reduce time for diagnosis, especially in peripheral centers. Objectives The present study was taken up to calculate the correlation between cytology and histopathology of skin lesions in leprosy. Material & Methods This study is a 2-year retrospective observational study taken up in the Department of Pathology, Rangaraya Medical College and Government General Hospital, Kakinada, Andhra Pradesh. A total of 49 cases of clinically suspected leprosy were included in the study. Skin biopsies and cytological smears were examined in all cases. Results A total of 49 cases of clinically suspected leprosy were included in the study. The age incidence ranged between 9 and 72 years. There was a male preponderance. The overall diagnostic accuracy of fine-needle aspiration smears was 83.3% and that of slit-skin smears was 62.1%. Conclusion Cytological examination being a simple, less time-consuming, and easy technique can enhance the diagnostic accuracy in detection of leprosy and act as an adjunct to clinical diagnosis.

A COMPARATIVE STUDY OF FINE NEEDLE ASPIRATION CYTOLOGY VS FINE NEEDLE NON ASPIRATION CYTOLOGY VS ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN THE CYTOLOGICAL EVALUATION OF THYROID LESIONS

Introduction: FNAC is mainly used in differentiating malignant thyroid nodules from benign nodules as the later can be followed up clinically. A modified sampling technique called fine needle non-aspiration cytology (FNNAC), has come into clinical use in recent times. To evaluate the efficacy of fine-needle non-aspiration cytology (FNNAC) with that of standard fine-needle aspiration cytology (FNAC) and USG guided FNAC of thyroid lesions as regards to cellular and hemorrhagic yield. Methodology: Patients attending Out patient and In patient Department of General Surgery with clinically palpable thyroid swelling for a period of one year are included in this study. Patients were randomised into 3 groups_ 25 patients in each group. After a thorough clinical examination, all the patients in group 1 were subjected to FNAC. Patients in group 2 were subjected to FNNAC .Patients in group 3 were subjected to USG guided FNAC. The details of the technique of Fine needle cytology were explained to the patient and an appropriate consent was obtained from each case before performing the procedure. After subjecting patients to FNNAC and FNAC using 23 gauge needle,the samples were smeared and air dried and sent to the pathologist. Cytological evaluation and reporting was done by pathologist. Results: Out of 50 patients, 25 patients were subjected to FNNAC & 25 patients were subjected to USG guided FNAC from thyroid lesions. The smears was scored and graded accordingly. Based on the results, it was found that superior quality smears were more in FNNAC technique, but diagnostically adequate samples are more in USG guided FNAC than FNNAC. Conclusion: For highly vascular organs like thyroid , FNNAC is the preferred technique as there is better material with less admixture of blood. The number of superior quality smears without admixture of blood is more from FNNAC. FNAC smears although equally diagnostic, mostly produced diagnostically adequate rather than superior quality smears.

Significance of Nuclear Morphometry in Breast Lesions: A Cross-Sectional Study.

Background Fine-needle aspiration cytology (FNAC) is one of the reliable methods in diagnosing breast cancers. Morphometric studies are done in benign and malignant neoplasms of various organs by using software, which measures cellular, cytoplasmic, and nuclear parameters. Nuclear parameters define the behavior of the neoplasm. This study aims to evaluate nuclear morphometry parameters in aspirated smears of breast lesions and determine the association between cytological findings with nuclear morphometry parameters. Methodology It's a retrospective cytology study from July 2020 to June 2022 conducted at a tertiary health care center in Kolar, Karnataka, India. The FNAC smears of breast mass were analyzed cytologically and were subjected to nuclear morphometry study. Nuclear parameters such asnuclear area, nuclear perimeter, nuclear Feret diameter, minimum Feret, and shape factor were captured inZen software (Zeiss, Oberkochen, Germany) and ImageJ software (National Institutes of Health,Bethesda, MD, USA;Laboratory for Optical and Computational Instrumentation [LOCI], University of Wisconsin-Madison, Madison, WI, USA). The association between nuclear morphometric findings and cytological findings was noted. A descriptive statistical analysis was done. Results Sixty cases of mass in the breast were considered for the study of which37 cases were benign and 23 were malignant. Nuclear morphometry parameters such asnuclear area, nuclear perimeter, nuclear Feret diameter, minimum Feret, and shape factor for benign breast lesions were 25.16 ± 3.2 µm2, 21.58 ± 1.89 µm, 6.5± 0.94 µm, 4.87 ± 0.50 µm, and 0.92± 0.02, respectively, and for malignant breast cases were 46.57 ± 12.24 µm2, 27.53 ± 3.26 µm, 10.08 ± 1.18 µm, 6.49± 0.88 µm, and 0.93 ± 0.01, respectively. The association of all nuclear parameters between benign and malignant lesions was statistically significant (P= 0.001). Conclusions Nuclear morphometric study in breast lesions is a concept that supplements FNAC findings in differentiating benign from malignant lesions.

Aliens in the thyroid gland: The secondary lesions.

A secondary lesion in the thyroid gland is a rare clinical scenario diagnosed preoperatively during the evaluation of a neck mass, postoperatively in a thyroidectomy specimen or in autopsy studies. Even though the thyroid gland is highly vascular, secondary malignant lesions are rare accounting for 0.2% of all thyroid malignancies. Thyroid gland secondary lesions are often metachronous in presentation as they are seldom evaluated in the initial diagnostic workup of the primary lesion. Fine-needle aspiration cytology (FNAC) is a useful modality for the diagnosis of secondary thyroid lesions. A 6-year retrospective review (2016-2021) was carried out to assess the secondary lesions in the thyroid gland. Papanicolaou and field-stained FNAC smears of secondary thyroid lesions were reviewed. Ancillary techniques were performed on the cell block for differentiating from the primary thyroid gland lesions. There were 383 patients in our archives. There were only 18 cases (4.7%) that presented with secondary neoplastic lesions in the thyroid gland either by direct extension, metastases or as a hematolymphoid malignancy. There were 14 (77.7%) cases that presented with non-hematolymphoid secondary lesions while 4 (22.3%) cases presented with hematolymphoid malignancies. Thyroid secondaries were predominantly seen in female patients (female: male ratio of 1.5:1). Most of the cases presented with a synchronous secondary lesion (n = 14, 77.7%) and few metachronous secondary lesions were also noted (n = 4, 22.3%). Although exceedingly rare, the detection of secondary thyroid gland lesions is important for staging and planning treatment.

The utilisation of digital droplet PCR to enhance the diagnosis of bladder and pancreaticobiliary tumours in cytology specimens.

Digital droplet PCR (ddPCR) is a relatively new technique used to detect molecular alterations with unprecedented precision and accuracy. It is particularly useful for detecting point mutations and copy number variation (CNV) in samples with small amounts of target DNA. This proof of principle study was conducted to see if ddPCR technology could be applied to cytology specimens to detect molecular alterations which may influence diagnostic decision making. A range of cytological specimens derived from bladder or pancreaticobiliary origin, with varying diagnoses but with an emphasis on abnormality, underwent ddPCR testing. DNA was manually extracted from Thinprep vials, cell blocks or direct fine needle aspiration smears. ddPCR was performed using two somatic point mutations TP53 R248W and TP53 R273H assays for both urine and pancreaticobiliary cytology specimens. Three CNV assays; CDKN2A, E2F3 and YWHAZ were applied to urine samples. SMAD4 and CDKN2A CNVs were applied to the pancreaticobiliary samples. 16 of 21 urine specimens showed molecular alterations using ddPCR testing. 12 of those 16 cases were associated with malignant outcomes. The pancreaticobiliary specimens showed 14 of 37 specimens with molecular alterations, all of which were associated with carcinoma. We demonstrated an increasing percentage of molecular aberrations associated with increasing severity of cytological results. Our results have shown that ddPCR can identify both mutations and CNVs in urine and pancreaticobiliary cytology derived samples. Being able to detect these molecular alterations may reduce the number of equivocal results leading to more timely and informed patient management decisions.