Liquid-based Cytology Smears Research Articles

Evaluation of the Utility of Liquid-based Cytology, Cell-blocks, and Flow Cytometric Immunophenotyping on Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Samples in the Diagnosis of Sarcoidosis.

There is little information on the value of different processing methods for samples obtained during endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) in suspected sarcoidosis. We evaluated the role of conventional smears, liquid-based cytology (LBC), cell-blocks and flow cytometric immunophenotyping in the diagnosis of sarcoidosis using EBUS-TBNA samples. This was a prospective study of consecutive EBUS-TBNA samples from clinically suspected cases of sarcoidosis. In addition to conventional smears, we prepared LBC smears, cell-blocks, and performed flow cytometric evaluation of the CD4:CD8 ratio. The final diagnosis of sarcoidosis was made based on the relevant clinical details and laboratory investigations including the results of transbronchial and endobronchial biopsies (TBLB and endobronchial biopsy). We included 60 subjects [mean age: 45.2 y; 29 (48.3%) men]. The sensitivity of conventional smears, LBC, and cell-blocks for diagnosing sarcoidosis was found to be 75.5%, 37.8%, 35%, respectively, when used alone. However, on combining conventional and LBC smears, the sensitivity increased to 84.4% and on combining all three techniques, the sensitivity was 86.7%. The CD4:CD8 ratio on flow cytometric immunophenotyping of EBUS-TBNA samples ranged from 0 to 11.5 with a mean of 3.17±2.78 in confirmed cases of sarcoidosis and 70% of these cases had CD4:CD8 ratio of more than 2. Cell-blocks and liquid-based preparations add to the yield of conventional preparation of EBUS-TBNA samples in the diagnosis of sarcoidosis. A combination of conventional and LBC works well in detecting almost 85% of the cases of sarcoidosis. Higher CD4:CD8 ratio favors a diagnosis of sarcoidosis.

Liquid based cytology and immunohistochemistry on cytosmears based diagnosis of letterer-siwe disease in a 40 year male

: Histiocytes with coffee bean like nucleus are the diagnostic hallmark of Langerhans cell histiocytosis (LCH) supported with immunohistochemical (IHC) demonstration of fascin, CD1a and S-100. We report a case of Letterer-Siwe disease in a 40year male diagnosed on cytology and IHC on cytosmears along with cytomorphology in Liquid based cytology (LBC) smears. Forty year male presented with complains of low grade fever and reduced appetite from two years with a cervical swelling and discomfort from five months. Fine needle aspiration(FNA) from cervical lymph node showed sheets of histiocytes in background of mixed inflammatory cells. LBC smears highlighted fine chromatin, delicate nuclear outline with coffee bean like morphology. On IHC tumor cells were positive for S-100 and CD1a. CT thorax revealed consolidation in left lower lung, bone lesions were found on skeletal survey. Hence diagnosis of Letterer-Siwe disease was given. Patient responded well to systemic chemotherapy.

Does Liquid-Based Technology Improve Detection of Cervical Epithelial Abnormalities and Worth in Low Resource Setting?

Introduction: Cervical cancer is the most frequent cancer among Nepalese women. Aims: This study was undertaken to assess the strength of liquid-based cytology (LBC) and conventional Pap smear (CPS) in detecting cervical dysplasia/cancer, and assess feasibility of LBC in our setting. Methods: It was a cross-sectional study. Samples were collected from 312 patients for CPS and LBC by split sampling technique. Smears were interpreted according to the Bethesda System. The results between two methods were compared and analyzed statistically by applying Chi-square and t-tests. Results: There was no significant difference in adequacy rates, representativeness, detection of organisms and epithelial abnormalities between two methods. Neutrophils, haemorrhage, mucus and debris were more in CPS than LBC (P value <0.05). Conclusion: We didn’t find significant difference between two methods in detecting cervical epithelial abnormalities. The high cost of LBC makes CPS still a better option in the countries with low resource setting.

Cytology of peritoneal implants of borderline serous tumor of ovaries in ascitic fluid.

Objectives:Peritoneal fluid cytology is done routinely in cases with serous carcinoma of ovary. However, morphologic features of borderline serous tumors (BSTs) of ovary in ascitic fluid have been rarely described. The aim of our study was to evaluate the morphologic features of BST with and without ascitic fluid involvement (BST+ and BST-, respectively) and compare with those of serous carcinomas, both in conventional and liquid-based cytology (LBC) smears.Material and Methods:Out of 30 BST cases reported in 3 years, seven cases had BST+. We compared the cytomorphology of seven cases of BST+, seven cases of BST-, and seven cases of serous adenocarcinoma with positive ascitic fluid cytology. Both conventional and LBC smears were studied in all cases and compared. Histopathology of omentum in these cases was also studied.Results:Most cases with BST+ had regular papillary fragment borders with nuclei showing mild-to-moderate pleomorphism, fine nuclear chromatin with small nucleoli as compared with serous carcinomas all of which had irregular borders with moderate-to-severe nuclear pleomorphism, coarse chromatin, and macronucleoli.Conclusion:A combination of cytoarchitectural and nuclear features can help in suspecting BST in ascitic fluid. Ascitic fluid cytology together with tissue histology can increase the rate of the detection of peritoneal implants.

Hybrid AI-assistive diagnostic model permits rapid TBS classification of cervical liquid-based thin-layer cell smears

Technical advancements significantly improve earlier diagnosis of cervical cancer, but accurate diagnosis is still difficult due to various factors. We develop an artificial intelligence assistive diagnostic solution, AIATBS, to improve cervical liquid-based thin-layer cell smear diagnosis according to clinical TBS criteria. We train AIATBS with >81,000 retrospective samples. It integrates YOLOv3 for target detection, Xception and Patch-based models to boost target classification, and U-net for nucleus segmentation. We integrate XGBoost and a logical decision tree with these models to optimize the parameters given by the learning process, and we develop a complete cervical liquid-based cytology smear TBS diagnostic system which also includes a quality control solution. We validate the optimized system with >34,000 multicenter prospective samples and achieve better sensitivity compared to senior cytologists, yet retain high specificity while achieving a speed of <180s/slide. Our system is adaptive to sample preparation using different standards, staining protocols and scanners.

English

BACKGROUND The major cause of mortality among women is cancer of the uterine cervix. It is the second most common cancer worldwide. Pap smear is done as a method of cervical screening to detect precancerous and cancerous lesions of the cervix. Early detection of these lesions prevent the number of deaths from cervical cancer. Liquid based cervical cytology was developed to improve the diagnostic accuracy of pap smears. The main purpose of this study was to compare the profile of distribution of cervical smear cytology lesions obtained by thin prep preparation (liquid based cytology) and conventional pap method among women in the age group of 25 – 60 yrs. METHODS This is a cross sectional study done among 110 women from the outpatient department of Obstetrics and Gynaecology. Conventional and liquid based cytology smears were taken simultaneously from the same women and reported according to the 2001 Bethesda system. RESULTS Majority of the women included in this study fall in the age group of 41 - 50 years [65 (59.1 %)]. Women with a history of persistant vaginal infection were 13 (11.8 %). Out of the 110 pap smears taken by both conventional and liquid based methods, unsatisfactory smears were not detected in liquid based cytology and 6 (5.5 %) unsatisfactory smears were found in conventional pap method. In liquid based cytology, inflammatory smears were detected more (80 %), atrophic smears (2.7 %), smears with features of atypical squamous cells of undetermined significance (ASCUS) were 4.5 %, low-grade squamous intraepithelial lesion (LSIL) were 3.6 %, and smears with high-grade squamous intraepithelial lesion (HSIL) were 0.9 %. Epithelial cell abnormalities were found to be high in liquid based cytology. CONCLUSIONS Abnormal epithelial lesions were detected more in liquid based cytology (thin prep method). The number of unsatisfactory smears were found to be decreased when compared to conventional pap method. KEY WORDS Bethesda Cervical Cytology, Cervical intraepithelial lesion, Conventional Pap Smear, Liquid Based Cytology Smear

Comparing Sensitivity and Specificity of Liquid-Based and Conventional Cytology Smears in Fine Needle Aspirates for Diagnosis of Breast Mass

Comparing Sensitivity and Specificity of Liquid-Based and Conventional Cytology Smears in Fine Needle Aspirates for Diagnosis of Breast Mass

Should Liquid Based Cytology (LBC) be Applied to Thyroid Fine Needle Aspiration Cytology Samples?: Comparative Analysis of Conventional and LBC Smears.

Context:Liquid-based cytology (LBC) is a cyto-preparatory technique that may be applied to fine-needle aspiration (FNA) samples. However, its efficacy over conventional smears (CS) in thyroid is controversial.Aims:The aim of this study was to compare CS versus LBC (SurePath, BD) preparations in thyroid FNA samples for diagnostic efficacy.Settings and Design:Prospective case-control study using split sample analysis in 200 non-consecutive cases of thyroid FNA reported as per the Bethesda system.Methods and Material:Detailed cytomorphological features were evaluated in CS and LBC preparations. Cellularity was scored as 0–3. Based on diagnostic efficacy, they were categorized into three groups:(i) CS and LBC equivalent for diagnosis, (ii) CS better than LBC, and (iii) LBC better than CS for providing the diagnosis.Statistical Analysis Used:Paired t test for cellularity scores and descriptive for diagnostic efficacy.Results:There were 7 unsatisfactory, 118 benign, 10 atypia or follicular lesion of undetermined significance, 25 follicular neoplasms, 6 suspicious for malignancy, and 34 malignant thyroid FNA cases based on routine conventional smears. Cellularity of conventional smears was significantly higher than paired LBC smears (paired t test, P < 0.005). Comparison of overall diagnostic efficacy showed that LBC and CS were equivalent in 59% of cases; CS was superior to LBC in 37% cases and LBC was better than CS in 4% cases only. LBC smears showed higher unsatisfactory rate as compared to CS (18% vs. 3.5%). In category 2, the two techniques were equivalent in 87% of cases. In categories 4 and 6, CS were superior to LBC.Conclusions:In thyroid FNA cases, conventional smears are superior to LBC preparation in terms of cellularity and diagnostic efficacy and hence, LBC preparations should not replace conventional smears for making a routine cytomorphological diagnosis.

Comparison of Liquid-Based Cytology and Conventional Papanicolaou Smear for Cervical Cancer Screening: An Experience From Pakistan.

IntroductionAfter the introduction of cervical cancer screening program with cervical cytology, a marked decline in deaths secondary to cervical cancer was observed in developed countries. Two methods are used for cervical cytology. The first one is the conventional Papanicolaou (PAP) and the second one is liquid-based cytology (LBC). Although various studies in western countries established the role of LBC in cervical cancer screening, no large-scale study was conducted in our population to compare the two techniques for cervical cancer screening. Therefore, in this study, we compared the diagnostic utility of these two techniques for detecting cervical epithelial lesions.MethodsA total of 3,929 patients, who presented to the Gynecology Clinic, Liaquat National Hospital, for cervical cancer screening from January 2015 until December 2019, over a period of five years, were included in the study. A total of 1,503 specimens were prepared by LBC, and 2,426 specimens were prepared by a conventional PAP smear method. All smears were interpreted using the Bethesda System of Reporting Cytopathology.ResultsThe mean age of the patients was 39.46±11.14 years. For cytological evaluation, 98.7% of specimens were adequate. The inadequacy rate was 1.3% for conventional PAP smear and 1.2% for LBC. While 97.2% of specimens were reported as negative for intraepithelial lesion or malignancy, 1.1% of specimens showed squamous epithelial lesions. There was a significant difference in the detection rate of squamous epithelial lesions using the two techniques. The detection rate of squamous intraepithelial lesions using LBC was 2.1%, which was higher than that of the conventional PAP smear (0.6%). The detection rates of glandular lesions using LBC and conventional PAP smear were 0.5% and 0.2%, respectively.ConclusionWe found a higher disease detection rate of squamous epithelial lesions using LBC compared to conventional PAP smear. Therefore, we recommend a widespread use of LBC for mass cervical cancer screening in our population.

A shape context fully convolutional neural network for segmentation and classification of cervical nuclei in Pap smear images.

Pap smear is often employed as a screening test for diagnosing cervical pre-cancerous and cancerous lesions. Accurate identification of dysplastic changes amongst the cervical cells in a Pap smear image is thus essential for rapid diagnosis and prognosis. Manual pathological observations used in clinical practice require exhaustive analysis of thousands of cell nuclei in a whole slide image to visualize the dysplastic nuclear changes which make the process tedious and time-consuming. Automated nuclei segmentation and classification exist but are challenging to overcome issues like nuclear intra-class variability and clustered nuclei separation. To address such challenges, we put forward an application of instance segmentation and classification framework built on an Unet architecture by adding residual blocks, densely connected blocks and a fully convolutional layer as a bottleneck between encoder-decoder blocks for Pap smear images. The number of convolutional layers in the standard Unet has been replaced by densely connected blocks to ensure feature reuse-ability property while the introduction of residual blocks in the same attempts to converge the network more rapidly. The framework provides simultaneous nuclei instance segmentation and also predicts the type of nucleus class as belonging to normal and abnormal classes from the smear images. It works by assigning pixel-wise labels to individual nuclei in a whole slide image which enables identifying multiple nuclei belonging to the same or different class as individual distinct instances. Introduction of a joint loss function in the framework overcomes some trivial cell level issues on clustered nuclei separation. To increase the robustness of the overall framework, the proposed model is preceded with a stacked auto-encoder based shape representation learning model. The proposed model outperforms two state-of-the-art deep learning models Unet and Mask_RCNN with an average Zijdenbos similarity index of 97 % related to segmentation along with binary classification accuracy of 98.8 %. Experiments on hospital-based datasets using liquid-based cytology and conventional pap smear methods along with benchmark Herlev datasets proved the superiority of the proposed method than Unet and Mask_RCNN models in terms of the evaluation metrics under consideration.

Cervical, anal and oral HPV detection and HPV type concordance among women referred for colposcopy

BackgroundInfection with human papillomaviruses (HPVs) can cause benign and malignant tumours in the anogenital tract and the oropharynx both in men and women. The aim of the presented study was to investigate cervical, anal, and oral HPV-detection rates among women referred to colposcopy for abnormal Cervical Cancer (CaCx) screening results and assess the concordance of HPV-types among these anatomical sites.MethodsWomen referred to colposcopy at a single centre due to abnormal cytology, conducted for CaCx screening, were subjected to cervical Liquid-based Cytology (LBC) smear testing, anal and oral sampling. Routine colposcopy consisted in multiple biopsies and/or Endocervical Curettage (ECC). HPV-detection was performed by PCR genotyping in all three anatomical sites. In high-risk (hr) HPV-DNA positive samples either from anal canal or oral cavity, anal LBC cytology and anoscopy were performed, or oral cavity examination respectively. Descriptive statistics was used for the analysis of HPV-detection rates and phi-coefficient for the determination of HPV-positivity concordance between the anatomical sites.ResultsOut of 118 referred women, hr. HPV-DNA was detected in 65 (55.1%), 64 (54.2%) and 3 (2.5%) at cervix, anal canal and oral cavity respectively while low-risk HPV-DNA was detected in 14 (11.9%) and 11 (9.3%) at cervix and anal canal respectively. The phi-coefficient for cervix/anal canal was 0.392 for HPV16, 0.658 for HPV31, 0.758 for HPV33, − 0.12 for HPV45, 0.415 for HPV52 and 0.473 for HPV58. All values were statistically significant (p < 0.001).ConclusionsThe results suggest that most HPV-types, high-risk and low-risk, detected in the cervix of women with prevalent cervical dysplasia, correlate with the ones detected in their anal canal. This particularly applies for the HPV-types included in the nonavalent HPV-vaccine (HPVs 6/11/16/18/31/33/45/52/58).

A comparison of liquid-based cytology and conventional smears in fine needle aspiration cytology of thyroid lesions: Diagnostic efficacy and pitfalls

Introduction: Fine needle aspiration cytology is an unrivalled method of preoperative triage of thyroid lesions. The use of liquid-based cytology (LBC) is now extended to nongynecological samples due to the advantages of lesser screening time, clearer background, and potential use of leftover material for ancillary investigations. Aims and Objectives: The aim of the study is cytomorphological comparison of LBC and conventional method and cytohistopathological correlation in surgically resected cases. Materials and Methods: Fine needle aspiration was done in 100 patients. Conventional smears were prepared followed by LBC from the remaining material. The smears from both the methods were scored semiquantatively and were compared cytomorphologically. Pearson's Chi-square test and fisher's exact test were used for P value calculation using SPSS software. A P Results: LBC had more unsatisfactory as well as suspicious for malignancy cases. The cells in LBC were in three-dimensional clusters and singly scattered with loss of cellular architecture. The nuclei were shrunkun and hyperchromatic with spilling of cytoplasm. The background colloid, blood as well as lymphocytes were mostly washed off. Immunocytochemisrty results were not affected by the LBC procedural steps. Conclusion: It was very difficult to come to a conclusive diagnosis with the help of LBC alone. It can be useful for ancillary investigations like immunocytochemistry as in this study. Thus, it can be used as a supplement to conventional method rather than replacing it.

The role of endobronchial ultrasound-guided transbronchial needle aspiration liquid-based cytology in the diagnosis of mediastinal lymphadenopathy.

BackgroundEndobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a minimally invasive, reliable technique for sampling mediastinal lymph nodes (LNs). Liquid‐based cytology (LBC) is widely used for cervical cancer screening because it provides reliable and feasible results. The present study aimed to evaluate effectiveness of the combination of EBUS‐TBNA and LBC in the diagnosis of mediastinal lymphadenopathy.MethodsA total of 602 LNs that were retrospectively analyzed were sampled in 442 patients who underwent EBUS‐TBNA between January 2014 and December 2016. The histopathological result of TBNA tissue or cell blocks was considered as the gold standard to evaluate diagnostic utility of LBC and conventional smears (CS) for the diagnosis of mediastinal lymphadenopathy.ResultsOf the 602 LNs, 265 were mediastinal LN metastases from lung cancer, four were lymphoma, and 333 were benign. The sensitivity of LBC and CS in the diagnosis of mediastinal LN metastases from lung cancer was 72.8% and 63%, respectively, and the specificity was 98.5% and 97%, respectively. The positive predictive values for LBC and CS were 97.5% and 94.4%, respectively, whereas the negative predictive values were 82.2% and 76.9%, respectively. The accuracy of LBC and CS was 88% and 83.7%, respectively. The diagnostic value of LBC was significantly higher than that of CS (P = .001).ConclusionsThe combination of EBUS‐TBNA and LBC is a highly reliable and feasible procedure that optimizes diagnostic utility for the diagnosis of lung cancer and mediastinal LN staging.

Incidental Finding of Microfilaria in Cervicovaginal Liquid-Based Cytology Smear.

Incidental Finding of Microfilaria in Cervicovaginal Liquid-Based Cytology Smear.

Machine Learning Classification of Cervical Tissue Liquid Based Cytology Smear Images by Optomagnetic Imaging Spectroscopy

Machine Learning Classification of Cervical Tissue Liquid Based Cytology Smear Images by Optomagnetic Imaging Spectroscopy

Artificial Intelligence via Competitive Learning and Image Analysis for Endometrial Malignancies

Objective of this study is to investigate the potential of an artificial intelligence (AI) technique, based on competitive learning, for the discrimination of benign from malignant endometrial nuclei and lesions. For this purpose, 416 liquid-based cytological smears with histological confirmation were collected, each smear corresponded to one patient. From each smear was extracted nuclear morphometric features by the application of an image analysis system. Subsequently nuclei measurement from 50% of the cases were used to train the AI system to classify each individual nucleus as benign or malignant. The remaining measurement, from the unused 50% of the cases, were used for AI system performance evaluation. Based on the results of nucleus classification the patients were discriminated as having benign or malignant disease by a secondary subsystem specifically trained for this purpose. Based on the results it was conclude that AI based computerized systems have the potential for the classification of both endometrial nuclei and lesions.

Comparative study of squamous intraepithelial lesion detection and unsatisfactory rates between liquid-based cytology and conventional smears from a split sample in cervical cancer screening: A Japanese experience

Comparative study of squamous intraepithelial lesion detection and unsatisfactory rates between liquid-based cytology and conventional smears from a split sample in cervical cancer screening: A Japanese experience

Comparative Analysis of Liquid based and Conventional Cytology Smears in Fine Needle Aspirates from Breast Lesions.

Context:Liquid-based cytology (LBC) is being extensively used for the evaluation of both gynecological and non-gynecological specimens. Suspension of cells in monolayer makes better morphological assessment possible. Along with this, inherent morphological changes such as altered, reduced, or lost background material, fragmented cell clusters, smaller cell size, nucleolar prominence, etc., need to be considered.Aim:Present study was aimed at comparative evaluation of utility of LBC versus conventional smear (CS) in assessing breast lesions and whether it can be used as an alternative to conventional preparation.Settings and Design:Present study was a prospective study in which 75 cases of breast fine-needle aspiration cytology from patients with palpable breast lumps constituted the study group.Material and Methods:The first pass was used for CS and LBC; a second pass was given. The representative CS and LBC smears were compared using several criteria.Statistics:Each feature was scored individually and evaluated statistically using Wilcoxon's signed rank test on the SPSS program.Results:A statistically significant difference was found in informative background and background blood-debris, whereas the difference was not statistically significant in other features such as cellularity, cytoarchitectural pattern, presence of monolayer, and nuclear and cytoplasmic details.Conclusion:LBC is a promising technique in the field of cytology. It has the potential to decrease the number of slides screened per case and decrease the turn-around-time.

Liquid-based cytological diagnosis of achylous unilateral bancroftian pleural effusion: An uncommon presentation of a common problem

Lymphatic filariasis is endemic and common in India. Filariasis is a widespread public health problem seen commonly in tropical countries. Filarial organism can be detected in cytological smears from various sites of the body in clinically unsuspected cases of filariasis. Incidental detection of filarial organism has been reported in cytological smears from almost any part of the body; however, it is very rare to detect these organisms in achylous hemorrhagic pleural fluid specimen. Demonstration of microfilaria in liquid-based cytological smears is rarely reported. To the best of our knowledge, the present case of achylous bancroftian pleural effusion diagnosed on liquid-based cytology (LBC) is the first one from the Indian subcontinent. We report a case with microfilariae of Wuchereria bancrofti in an 80-year-old male patient who presented with achylous, hemorrhagic unilateral pleural effusion in LBC.

Liquid-based cytology versus conventional cytology in fine-needle aspiration cytology of thyroid, salivary gland, and lymph node swellings: a comparative study

Purpose To compare the cytomorphologic features of liquid-based cytology (LBC) and conventional preparation (CP) smears in fine-needle aspiration of thyroid, lymph node, and salivary glands. Patients and methods The study included 110 patients experiencing thyroid, salivary gland, and lymph node swellings, who presented to the Surgical Oncology Outpatient Clinic and referred to Cytology Unit of the Pathology Department of the National Cancer Institute, Cairo University, for fine-needle aspiration cytology, from the period January 2017 till July 2018. For each fine-needle aspiration cytology, three passes were performed: the first two were for conventional cytology, and the third one for LBC, where a semiautomated SurePath technique was used. The comparison between both techniques was done using Wilcoxon signed rank test, regarding the cellularity, cell architecture, monolayering, nuclear details, cytoplasmic details, informative background, and bloody background. Results CP was significantly better regarding the cellularity, cellular architecture, and informative background of thyroid lesions, whereas LBC was better when the absence of bloody background was considered. On the contrary, no significant difference was found between both preparations regarding monolayer formation and nuclear and cytoplasmic details. Conclusion CP is superior to LBC in preservation of cellular pattern, gives better cellular yield, eliminates hemorrhagic background, and maintains the stroma and background, which are important for diagnosis. As such stroma is lacking in LBC, it should be interpreted with support of CP in certain lesions.