Needle Aspiration Smears Research Articles

Improving Diagnostic Accuracy for Plasmacytoid Urothelial Carcinoma: Insights from Cytological Evaluation of Fine Needle Aspiration (FNA) Smears and Urine Samples

Improving Diagnostic Accuracy for Plasmacytoid Urothelial Carcinoma: Insights from Cytological Evaluation of Fine Needle Aspiration (FNA) Smears and Urine Samples

Comparative Study of May-Grunwald Giemsa-stained Hemorrhagic Thyroid Aspirates with Turk\'s Fluid-treated Hemorrhagic Thyroid Aspirates to Improve the Quality of Fine Needle Aspiration Smears

Comparative Study of May-Grunwald Giemsa-stained Hemorrhagic Thyroid Aspirates with Turk\'s Fluid-treated Hemorrhagic Thyroid Aspirates to Improve the Quality of Fine Needle Aspiration Smears

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.

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.

A case report of Rosai–Dorfman disease of the breast

Abstract Rosai-Dorfman disease (RDD), or sinus histiocytosis with massive lymphadenopathy, is a benign, self-limiting disease. In the majority of cases, there is massive and painless lymphadenopathy in any lymph node group but most commonly in the cervical lymph nodes, associated with constitutional symptoms. Extranodal involvement has been reported to occur in almost every organ system, with or without concomitant nodal disease. The breast is a rare site of presentation of this disease. A 52-year-old female presented with a hard, nodular swelling(3x2cm) in the left breast, with a clinical suspicion of malignancy. Atypical cells were note in fine needle aspiration smears. Histopathology and immunohistochemistry were of critical importance and showed a specific pattern of histiocytosis. A diagnosis of Rosai-Dorfman disease (RDD) was made. RDD of the breast is a rare form of histiocytosis, with fewer than 100 globally published cases. Although the management of this disease is not established yet by guidelines, a follow-up approach should be enough for these patients, and surgery might be overtreatment. Mortality from RDD is very low due to comorbidities. A multidisciplinary team decision is important, and abstinence might significantly benefit these patients.

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.

The Role of Cytomorphometric Image Analysis in the Diagnosis of Thyroid Nodules.

Introduction Fine needle aspiration cytology (FNAC) plays a vital role in the diagnosis of thyroid nodules. However, it is challenging due to the heterogeneity of thyroid nodules, overlapping cytomorphological features, and interobserver variability. Cytomorphometric analysis turns subjective observations into quantitative values. In this study, we performed cytomorphometric image analysis on cytological smears of thyroid nodules, classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Materials and methods A retrospective analysis of Papanicolaou (PAP) and Hematoxylin & Eosin (H&E) stained fine needle aspirate smears from 50 patients with thyroid nodules with available follow-up histopathology was performed for a period of two years (March 2021 - March 2023), after obtaining approval from the institutional human ethical committee (IHEC-LOP/2020/IM0355). The nodules were categorized according to TBSRTC and werethen subjected to cytomorphometric image analysis. Each nucleus was analyzed for 14 parameters, including aspect ratio, intensity, diameter, perimeter, roundness, area, fractal dimension, feret diameter, circularity, radii, fournier description, and chromatin texture parameters such as heterogeneity and clumpiness. The data obtained was analyzed through relevant statistical methods using SPSS version 23 (IBM Inc., Armonk, New York) and was compared by using the analysis of variance (ANOVA) test and post hoc test. Results Our results revealed that cytomorphometric image analysis not only distinguishes benign and malignant thyroid nodules but also can aid in categorizing thyroid nodules with predominant follicular patterns, such as follicular variant of papillary carcinoma, follicular adenoma and follicular carcinoma (p<0.001). Conclusions Morphometric analysis of cytological smears combined with cytomorphology has the potential to be an important tool in the diagnosis of thyroid nodules. It can improve diagnostic accuracy for better treatment and improved prognosis.

To Study the Correlation between Fine Needle Aspiration Cytology, Smear and Culture in Tubercular Cervical Lymphadenitis in Central India Population

To Study the Correlation between Fine Needle Aspiration Cytology, Smear and Culture in Tubercular Cervical Lymphadenitis in Central India Population

MASC Gets UNMASKED: Visiting a Rare Tumor with Emphasis on Cytomorphological Features.

Secretory carcinoma (SC) is a newly described entity which has been often misdiagnosed earlier as acinic cell carcinoma on cytology. Diagnosing SC was initially based upon identifying the ETV6:NTRK3 fusion gene with the help of fluorescence in situ hybridization (FISH). Lately, with more knowledge of the reliable histomorphology, cytology, and immunohistochemistry features, definitive diagnosis can be confidently made without the help of FISH in almost every case. Six histologically confirmed cases of SC were studied. The cytology slides of all the six cases were retrieved and reviewed to identify the characteristic features which could have helped in raising the possibility of SC on fine needle aspiration cytology itself. Cell blocks were also studied, wherever available. Patients were all male with average age of 35.2 years. The six cases in the current study demonstrated at least focal cytoplasmic vacuolization of varying sizes, papillae formations, and bland nuclear features on fine needle aspirate smears. It was also seen that S-100 and mammaglobin immunohistochemistry (IHC) are very helpful in confirming the diagnosis. The results of the current study highlight the cytomorphological features which may help in clinching the diagnosis SC on cytology itself. They also highlight certain cytological features which help to rule out the other differential diagnoses.

Cytological findings of rhizomelic chondrodysplasia punctata: A rare skeletal dysplasia

Chondrodysplasia punctata (CDP) is a rare, skeletal dysplasia characterized by stippled, punctuate calcifications around joints and within cartilages. A 4 months old female infant presented to us for aspiration cytology with clinical suspicion of sarcoma due to complaint of ankle swelling and failure to thrive. Fine needle aspiration (FNA) smears were acellular with only calcific deposits. On clinical co-relation depressed nose and frontal bossing were noted. We suspected it to be a case of congenital skeletal dysplasia. Plain X-ray of the lesion was ordered and it revealed stippled calcification in place of ankle bones consistent with chondrodysplasia punctata. The present case is an index case describing the cytology of chondrodysplasia punctata. CDP is mainly a radiologically diagnosed lesion, however the knowledge of its cytological picture through this case will make pathologists alike aware if they encounter such case. The management is basically supportive and rehabilitative.

Study the estrogen (ER) and progesterone (PR) receptor in case of primary and metastatic breast cancer

Background: Worldwide, breast cancer is the most common invasive cancer in women.It comprises 22.9% of invasive cancers in women and 16% of all female cancers. It accounts for 15% of cancer deaths worldwide.Objective: to study the expression of ER/PR on breast cancer by immunocytochemistry on fine needle aspiration smears. Material and Methods: A prospective study was carried out on 120 cases of breast lump, referred from various clinical Departments to cytopathology lab of a tertiary care center in North India, during September 2018 to March 2020. Two sets of Fine Needle Aspirate smears were obtained from breast lump and palpable lymph node, if present. Both sets of smear were air dried and fixed in propyl alcohol for 1-2 hours.First set of smear was used for cytology, in which cytology was positive, the second set of smear were packed in aluminum foil and preserved at -20 degree Celsius. Slides were then stained for ER and PR receptor. Later on when patient undergone surgery findings were correlated with histopathology. Results : The most common symptom was breast lump (87.5%) with tumour size of 2.0-5.0 cm. ER were positive in 65.0% cases, PR were positive in 57.5% and ER+/PR+ in 55.0% of cases.

Value of measurement of nuclear diameter of cells in fine needle aspiration smears in the diagnosis of follicular lesions of the thyroid

Journal of Diagnostic Pathology is a peer reviewed journal published biannually by the College of Pathologists of Sri Lanka. The journal publishes manuscripts dealing with all aspects of pathology. The aim of the journal is to update knowledge and encourage original research in the field of pathology.

Importance of eosinophilic structures and its correlation with acid fast bacilli in fine needle aspiration smears of tubercular lymphadenitis

BackgroundThe hallmark of tuberculosis in cytological smears is the presence of epithelioid cell granulomas, necrosis and AFB. In cases, where AFB not detected, diagnosis of tuberculosis can be made by ancillary tests like PCR which requires infrastructure besides being expensive. In India, where majority of population is rural-based there is an imminent need of some morphological change in cytological smears which can point towards diagnosis of tuberculosis in absence of AFB. This study was done to assess the importance of eosinophilic structures (ES) and its correlation with presence of AFB. Material & methodsThis was a retrospective study over a period of one year. Lymph node aspirates reported as granulomatous lymphadenitis, tubercular lesion or suppurative lesion were included. All smears for each case, stained with May Grunwald Giemsa (MGG), Hematoxylin and Eosin (H&E) and ZN stain were retrieved and rescreened for the presence of eosinophilic structure, necrosis, granulomas and AFB. ResultsOur study included 256 cases. Most common age group was 21–30 years with female predominance. Cervical lymph nodes were most commonly involved. In relation to ES and AFB four cytological pictures were seen i.e ES + AFB+ (44.54%) ES + AFB- (5.46%) ES- AFB+ (14.45%) ES - AFB- (35.55%). Chi square test showed a high significant statistical association between ES and AFB(p = 0.00001). ConclusionIn developing countries with very high TB prevalence like India, where new diagnostic modalities are unaffordable by rural population, presence of ES should be included as a morphological parameter in routine cytology reporting of tubercular lesions.

Cytological and histopathological characterization of squamous cell carcinoma from mammary region in a male dog : A case study

Cancer is a fatal malignant disturbance of growth and one of the major causes of morbidity and mortality among canines. Squamous cell carcinoma (SCC) is relatively more common and a highly malignant neoplasm, known to affect dogs. However, SCC of the mammary region is rare in occurrence in both veterinary and human medicine. The present study describes a case of well differentiated SCC of the mammary region in a male dog. An eleven-year-old intact male Pit Bull was presented in Veterinary Polyclinic Lalhri Distt Una, with a history of multiple cutaneous ulcerative lesions in the region of right posterior mammary gland. Fine needle aspiration and touch impression cytology smears were stained with giemsa examined on the day of presentation revealed large number of malignant squamous epithelial cells occurring either individually or in clusters exhibiting marked pleomorphism, anisocytosis and anisokaryosis suggestive of SCC. Surgical resection of the lesion involving mammary tissue was done. The excised mass grossly presented as grayish, irregular in size, lobulated subcutaneous tissue. The representative tissue pieces preserved in 10% neutral buffered formalin were subjected to histopathological evaluation. Histopathological examination revealed cords and nests of proliferating neoplastic cells in the dermis consisting of immature polyhedral cells at the periphery and eosinophilic laminated keratin pearls at the centre separated by thin fibrous tissue stroma confirmed it for well differentiated form of SCC. The diagnosis of a well differentiated SCC was made on the basis of cytological findings and further confirmed on histopathological evaluation besides special staining.

Diagnostic Significance of Fine Needle Aspiration Smear and Cell Block Study in Skin and Subcutaneous Nodules

Background: Evaluation of patients with skin or subcutaneous nodules, especially if it was multiple represents a major problem for the clinicians. But with full investigations, the problem becomes easier. However, the final diagnosis depends on pathological reports of tissue biopsy [1]. The easy access of the skin nodule provides the soil for performance fine needle aspiration cytology and taking the samples by the pathologists, or the clinicians. Smear cytology gives many defaults[2]. Performance of cell blocks was a trial to avoid these defaults and improve the diagnosis. The results of smear and cell block examinations were compared with examination of tissue biopsies. Methodology: Two hundred twenty five skin and subcutaneous nodules from 225 patients underwent the material of this study. The patients were selected from those referred topathology department, faculty of medicine Zagazig University, through the period between January 2018 and December 2020. Fine needle aspirations were performed utilizing the ordinary 22-gaugeneedle 10 cc syringes. Cell blocks were done utilizing the remnants in the syringe after performance of the smears. Histopathological examination was done using biopsies taken later on. Results: According to tissue biopsy examination: Benign lesions constitute the commonest findings (180 cases) 80% 0f cases: Lipoma35 cases (15.5%), Adipose tissue30 cases (13.3%), Fibrolipoma 20 cases (8.8%), Fibroma20 cases (8.8%), Juvenile fibroma 5 cases (2.2%), Neurofibroma 5 cases (2.2%), Sebaceous cyst in 25 cases (11.1%), Implantation cyst, or dermoid cyst 20 cases (8.8%), Pilomatrixoma 5 cases (2.2%), Seborrheic keratosis 10 cases (4.4%), Madura foot (actinomycosis) 5 cases (2.2%). Intermediate lesions: Atypical lipoma 5 cases (2.2%). Malignant lesions 25 cases (11.11%): Basal cell carcinoma10 cases (4.4%), squamous cell carcinoma 10 cases (4.4%), Basosquamous cell carcinoma 5cases (2.2%). For the FNAC smear examination, the sensitivity test was: 83.01%, the specificity test was: 16.66%. For the cell blocks examination, the sensitivity test was: 97.77%, specificity test was: 100%. Conclusion: Smear cytology is an easy, rapid test for diagnosis of skin nodule and performance of cell blocks improves its sensitivity and specificity outcome, but both must be attempted, because smear may be inefficient for some cases while cell block cannot be performed others.

The Role of Immunocytochemical Markers to Differentiate Primary from Secondary Neoplastic Hepatic Masses: A Diagnostic Challenge on Cytology.

It is challenging and difficult to differentiate primary from metastatic hepatic masses solely on cytology. The present study aimed to correlate cytomorphological spectrum of hepatic masses with immunocytochemical markers to differentiate primary from metastases in liver. The present study comprised of 30 clinico-radiologically suspicious cases of neoplastic hepatic masses. Ultrasound-guided fine needle aspiration smears and cell blocks were prepared as per standard technique; two of the smears were air-dried and Giemsa stained to study cytomorphological features. A panel of markers (HepPar-1, CD 10, CK7, CK19, CD34, and MOC-31) were studied both in smears and cell blocks. Cytomorphological features on smears were evaluated and correlated with immunocytochemistry in all cases; the final diagnosis was: Hepatocellular carcinoma (n=7), cholangiocarcinoma (n=2), hepatoblastoma (n=1) and metastatic carcinoma (n=20). HepPar-1, CD10 and CD34 demonstrated 86%, 72%, 86% sensitivity and 100% specificity respectively for hepatocellular carcinoma; CK7&CK19 showed 100% sensitivity for cholangiocarcinoma, MOC 31 showed 90% sensitivity and 100% specificity for metastatic carcinoma. The present study recommends a panel of minimum three markers (HepPar-1, CD10, and MOC-31) which were helpful to differentiate hepatocellular carcinoma from metastatic carcinoma that was a major diagnostic challenge solely on cytomorphology. Correlating cytomorphology with these three markers, 100% of the cases could be diagnosed as primary malignancy and distinguished accurately from metastatic carcinoma.

A novel combined animal tissue model for freehand and ultrasound-guided fine needle aspiration biopsy and smear preparation techniques training.

A variety of models are used for fine needle aspiration biopsy (FNAB) and smear preparation techniques training: human, animal and silicon models or combined models. We present fresh animal tissues as models for freehand and ultrasound (US)-guided FNAB technique training, enabling an integrated approach from tumour detection to smear evaluation. We introduced a novel combined animal tissue model using dietary animal meat with covering skin as a substrate. Animal liver tissue of various sizes, representing tumour, was inserted into the various layers of the substrate (subcutaneous fat, muscle tissue, proximity of bone). Freehand and US-guided FNAB smear preparation, including fixation, was then performed and assessed. The use of a combined animal tissue model for 6 freehand and 3 US-guided FNAB sessions showed a statistically significant improvement in the US-guided FNAB retrieval of liver tissue (Fisher's exact test, p = .0216), in smear preparation technique reflected in a decrease in the number of too thick smears after freehand FNAB (Fisher's exact test, p = .0070), in the overall number of smears satisfactory for evaluation by US-guided FNAB (Fisher's exact test, p = .0206) and in the number of flawless smears obtained in the freehand FNAB training sessions (Fisher's exact test, p = .0020). A unique advantage of the presented model encompassing various layers of animal tissues with covering skin, offers an integrated approach for FNAB training from "tumour" detection, puncture precision, to smear preparation and cytological evaluation for a wider audience and does not compromise patient safety.

Role of nuclear morphometry in diagnosis of salivary gland neoplasms.

Fine needle aspiration cytology is an important diagnostic tool in salivary gland cytopathology. However, cytology of salivary gland neoplasms shows diversity with morphological overlap, heterogeneity and subjective variability, posing diagnostic challenge. Nuclear cytomorphometric image analysis turns the subjective criteria into quantitative parameters, which may aid not only in differentiating between benign and malignant tumours but also can aid in categorising challenging cases with morphological overlap. A retrospective analysis of Papanicolaou stained fine needle aspirate smears from 50 patients with salivary gland neoplasms, with available follow-up histopathology, was performed. The aspirates were categorised in to three neoplastic categories of Milan system for reporting salivary gland cytology (MSRSGC) that is benign neoplasm, salivary gland neoplasm with uncertain malignant potential, and malignant. The smears were subjected to cytomorphometric image analysis using Image Pro Software (version 10). Each nucleus was analysed for 13 parameters including aspect ratio, intensity, diameter, perimeter, roundness, area, Feret diameter, circularity, radii, Fournier description and chromatin texture characteristics such as margination, heterogeneity and clumpiness. The data obtained was compared through relevant statistical methods. The comparative morphometric data obtained for parameters using ANOVA, for the three categories showed statistically significant P values (<0.001). The post hoc test (Games-Howel) test also showed significant P values (<.001). Cytomorphometric image analysis is an important tool in diagnosis of salivary gland neoplasms and can improve the diagnostic accuracy for better treatment and improved prognosis. However, more studies with larger sample size may be needed in future for further affirming its role.

Efficacy of modified cell block cytology compared to fine needle aspiration cytology for diagnostic oral cytopathology

ABSTRACT Cell blocks and fine needle aspirations can be used for cytopathological diagnosis. Conventional fine needle aspiration smears provide limited material for diagnosis. The cell block technique provides more tissue, which improves diagnostic accuracy. We compared a modified cell block cytology to fine needle aspiration for providing optimal preservation of histochemical and immunocytochemical properties. We used 30 fine needle aspirates from oral lesions in two groups: group 1, fine needle aspiration cytology; group 2, cell block cytology. Smears of fine needle aspirates were stained with Papanicolaou. For the modified cell block technique, aspirated material was centrifuged to create a cell pellet, which then was fixed with Nathan alcohol formalin substitute. After routine histopathological processing, cell pellets were embedded in paraffin, then sectioned and stained with hematoxylin and eosin. Sections were compared to Papanicolaou stained smears of fine needle samples. Cellular morphology and staining quality of modified cell block samples were superior to fine needle aspiration cytology; both methods exhibited distinct nuclear morphology. Modified cell blocks provide excellent cytopathologic features compared to fine needle aspiration cytology.

Removal of Air-Drying Artifact of Papanicolaou Stained Smears with Normal Saline and Fresh Frozen Plasma

Background Papanicolaou stained (Pap) smears in fine needle aspiration cytology play an important role for studying chromatin details of the cells and also ensures its optimal resemblance with the cell nuclei on histological sections. The conventional Pap Stained smears are ethanol fixed before drying. But delay in fixation due to any reason results in drying artifacts in the stained smears making it an inept smear for further examination. Aims & objectives: To study the role of rehydration fluid for removal of air drying artifact. Material and methods: Fifty fine needle aspiration smears from different organs with drying artifact in Pap Stained smears were included in the study. The smears were destained, rehydrated with rehydrating fluid for two hours and were restained with Pap stain after fixation with 95 % alcohol. Results : Smears treated with this solution showed reversal of the air drying artifact with better nuclear details and background material staining. Conclusion: Rehydration of destained Pap smears with rehydrating fluid followed by restaining results in optimal staining of the nuclear and background details preventing the material loss and making the smears appropriate for staining.