Suspicious Cytology Research Articles

Pilot imaging study of o-BMVC foci for discrimination of indeterminate cytology in diagnosing fine-needle aspiration of thyroid nodules

Fluorescence lifetime imaging microscopy of a fluorescence probe, 3,6-bis(1-methyl-2-vinylpyridinium) carbazole diiodide (o-BMVC), provides an objective method for preoperative diagnosis of fine-needle aspiration (FNA) of thyroid nodules. The key of this o-BMVC test of FNA smears is the measurement of the digital number of o-BMVC foci in the nucleus. Thus, there are three categories classified in the o-BMVC test, which are nondiagnostic for unsatisfactory samples, benign for less numbers of o-BMVC foci, and malignant for more numbers of o-BMVC foci. The discrimination of indeterminate (including atypia, follicular neoplasm, suspicious) cytology into benign or malignant cases can reduce diagnostic uncertainty and benefit clinical decision making. This pilot study strongly suggests that the o-BMVC test is an invaluable method for diagnosing FNA samples. Particularly, the combination of FNA cytology and the o-BMVC test holds great promise to improve the efficacy of diagnosis and reduce the healthcare costs.

PD63-12 USE OF CXBLADDER MONITOR DURING THE COVID-19 PANDEMIC TO REDUCE THE FREQUENCY OF SURVEILLANCE CYSTOSCOPY

You have accessJournal of UrologyBladder Cancer: Non-invasive III (PD63)1 Sep 2021PD63-12 USE OF CXBLADDER MONITOR DURING THE COVID-19 PANDEMIC TO REDUCE THE FREQUENCY OF SURVEILLANCE CYSTOSCOPY Carissa Chu, Kevin Li, Maxwell Meng, and Sima Porten Carissa ChuCarissa Chu More articles by this author , Kevin LiKevin Li More articles by this author , Maxwell MengMaxwell Meng More articles by this author , and Sima PortenSima Porten More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002107.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic brought unprecedented changes to urologic care in order to minimize risks of transmission. At UCSF, we performed a prospective pilot study of the home-based, mail-in urine CxBladder Monitor (CxM) test to inform the urgency of surveillance cystoscopy in patients with non-muscle invasive bladder cancer (NMIBC). METHODS: From March-June 2020, patients with NMIBC due for surveillance cystoscopy were offered CxM prior to scheduling a clinic visit. Based on prior studies, a CxM score ≥3.5 was used to proceed with cystoscopy while a score below that threshold led to deferring (negative predictive value 97%) cystoscopy. Outcomes of interest included whether in-office cystoscopy was deferred or performed based on CxM and detection of urothelial cancer at immediate or next surveillance cystoscopy. RESULTS: 52 patients (73% men) were included in this study. Median age was 71 (IQR 65-78) years with a median of 4.0 (IQR 2.5-6.1) years since initial bladder cancer diagnosis; 3 (6%) had a history of upper tract urothelial carcinoma (UTUC). By AUA risk stratification criteria, 14 (27%), 17 (33%), and 20 (41%) were low, intermediate, and high-risk, respectively. 50% of patients had experienced recurrence since diagnosis (median 2, IQR 1-4). CxM score was ≥3.5 in 17 (33%) patients. These patients were more likely to have high grade disease at diagnosis (78% vs 64%, p=0.06) but did not differ by age, gender, race, history of UTUC, T stage, or prior recurrences versus patients with CxM results <3.5. 4 patients had tests that could not be resulted and had to be repeated. 14/17 patients (82%) with CxM≥3.5 underwent immediate cystoscopy. 7 (50%) had findings on cystoscopy necessitating biopsy (2 CIS, 2 HG Ta, 2 T2, and 1 subsequently found to have UTUC). In contrast, 35 patients with CxM scores <3.5 deferred cystoscopy to next surveillance at 3 months (63%), 6 months (34%) or 9 months (3%). Of these patients, 32 (91%) have since undergone surveillance cystoscopy (median 4.0 months after) with no suspicious tumor or cytology detected. One patient passed away from unrelated causes. CONCLUSIONS: CxM was feasible and safe for patients on surveillance for NMIBC and decreased frequency of cystoscopy. CxM may be used to further risk stratify patients to deintensify surveillance for NMIBC during the COVID-19 pandemic and beyond. Additional study of patient ease and acceptability is ongoing. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1142-e1142 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carissa Chu More articles by this author Kevin Li More articles by this author Maxwell Meng More articles by this author Sima Porten More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinico-pathological significance of suspicious peritoneal cytology in endometrial cancer

<h3>Objectives:</h3> While malignant peritoneal cytology is not the component of the current cancer staging schema, the collection of a peritoneal cytologic sample at the time of hysterectomy-based surgical staging for endometrial cancer is highly endorsed by multiple societies and organizations. Suspicious peritoneal cytology refers to the result of peritoneal cytology testing that is insufficient in either quality or quantity for a definitive diagnosis of malignancy. This study examined characteristics and survival outcomes related to suspicious peritoneal cytology in endometrial cancer. <h3>Methods:</h3> A population-based retrospective study by querying the National Cancer Institute's Surveillance, Epidemiology, and End Results Program was conducted. A total of 41,229 women with stage I-III endometrial cancer who had peritoneal cytologic sampling at hysterectomy from 2010 to 2016 were examined. A Cox proportional hazard regression model and a competing risk analysis with Fine-Gray model were fitted to assess survival outcome related to suspicious peritoneal cytology. <h3>Results:</h3> Suspicious peritoneal cytology was seen in 702 (1.7%) cases. On multivariable analysis, tumors related to suspicious peritoneal cytology had distinct characteristic for T and N stages compared to negative or malignant peritoneal cytology (all, <i>P</i><0.05). In parsimonious adjustment models, suspicious peritoneal cytology was associated with increased risk of endometrial cancer mortality (subdivision-hazard ratio 1.69, 95% confidence interval 1.29-2.20, <i>P</i><0.001) and all-cause mortality (adjusted-hazard ration 1.55, 95% confidence interval 1.27-1.90, <i>P</i><0.001) and compared to negative peritoneal cytology. A sensitivity analysis demonstrated that suspicious peritoneal cytology had discrete overall survival improvement compared to malignant peritoneal cytology in a propensity score weighting model (hazard ratio 0.85, 95% confidence interval 0.72-0.99, <i>P</i>=0.049). <h3>Conclusions:</h3> Our study suggests that suspicious peritoneal cytology may be a prognostic factor for decreased survival in endometrial cancer. The results of our analysis call for a development of further studies highlighting the significance of suspicious peritoneal cytology in endometrial cancer.

Descriptive Study: Colposcopy as a diagnostic method for cervix lesions in Hospital de Especialidades Jose Carrasco Arteaga, Cuenca-Ecuador. 2015-2019

BACKGROUND: Cervical cancer is a public health issue, being one of the main causes of morbidity and mortality in developing countries. Cervical cytology (Papanicolaou) is performed for screening and diagnosis of cervical lesions. In case of a suspicious cytology report, colposcopy is an essential procedure for evaluation of the lower genital tract, to detect early lesions and cancer. The aim of this study was to characterize the colposcopy procedures performed, as a diagnostic and therapeutic method, in patients with abnormal Papanicolaou results. METHODS: This is an observational, descriptive cross-sectional study, whose universe were all the patients with abnormal cytological diagnosis in pap smear, who underwent a colposcopy procedure between 2015 and 2019 at Hospital José Carrasco Arteaga, with a total of 1 628 patients. RESULTS: 1 628 colposcopic procedures were included. 55.46% of the population were between 27 to 46 years of age. The predominant marital status was married status (75%). 63.45% of women had their first sexual experience between 21 and 30 years of age. 95.20% of the patients had between 1 and 3 sexual partners. Abnormal pap smear results represent; 37.28% to LSIL, followed by ASC-US (35.81%), and HSIL (14.18%). 67.32% of colposcopies were classified as satisfactory. Biopsy was performed in 71% of the patients, followed by loop electrosurgical excision procedure (LEEP) (13.69%), endocervical curettage in 11.05%. The pathology results reported HSIL in 46.56% of the cases, followed by 22.23% as LSIL and chronic cervicitis in 16.27%, 12.28% of the results were negative. CONCLUSION: Three-quarters of all colposcopies were performed on women between 27 and 56 years of age. The most frequently abnormal Pap smear results were: LSIL, followed ASC-US. 67% of the colposcopies were satisfactory. After colposcopy, biopsy was performed in most of the patients, in lower percentage: loop electrosurgical excision procedure (LEEP), endocervical curettage and diagnostic hysterectomy. Pathology results reported HSIL in 46.56%, LSIL IN 22.23% and chronic cervicitis in 16.27%; 12.28% of studies were negative.

How to manage patients with suspected upper tract urothelial carcinoma in the pandemic of COVID-19?

BackgroundThe pandemic of COVID-19 has disrupted the clinical pathway for patients with suspected upper tract urothelial carcinoma (UTUC). This aims to investigate the optimal management of UTUC during the pandemic by determining 1) Whether a three-month delay of RNU leads to worsened overall survival, 2) Whether radical nephroureterectomy (RNU) can be performed without prior diagnostic ureteroscopy (URS). MethodsConsecutive patients with RNU performed for suspected UTUC in four hospitals in Hong Kong and Taiwan were included. Patients with histologically proven UTUC and with RNU performed within one year were dichotomized into early (≤3 months) and delayed (>3 months) RNU groups. Diagnostic performances of predictive models based on pre-URS factors (gross haematuria, suspicious or malignant urine cytology, and filling defect or contrast-enhancing mass on computed tomography), with or without URS, were analysed using receiver operating characteristics and area under curve (AUC). Overall survival was analysed using Kaplan-Meier method and multivariate Cox regression analysis. ResultsBetween 2000 and 2019, 665 patients underwent RNU, and 491 of them had prior diagnostic URS. The early RNU group had a better overall survival (P = 0.015). Early RNU was associated with a better overall survival upon multivariate analysis (HR 1.55, 95% CI 1.03–2.33, P = 0.035). Large tumour size, multi-focal tumour, T2 or above disease, and positive nodal status were associated with a poorer overall survival. A combination of any 2 out of the 3 pre-URS factors achieved a positive predictive value of 99.5 to 100%. Presence of all 3 pre-URS factors achieved an AUC of 0.851 with URS, and AUC of 0.809 without URS. ConclusionsA delay of RNU for over 3 months was associated with poorer overall survival and has to be avoided despite the current COVID-19. We can also consider direct RNU based on clinical factors alone. This also avoids URS hospitalization and expedites the clinical pathway of UTUC.

Clinico-pathological significance of suspicious peritoneal cytology in endometrial cancer.

Suspicious peritoneal cytology refers to the result of peritoneal cytology testing that is insufficient in either quality or quantity for a definitive diagnosis of malignancy. This study examined characteristics and survival outcomes related to suspicious peritoneal cytology in endometrial cancer. A population-based retrospective study by querying the National Cancer Institute's Surveillance, Epidemiology, and End Results Program was conducted. A total of 41,229 women with Stage I-III endometrial cancer who had peritoneal cytologic sampling at hysterectomy from 2010 to 2016 were examined. A Cox proportional hazard regression model and a competing risk analysis with Fine-Gray model were fitted to assess survival outcome related to suspicious peritoneal cytology. Suspicious peritoneal cytology was seen in 702 (1.7%) cases. In multivariable models, suspicious peritoneal cytology was associated with increased risk of endometrial cancer mortality (subdistribution-hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.29-2.20, p < 0.001) and all-cause mortality (adjusted-HR: 1.55, 95% CI: 1.27-1.90, p < 0.001) compared with negative peritoneal cytology. Sensitivity analysis demonstrated that suspicious peritoneal cytology had discrete overall survival improvement compared with malignant peritoneal cytology in a propensity score weighting model (HR: 0.85, 95% CI: 0.72-0.99, p = 0.049). Our study suggests that suspicious peritoneal cytology may be a prognostic factor for decreased survival in endometrial cancer.

The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem

Purpose To investigate whether outpatient blue-light flexible cystoscopy could solve the diagnostic challenge of positive or suspicious urine cytology findings despite normal white-light flexible cystoscopy results and normal findings on computerized tomography urography, in patients investigated for urothelial cancer. Material and methods In a multicentre study, a total of 70 examinations were performed with the use of blue-light flexible cystoscopy (photodynamic diagnosis) after intravesical instillation of the fluorescence agent hexaminolevulinate. The examination started with a conventional white-light flexible cystoscopy and then the settings were switched to use blue light. Suspicious lesions were biopsied. Afterwards, the patients were interviewed regarding their experience of the examinations. Results Bladder cancer was diagnosed in 29 out of 70 (41%) cases, among them 14/29 (48%) had malignant lesions seen only in blue light. The majority had carcinoma in situ (21/29). Normal findings were seen in 41 cases that underwent BLFC. During the further course, malignancy of the bladder was detected in six cases (9%) and malignancy of the upper urinary tract was detected in one case (1%). The majority of patients (93%) preferred the blue-light flexible cystoscopy performed at the outpatient clinic instead of the transurethral resection under general anaesthesia. Conclusion Blue-light flexible cystoscopy at the outpatient clinic may be a useful tool to solve unclear cases of a malignant or suspicious urinary cytology suggestive of bladder cancer. The procedure was well tolerated by the patients.

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology.

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine-needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cutoff in 23 (2.6%) patients ranging between 6.5 and 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, seven patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III), and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement.

Neoadjuvant Intraperitoneal Chemotherapy in Patients with Pseudomyxoma Peritonei-A Novel Treatment Approach.

Neoadjuvant intravenous chemotherapy in patients with pseudomyxoma peritonei (PMP) has not shown convincing results. The effectiveness of neoadjuvant intraperitoneal (IP) chemotherapy has never been reported. This prospective, non-randomized phase II study included patients with PMP treated between May 2017 and December 2018, who were not considered suitable for primary cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The majority of patients were treated with laparoscopic HIPEC (oxaliplatin 200 mg/m2, 60 min, 43 °C). IP chemotherapy was started 2 weeks after docetaxel 40 mg/m2 + cisplatin 40 mg/m2, accompanied by oral S1 (tegafur, gimeracil, and oteracil) (50 mg/m2) for 14 days, followed by one week rest. Clinical parameters and complications were recorded. In total, 22/27 patients qualified for CRS and HIPEC after neoadjuvant treatment. A complete cytoreduction (Completeness of cytoreduction Score 0/1) could be achieved in 54.5%. The postoperative morbidity rate was 13.6% and mortality was rate 4.5%. In total, 20/22 patients had major pathological tumor responses. The mean drop in CEA was 28.2% and in the peritoneal carcinomatosis index (PCI) was 2.6. Positive or suspicious cytology turned negative in 69.2% of patients. Thus, for PMP patients who were not amenable for primary surgery, the majority received complete cytoreduction after treatment with neoadjuvant IP chemotherapy, with satisfying tumor regression and with low complication rates. The oncological benefit in terms of survival with this new treatment regimen needs to be proven.

57. CIRCULATING TUMOR CELLS (CTC) IN CEREBROSPINAL FLUID (CSF) AS A PREDICTOR OF SURVIVAL IN CNS METASTASES

BACKGROUNDCSF-CTC testing using the CellSearch® platform is a validated diagnostic tool for leptomeningeal metastases (LM) from solid tumors. CSF-CTCs can also be detected in patients with brain metastases (BM), but their significance is unclear. Our objective was to evaluate the utility of CSF-CTC measurement in predicting outcomes in CNS metastases.METHODSWe conducted a retrospective single-institution review of patients who underwent CSF-CTC testing from 2016–2019. Information on neuroaxis imaging, CSF results, systemic cancer status, tumor molecular profile and survival was collected. LM was diagnosed by unequivocal MRI findings and/or positive or suspicious CSF cytology. Survival analyses were performed using Cox proportional hazards modeling, and CSF-CTC splits associated with survival were identified through recursive partitioning analysis.RESULTSA total of 407 patients (38% lung primary, 34% breast, 28% other tumor types) were included; of these, 144 had LM and 233 had BM diagnosed before or around the time of CSF analysis (97 had both). We identified a subgroup of newly diagnosed CNS metastases, comprising 144 patients with LM, BM, or both diagnosed within 30 days of CSF sampling: 70 patients with LM, 43 with BM, and 31 with both. For 101 patients with newly diagnosed LM, mean and median CSF-CTCs were 127.3 and 200, respectively, compared to 44.6 and 0 in the overall cohort; 73/101 had positive (66) or suspicious (7) cytology. CSF-CTCs predicted survival in patients with newly diagnosed LM, with optimal cutoff identified at 61 CSF-CTCs, above which the risk of death doubled (HR=2.09, 95% CI: 1.13–3.87, p=0.02). For this group, positive/suspicious cytology was also associated with higher risk of death, but this result was not statistically significant (HR=1.79, 95% CI: 0.95–3.35, p=0.07).CONCLUSIONIn newly diagnosed LM, quantification of CSF-CTCs predicts survival. CSF-CTC measurement can be used as a prognostic tool in patients with CNS metastases.

The Added Value of Operator's Judgement in Thyroid Nodule Ultrasound Classification Arising From Histologically Based Comparison of Different Risk Stratification Systems.

Objective: Several ultrasound classifications for thyroid nodules were proposed but their accuracy is still debated, since mainly estimated on cytology and not on histology. The aim of this study was to test the diagnostic accuracy and the inter-classification agreement of AACE/ACE-AME, American Thyroid Association (ATA), British Thyroid Association (BTA), and Modena Ultrasound Thyroid Classification (MUT) that stratifies malignancy risk considering also the clinician subjective impression.Methods: A prospective study collecting thyroid nodule features at ultrasound and histological diagnosis was conducted. Ultrasound features were collected following a preformed checklist in candidates for surgery because of indeterminate, suspicious, or malignant cytology. All the nodules, besides the cytologically suspicious one, were blinded analyzed. MUT score was applied prospectively, and the others retrospectively. Sensitivity, specificity, diagnostic cut-off value, and accuracy of each classification were calculated. The overall agreement between classifications was tested by Bland-Altman, and agreement between single nodule analysis by different classifications by Weighted Cohen's Kappa.Results: In classifying a total of 457 nodules, MUT has the highest accuracy (AUC 0.808) and specificity (89%), followed by ATA and BTA, and finally by AACE/ACE-AME. ATA, BTA, and MUT are highly interchangeable. Considering agreement between single nodule analyses, ATA and BTA had the best (κ = 0.723); AACE/ACE-AME showed slight agreement with BTA (κ = 0.177) and MUT (κ = 0.183), and fair agreement with ATA (κ = 0.282); MUT had fair agreement with both ATA (κ = 0.291) and BTA (κ = 0.271).Conclusion: Classifications have an acceptable overall diagnostic accuracy, improved using a less rigid system that takes into consideration operator subjective impression.

The predictive value of positive and suspicious urine cytology: Are they different?

Urine cytology evaluation is an effective test in the detection of high-grade urothelial carcinoma (HGUC). While the guideline distinguishes the 2 categories: "positive for HGUC" (PHGUC) and "suspicious for HGUC" (SHGUC), the association between these categories with their subsequent follow-up biopsies remains unclear. This study aims to determine and compare the positive predictive value (PPV) of the specimens in PHGUC and SHGUC categories with their respective histologic diagnoses. During the period of 03/01/2008 to 07/31/2018, urine cytology cases diagnosed as PHGUC and SHGUC with subsequent bladder biopsy within 12 months were retrieved. All cases were correlated with first biopsy obtained during 12 months of cytology specimen. Biopsy result with HGUC, carcinoma in situ, or non-urothelial carcinoma diagnoses were considered as concordance. 378 cases (229 SHGUC and 149 PHGUC) were identified from 263 patients. For the 229 SHGUC cases, the PPV was 72% (n = 166) and for the 149 PHGUC cases, the PPV was 85% (n = 127). While both categories have high PPV, they are statistically significant (p < 0.0001). Additionally, 33 cases were found to have low-grade urothelial carcinoma (LGUC), constituting a portion of discordant results. PHGUC and SHGUC categories are both associated with a high risk of malignancy, however, there is a statistically significant difference between them in our study, supporting the PSRUC guidelines of two separate categories. In instances when urine cytology is discordant with biopsy results, further investigation and clinical follow up is warranted. LGUC appears to remain a common pitfall especially in the suspicious category.

Sa1427 LONG TERM FOLLOW-UP OF ENDOSCOPIC ULTRASOUND- FINE NEEDLE ASPIRATION OF SOLID PANCREAS LESIONS WITH ATYPICAL AND SUSPICIOUS CYTOLOGY

Endoscopic Ultrasound with Fine Needle Aspiration (EUS -FNA) is a proven diagnostic tool for solid pancreatic masses. Not uncommonly, indeterminant cytology characterized as either “atypical” or “suspicious for malignancy” may be found. The risk of malignancy and follow up in these indeterminant categories has not been well established. The aim of this study was to determine the long term follow up of risk of malignancy in patients with indeterminant cytology. A total of 2,338 consecutive patients with solid pancreas lesions seen by EUS had FNA performed at a single academic tertiary care center over an 8-year period. Patients who had “suspicious” or “atypical” final cytology were identified for further clinical outcome analysis. The primary end point was the risk of having a subsequent diagnosis of malignancy based upon repeat FNA/biopsy, surgical pathology, or clinical follow-up. Fishers exact test was used for prediction of malignancy with p<0.01 considered significant. Of the 2,338 patients with pancreas mass lesions, 133 (5.7%) were given an indeterminate final cytologic diagnosis with 69 “atypical” and 64 “suspicious for malignancy.” Of the 69 patients with atypical cytology (mean 489 d of follow-up), 10 were lost to follow-up. Of the remaining 59, a total of 39 (66.1%) had subsequent diagnosis of malignancy. 66.7 % adenocarcinoma, 33.3% other malignancies. Size of atypical lesions > 2 cm (p=1.0) and > 3cm (p=0.64) did not predict final cancer diagnosis but a CA 19-9 > 100 at time of FNA predicted cancer diagnosis (p<0.01). In the suspicious for malignancy cytology group (mean 569 d follow up) 5 patients were lost to follow up. Of the remaining patients 50/59 (84.7%) were found to eventually develop malignancy. 75 % adenocarcinoma, 25 % other malignancies. Size of suspicious lesion > 2 cm (p=0.45) and > 3cm (p=0.26) did not predict malignancy. Ca 19-9 > 100 trended (p=0.06) towards eventual cancer diagnosis. 1) Atypical and suspicious cytology is found in a small but not insignificant number of patients who undergo EUS-FNA for solid pancreas masses. 2) The majority of patients with atypical cytology and vast majority with suspicious cytology will be found to have cancer with a sizable minority having cancers other than adenocarcinoma 3) Findings of indeterminate cytology in solid pancreas masses should routinely lead to repeat attempts at tissue acquisition and referral to surgery/medical oncology.

Are NLR Rate and MPV Values Useful in Predicting Malignancy in Follicular Neoplasia, Atypia of Undetermined Significance and Suspicious Cytology?

Are NLR Rate and MPV Values Useful in Predicting Malignancy in Follicular Neoplasia, Atypia of Undetermined Significance and Suspicious Cytology?

MP73-02 MALIGNANT URINARY CYTOLOGY OF UNKNOWN ORIGIN-BLUE LIGHT FLEXIBLE CYSTOSCOPY AT THE OUTPATIENT CLINIC MAY BE A VALUABLE DIAGNOSTIC TOOL

INTRODUCTION AND OBJECTIVE:The diagnostic process may be extensive in patients with positive or suspicious urinary cytology when white-light flexible cystoscopy (WLFC) is negative. The next step wo...

Performance of a dual-component molecular assay in cytologically indeterminate thyroid nodules.

Deciding whether patients with a cytologically indeterminate thyroid nodule should be referred for surgery or for active surveillance is an important challenge for clinicians. The aim of this study was to evaluate the performance of a novel dual-component molecular assay as an ancillary molecular method for resolving indeterminate thyroid nodule cytology. We selected 156 thyroid nodules from those that had undergone fine-needle aspiration processed by liquid-based cytology and surgical resection between June 2016 and December 2017. The sample set included 63 nodules cytologically classified as indeterminate, and 93 other nodules randomly selected from those with non-diagnostic, benign, suspicious, or malignant cytology. Nucleic acids from each nodule were subjected to next-generation sequencing analysis for mutation detection in 23 genes and to digital polymerase chain reaction (PCR) evaluation for miR-146b-5p expression levels. Used alone, mutation analysis in the indeterminate subset (cancer prevalence: 22.5%) displayed high sensitivity (89%) and NPV (96%). In contrast, the miR-146b-5p assay offered high specificity (93%) and PPV (93%). Combined use of both analyses improved panel performance by eliminating false-negative results. These preliminary data suggest that a dual-component molecular test can increase the diagnostic accuracy of thyroid cytology alone by reducing the number of nodules that will be classified as indeterminate and increasing those that can be reliably classified as benign. If these findings are confirmed, this test can be considered for use in clinical practice and is expected to reduce diagnostic surgery and health care costs, and to improve patient quality of life.

Wire Guided Wide Local Excision of Clinically Undetectable Breast Cancer - Initial Experience in Bangladesh

Background: With the rise of awareness of breast cancer and better screening mammography, there are increasing number of breast cancers detected before becoming clinically evident. These cancers are mostly treated by wide local excision under guidance of a wire which is put with mammogram and/or USG. In Bangladesh this procedure has never been done. We started it in Surgical Oncology Division in BSMMU with the collaboration of Department of Radiology.&#x0D; Methods: We have performed the procedure on 7 patients within 19 months. All of them had USG and mammography detected small lesions. The average size being 7.24mm. From needle biopsy 3 cases showed suspicious cytology, 4 had IDCC, and 1 had DCIS. Wire was put in all cases under USG guidance. Wire Guided Wide Local Excision was performed in all cases. $ patients underwent SLNB.&#x0D; Results: The age range was between 26 to 55 years with the average age of 43.86 years. 4 of them being post-menopausal. One case came benign. Other were malignant with clear margins. One case had close margin, which was later re-excised. All cases were sent for adjuvant therapy. Histopathology showed 4 patients of invasive ductal carcinoma, 1 patient each of invasive lobular carcinoma, DCIS and 1 being benign.&#x0D; Conclusion: This well-established procedure can be performed in Bangladesh to meet the goal of ensuring adequate treatment and cosmesis of the patients with impalpable cancer, amidst constrained facilities.&#x0D; Journal of Surgical Sciences (2019) Vol. 23(2): 81-86

Usefulness of Serum Calcitonin in Patients with Thyroid Nodules ≤ 1 cm Without an Indication for Fine-Needle Aspiration.

Fine-needle aspiration (FNA) is not necessary in adults with nodules ≤ 1 cm without apparent extrathyroidal extension (ETE) or lymph node (LN) involvement on ultrasonography (US). In the absence of FNA and serum calcitonin (Ctn) measurement, medullary thyroid microcarcinomas (microMTC) are not diagnosed. The aim of this prospective study was to evaluate Ctn levels in adults with a low clinical risk of MTC and nodules ≤ 1 cm without ETE or LN involvement on US. A total of 506 consecutively seen adults who had nodules with two or more suspicious features were included. Patients with elevated basal Ctn underwent a calcium stimulation test and FNA. Basal Ctn was normal in 490 patients (96.8%). In the 16 patients with elevated basal Ctn, FNA revealed MTC in only one patient and MTC was not suspected in the 15 patients with elevated basal Ctn. Three patients with stimulated Ctn<100 pg/ml and benign cytology were not submitted to surgery. MTC was excluded by histology in three patients with stimulated Ctn<100 pg/ml and indeterminate or suspicious cytology and in eight patients with stimulated Ctn>100 pg/ml. One patient with stimulated Ctn>100 pg/ml had MTC. Ctn was undetectable 6 months after surgery in two patients with MTC. Although uncommon, even subjects without a suspicious history and with nodules ≤ 1 cm without ETE or LN involvement on US, but with suspicious findings, can have microMTC. The measurement of Ctn permits the diagnosis of these cases.

Targeted deep sequencing of cell-free DNA in serous body cavity fluids with malignant, suspicious, and benign cytology.

Liquid biopsy using cell-free DNA (cfDNA) presents new opportunities for solid tumor genotyping. While studies have demonstrated the utility of cfDNA from plasma, cfDNA from other body fluids remains underexplored. We evaluated the molecular features and clinicopathologic correlates of cfDNA from serous body cavity fluids by performing hybrid capture-based next-generation sequencing (NGS) on cfDNA isolated from residual effusion supernatants. Twenty-one serous effusions from pleural (n=15), peritoneal (n=5), and pericardial (n=1) cavity were analyzed. The supernatants provided a median cfDNA concentration of 10.3ng/µL. Notably, all effusions were sequenced successfully to a median depth >1000×, revealing a broad range of genetic alterations including single nucleotide variants, small insertions and deletions, amplifications, and fusions. Specifically, pathogenic alterations were identified in all malignant fluids (13/13), all fluids suspicious for malignancy (2/2), and 1 benign fluid (1/6) from a patient with metastatic cancer. To validate our findings, we examined matching results from 11 patients who underwent additional testing using formalin-fixed, paraffin-embedded (FFPE) specimens. In 8 patients, the paired results between FFPE and supernatant testing were concordant, whereas in the remaining 3 patients, supernatant analysis identified additional variants likely associated with resistance to targeted therapies. Additional comparison between FFPE and supernatant testing showed no difference in DNA concentration (P=.5), depth of coverage (P=.6), or allele frequency of pathogenic mutations (P=.7). cfDNA isolated from serous body cavity fluids represents a promising source of genomic input for targeted NGS.

Use of the term atypical cells in the reporting of ascitic fluid cytology: A caveat.

Background:Abdominal paracentesis is a routine diagnostic procedure for assessment of patients with recent onset or worsening of ascites.Objectives:The objective of the study is to (1) review clinically confirmed cases of malignancy with negative, atypical, and suspicious cytology reports and provide reasoning for discrepancies and (2) recalculate sensitivity, specificity, and predictive values after review.Materials and Methods:Papanicolaou smears of ascitic fluid paracentesis samples received over one calendar year were reviewed retrospectively by an expert in cytopathology blinded to the final clinical and/or histopathological diagnoses. Cases with discrepancies after review were noted. Sensitivity, specificity, and predictive values were calculated before and after review of slides. Data were analyzed using SPSS version 16.Results:Malignant etiology was identified in 49/115 cases (42.6%) with female genital tract being the most common site of malignancy (22, 44.8%). The remaining 66 (57.4%) had a benign etiology with hepatic cirrhosis in 42 cases (63.6%). A review revealed discrepancies in five cases, three of which were earlier called negative for malignant cells (one case each of ovarian adenocarcinoma, cecal adenocarcinoma, and cholangiocarcinoma). Two cases of ovarian adenocarcinoma that were reported as atypical/reactive mesothelial hyperplasia showed malignant cells upon review. Sensitivity and specificity after review were 69.4% and 100%, respectively, with 100% positive predictive value.Conclusion:Being a minimally invasive procedure, abdominal paracentesis continues to be an important diagnostic tool in guiding patient management. A proper morphological assessment with adequate clinical information and correlation with other investigations can be used to arrive at a definitive diagnosis in most cases. The term “atypical” can be misleading and is often used for want of clinical information and is best avoided.