Urine and bladder washing cytology for detection of urothelial carcinoma: standard test with new possibilities

Background

Light microscopic evaluation of cell morphology in preparations from urine or bladder washing containing exfoliated cells is a standard and primary method for the detection of bladder cancer and also malignancy from other parts of the urinary tract. The cytopathologic examination is a valuable method to detect an early recurrence of malignancy or new primary carcinoma during the follow-up of patients after the treatment of bladder cancer.

Conclusions

Characteristic cellular and nuclear signs of malignancy indicate invasive or in situ urothelial carcinoma or high-grade papillary urothelial carcinoma. However, low sensitivity of the method reflects the unreliable cytopathologic diagnosis of low-grade urothelial neoplasms as cellular and nuclear signs of malignancy in these neoplasms are poorly manifested. Many different markers were developed to improve the diagnosis of bladder carcinoma on urinary samples. UroVysion™ test is among the newest and most promising tests. By the method of in situ hybridization one can detect specific cytogenetic changes of urothelial carcinoma.     

Ovarian cytology. An application of cytology in an attempt at the early detection of ovarian carcinoma

The possibility of detecting pre-clinical ovarian carcinoma by ovarian cytology taken at the time of laparotomy has been studied in 472 patients. Malignant cells have been recovered from ovarian carcinomas but never from macroscopically normal ovaries. It is suggested that this simple, inexpensive technique of sampling cells from the ovarian surface should be continued to be practised on all occasions at which ovaries present such as at laparotomy or at laparoscopy, as with further experience this technique may prove to be of help in the early diagnosis of ovarian carcinoma.     

Accuracy of biopsy and cytology for the preoperative diagnosis of colorectal adenocarcinoma.

BACKGROUND AND OBJECTIVES: Endoscopic biopsy for the diagnosis of colorectal adenocarcinoma is not accurate in every case. Brush cytology can increase the sensitivity for the diagnosis of gastroesophageal lesions when combined with biopsy, but very little information is available for these techniques in the diagnosis of colorectal adenocarcinoma. METHODS: A retrospective medical records review of 110 patients was performed. All patients underwent a colorectal resection for primary adenocarcinoma after a diagnostic endoscopy. Biopsy and brush cytology was evaluated for their respective sensitivity. Seventy-three patients had both biopsy and cytology. RESULTS: The sensitivity of biopsy was 83.6% (92/110); for cytology, 78.1% (57/73; P = 0.44). From the 73 patients who had both diagnostic techniques, 68.5% (50/73) had both positive biopsy and cytology, 12.3% (9/73) only a positive biopsy, and 9.6% (7/73) only a positive cytology. The two techniques combined were not significantly superior to biopsy alone (90.4%, 66/73, vs. 80.8%, 59/73, respectively; P = 0.16), but tended to be superior to cytology alone (P = 0.07). CONCLUSIONS: Cytology and biopsy have a comparable sensitivity. The combination of the two techniques compares favorably, but does not significantly increase the sensitivity of biopsy alone. Both techniques should be used whenever there are any uncertainties concerning the diagnosis of colorectal adenocarcinoma.     

Ultrasound-guided fine-needle aspiration cytology in the early detection of melanoma metastases

BACKGROUND: The early detection and treatment of tumor recurrences in melanoma patients is dependent on reliable, sensitive, and specific techniques to verify suspected tumor metastases. As of now, fine-needle aspiration cytology (FNAC) has yet to establish itself in the routine follow-up of melanoma patients. METHODS: FNAC procedures were performed in melanoma patients with palpable tumors or nonpalpable, ultrasonically suspicious lesions. Cytodiagnostic evaluation of fine-needle samples obtained from suspicious lesions was performed morphologically. Findings were validated either by histopathologic diagnosis or prolonged clinical follow-up. RESULTS: The cytologic examination of 739 FNACs from 330 melanoma patients was conducted within 1 day of sampling. Complications were not observed. This study showed a sensitivity of 97.9% and a specificity of 100.0%. Moreover, in 158 FNACs derived from lesions with a diameter less than 1 cm a sensitivity of 94.6% was achieved. Diagnosis of metastatic melanoma with unknown primary tumor was established in 20 cases. CONCLUSIONS: FNAC is very reliable for the early detection of melanoma metastases. FNAC is a swift method free of complications and is able to replace diagnostic surgery completely for nonmalignant lesions in a large number of patients. Moreover, FNAC is especially useful in combination with ultrasound in melanoma follow-up and can enable diagnosis of lesions smaller than 1 cm without impairment of sensitivity or specificity.     

BRAF mutation detection in indeterminate thyroid cytology specimens

BACKGROUND:

BRAF mutations are highly specific for papillary thyroid carcinoma (PTC) and many cytology specimens with BRAF mutations are expected to demonstrate cytologic features typical of PTC. However, indeterminate thyroid cytology cases are inevitable and understanding the significance of the BRAF mutation within the context of the Bethesda System for Reporting Thyroid Cytopathology would be valuable.

METHODS:

Thyroid cytology cases submitted for conventional cytomorphologic evaluation and BRAF mutational analyses were selected from the authors' cytopathology files from April 2007 to October 2011. From this group, the diagnostic usefulness of BRAF mutations in indeterminate and malignant cases was assessed and analyses of cytologic and histopathologic features associated with the mutations in this gene were performed.

RESULTS:

A total of 131 cases with a BRAF mutation were identified. Of these, 119 underwent surgical pathology resection follow‐up and demonstrated PTC. Approximately 75% of the cases were cytologically diagnosed as being positive for malignancy and these cases were associated with both the classic and tall cell variants of PTC at the time of resection, a greater likelihood of extrathyroidal extension, and the V600E type of BRAF mutation. In contrast, BRAF‐mutated cases with diagnoses of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and follicular neoplasm/suspicious for follicular neoplasm were found to be more strongly associated with the follicular variant of PTC, a K601E BRAF mutation, and a lower likelihood of extrathyroidal extension. However, a subset of AUS/FLUS cases with the V600E BRAF mutation appeared to represent sampling variability of the classic or tall cell variants of PTC.

CONCLUSIONS:

Bethesda thyroid diagnoses in the setting of a BRAF mutation reflect differences in PTC subtypes, the nature of cytology specimens, and molecular characteristics. Cancer (Cancer Cytopathol) 2013;121:197–205. © 2012 American Cancer Society.     

Predicting pulmonary adenocarcinoma outcome based on a cytology grading system

BACKGROUND:

Pulmonary adenocarcinoma (AD) has a variety of architectural patterns. Recently, a 3‐tiered histological pattern‐based grading system was developed for stage I lung AD, stratifying patients into low, intermediate, and high risk for recurrence. However, cytology may serve as the primary method for diagnosis in patients with inoperable disease. Attempts to correlate architecture between parallel cytological and histological preparations have not been successful. Therefore, we evaluated cytomorphologic features of previously histologically graded AD to identify features of potential prognostic significance.

METHODS:

One hundred and thirteen fine‐needle aspirations with excised adenocarcinomas were reviewed. In the liquid‐based preparation, we evaluated cell arrangements (flat sheets vs 3‐D clusters vs single cells), nuclear features (size variability, shape, and contour), nucleoli (prominent or inconspicuous), presence of nuclear inclusions, chromatin (fine, coarse, or clumped), and quality of background. The features were tested by multivariate analysis to identify associations with histological grade and disease‐free survival (DFS), and a cytological score was generated.

RESULTS:

Nuclear size, chromatin pattern, and nuclear contours showed a significant association with histological grade and DFS. These features were included in the composite cytological score (range, 0‐5). By grouping the cytological scores, we stratified the tumors into low (median DFS, 100%), intermediate (median DFS, 78%), and high (median DFS, 55%) rate of recurrence (P = .008). There was a good correlation with the histological grading system.

CONCLUSIONS:

In liquid‐based preparations, distinctive cytological features of pulmonary adenocarcinoma correlate with levels of histological differentiation and can be combined into a score with prognostic significance. Cancer (Cancer Cytopathol) 2012. © 2011 American Cancer Society.     

Metastatic renal adenocarcinoma to the ureteral stump in a hemophiliac

A case of a delayed distal ureteral metastasis from a cortical renal adenocarcinoma in a hemophiliac is presented as an unusual but significant problem. The need for total ureterectomy with nephrectomy is discussed. The various metastatic pathways for this tumor are presented. It would seem that the proposed avenues are, at present, only theoretical, and it might be reasonable to assume that any one or several of them may be the pathway in an individual case. Regardless of the mode of spread, we must be cognizant of the possibility of distal ureteral metastases long after nephrectomy. The diagnostic value of cystoscopy during active bleeding is emphasized. With the use of coordinated efforts on the part of hematology, general medicine, and surgery, such instrumentation and quite radical operations can be and are being carried out successfully in hemophilia.     

Immunohistochemical detection of eosinophilic infiltration in pulmonary adenocarcinoma

OBJECTIVES: Tumor-associated eosinophils play an important role in the biological behavior of cancer. We have detected eosinophilic infiltration immunohistochemically in tissue specimens from patients with pulmonary adenocarcinoma and assessed its association with the prognosis. MATERIALS AND METHODS: Utilizing the monoclonal antibody for EG2 thought to be a specific marker for eosinophils, the authors quantified eosinophil infiltration immunohistochemically in patients with pulmonary adenocarcinoma to investigate the relationship between EG2- positive cell counts and the prognosis. RESULTS: A significant difference in the rate of patient survival was detected between patients whose tumors had high EG2-positive cells and patients whose tumors had low EG2-positive cells overall (p=0.0086). Multivariate analysis also showed that eosinophils were significantly related to survival (p=0.044). CONCLUSION: These data indicate that eosinophilic counts utilizing the monoclonal antibody EG2 serve as a useful independent prognostic marker in pulmonary adenocarcinoma.