Accuracy of fine needle aspiration biopsy processed by cytologic smear and cell block techniques for the diagnosis of lacrimal gland tumors: a study of 48 cases

Objective: To study the accuracy of fine needle aspiration biopsy (FNAB) processed by smear cytology and cell block (CB) techniques for the diagnosis of lacrimal gland tumors (LGTs). Study Design: In a prospective study, we enrolled 48 consecutive patients with LGTs. Immediately after excision of LGTs, the tissues were underwent FNAB with 23-gauge needles. The FNAB samples were processed to produce cytologic smears and CB from which slides were cut for immunohistochemical staining. The remainders were submitted for routine histopathologic processing. The diagnostic value of FNAB was assessed by comparing the FNAB diagnoses to those made by routine histopathology. Results: Cytopathologic evaluations based on smear cytology and CB with sections stained immunohistochemically can distinguish non-epithelial lesions from epithelial ones in all cases. The diagnostic sensitivities, specificities, and accuracies for distinguishing benign from malignant lesions were: cytologic smears--76%, 68%, and 71%, respectively; CB with immunohistochemical staining--88%, 87%, and 88%, respectively. The accuracy of the tissue diagnosis compared to routine histopathology was less for cytologic smears (58%) than for CB with immunohistochemistry (81%; P < 0.05). Conclusions: FNAB of LGT processed using a CB technique capable of producing immunohistochemically stained slides results in a greater percentage of accurate tissue diagnoses than do cytologic smears, when compared to routine histopathology.     

Cervical biopsy-based comparison of a new liquid-based thin-layer preparation with conventional Pap smears

The objective of this study is to compare the diagnostic efficacy of universal collection medium (UCM) liquid-based cytology (LBC) (Digene Corp., MD) and the conventional Pap smear in a comparative study, using histologic results as the gold standard. This was a cross-sectional study. Conventional Pap smears and UCM LBC specimens, obtained from women in a low socioeconomic outpatient population referred to a tertiary center for gynecologic care, were compared. For the purpose of this study, when cervical specimens were collected for cytology, all women underwent colposcopy and biopsy was done if a cervical abnormality was observed. Cytologic evaluation of UCM LBC and conventional Pap smears were carried out separately, masked to the results of the other method. Agreement beyond chance between the two cytologic methods was ascertained by means of the unweighted kappa statistic. Sensitivity, specificity, and predictive values with 95% confidence intervals were calculated for both methods. McNemar's test was used to determine the level of association between the two cytology procedures. A total of 800 women were evaluated. Assessment of the overall agreement between the two cytologic methods yielded a kappa of 0.777 (P < 0.0001). After adjustment for histologic diagnosis, the computed kappa in each stratum was as follows: normal = 0.733; CIN 1 = 0.631; CIN 2/3 = 0.735; cancer = 0.652. The sensitivity and specificity of UCM LBC for detection of cervical intraepithelial lesions and cancer were 75.3% and 86.4%, respectively, not statistically different from the 81.8% and 85.2% seen with the conventional method. This study demonstrates that the UCM LBC method is as accurate as the conventional Pap smear cytology in detecting cervical intraepithelial lesions and cancer even so the UCM samples were systematically prepared from a second sampling of the cervix.     

Pap test in a high-risk population comparison of conventional and liquid-base cytology

Liquid‐based cytology (LBC) is believed to have better sensitivity than conventional smears (CSs) and offers the possibility to perform molecular assay. The goal of this work was to study the performance of CS and LBC in a high‐risk population and to compare the results with the hybrid capture (HC) II for high‐risk human papillomavirus (HPV). Samples were collected from selected women with clinical suspicions of low genital tract lesion at Pérola Biygnton Hospital (São Paulo, Brazil). After CS preparation, the brush was introduced in the endocervix and a new sample was collected and rinsed in the preservative medium of the system. The residual material was used to HC2. From 925 cases, LBC was unsatisfactory in 4 (1.51%) cases and CS was unsatisfactory in 100 cases (10.81%); among theses cases HC2⁺ reactions was observed in 54 (54%) CSs and 3 (21.4%) LBCs. Considering cases with atypia of undetermined significance (squamous and glandular), 85 (77.27%) cases from LBC and 44 (86.4%) from CS were positive for HC2 assay for high‐risk DNA‐HPV. The difference among the methods was not significant (P < 0.38). The diagnosis improvement of LBC in comparison with CS was 86% in satisfactory samples, 92.76% in undetermined atypical lesions (including glandular), 83% in positive low‐grade squamous intraepithelial lesions (LSIL⁺), and 86.84% in high‐grade SIL⁺ (HSIL⁺). HC2⁺ reactions were observed in 144 CS cases and 266 LBC cases with abnormalities. Our results have showed that LBC was superior to CS in a high‐risk population to detect lesions with high concordance with HC2⁺ reactions; CSs also exhibit a high concordance with HC2 assay but with inferior performance to detect lesions. Diagn. Cytopathol. 2004;31:169–172. © 2004 Wiley‐Liss, Inc.     

How accurate is cytological diagnosis of cervical glandular lesions?

Gynecological cytology has some inaccurate morphological categorization and poor interobserver reproducibility especially for glandular lesions. Liquid-based cytology (LBC) preparations are presumed to reduce artifacts that interfere in diagnosis performance, but its value to correctly identify glandular alterations has not been sufficiently reported. The objective of this study was to compare the diagnostic performance and interobserver agreement of LBC and conventional Pap smear to identify histologically confirmed glandular lesions according to five cytologists. Sensitivity ranged from 55.8 to 73.1% and 32.7 to 48.1% for Pap smear and LBC, respectively. Specificity ranged from 66.1 to 87.1% and 69.4 to 94.4%, respectively. In general, agreement between pairs of cytologists was poor with kappa-values around 0.45. In conclusion, relying entirely on cervical cytology to rule out glandular lesions may be risky. The use of HPV DNA test alone or combined to screening glandular lesions may contribute to minimize the limitations of both conventional and LBC preparations to diagnose glandular abnormalities.     

Comparison of diagnostic accuracy between CellprepPlus® and ThinPrep® liquid‐based preparations in effusion cytology

Liquid‐based cytology (LBC) is being increasingly used for body fluid specimens and has improved diagnostic accuracy when compared to conventional smears. We compared the diagnostic accuracy and cellular morphologic features between CellprepPlus® LBC and ThinPrep® LBC in effusion cytology. One hundred and eighty body fluid specimens, consisting of 119 pleural fluid specimens, 59 peritoneal fluid specimens, and 2 pericardial fluid specimens, were obtained from 166 patients. Equal volumes of body fluid from each specimen were used in the CellprepPlus® and ThinPrep® preparations. Sensitivity, specificity, and positive and negative predictive values were evaluated. In addition, we selected 16 specimens from patients with metastatic adenocarcinoma, confirmed them by both LBC preparations, and measured the size of the nucleus in the tumor cells in these specimens. The sensitivity of the CellprepPlus® and ThinPrep® methods was 73.1% and 50.0%, respectively. The specificity and positive predictive values were 100% for both LBC methods, and the negative predictive values of the CellprepPlus® and ThinPrep® methods were 90.9% and 83.3%, respectively. The average nuclear size of the tumor cells was calculated as 20.87 μm using the CellprepPlus® method and 15.08 μm using the ThinPrep® method (P < 0.05). The CellprepPlus® method provided better diagnostic accuracy of effusion cytology compared to the ThinPrep® method and revealed the characteristic morphological features of tumor cells, including large and hypochromatic nuclei, prominent nucleoli, distinct nuclear membranes, and high cellularity. Diagn. Cytopathol. 2014;42:384–390. © 2013 Wiley Periodicals, Inc.     

Rinse fluid and imprint smear cytology of bronchial biopsies in diagnosis of lung tumors

The usefulness of rinse fluid and imprint smear cytology of the bronchial biopsy has been studied in diagnosis of lung cancer. However, scarce data is available regarding rinse fluid cytology of biopsy. The aim of this study was to evaluate these cytologic techniques for their diagnostic accuracy. Bronchial biopsy was taken in 52 patients clinically/radiologically suspected to have lung carcinoma. Imprint smears of the biopsy were prepared, following which it was put in balanced saline solution to collect rinse fluid of biopsy before transferring it to formalin for fixation. Cytological diagnosis from imprint and rinse fluid smears was compared with histopathological diagnosis. Malignancy was detected in 45 cases of 52 patients on histopathology. Positive result was given by rinse fluid cytology in 34 (65.4%) cases while diagnostic accuracy was 78.8%. The imprint smears were positive for malignancy in 44 (84.6%) cases with diagnostic accuracy of 98.08%. There were no false-positive results, but one case was incorrectly typed by both the techniques. Imprint smear cytology has a better diagnostic accuracy and efficacy over rinse fluid while the two cytologic techniques can be used in combination routinely with biopsy to provide an early and reliable diagnosis in lung cancer.     

A comparative study between conventional and liquid‐based cytology in screening for anal intraepithelial lesions in HIV‐positive patients

Anal intraepithelial neoplasia (AIN) is associated with HPV infection and can be detected by cytological screening. While conventional exfoliative cytology (CC) is a low‐cost and nonaggressive method, liquid‐based cytology (LBC) tends to give clearer readings. Although studies of the efficacy of anal cancer screening methods would be of great importance for groups at high risk for AIN, few such studies have been conducted. The aim of the present study was to assess the concordance of CC and LBC in diagnosing anal pre‐neoplastic lesions, and to compare cytological results with anoscopy, histopathological, and molecular biology findings. Comparative study involving 33 HIV‐positive patients, who underwent anoscopy and biopsy of suspected lesions. Concordance between the two cytology methods was calculated, as were the associations between cytology results and findings from other screening methods. A total of 54.5% of cases were considered AIN‐negative by CC and LBC, and concordance between the two methods was statistically significant (P < 0.05). Anoscopy was negative in 15 of the 18 CC‐ and LBC‐negative cases. CC identified 75% of patients with positive biopsy, while LBC identified 85.71% of these patients. Molecular biology results showed that patients with LSIL tested positive for the highest number of HPV subtypes. The associations between positive biopsy and high grade HPV, HPV 16, and multiple HPV infections were not statistically significant. Conventional and liquid‐based cytology are equally effective in screening for anal preneoplastic lesions. Diagn. Cytopathol. 2014;42:840–845. © 2014 Wiley Periodicals, Inc.     

57例骨肿瘤的穿刺细胞学诊断分析

目的 评价CT引导下穿刺活检涂片细胞学对骨肿瘤诊断的意义和价值。方法 57例临床疑为骨肿瘤患者采取穿刺活检送病理检查的同时，做细胞涂片，分别进行组织学和细胞学观察。结果 细胞学检查总准确性80．7％，敏感性和特异性分别为80．0％和100％，无假阳性。结论 骨穿刺细胞涂片方法快速．经济实用，安全可靠和准确性高。     

Increased risk of malignancy for non‐atypical urothelial cell groups compared to negative cytology in voided urine. Morphological changes with LBC

Liquid‐based cytology (LBC) has recently become the preferred method for urine cytology analysis, but differences with conventional cytology (CC) have been observed. The purpose of this study is to analyze these differences and the clinical relevance of non‐atypical urothelial cell groups (UCG) in voided urine specimens. Reporting terminology is discussed. Initially, diagnostic categories from 619 LBC and 474 CC samples, reviewed by five different pathologists, were compared (phase 1). Five years after LBC was implemented and applying strict cytologic criteria for UCG diagnosis, 760 samples were analyzed (phase 2) and compared to previous LBC specimens. Diagnostic differences, interobserver variability and clinicopathological correlation with a 6‐month follow‐up, were analyzed. UCG increased from 6.5% with CC to 20.7% (218%, 3.2 fold, P < 0.0001) with LBC. This difference was not related to interobserver variability. Five years later, the rate of UCG had decreased to 13 2%. While 6% of cases with a negative cytology had urothelial carcinoma (UC) within 6 months of diagnosis, this percentage increased to 15.7% with UCG. The sensitivity of the UCG category for UC was low (30.4%), but the specificity and the negative predictive value (NPV) were high (87.1% and 94%, respectively). LBC increases UCG when compared to CC. This can be corrected with observe?s experience and using set cytological criteria. Due to its association with carcinoma, the presence of UCG in voided urine should be framed in a diagnostic category other than “negative for malignancy.” Diagn. Cytopathol. 2016;44:582–590. © 2016 Wiley Periodicals, Inc.     

The role of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in distinguishing pancreatic cystic lesions

Distinguishing mucinous from nonmucinous cystic lesions of the pancreas often constitutes a diagnostic dilemma. The clinical management differs between such lesions; therefore it is important to make an accurate preoperative diagnosis. Various centers have reported conflicting results regarding their ability to detect mucin-producing neoplastic cells and appropriately reach a diagnosis based on endoscopic ultrasound (EUS) guided FNA. The aim of this study is to assess the ability of EUS-FNA cytology to diagnose and differentiate mucinous from nonmucinous pancreatic cystic lesions. We reviewed records of patients who underwent EUS of pancreatic cystic lesions. If FNA was performed and mucinous neoplasm was suspected, aspirate was evaluated for cytomorphology and presence of mucin. FNA results were compared to final histologic diagnosis if surgery was performed.Cytologic diagnosis was provided for 28/30 (93%). By comparing EUS-FNA diagnoses with final surgical pathology, FNA accurately diagnosed in 10/11 cases with sensitivity and specificity for detection of malignancy of 100 and 89, respectively, while the accuracy for identification of mucinous cystic neoplasms was 100%. Our results indicate that in the appropriate clinical and imaging setting, EUS-FNA cytology with analysis for mucin production by tumor cells is an important test in distinguishing pancreatic cystic lesions and guiding further management.     

Liquid-based cytology in the fine needle aspiration of parathyroid lesions: a comparison study with the conventional smear,ThinPrep, and SurePath

Liquid-based cytology (LBC) has been progressively used for evaluating fine needle aspiration (FNA) specimens. However, limited studies have examined LBC in FNA of parathyroid lesions. We retrospectively reviewed 24 FNA specimens of parathyroid lesions, including 6 specimens prepared by conventional smear, 12 specimens prepared using ThinPrep method, and 6 specimens prepared using SurePath method. The 18 LBC specimens were also used for cell block preparation and immunostaining for parathyroid hormone (PTH). LBC specimens more frequently showed variable cellularity; microfollicular structure; bubbly or vacuolated cytoplasm; and small, round cells with distinct borders compared to specimens prepared by conventional smear. ThinPrep specimens showed a clean background and fewer isolated cells and naked nuclei compared to specimens prepared using the other methods. SurePath specimens showed many white blood cells in the background and more scattered single cells and naked nuclei compared to ThinPrep specimens. Specimens prepared using the 3 methods often showed colloid-like material but did not contain dense globular colloidal structures. White blood cells in the background of LBC specimens serve as useful indicators for estimating cell size. The nuclear size of parathyroid cells was similar to or smaller than that of inflammatory cells in the background. Cell block sections showed definite histological features of the parathyroid tissue and strong positive immunostaining for PTH. Awareness of these cytologic features of parathyroid FNA specimens prepared using ThinPrep and SurePath methods may help in preventing misdiagnosis. Cell block preparation and PTH immunostaining should be performed for the definitive diagnosis of parathyroid lesions.     

Morphological and immunocytochemical diagnosis of thyroiditis: Comparison between conventional and liquid-based cytology

The efficacy of thyroid (FNAB) processed by liquid-based cytology (LBC) in Hashimoto's Thyroiditis (HT) in two reference periods, is evaluated. The morphologic features of 820 cases with both methods and the cyto-histological comparison are analyzed. The diagnosis of hyperplastic nodules (HN) in HT, its mimickers especially in presence of oxyphilic cells and the role of immunocytochemistry (IHC) are studied. 150 cases of HT processed by conventional smear (CS) in 1996-98 and 670 with LBC in 2005-2007,were included. The majority of FNAB were carried out under USguidance and fixed with ethyl alcohol for the CS. LBC material was rinsed in the Cytolit solution, processed according to the manufacturer's recommendations. Among the 150 CS, 83 were HT while 67 were HN in HT; in the second triennium 245 LBC were HT and 425 were HN in HT. In the first period a follow-up (including a second FNA or surgery) was done in 92 cases, in the second period in 116. In the surgical group 97.1% in the first period were benign (all HT and 34/36 HN) and 2.8% malignant(all HN). In 2005-2007, 94% were benign (15 HT and 45/49 HN) and 6%malignant. Thirty HN from the second triennium had ICC for HBME-1 and Galectin-3 resulting negative in 93.5%. Among these cases, 10 had a benign histology and a concordant negative ICC. LBC can be used as a valid method for HT, especially for the possible application of ICC to HN, and it allows a correct preoperative selection of lesions     

Endoscopic ultrasound–guided fine needle aspiration as a diagnostic and staging tool for rectal and perirectal lesions—an institutional experience

The role of endoscopic ultrasound–guided fine needle aspiration (EUS-FNA) in evaluating lesions adjacent to the upper gastrointestinal tract wall is well established. However, this tool is underused in evaluating rectal and perirectal lesions, possibly due to insufficient experience and underrecognized value of this procedure. In this study, we report our institutional experience with EUS-FNA as a diagnostic and staging tool for rectal and perirectal lesions. A retrospective chart review was performed and a cohort of 38 patients who underwent rectal EUS-FNA (41 specimens) at our institution between January 2002 and July 2012 was retrieved. The cytology diagnoses were compared with the concurrent or follow-up histologic and clinical diagnoses. Among the total 41 cases, rectal EUS-FNA was performed as a diagnostic procedure in 22 (54%) and a staging procedure in 19 (46%) cases. On cytology examination, 18 cases (44%) were diagnosed as malignant; 1 (2%), as atypical/suspicious for malignancy; 3 (7%), as benign neoplastic; 13 (32%), as nonneoplastic; and 6 (15%), as nondiagnostic cases. Concurrent or follow-up histologic diagnoses were available in 20 cases (48%), 19 of them had concordant cytological/histologic findings (10 benign, 9 malignant). One perirectal lymph node with negative cytology diagnosis was found to be positive on histologic examination, probably due to sampling error on cytology. The sensitivity and specificity of EUS-FNA for detecting malignant rectal/perirectal lesions in this study were 91% and 100%, respectively. Endoscopic ultrasound–guided fine needle aspiration is a useful diagnostic tool for rectal/perirectal lesions; it confirms or excludes malignancy for lesions with high or low clinical suspicions. It serves as a reliable staging method to identify patients for proper clinical management.     

Cytology of bone lesions by intraoperative sampling during fracture treatment

Cytology was performed on 314 patients who were treated by surgery for hip joint fracture, to determine and evaluate the role, accuracy, and perspective of intraoperative bone sampling. Specimens were collected from bone lesions during surgery by imprints or driller washing in normal saline. The results were compared with those of subsequent biopsies or clinical follow-up. All 13 neoplastic cases (malignant or benign) were identified by cytology. An accuracy rate of 69.2% was achieved by this method when the type and origin of the neoplasms were to be conclusive. There were no false-positive diagnoses, and all benign conditions showed negative results on cytology (specificity and sensitivity of 100%). Cytology can play a valuable role in the diagnosis of bone lesions. The morphologic diagnostic criteria allow for a high level of diagnostic accuracy of cytologic assessments in most cases of bone lesions, no matter the sampling technique.     

Clinicopathological Implications of Human Papilloma Virus (HPV) L1 Capsid Protein Immunoreactivity in HPV16-Positive Cervical Cytology

Background: The objective of this study was to investigate the expression of human papilloma virus (HPV) L1 capsid protein in abnormal cervical cytology with HPV16 infection and analyze its association with cervical histopathology in Korean women.Material and Methods: We performed immunocytochemistry for HPV L1 in 475 abnormal cervical cytology samples from patients with HPV16 infections using the Cytoactiv^® HPV L1 screening set. We investigated the expression of HPV L1 in cervical cytology samples and compared it with the results of histopathological examination of surgical specimens.Results: Of a total of 475 cases, 188 (39.6%) were immunocytochemically positive and 287 (60.4%) negative for HPV L1. The immunocytochemical expression rates of HPV L1 in atypical squamous cells of unknown significance (ASCUS), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and cancer were 21.8%, 59.7%, 19.1%, and 0.0%, respectively. LSIL exhibited the highest rate of HPV L1 positivity. Of a total of 475 cases, the multiple-type HPV infection rate, including HPV16, in HPV L1-negative cytology samples was 27.5%, which was significantly higher than that in HPV L1-positive cytology samples (p = 0.037). The absence of HPV L1 expression in ASCUS and LSIL was significantly associated with high-grade (≥cervical intraepithelial neoplasia [CIN] 2) than low-grade (≤CIN1) histopathology diagnoses (p < 0.05), but was not significantly different between HPV16 single and multiple-type HPV infections (p > 0.05). On the other hand, among 188 HPV L1-positive cases, 30.6% of multiple-type HPV infections showed high-grade histopathology diagnoses (≥CIN3), significantly higher than the percentage of HPV16 single infections (8.6%) (p = 0.0004)Conclusions: Our study demonstrates that the expression of HPV L1 is low in advanced dysplasia. Furthermore, the absence of HPV L1 in HPV16-positive low-grade cytology (i.e., ASCUS and LSIL) is strongly associated with high-grade histopathology diagnoses. The multiplicity of HPV infections may have an important role in high-grade histopathology diagnoses (≥CIN3) in HPV L1-positive cases.     

Diagnostic accuracy and safety of fine-needle aspiration biopsy of the parapharyngeal space

Fine-needle aspiration (FNA) biopsy of the parapharyngeal space (PPS) is a diagnostic challenge and sampling is often done without image guidance, often trans-orally. Primary PPS tumors are rare, and there is a broad differential diagnosis. The accuracy of PPS FNA, in particular without CT-guidance and using liquid-based cytology (LBC), has not been well studied. Pathology records from our institution (a 1,100 bed Canadian academic tertiary care centre) were searched to identify all patients who underwent PPS FNA from September 1991 to August 2009. The FNA diagnosis was compared to the gold standard of subsequent histopathology or long-term clinical follow-up. Of 36 FNAs, 3 employed image guidance. Eleven (31%) FNAs were nondiagnostic. In the 25 diagnostic FNAs, there was sensitivity 89%, specificity 94%, PPV 89%, NPV 94%, and accuracy 92% for the diagnosis of positive or negative for malignancy. A correct specific diagnosis was made in 9/25 (36%) cases. The nondiagnostic rate was significantly higher (P < 0.025) in FNAs prepared as conventional smears (9/17 = 53%) versus LBC (2/19 = 11%). A specific diagnosis was made significantly more often (P < 0.05) with LBC (8/19 = 43%) versus conventional smear (1/17 = 5.9%). One minor complication from FNA occurred. In conclusion, PPS FNA is safe and accurate for the diagnosis of malignancy. The rate of reporting a specific diagnosis is low. Nondiagnostic FNAs are common. There are more specific diagnoses and fewer nondiagnostic tests with LBC than with conventional smears. Improved specimen quality with LBC is likely a factor.     

Intraoperative cytology in breast cancer diagnosis: Comparison between cytologic and frozen section techniques

The diagnostic accuracy of frozen section (FS) examination and intraoperative cytology (IOC) has been compared in two different series of breast biopsies in which only one of the two methods has been used. The intraoperative results have been compared with the final histological diagnoses. Five-hundred-ten cases have been investigated by using FS only, and 407 by means of IOC. The two series were comparable because they included the same pathologies; moreover we have subdivided each series into four groups of pathologies to better evaluate the diagnostic accuracy of two methods. The total diagnostic accuracy of FS has been 93.13% vs. 95.-33% of IOC The value of diagnostic accuracy of FS and IOC in the four sub-groups substantially overlapped; there was only a little difference in the group of “various lesions” in which the diagnostic accuracy of IOC was higher. No false positive has been observed in IOC. FS have produced one false positive (0.19%), whereas false negatives have amounted to 1.77% for IOC and to 1.72% for FS. Deferred diagnoses have been 2.95% in IOC and 4.90% in FS examination. For both methods according to Galen and Gambino the following values have been calculated: sensitivity, specificity, efficiency, and predictive value. By comparing the data, the value of the cytological examination in the intraoperative diagnoses results is evident mainly when the latter is coupled with the gross observation. Causes of diagnostic errors clearly overlap both in IOC and in FS: (1) lesions with a fibroadenomatous appearance can involve an overdiagnosis or an underdiagnosis; (2) low-grade lesions like tubular carcinomas or in situ lobular carcinomas can be interpreted as benign; (3) the differential diagnosis of intraductal lesions may be very difficult, and a conservative approach is the best choice; and (4) infiltrating lobular carcinoma may be neglected both in FS and IOC. The few disadvantages of the cytologic method are offset by its low cost, the wider sampling, the possibility of sparing tissue for further investigations (such as steroid receptors, cellular kinetic, electron microscopy, and other biological studies) proved more useful in prognostic evaluation of breast cancer.     

Liqui‐PREP® versus conventional papanicolaou smear to detect cervical cells abnormality by split‐sample technique: A randomized double‐blind controlled trial

To assess the diagnostic performances of LiquiPrep® (LP) to detect cervical cellular abnormality in comparison to Papanicolaou (Pap) smear in 194 women with abnormal cervical cytology who were scheduled for colposcopy at the institution between January 2008 and November 2008. The women were randomized to undergo a repeated cervical cytologic evaluation by Pap smear followed by LP, or the two methods in alternating order. The pathologist was blinded to previous cytologic diagnosis and the pair of slides assigned for each woman. Cytologic results from each method were compared to subsequent histopathology. Mean screening time for each LP and Pap slides were 4.3 ± 1.2 minutes and 5.4 ± 1.1 minutes, respectively (P < 0.001). From 194 cases, ASC or AGC were diagnosed in 72 cases (37.1%) from LP and 68 cases (35.1%) from Pap smear. After excluding the ASC/AGC group, the overall cytologic diagnostic agreement between the two tests were 69 of 87 cases (73.6%) while the agreements with histologic diagnoses were 39/87 cases from LP (44.8%) and 41 (47.1%) from Pap smear (P = 0.824). The accuracy of LP was not significantly different from Pap test, 43.4% (95% confidence interval [CI]: 34.8–52.1%) compared to 44.4% (95% CI: 35.7–53.1%). LP did not have superior performance over Pap test to detect high‐grade lesions (≥cervical intraepithelial neoplasia II) using ASC/AGC as the threshold with the sensitivity of 70.5% (95% CI: 64.0–76.9%) versus 77.3% (95% CI: 71.4–83.2%), respectively. Diagn. Cytopathol. 2011;39:22–27. © 2010 Wiley‐Liss, Inc.     

Diagnostic findings of ultrasound-guided fine-needle aspiration cytology for gastrointestinal stromal tumors: Proposal of a combined cytology with newly defined features and histology diagnosis

Recently, endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has been applied for diagnosis of gastrointestinal submucosal tumors. There have been no definite criteria, however, for the adequate cytological diagnosis of gastrointestinal stromal tumor (GIST) in practice. To facilitate this a novel method is proposed that combines cytology and histology. For 49 cases of submucosal tumor of gastrointestinal tract, EUS-FNA was performed. The aspirated materials were processed for cytology and histology. Both cytological and histological findings were examined on immunocytochemical and immunohistochemical staining of c-kit. Of 49 cases, 40 (81.6%) proved adequate for cytological and/or histological examination. On cytology, cluster types were classified into type A (piled clusters with high cellularity showing a fascicular pattern), type B (thin layered clusters with high cellularity showing a fascicular pattern), and type C (mono-layered clusters or scattered cells). Types A and B were strongly associated with histological diagnosis of GIST. Type C clusters needed confirmation on c-kit positivity and histology. Thus, the combined cytology with newly defined features, and classification and histological diagnostic method for EUS-FNA materials can contribute to improved routine diagnosis for GIST.