超声造影联合细针穿刺手感对甲状腺乳头状癌的诊断价值

 目的 探讨超声造影(contrast enhanced ultrasound, CEUS)和超声引导下细针穿刺细胞学检查(fine-needle aspiration cytology, FNAC,简称“穿刺手感”)及二者联合诊断甲状腺乳头状癌(papillary thyroid carcinoma ,PTC)的价值。方法 回顾性分析2017-09至2020-01解放军总医院海南医院超声诊断科进行超声检查、CEUS及超声引导下穿刺手感患者312例(312个结节),每个结节在穿刺过程中均记录穿刺手感,最终以手术病理结果为金标准。采用特征曲线(ROC)评价CEUS、穿刺手感和两者联合应用的诊断效果。结果 312例中共有良性结节116个,196个诊断为PTC。穿刺手感联合CEUS的准确率(97.450%)高于单独使用CEUS(87.244%)或穿刺手感(63.776%),差异有统计学意义(P<0.05)。CEUS和穿刺手感联合诊断甲状腺结节ROC曲线下面积(0.767)大于单独使用超声造影(0.734)及穿刺手感(0.711),差异均有统计学意义(P<0.05),但CEUS与穿刺手感在诊断PTC ROC曲线下面积差异无统计学意义。结论 CEUS联合穿刺手感对PTC诊断的准确性高于单一使用超声造影或穿刺手感。     

The practice of cytopathology during the era of COVID-19: challenges and changes

This paper reviews the challenges faced by cytology laboratories during the COVID-19 pandemic. Various safety guidelines regarding collection, handling, transport and sampling in cytology laboratory are presented. A brief literature overview of adapted changes regarding new safety techniques, processing, sampling techniques implemented by the cytology laboratories in this part of the world is presented. The use of cytology in COVID-19 patients is discussed. The authors have also tried to present the challenges and changes faced for training and education during this time. Migration from multi-headed scope in-person sign-out to digital based platforms were adapted to continue medical education. The potential long-term implications of these adaptations on cytology services are also touched upon.     

Diagnostic efficacy of different pathologic methods for assessing tissue obtained by endoscopic ultrasound-guided fine needle aspiration: a prospective study

Aims: The best method for processing specimens by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has not been standardized and varies considerably between medical centers. The purpose of this study is to explore whether a combination of histologic and cytologic methods can increase the diagnostic efficacy of EUS-FNA in solid lesions around the digestive tract. Methods: We recruited 52 patients (65 cases total) with solid lesions around the digestive tract who underwent EUS-FNA as performed by the same endoscopic physician from December 2016 to January 2018. All the EUS-FNA specimens were processed by conventional smear cytology (CS), liquid-based cytology (LBC), cell block (CB), and histopathology. All the pathologic results were tracked to investigate the diagnostic value of the methods. Results: Fifty-three malignant lesions and 12 benign lesions were analyzed. The diagnostic accuracy levels of the CS, LBC, CB, and histopathology were 96.9%, 89.2%, 91.9%, and 48.1%, respectively. CS had a higher diagnostic accuracy than CB (P < 0.05) and LBC (P < 0.05). The cytologic methods had a significantly higher diagnostic accuracy than histopathology (P < 0.05). The combined diagnostic accuracy of all the methods was 100%. The diagnostic sensitivities of the CS, LBC, CB and histopathology were 96.2%, 86.8%, 90.4%, and 37.2%, respectively, and the diagnostic specificity of each of the four methods was 100%. Conclusions: Different pathological methods can compensate for one another, substantially improving the overall positive detection rate of EUS-FNA. Combining cytology and histology can contribute additional diagnostic efficacy to EUS-FNA in solid lesions around the digestive tract.     

A case of urothelial carcinoma,lipid cell variant

The lipid cell variant of urothelial carcinoma is a rare variant of urinary bladder cancer, comprised of lipoblast‐like cells. In this report, we describe a case of the lipid cell variant of aggressive urothelial carcinoma. A 78‐year‐old man was admitted to the hospital because of gross hematuria. On cystoscopy, an ulcerative lesion, non‐papillary architecture, was observed in the lateral wall of the bladder. Transurethral resection was performed. Histopathological findings of the bladder tumor indicated neoplastic cells forming irregular solid nests and sheets. Lipoblast‐like neoplastic cells that had eccentric nuclei and cytoplasmic vacuoles were observed, not only in the resected specimen, but also in urine samples. On mucin histochemistry, the tumor cell cytoplasm contained no neutral or acidic mucus. The lipoblast‐like cells were positive for cytokeratins (AE1/AE3, CK7) and adipophilin, known as a protein associated with neutral lipid synthesis. In general, it is difficult to prove the existence of intracytoplasmic lipid in formalin‐fixed paraffin‐embedded materials. This is the first report in which the presence of lipid in vacuoles of the lipid cell variant has been verified by immunohistochemistry.     

The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital

Background

Diagnostic thyroid lobectomy is performed to resolve the dilemma of indeterminate (Thy3) cytology of thyroid nodules. But on final histology most nodules are benign thereby subjecting this group of patients to surgery with its associated risks.

Aim

To determine the proportion of cancers in patients with indeterminate thyroid nodules.

Patients and methods

This is a retrospective observational study of 621 patients who underwent fine needle aspiration cytology (FNAC) of their thyroid nodules over a 60 month period in a district general hospital. Patient demographics, cytology and final histology results were extracted from the hospital database.

Results

On final analysis, 48 patients had an indeterminate cytology (7.7%) and 12 patients had cancer in this group (25%) following diagnostic lobectomy.

Conclusion

Till an alternative robust technology becomes widely available we need to continue to perform diagnostic lobectomy in patients with indeterminate cytology in view of the high incidence of thyroid cancer in this group of patients.     

Effectiveness of different diagnostic tools for upper urinary tract urothelial carcinoma

ObjectiveThe results of urinalysis, radiographic studies, urinary cytology examinations, and ureterorenoscopy (URS) biopsies, as well as the results of histopathology can be used to establish a diagnosis of upper urinary tract urothelial carcinoma (UTUC).Materials and MethodsWe enrolled 99 patients who underwent radical nephroureterectomy (RNU) during the period 2003–2007. A total of 65 random urine and 83 URS washing cytology examinations, 48 intravenous urography (IVU), 59 retrograde pyelography (RP), and 81 URS biopsy results were available prior to RNU and were compared with the pathological grades and stages of these surgical specimens.ResultsNinety-three UTUCs were found among the 99 RNU specimens. Initial presentations and urinalysis results could not predict tumor stages. The patient with preoperative pyuria was significantly associated with high-grade UTUC (75.0% vs 52.6%, p = 0.031). Random urine and URS washing cytology results could not predict tumor grades or stages. The sensitivity of 3-day random urine cytology was significantly better than 2-day and 1-day examinations (p = 0.002 and p = 0.019, respectively). The abnormal findings in IVU and RP accounted for 89.4% and 100%, respectively. Non-enhancement of images was significantly associated with high tumor grading (p = 0.01). URS biopsy (n = 72) was positive for malignancy in 52 patients (69.3%). Biopsy grade had a significant correlation with surgical tumor grade (κ = 0.649) and high-grade biopsy results were significantly associated with invasive tumor stage (pT2–T4) (p = 0.004).ConclusionCombining random urine cytology for 3 nonconsecutive days, upper urinary tract images, and URS biopsies provided an accurate diagnosis of UTUC. This study found that preoperative pyuria in urinalysis, non-enhancement in IVP or RP, and high-grade tumor in URS biopsy could predict high-grade tumor in RNU specimens.     

Unusual fungal bodies in conventional cervical smears: Report of nine cases

Candida spp have often been reported in cervical cytology, other fungal organisms are very rare in modern literature. We report nine cases of conventional cervical smears showing Penicillium, Aspergillus, and Cladosporium spp in healthy imunocompetent females. Penicillium spp seen in four out of nine smears, Cladosporium spp alone in three out of nine smears, and Cladosporium spp along with Aspergillus spp in two out of nine smears. A detail of these nine cases is presented with discussion on importance of these structures when observed in conventional cervical smears. Awareness of such contaminants is important to differentiate from true infection for relevant therapeutic implications. A systematic step‐wise approach to such structures is also suggested. Diagn. Cytopathol. 2015;43:234–237. © 2014 Wiley Periodicals, Inc.