Efficacy and Diagnostic Accuracy of Centrifuged Liquid-Based Cytology over Conventional Oral Exfoliative Cytology in Normal Oral Mucosa and Oral Squamous Cell Carcinoma: Comparative Study

Background: The five-year survival rate of oral cancer remains 50% or less despite the treatment advances. An effective screen- ing test is necessary for early detection of oral cancer. Aim: To assess the efficacy and diagnostic accuracy of centrifuged liquid-based cytology in comparison to conventional exfolia- tive cytology in normal oral mucosa and oral squamous cell carcinoma. Materials & Methods: The study population comprised of 40 individuals, equally divided into two groups: healthy individuals and previous histopathologically proven oral squamous cell carcinoma cases. Exfoliative cytology was done and the samples were processed by conventional cytology as well as by centrifuged liquid-based cytology and stained with Papanicolaou stain. Seven cytological parameters were analysed to assess the quality of slides prepared. A cytological diagnosis of the case group was also made and was compared with histopathological diagnosis to evaluate the diagnostic accuracy. Results: The present study revealed statistically significant superior results in all the cytological parameters evaluated by centri- fuged liquid-based cytology compared to conventional exfoliative cytology (P ?0.05). There was an ‘almost perfect agreement’ found between centrifuged liquid-based cytology diagnosis and histopathology (k=0.89) while only a ‘substantial agreement’ was found between conventional exfoliative cytology with histopathology (k=0.79). Conclusion: The present study summarizes that centrifuged liquid based cytology is more effective than conventional oral exfoliative cytology in screening oral cancer. Further studies with larger sample size in different oral lesions are necessary to validate the use of this cytology technique.

Variaciones celulares de la mucosa bucal en pacientes portadores de prótesis dental completa / Cellular variations of the oral mucous in patients with complete dental prosthesis i: en

Introducción: La prótesis dental completa genera una reacción tisular en el medio bucal, cuyo diagnóstico puede ser confirmado mediante el estudio citológico, que constituye una herramienta imprescindible para identificar cambios displásicos tempranos de la mucosa subprótesis. Objetivo: Identificar las posibles variaciones celulares de la mucosa bucal en pacientes portadores de prótesis completa. Métodos: Se realizó un estudio descriptivo y transversal en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, de junio de 2014 a enero de 2019, de 100 pacientes atendidos en la consulta de Prótesis Estomatológica, a los cuales se les realizó el raspado citológico de la mucosa del paladar y los rebordes para su posterior análisis microscópico según variables de interés. Para el procesamiento estadístico se empleó el porcentaje como medida de resumen y el estadígrafo de la Χ2, con un nivel de significación de 0,05. Resultados: En la serie predominaron las displasias leves (66,7 %), que resultaron más frecuentes en las edades de 20 a 39 años (12,5 %), en tanto, las moderadas y las graves figuraron principalmente en el grupo etario de 60 y más años (9,3 y 27,7 %, respectivamente). Todos los tipos de displasia primaron en los pacientes que habían portado la prótesis por más de 5 años y afectaron mayormente la queratina; de igual modo, entre las lesiones observadas, la estomatitis afectaba a un mayor porcentaje (31,2), sobre todo en el paladar (82,3 %), mientras que 8,3 % correspondió a la leucoplasia. Conclusión: Las pruebas citológicas son imprescindibles para la confirmación diagnóstica de cambios displásicos y posibilitan la prevención temprana del cáncer bucal.

Introduction: The complete dental prosthesis generates a tisular reaction in the oral cavity which diagnosis can be confirmed by means of citological study that constitutes an indispensable tool to identify early dysplastic changes of the subprosthesis mucous. Objective: To identify the oral possible cellular variations of the oral mucous in patients with complete prosthesis. Methods: A descriptive and cross sectional study was carried out in Mártires del Moncada Provincial Stomatological Clinic of Santiago de Cuba, from June, 2014 to January, 2019, with 100 patients, assisted in the Stomatological Prosthesis Department to whom the cytological scrapings of the palate and the edges were carried out for their later microscopic analysis according to variables of interest. For the statistical procedures, the percentage was used as summary measure and the Chi squared statistician, with a significance level of 0,05. Results: In the series the mild dysplasias prevailed (66,7%) that were more frequent in the 20 to 39 age group (12,5%), while the moderate and the serious dysplasias figured mainly in the age group of 60 and over (9,3 and 27,7%, respectively). All the dysplasia types prevailed in the patients that had carried the prosthesis for more than 5 years and they mostly affected the keratin; in a same way, among the observed lesions, the stomatitis affected a higher percentage (31,2), mainly in the palate (82,3%), while 8,3% corresponded to the leukoplakia. Conclusion: The cytological checkups are indispensable for the diagnostic confirmation of dysplasic changes and they allow to prevent early oral cancer.

Value of an online interactive training program for improving cytopathological diagnostic ability of endoscopists in endoscopic ultrasound-guided fine-needle aspiration of pancreas / 中华消化内镜杂志

Objective:To develop an online interactive cytopathological training program, and to evaluate it for improving the cytopathological diagnostic ability of endoscopists in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreas.Methods:A total of 5 500 cytopathological images were collected from 194 patients with pancreatic solid mass who underwent EUS-FNA in Nanjing Drum Tower Hospital from August 2018 to August 2019. The cell type in each cytopathological picture was labeled by senior cellular pathologists, which was used to build a learning and testing platform for online interactive cytopathological training. Five endoscopists without cytopathological background were invited to participate in this training. Sensitivity, specificity, positive predictive value and negative predictive value of endoscopists in differential diagnosis of cancer and non-cancer before and after training were compared to evaluate the effect of the online interactive cytopathological training program on improving the ability of endoscopists in diagnosis of cytopathology.Results:A cytopathological training platform for endoscopists to learn and take online test was successfully built. Before training, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosis of cancer and non-cancer for endoscopists were 0.55 (95% CI: 0.53-0.58), 0.32 (95% CI: 0.30-0.35), 0.43 (95% CI: 0.41-0.45), 0.44 (95% CI: 0.41-0.47) and 0.43 (95% CI: 0.42-0.45), respectively. After training, the above indicators were 0.96 (95% CI: 0.95-0.97), 0.70 (95% CI: 0.68-0.73), 0.74 (95% CI: 0.72-0.76), 0.95 (95% CI: 0.94-0.96) and 0.81 (95% CI: 0.80-0.83), respectively, which were significantly improved compared with those before ( P<0.001). Conclusion:The online interactive cytopathological training program can improve the understanding and diagnostic ability of endoscopists in pancreatic cytopathology, help to implement rapid on-site evaluation in the process of EUS-FNA, and improve the diagnostic efficiency of EUS-FNA.

Increasing the rate of timely completion of a rapid frozen-section pathological report using the PDCA cycle / 中国基层医药

Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.

A Correlative Study of Fine Needle Aspiration Cytology with Histopathology of Female Breast Lesions.

Breast lesions remain a major public health problem worldwide. Fine needle aspiration cytology (FNAC) has become one of the first-line investigations for the diagnosis of breast lumps. Although one of the major goals of FNAC is to differentiate benign from malignant lesions, in certain cases, this may not possible due to a lack of uniformity with regards to the reporting terminology used in breast cytology by pathologists worldwide, resulting in poor communication of results among health‑care providers. The present study aims to evaluate the role and diagnostic accuracy of FNAC in the evaluation of breast lesions using the National Cancer Institute (NCI) recommended terminology by correlating with histopathological examination (HPE) results.METHODSIn this retrospective study conducted over a period of two years, a total of 382 female patients with breast lesions underwent FNAC and was categorized according to the NCI guidelines. Of these, 156 cases had histopathological follow‑up and their FNAC diagnoses were compared. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence interval (95% CI) and accuracy of FNAC were calculated.RESULTSAmong the 156 cases, none were unsatisfactory (C1); 105 (67.1%) were benign (C2); 7 (4.4%) were atypical but probably benign (C3); 2 (1.1%) were suspicious favouring malignancy (C4); 43 (27.4%) were malignant (C5). Cyto-histopathological correlation was carried out. Of categories C2 and C3 (total of 112 cases), 109 were confirmed as benign (true negative) and the remaining 3 cases turned out to be malignant (false negative). Of categories C4 and C5 (total of 45 cases), all cases were confirmed as malignant (true positive) and none were benign (false positive). The present study showed a sensitivity, specificity, PPV, NPV and accuracy of 93.62% (95% CI, 82.46%–98.66%), 100% (95% CI, 96.67%–100%), 100% (95% CI, 92.5%–99.6%), 97.32% (95% CI, 92.4%–99.09%) and 98.08% respectively.CONCLUSIONSOur study concluded that FNAC is a rapid and effective method, and reporting of smears using NCI guidelines highly correlated with the histopathological diagnosis.

Cytodiagnosis of Filariasis – A Retrospective Study of 8 Years

Introduction: In India Filariasis is considered to be a majorpublic health problem. India constitutes about 20% of totalglobal burden. Microfilaria are released and circulate inthe peripheral blood with nocturnal periodicity. Due toits extremely rarity it is difficult to detect them in routineperipheral blood smears, Fine Needle Aspiration (FNAC)Smears and body fluids. The objective of our study was toemphasise on having a high index of suspicion of filarialinfection in any swelling especially in patients from endemiczones. This study also aims to highlight the importance ofFNAC as a cheap and effective tool to diagnose microfilaria.Material and Methods: A total of 9590 cases, with lesionsin different sites were encountered in this study.The patientsunderwent thorough clinical examination and routineinvestigations.The cystic lesions that were included in thisstudy were aspirated. The material centrifuged and smearsprepared were stained with Leishman-Giemsa and PAP stain.Results: In this study out of a total of 9590 cases of superficialswellings that were subjected to fine needle aspirationcytology, 11 cases of filariasis were diagnosed on routineFNAC material from various sites. Out of these11 cases,maximum cases of filariasis were reported in lymph nodes (3cases),breast swelling (2 cases), followed by scrotal swellings(2 cases), thyroid swellings (2 cases), parotid (1 case) andPleural (1 case).Conclusions: Filariasis is an uncommon condition and needa high index of suspicion and careful screen of FNA smearsespecially in asymptomatic patients belonging to endemiczones, so as not to miss this incidental finding especially inpatients from endemic areas. This study also highlights theimportance of FNAC as a cheap and effective tool to diagnosemicrofilaria.

Brush Biopsy Sample Quality: Preliminary Investigation of a Metal Brush Prototype

Objective: To qualitatively investigate whether a prototype brush composed of metal bristles collects oral epithelial cells effectively for cytological evaluation of oral mucosal lesions. Material and Methods: Twenty patients with suspicious oral mucosal lesions were enrolled. Patients were asked to gargle with saline and to deposit the oral rinse into specimen cup. Then, oral mucosal cell samples were collected using a metal oral brush, via sweeping motion. Punch biopsy was performed for histological examination. All samples were evaluated with liquid based cytology (LBC) according to the cellularity, the depth of the epithelial layer, cellular integrity by an oral pathologist. Results: Oral rinse provided samples with 100% cellular integrity and cellularity, mostly from the intermediary layers. With metal brush, both inadequate cellularity and cellular integrity was observed in 25% of the cases. Cellular integrity was adequate in 65%, cellularity was adequate in 45% of the lesions. Samples were dominantly from the intermediary layers, but in one case, metal brush collected cells from the parabasal layer. Conclusion: The narrow spiral pitch and width of metal bristles may have resisted to release the cellular samples collected. With adjustment of the spiral pitch and diameter of metal brush bristles, its' efficacy could be enhanced.

Hallazgos en colposcopia. Experiencia en una unidad de referencia / Findings in colposcopy. Experience in a reference unit

Resumen OBJETIVO: Describir los desenlaces colposcópicos de pacientes con alteraciones citológicas atendidas en una institución colombiana. MATERIALES Y MÉTODOS: Estudio observacional, trasversal y retrospectivo al que se incluyeron pacientes a quienes se tomó una colposcopia, indicada por reporte anormal en la citología (2012-2106). La muestra se seleccionó a partir de un muestreo aleatorio, estratificado por grupos etarios. Se establecieron las frecuencias de las alteraciones colposcópicas y de los reportes histológicos. RESULTADOS: Se incluyeron 372 pacientes. La principal indicación de la colposcopia fue el reporte de atipia de células escamosas de significado indeterminado (70.6%), seguido por lesiones intraepiteliales de bajo grado (16.9%) y pólipos endocervicales (2.9%). La colposcopia fue negativa en 32% de los casos, positiva en 31% y con inflamación en 21%. El resto de los casos correspondió a atrofia o pólipos. De las colposcopias positivas, el principal reporte fue de cambios menores o grado 1; sobre todo en las pacientes de 15 a 24 años. De las pacientes con biopsia se reportó un caso de adenocarcinoma (3.1%) y otro de carcinoma in situ (3.1%) en el mismo grupo etario. CONCLUSIÓN: La colposcopia identificó lesiones de alto y bajo grado clínicamente no significativas. La colposcopia es una herramienta decisiva para el diagnóstico de lesiones premalignas del cuello uterino.

Abstract OBJECTIVE: This study describes the colposcopic results of patients with cytological alterations in a Colombian institution. MATERIALS AND METHODOS: Observational Cross-sectional study based on retrospective data. Patients who underwent colposcopy due to abnormal cytologies during 2012-2106 were included. A stratified random sampling was carried out by age groups. The frequencies of colposcopic alterations and histological results were established. RESULTS: 372 patients were selected. The main indication for colposcopy was the ASCUS report (70.6%), followed by LSIL (16.9%) and endocervical polyps (2.9%). Colposcopy was negative in 32% of the cases, positive in 31% and inflammation in 21%. The rest of cases corresponded to varied findings such as atrophy or polyps. Of the positive colposcopies the main report was minor changes or grade 1; especially in patients between 15-24 years. Of the patients with a biopsy, one case of adenocarcinoma (3.1%) and another of carcinoma in situ (3.1%) were reported in the same age group. CONCLUSIONS: The realization of colposcopy identified the high-grade lesions in this population, but also detected clinically insignificant low-grade lesions. Colposcopy is a key tool for the diagnosis of premalignant lesions of the cervix.

Experimental validation of a rapid staining method and digital cytology for cervical and anal cancer / Validação experimental de um método de coloração rápida e citologia digital para cancro ginecológico e anal

ABSTRACT Cytology is used as detection and screening method of malignant and pre-malignant lesions showing their potential since the original works of Papanicolaou. The cytological smears are usually stained with the Pap staining, although this method is time consuming and requires different reagents. The aim of this study is to assess the quality of an original Blue staining in exfoliative smears comparing it with the standard Papanicolaou staining. The new Blue staining allows staining gynecological cytology with high quality standards at reduced cost and time when compared to the Papanicolaou method.

RESUMO A citologia é utilizada como método de detecção e rastreio de lesões malignas e pré-malignas e mostra seu potencial desde os trabalhos originais de Papanicolaou. Geralmente, os esfregaços citológicos são corados com a coloração de Papanicolaou, apesar desse método exigir muito tempo e vários reagentes. O objetivo deste estudo é avaliar a qualidade de uma coloração original Blue Stain em esfregaços esfoliativos comparando-a com a coloração standard de Papanicolaou. O novo método de coloração Blue Stain permite corar citologias ginecológicas com elevados padrões de qualidade a um custo e tempo reduzidos quando comparado com o método de Papanicolaou.

External quality monitoring of the cervical cytopathological exams in the Rio de Janeiro city / Monitoramento externo da qualidade dos exames citopatológicos cervicais na cidade do Rio de Janeiro

Abstract Objective To discuss the implementation and contributions of the External Quality Monitoring in the city of Rio de Janeiro and to analyze the performance of the main providers of cervical cytopathology in this city from September 2013 to March 2017, here referred to as "Alpha laboratory" and "Beta laboratory." Methods Observational, cross-sectional, retrospective study using information from the Cervical Cancer Control Information System (SISCOLO, in the Portuguese acronym), municipal coordinationmodule, External QualityMonitoring report. The proportions of false positives, false negatives, unsatisfactory samples and rejected samples were estimated. The agreement among the observers was analyzed through the Kappa index and the reduction of disagreements in the period for each laboratory studied, comparing the results of each cycle. Results A total of 19,158 examinations were selected, of which 19,130 (99.85%) were monitored, 16.649 (87, 03%) were reviewed by the External Quality Monitoring Unit, 2,481 (12,97%) were rejected and 441 (2,65%) were considered unsatisfactory. The "Beta laboratory" presented excellent concordance in all cycles; the "Alpha laboratory" had good concordance in the first two cycles (K = 0.76 and 0.79), becoming excellent in the following four cycles. The average Kappa index was 0.85, with median of 0.86. The percentage of diagnostic disagreement was 6.63% of the reviewed exams, of which 5.38% required a change of conduct Conclusion External Quality Monitoring is an exercise in diagnostic improvement, and its implementation was fundamental to ensure the reliability of the cytopathological exams in the city of Rio de Janeiro.

Resumo Objetivo Discutir a implementação e as contribuições do Monitoramento Externo da Qualidade na cidade do Rio de Janeiro e analisar o desempenho dos principais provedores de citopatologia cervical nessa cidade no período de setembro de 2013 a março de 2017, aqui denominado "laboratório Alfa" "e" "laboratório Beta." Métodos Estudo observacional, transversal, retrospectivo, utilizando informações do Sistema de Informação de Controle do Câncer do Colo do Útero (SISCOLO), domódulo de coordenação municipal, e do relatório de Monitoramento da Qualidade Externa. As proporções de falsos positivos, falsos negativos, amostras insatisfatórias e amostras rejeitadas foramestimadas. A concordância entre os observadores foi analisada através do índice Kappa bem como a redução de divergências no período para cada laboratório estudado, comparando os resultados de cada ciclo. Resultados Foram selecionados 19.158 exames, dos quais 19.130 (99,85%) foram monitorados, 16.649 (87, 03%) foram revisados pela Unidade de Monitoramento da Qualidade Externa, 2.481 (12,97%) foram rejeitados e 441 (2,65%) foram considerados insatisfatório. O "laboratório Beta" apresentou excelente concordância em todos os ciclos; o "laboratório Alfa" apresentou boa concordância nos 2 primeiros ciclos (K = 0,76 e 0,79), tornando-se excelente nos 4 ciclos seguintes. O índice Kappa médio foi de 0,85, com mediana de 0,86. O percentual de discordância diagnóstica foi de 6,63% dos exames revisados, dos quais 5,38% necessitaram de mudança de conduta. Conclusão OMonitoramento Externo da Qualidade éum exercício de aprimoramento diagnóstico, e sua implementação foi fundamental para garantir a confiabilidade dos exames citopatológicos no município do Rio de Janeiro.

The diagnostic value of automated quantitative DNA cytometry for pancreatic malignancy / 中华消化内镜杂志

Objective To estimate the diagnostic value of cytology, DNA-ICM(DNA-image cytometry),cytology combined with DNA-ICM for pancreatic malignancy,and to explore the cut-off value for DNA-ICM. Methods Patients with suspicious pancreatic malignancy were retrospectively identified. In total,145 EUS-FNA specimens acquired from 140 separate patients were examined by cytology and DNA-ICM. Diagnostic values among cytology, DNA-ICM and the combination of the techniques in detecting pancreatic malignancy were compared. Results Compared with cytology, DNA-ICM had a lower sensitivity (63.0% VS 82.4%)and accuracy(69.7% VS 85.5%). After combining the techniques, the diagnostic value for pancreatic malignancy significantly improved compared with that by cytology(0.941 VS 0.912, P=0.007 0)or DNA-ICM only(0.941 VS 0.815, P<0.000 1). By using the Youden index, the cut-off value for DNA-ICM to detect pancreatic malignancy was one cell with DI(DNA index)≥2.5. Notably,with this standard, the sensitivity and accuracy of DNA-ICM significantly increased to 72.3% and 77.2%, and those of the combined techniques increased to 91.6% and 93.1%, respectively. Conclusion Automated DNA-ICM is an objective and effective method for pancreatic malignancy. Although DNA-ICM has a lower diagnostic value than that of conventional cytology, an improved value was obtained after combining the techniques.

Use of the ultrasound-based total malignancy score in the management of thyroid nodules

PURPOSE: The purpose of this study was to validate the role of the total malignancy score (TMS) in identifying thyroid nodules suspicious for malignancy through the sum of their ultrasound features. METHODS: The local ethical committee approved this prospective observational study. We examined 231 nodules in 231 consecutive patients (164 females and 67 males; age range, 20 to 87 years; median age, 59 years; interquartile range, 48 to 70 years) who underwent ultrasound followed by fine-needle aspiration cytology (FNAC). The nodules were further classified using the TMS, which considers ultrasound features (number, echogenicity, structure, halo, margins, Doppler signal, calcifications, and growth), and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), which considers cytological features. Patients with non-negative nodules (TBSRTC categories III to VI) underwent histological analysis, repeated FNAC, or 2 years of regular ultrasound follow-up. The associations between the final diagnosis, each of the ultrasound features, and the TMS were estimated using the chi-square test, the Mann-Whitney U test, and multivariate logistic regression. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of the TMS. RESULTS: On ultrasound, 47% of the nodules (108 of 231) had a TMS 3. The FNAC results of 85% of the nodules (196 of 231) were benign, while 15% (35 of 231) had non-negative results. Hypoechogenicity, solid structure, the presence of microcalcifications, and the number of nodules were independent predictors of the final diagnosis, and the diagnostic accuracy of the TMS was good (area under the ROC curve, 0.82). CONCLUSION: The TMS system is simple to use, reliable, easily reproducible, and closely reflects malignancy risk. Based on our results, FNAC could be limited to nodules with a TMS ≥3 without missing any cases of carcinoma.

Prognostic factors for patients with early-stage uterine serous carcinoma without adjuvant therapy / 부인종양

OBJECTIVE: Uterine serous carcinoma (USC) is an aggressive type 2 endometrial cancer. Data on prognostic factors for patients with early-stage USC without adjuvant therapy are limited. This study aims to assess the baseline recurrence risk of early-stage USC patients without adjuvant treatment and to identify prognostic factors and patients who need adjuvant therapy. METHODS: Sixty-eight patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–II USC between 1997 and 2016 were included. All the cases did not undergo adjuvant treatment as institutional practice. Clinicopathological features, recurrence patterns, and survival outcomes were analyzed to determine prognostic factors. RESULTS: FIGO stages IA, IB, and II were observed in 42, 7, and 19 cases, respectively. Median follow-up time was 60 months. Five-year disease-free survival (DFS) and overall survival (OS) rates for all cases were 73.9% and 78.0%, respectively. On multivariate analysis, cervical stromal involvement and positive pelvic cytology were significant predictors of DFS and OS, and ≥1/2 myometrial invasion was also a significant predictor of OS. Of 68 patients, 38 patients had no cervical stromal invasion or positive pelvic cytology and showed 88.8% 5-year DFS and 93.6% 5-year OS. CONCLUSION: Cervical stromal invasion and positive pelvic cytology are prognostic factors for stage I–II USC. Patients with stage IA or IB USC showing negative pelvic cytology may have an extremely favorable prognosis and need not receive any adjuvant therapies.

Ausencia de lesión intraepitelial en piezas de conización / Related factors to absence of cervical intraepithelial neoplasia in the conization specimen

Resumen OBJETIVO: Investigar las posibles causas de los conos blancos, establecer estrategias para disminuir su incidencia y desarrollar protocolos de seguimiento. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, de casos y controles. Se incluyeron las pacientes a quienes se efectuó una conización en el Hospital Universitario La Paz. Las variables analizadas más importantes fueron: anatomía patológica de la pieza y su relación con la biopsia y citologías previas, longitud del cono, presencia o no de artefacto y de cervicitis. Para el análisis estadístico se utilizaron: χ2, prueba exacta de Fisher, t de Student, U de Mann-Whitney, Kruskal-Wallis y Kolmogorov-Smirnov. RESULTADOS: Se integraron dos grupos: 371 conos positivos (85.9%) y 61 negativos (14.1%), con diferencias estadísticamente significativas en la citología, colposcopia y biopsia. Hubo mayor porcentaje de lesiones de menor grado en las pacientes con conización blanca. La longitud del cono fue menor en el grupo de análisis y en éste también se observó mayor porcentaje de cervicitis y artefactos. CONCLUSIONES: Las causas de lesión residual luego de una conización son variadas y difíciles de demostrar. Las pacientes con citología anómala e inflamación o atrofia deben recibir tratamiento para evitar falsos positivos y mejorar la técnica quirúrgica para impedir artefactos.

Abstract OBJECTIVES: to investigate the possible causes of the negative cones, to establish strategies to reduce their incidence and to develop monitoring protocols. MATERIALS AND METHODS: This is a retrospective observational cases and controls study of 432 conizations made in the Hospital Universitario La Paz (HULP) between 2013 and 2015. The most important analysed variables were the pathological anatomy of the piece and its relationship with the biopsy and previous cytology, the cone length, as well as the presence and artefact and cervicitis. The analysis it was used Chi - Square and Fisher´s test, T-Student, Mann Whitney U, Kruskal-Wallis and Kolmogorov- Smirnov. RESULTS: There are two groups: 371 positive (85,9%) and 61 negative cones (14,1%). We find statistically significant differences in the cytology, colposcopy and biopsy pre-conization, finding a major percentage of injuries of lesser degree in the patients with negative cone. The length of the cone was lower in the analysis group and in this we also observed a greater percentage of cervicitis and artefacts. CONCLUSIONS: The causes that make the remaining injury not appear after a diagnosed and/or therapeutic conization are a wide variety and difficult to prove. We should try to treat the patients with inflammation or atrophy to avoid false positives in the cytology and biopsy, improve the surgical technique to avoid artefacts and perform conservative management of low-risk injuries.

Incidencia y caracterización de pacientes con células escamosas atípicas de significado indeterminado / Incidence and Characterization of Patients with Atypical Squamous Cells of Undetermined Significance

Fundamento: el estudio citológico es el más importante en los programas de detección precoz de cáncer cervicouterino, siendo la atipia de células escamosas de significado indeterminado la anomalía más frecuente encontrada. Objetivo: determinar la incidencia de atipia de células escamosas de significado indeterminado en la consulta de patología de cuello del Hospital Universitario Ginecobstétrico Mariana Grajales de la provincia Villa Clara. Método: se realizó un estudio de tipo transversal en el que el universo estuvo constituido por las 206 pacientes remitidas a la consulta de patología de cuello durante el año 2011, la muestra fue de 120 mujeres que en el libro de registro de citologías orgánicas del departamento de anatomía patológica del Hospital, contaban con la totalidad de los datos requeridos con un reporte de células escamosas atípicas de significado indeterminado. Las variables estudiadas fueron: edad en años cumplidos al momento del diagnóstico, la edad en años de las primeras relaciones sexuales y el número de partos. Se confeccionó un fichero de datos en Excel donde se realizaron los cálculos necesarios. Se emplearon números absolutos y porcentajes para resumir las variables cualitativas y media, desviación estándar, valores mínimos y máximos para las cuantitativas. Resultados: se obtuvo una incidencia de células escamosas atípicas de significado indeterminado de un 0,37 %, predominó en las mujeres mayores de 40 y menores de 50 años, la mayoría inició sus relaciones sexuales antes de los 20 años y tuvieron 2 hijos. Conclusión: la incidencia de reportes de células escamosas atípicas durante el período de tiempo estudiado fue baja, predominó en mujeres de mediana edad, en aquellas que iniciaron sus primeras relaciones sexuales de manera precoz y en las multíparas.

Foundation: cytological study in the most important of the programs for early detection of cervical uterus cancer. The most frequently atypia found was squamous cells of undetermined significance. Objective: to determine the incidence of squamous cells of undetermined significance in the consultation of Cervix Pathology at the Gyneco-Obstetric University Hospital Mariana Grajales. Method: it was a cross-sectional study in a universe constituted by the 206 patients referred to the cervix pathology consultation during the year 2011. The sample was 120 women from the organic cytology registration book at the pathological anatomy department of the Hospital, who had all the required data with a report of atypical squamous cells of undetermined significance. The studied variables were: age in years completed at the time of diagnosis, age in years of the first sexual relations and the number of births. A data file was created in Excel where the necessary calculations were made. Absolute numbers and percentages were used to summarize the qualitative and average variables, standard deviation, minimum and maximum values for the quantitative variables. Results: an incidence of atypical squamous cells of undetermined significance of 0.37 % was obtained, it predominated in women older than 40 and younger than 50 years old and most of them started their sexual relations before the age of 20 and had 2 children. Conclusion: the report incidence of atypical squamous cells during the studied period of time was low; it predominated in middle-aged women, in those who had an early sexual relation and in multiparous women.

Lesões precursoras do câncer uterino em mulheres HIV-positivo e sua relação com linfócitos CD4+ e carga viral do Hospital Universitário Gaffrée e Guinle ­ UNIRIO / Precursor lesions of cervical cancer in HIV-positive women and their relationship with CD4+ and viral load Gaffrée and Guinle University Hospital ­ UNIRIO

Objetivo: Associar as alterações citológicas do colo uterino com a carga viral e a contagemde CD4+ das pacientes portadoras do vírus HIV. Métodos: O estudo realizado foi transversal e prospectivo, sendo 112 mulheres examinadas, e o exame citológico foi colhido no HUGG e corado pela técnica de Papanicolaou na SITEC/ INCA. A carga viral e contagem de CD4+ foram retiradas dos prontuários das pacientes. Resultados: A frequência das alterações citológicas foi de 15,2%, sendo 7,1% de LSIL, 4,5% de ASCUS e 3,6% de HSIL. Pacientes com CD4+ menor que 200 células ou sem adesão ao tratamento apresentaram maior frequência de alterações citológicas; pacientes com CD4+ maior que 500 células e carga viral indetectável apresentaram menor frequência de alterações citológicas. Conclusão: Esses resultados demonstraram que houve maior frequência de alterações citológicas nas mulheres com menor contagem de CD4+ ou sem adesão ao tratamento, demonstrando uma maior associação de alterações citológicas nas mulheres com doenças que provocam imunossupressão e reforçando a importância do rastreamento do câncer de colo uterino nas mulheres HIV positivo

Objective: To associate cervical lesions with viral load and CD4+ counts of HIV positive women. Methods: The study was cross-sectional and descriptive involving 112 patients with HIV infection. Pap smear was collected at HUGG and stained by the Papanicolaou method. All cytology examination was done in INCA. Viral load and CD4+ count were taken from medical records. Results: The positivity rate of cytology lesions was 15.2%, 7.1% of LSIL, 4.5% of ASC-US and 3.6% of HSIL. Patients with CD4+ counts less than 200 cells or without adherence to treatment had higher risk of positive result and the patients with CD4 counts greater than 500 cells and an undetectable viral load were less likely to have positive cytology results. Conclusion: These results showed a higher frequency of cytological abnormalities in women with lower CD4+ count or without adherence to treatment demonstrating a greater association of cytological abnormalities in women with diseases that cause immunosuppression and reinforcing the importance of screening for cervical cancer in HIV positive women

Analysis of characteristics of ultrasound and fine needle aspiration cytology in patients with papillary thyroid carcinoma / 天津医药

Objective To analysis the diagnostic values and characteristics of ultrasound and ultrasound guided fine needle aspiration cytology (FNAC) in patients with papillary thyroid carcinoma (PTC) before operation. Methods The data of ultrasound and ultrasound guided FNAC in 129 patients (including 148 PTC nodules) with PTC were collected from January 2014 to February 2017, and the diagnostic reports and feature descriptions of ultrasound and ultrasound guided FNAC were analyzed retrospectively. Results Among the 148 PTC nodules, the ultrasonographic imaging showed that 84.5% (125/148) with low echo-level solid nodules, 61.5% (91/148) with echo heterogenicity, 77.7% (115/148) with a ratio ≥ 1 in longitudinal/breadth, 69.6 % (103/148) with fuzzy boundary, 75.0% (111/148) with microcalcification in nodules, 97.3% (144/148) without or with incomplete aureole, 64.9% (96/148) with rich blood flow and 7.0% (9/129) with enlargement of cervical lymph nodes. The FNAC diagnosis showed that 78.4% (116/148) was diagnosed with suspected papillary carcinoma, 1.4% (2/148) was diagnosed with malignent tumor, 11.5% (17/148) was diagnosed with atypia of undetermined significance (AUS), 1.4% (2/148) was diagnosed with benign lesion, 0.7% (1/148) was diagnosed with follicular neoplasm and 6.7% (10/148) could not be diagnosed. If the suspected papillary carcinoma and malignent tumor were defined as cytodiagnosis, the diagnostic accordance rate with intraoperative pathology was 79.7%. Conclusion The preoperative accuracy rates of ultrasound diagnosis and ultrasound guided FNAC diagnosis for patients with PTC are high, and the characteristics of the both are also typical. The two examinations before operation are helpful for early diagnosis and treatment formulation for patients with PTC.

Study on clinical management of HPV+/Pap-during cervical cancer screening / 中华妇产科杂志

Objective To study the clinical management way for HPV+/papanicolaou (Pap)-during cervical cancer screening.Methods To analyze retrospectively the data from the patients who had loop electrical excision procedure (LEEP) for biopsy confirmed cervical intraepithelial neoplasia (CIN)Ⅱ in Peking University People's Hospital from Jan.2010 to Dec.2014.Results (1) For biopsy confirmed CINⅡ,HPV positive rate was 98.5％ (135/137),Pap test positive [≥atypical squamous cell of undetermined significance (ASCUS)] rate was 69.3％ (95/137),there was significant difference between them (x5=43.32,P＜0.01).(2) For the 42 patients with HPV+/Pap-,whose cytology slides were reviewed again.Among them,the interpretations of there were 16 cases confirmed as the same before,while 26 cases were changed to abnormal (≥ASCUS).Cytology be misdiagnosed was 19.0％ (26/137) at the first review.Among the 26 cases,13 (50.0％) cases were missed for the little amount of abnormal cells,8 (30.8％) cases for mild atypical morphology changed;the other 5 (19.2％) cases missed for stain problems.(3) For the cervical LEEP samples,37 cases of the pathology diagnosis were upgrade to CIN Ⅲ+,among them,2 cases of microinvasive cervical carcinoma,1 case of invasive cancer,34 cases of CIN Ⅲ;37 cases were CINⅠ or no lesion found;63 cases were still CIN Ⅱ.Four to six months later after LEEP,the cytology abnormal rate was 11.7％ (16/137),and the HR-HPV positive rate was 34.3％ (47/137).Conclusions Compared with cytology alone,cytology combined with HPV testing increase the sensitivity of cervical high grade lesion.For the cases of HPV+/Pap-cases,the cytology slides should be reviewed.The quality control of cervical exfoliate sample collection and interpretation should be strengthened.LEEP procedure is not only a treatment method,but also it could provide samples to confirm the diagnosis.

Significance of p16/Ki-67 double immunocytochemical staining in cervical cytology ASCUS, LSIL,and ASC-H / 中华妇产科杂志

Objective To investigate the application value of p16/cell proliferation associated nuclear antigen (Ki-67) double-staining and human papillomavirus mRNA in the cytological screening.Methods Two hundred and fifty-one cases who suffered from atypical squamous cell of undetermined significance (ASCUS),low-grade squamous intraepithelial lesion (LSIL),atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) in ThinPrep cytologic test (TCT) were collected in Peking University First Hospital between October 2015 and March 2016.And p16/Ki-67 double-staining and hybrid capture Ⅱ (HC-Ⅱ) detection were performed on the cervical cells.The result was compared with the pathological result of colposcope guided biopsy.All statistical analysis was completed by Stata 12.0 statistical software analysis.The results of diagnostic tests were described by using the sensitivity,specificity,positive predictive value,negative predictive value,and the area under the receiver operating characteristic (ROC) curve.Results (1) One hundred and eight cases of liquid based cytology diagnosis of ASCUS patients,the positive rate of p16/Ki-67 was 13.9％ (15/108),102 cases of liquid based cytology diagnosis of LSIL patients,the positive rate of p16/Ki-67 was 21.6％ (22/102),41 cases of liquid based cytology diagnosis of ASC-H patients,the positive rate of p16/Ki-67 was 39.0％ (16/41),compared amongthree groups,the difference was statistically significant (x2=78.516,P＜0.05);cervical exfoliated cells p16/Ki-67 expression rate was 13.0％ (28/215) in cervical low-grade lesions [cervical intraepithelial neoplasia (CIN)Ⅰ],which was 69.4％ (25/36) in high level lesions (CIN Ⅱ-Ⅲ),the difference was statistically significant (x2=7.932,P＜0.05).(2) The specificity of p16/Ki-67 detection and diagnosis were higher than those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (89.8％ vs 71.4％,83.3％ vs 15.6％,88.9％ vs 40.7％;all P＜0.05),meanwhile,the positive predictive value of p16/Ki-67 detection and diagnosis exceed those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (33.3％ vs 26.3％,31.8％ vs 12.6％,81.3％ vs 38.5％;all P＜0.05).Moreover,the ROC curve of p16/Ki-67 were bigger than those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (0.799 vs 0.696,0.708 vs 0.531,0.909 vs 0.561;all P＜0.05).Conclusion For patients with cytological diagnosis of ASCUS,LSIL,and ASC-H,p16/Ki-67 double staining method could be used as an effective method to assist in the diagnosis of high-grade cervical lesions,and the screening efficiency is superior to that of high-rist HPV.

The clinical application of cerebrospinal fluid cytological examination / 中华检验医学杂志

Cerebrospinal fluid contains various types of cells,and in disease state,the appearance, disappearance and quantity of these cells will change significantly, the cell composition and morphology characteristic of cerebrospinal fluid have great clinical relevance.morphological observation and classification of cerebrospinal fluid provide accurate diagnosis, differential diagnosis, clinical observation and prognosis evaluation.for Central Nervous System(CNS)diseases,Especially for CNS infection and metastasis diseases,it is almost impossible to diagnose without reference to cerebrospinal fluid cytology.Therefore, cerebrospinal fluid cytology is simple, fast and effective, and its uniqueness, accuracy and determination cannot be replaced by simple cell classification.