Body fluids: Comparison of liquid based cytology with conventional cytopreparatory technique

Introduction: In the diagnosis of malignant tumors, cytological examinations of various body fluids are useful. For the preparation of body fluid, many methods are used till date. The use of liquid-based cytology is new upcoming in the field. Aim: To examine the performance of liquid-based cytology on body cavity fluids as compared to conventional cytopreparatory techniques. Methodology: In the present study, 700 body fluid samples were processed by both liquid- based cytology (BD SurePath™) and conventional cytopreparatory technique (Thick & Thin). The performance of both techniques was compared in terms of “smear quality” and “overall diagnostic test performance.” Results: Out of 155 body fluid samples from proven malignancy patients, 32 (20.65%) were reported as Positive for malignancy, 23 (14.84%) as Suspicious of malignancy, and 100 (64.51%) as Negative for malignancy by CS (Thick and Thin). A total of 44 (28.39%) were reported as Positive for malignancy, 12 (7.74%) as Suspicious of malignancy, and 99 (63.87%) as Negative for malignancy by LBC. Conclusion: Liquid-based cytology is advantageous over conventional techniques in cytomorphology of body fluids, but not better in sensitivity and specificity. Also saves cytopathologist's valuable time for screening.

Application of artificial intelligence assists bone marrow cytomorphology analysis in the diagnosis and treatment of acute myeloid leukemia / 中华检验医学杂志

Objective:To investigate the value of artificial intelligence (AI) cytomorphologic analysis system in the cytomorphological diagnosis and therapeutic evaluation of acute myeloid leukemia (AML).Methods:Bone marrow smear samples were collected from 150 patients with newly diagnosed and treated acute myeloid leukemia who were inpatients and outpatients at the Department of Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 1, 2021 to July 31, 2022 for retrospective analysis. Among them, there were 50 patients in the newly diagnosed group, including 28 males and 22 females, with the onset age of 43.5(32.3,58.8)years. There were 100 patients in the post-treatment group, including 36 males and 64 females, with the onset age of 34.5(23.0,47.0)years. The results from cytomorphology expert were used as the gold standard and the Python 3.6.7 was used for analysis to evaluate the accuracy, sensitivity, and specificity of the AI cytomorphologic analysis system for blast cell recognition in AML diagnosis and treatment.Results:The proportion of blasts in AI analysis of 50 samples in the newly diagnosed group was≥20%, which met the diagnostic criteria of AML. AI analysis of blasts had an accuracy of 90.3%, sensitivity of 85.5%, and specificity of 98.0%. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.882, P<0.001). Meanwhile, in the post-treatment group, the sensitivity and specificity of AI analysis of blasts were 89.7% and 99.2%, respectively. The correlation coefficient between AI and the proportion of blasts analyzed by experts was positively correlated( r=0.957, P<0.001). According to AI analysis data, there are 8 samples in this group whose AI efficacy evaluation results on AML are inconsistent with expert analysis. Conclusion:AI cytomorphologic analysis system has high accuracy, sensitivity and specificity for blast cell recognition in AML morphological diagnosis and therapeutic evaluation.

Cytomorphological Study Of Benign And Malignant Breast Lesions Diagnosed By Fine Needle Asiration Cytology In A Tertiary Care Hospital

Background:Carcinoma of breast is the most common non skin malignancy in women and is second only to lung cancer as a cause of cancer deaths 1. FNA has now become a popular investigation to assess the nature of palpable breast lesions. The purpose of FNA is to confirm cancer preoperatively and to avoid unnecessary surgery in specific benign conditions2.Material And Methods:The observational study (prospective) was conducted in the cytology section in Department of Pathology over a period of 2 years (December 2018-November 2020) and included 100 patients who pre sented with palpable breastbreast lumps. Cytomorphological features of all the lesions were studied. The findings were tabulated and analysed. Result:There were 98 female and 2 male patients. Majority of the patients were from the age group of 31 –40 yrs. There was no significant association between the gender, duration of symptoms with the side of the breast involved. In benign breast lesions, fibroadenoma was most common and amongst malignant lesions, Ductal carcinoma. Conclusion:FNAC is a good diagnostic tool for breast lesions and it should be considered as a primary investigation of choice for suspected breast lesions considering its safety, simplicity and inexpensive characteristics.

Myelodysplastic syndrome: validation of flow cytometry multilineage score system / Síndrome mielodisplásica: validação de ficha de escore multilinhagem por citometria de fluxo

ABSTRACT Objective To validate multilineage score system correlating results of flow cytometry, cytogenetics, cytomorphology and histology from samples of patients with suspected myelodysplastic syndrome or cytopenia of unknown origin. Methods A retrospective study analyzing laboratory data of 49 patients with suspected myelodysplastic syndrome or cytopenia of unknown origin, carried out between May and September 2017. The inclusion criteria were availability of flow cytometry results, and at least one more method, such as morphology, histology or cytogenetics. Thirty-eight patients were classified as diagnosis of myelodysplastic syndromes, whereas 11 were classified as normal. Patients were evaluated based on score systems, Ogata score and flow cytometry multilineage score. Results Comparing the scores obtained in the Ogata score and the multilineage score, it was observed that in four cases the Ogata score was zero or 1 point, while the multilineage score was higher than 3 points. In addition, in 12 cases with Ogata score of 2, the multilineage score was greater than 3. Conclusion The flow cytometry multilineage score system demonstrated to be more effective in dysplasia analysis, by assessing the erythroid, monocytic, granulocytic and precursor cell lineages, apart from the parameters evaluated by the Ogata score.

RESUMO Objetivo Validar ficha de escore multilinhagem correlacionando resultados obtidos de citometria de fluxo, citogenética, citomorfologia e histologia de amostras de pacientes com suspeita de síndrome mielodisplásica ou citopenias a esclarecer. Métodos Estudo retrospectivo de análise de dados laboratoriais de 49 pacientes com suspeita clínica de síndrome mielodisplásica ou citopenias a esclarecer realizado entre maio e setembro de 2017. Os critérios de inclusão foram a disponibilidade de resultados de citometria de fluxo e de, pelo menos, outra metodologia, entre morfologia, histologia, ou citogenética. Trinta e oito pacientes foram classificados como diagnosticados com síndromes mielodisplásicas enquanto 11 foram classificados como normais. Os pacientes foram avaliados utilizando sistemas de escore, escore de Ogata e ficha multilinhagem. Resultados Comparando as pontuações obtidas no escore de Ogata e na ficha multilinhagem, observou-se que, em quatro casos, o score de Ogata foi zero ou 1 ponto, enquanto, pela ficha multilinhagem, a pontuação foi superior a 3 pontos. Além disso, em 12 casos com escore de Ogata 2, a pontuação pela ficha multilinhagem foi superior a 3. Conclusão A ficha multilinhagem demonstrou ser mais eficaz na análise de displasia por avaliar as linhagens eritroide, monocítica, granulocítica e células precursoras, além dos parâmetros avaliados no escore de Ogata.

Cytological Evaluation of Superficial Lymphadenopathy: A Three- Year Study

Background: The purpose of the study is to find out the various cytomorphology of palpable superficial lymph nodes and to determine the diseases commonly affecting the lymph nodes and their prevalence in relation to age, sex and anatomical location. Methods: The study was a retrospective descriptive study, comprised of 500 patients with peripheral lymphadenopathy who attended Cytology OPD at Zoram Medical College, Falkawn, Mizoram during the period of August 2016 to July 2019. FNAC was done with the help of 23G needle with a negative suction from 20ml syringe. Smears from the aspirates were routinely stained with May-Grϋnwald-Giemsa. Acid fast bacilli (AFB), Papaniculaou (PAP) stains were done as and when required. Results: Nonspecific reactive lymphadenitis was the most common cytomorphological diagnosis accounting for 69% of the cases followed by Metastatic carcinoma accounting for 9.2%. Tuberculous lymphadenitis was seen in 7.4%, Granulomatous lymphadenitis accounted for 6%, and suppurative lymphadenitis accounted for 4.4%. Conclusion: The knowledge of the pattern of lymphadenopathy of a particular geographical area is a very useful diagnostic aid for clinicians and pathologists alike. In the present study, nonspecific reactive lymphadenitis was the commonest pattern affecting all age groups. Metastatic lymph node was the second most common reflecting the high incidence of carcinomas in Mizoram. Metastasis was most commonly seen in the age group of more than 40 years. The commonest site involved in all age groups was cervical lymph node.

Fine Needle Aspiration Cytomorphological Spectrum (FNAC) Of Peripheral Lymph Node Lesions At A Tertiary Care Teaching Medical College & Hospital

Introduction: Peripheral lymhadenopathy is common presentation of inflammatory and neoplastic lesions.FNAC is one of the first–line investigations of managenent for the evaluation of lymphadenopathy.Enlargement of Lymph node is seen in variety of reactive inflammatory to neoplastic conditions related to regional or systemic diseases. It is very useful, easy, rapid, minimal invasive, cost effective and accurate approach in diagnosing various lymph node lesions and helpful in the workup of management of patients with nodal enlargement. Methods: A total of 175 patients were included in our study Department of Pathology, referred from the department of ENT, Medicine, Paediatrics, Surgery, Respiratory Medicine and Tuberculosis of Karpaga Vinayaga Hospital in the period from January 2017 to Dec 2018. Alcohol fixed and air dry smears were prepared and stain with H&E, PAP, and MGG. The special stain like PAS, ZN (20%) etc were done whenever required. Results:In present study total 175 cases of lymphadenopathy were studied. The presentation of various lymph node lesions on cytomorphological findings were Acute non–specific lymphadenitis cases were 5 (2.85%), Chronic non–specific lymphadenitis cases were 11 (8.28%), Granulomatous lymphadenopathy cases were 6 (3.42%), Tuberculous lymphadenitis cases were 60 (34.28%)’ Reactive lymphadenitis cases were 48 (27.42%), Metastasis to lymph node cases was 36 (20.57%), Lymphoma cases were 9 (5.14%). Unsatisfactory smears(11) were excluded from the study. The detailed clinical material data, relevant investigations were taken for supporting the diagnosis. Conclusion: Cytomorphological features of lymph node FNAC, used in conjunction with clinical details, laboratory test investigations, radiology imaging study will be very helpful for diagnosing various disorders. It will be rapid, cost effective, safe, and reliable method for early diagnosis and treatment of the patients

Ultrasound guided fine needle aspiration cytology of space occupying lesions of liver

Background: The liver is a common site for primary and secondary tumors; most often from malignant tumors within the abdomen and from extra-abdominal primary malignant neoplasm, but also for sarcomas and lymphomas. The main indication of fine-needle aspiration cytology (FNAC) of the liver is diagnosis of single or multiple space occupying lesions. This study aims to evaluate the cyto-morphology of primary and secondary neoplasms of liver and non-neoplastic conditions in the smears of ultrasound guided fine needle aspiration of SOL of liver, to evaluate the cytomorphologic features and to evaluate the erroneous diagnosis when compared with cell block preparation of aspirate (tissue diagnosis).Methods: This study is hospital-based prospective study including 57 patients with space occupying lesion of the liver mass. FNAC were carried out under the guidance of sonography and/or computed tomography. The staining performed were conventional for smears of the aspirate. The cell blocks were prepared from the aspirates by the established procedures. The values of correlation were bought out.Results: Males predominated over females. The distribution of cases for cyto-diagnosis were as follows; cirrhosis with hepatic granulosa (3 cases),pyogenic abscess (3 cases), hepatic adenoma (2 cases), Focal nodular hyperplasia (2 cases), hepatoblastoma (1 case), hepatocellular carcinoma (17 cases), adenocarcinoma deposits (20 cases), deposits of small cell carcinoma (3 cases), deposits of ductal carcinoma (2 cases) and 1 case each of deposits of squamous cell carcinoma, non-Hodgkin’s lymphoma, neuroendocrine tumor and adeno-squamous carcinoma. Values of correlation were as follows: sensitivity 97.61%, specificity 100%, PPV 100%, NPV 97.82% and diagnostic accuracy of 98.85%.Conclusions: FNAC is concluded to be first rank diagnostic procedure in diagnosis of SOL of liver of varied etiology with high values of NPV and PPV. It is also concluded that it helps in staging of metastatic malignancies.

A clinicopathologic study of malignant melanoma based on cytomorphology.

CONTEXT: Melanoma accounts for 1‑3% of all malignancies. It is usually diagnosed as metastasis in the draining lymph nodes, that is inguinal lymph node. Due to paucity of cytological studies on melanoma in India, the present study was undertaken. AIM: To study the cytomorphology of malignant melanoma and to correlate the cytological diagnosis with histopathology and clinical details. SETTINGS AND DESIGN: Sixteen cytomorphological features were studied and analysed from the cases diagnosed as melanoma on cytology with histopathological correlation. MATERIALS AND METHODS: Thirty patients diagnosed with malignant melanoma on fine‑needle aspiration cytology (FNAC) were studied over a period of 10 years and compared by histopathology. Papanicolaou (Pap)‑ and May Grunwald Giemsa (MGG)‑stained smears were studied and analysed for the cytomorphological spectrum of melanoma. RESULTS: Among the 30 patients studied, males were 19 and females were 11 (M:F:1.7:1) with a mean age of 49.3 years. The commonest primary site was foot followed by maxilla and thigh. The most common site for metastasis was inguinal lymph node. All 30 cases had histopathological correlation. Pigmented melanophages (83%) was the predominant feature followed by presence of melanin pigment (77%) and pseudo‑inclusions (73%). Condensed chromatin was observed in the majority of the patients (53%). Smooth and irregular nuclear contours were seen in combination in 37% of the cases. A combination of nuclear placement, that is eccentric and central was observed as a predominant feature (53%). Spindle cell pattern was the predominant shape. Among cytoplasmic features, melanin granules and vacuoles were equally distributed (50%). Mixed pattern, that is singly scattered plasmacytoid cell pattern and cell clusters was the predominant cell architecture. CONCLUSION: A spectrum of cytomorphological features in correlation with clinical details leads to greater precision in diagnosis and helps to avoid pitfalls in diagnosing melanoma.

Cytomorphological changes in breast carcinomas, after neoadjuvant chemotherapy: a study of twenty cases.

Background: Neoadjuvant chemotherapy administered pre-operatively is the standard of care therapy for locally advanced breast cancers, mainly for clinical down staging. The histopathological evaluation of tumor response is the gold standard. Aims: To study the morphological changes induced with neoadjuvant chemotherapy in breast carcinoma and assess the response or non-response of cancers to systemic therapy, based on a web based calculation script at www.mdanderson.org/breastcancer_RCB and also evaluated basing on NSABP-B18 system. Methods: 20 cases of radical mastectomies in locally advanced breast carcinomas with neoadjuvant chemotherapy are studied. Results: All the cases are female breast cancers. Macroscopically, the size of the tumor bed ranges from 10 mm to 90 mm in maximum dimension. The morphological changes: Tumor cellularity, cytomorphological changes. In the present study 20% of cases are pCR/RCB 0, 40% are pNR/RCB III cases and 40% are pPR/RCB I & II (i.e. pCR- pathological complete response, pNR-pathological no response, pPR-pathological partial response, RCB-Residual Cancer Burden). Conclusions: The spectrum of changes observed in the tumor bed is coagulative necrosis, hyalinisation, dystrophic calcification and intense mononuclear inflammatory cell collections, cytoplasmic vacuolization and bizarre nuclei. Quantification of the residual disease by RCB system and to categorize the residual disease is important, to predict the disease-free relapse rate.

Cytomorphometrical Analysis of Exfoliated Buccal Mucosal Cells: Effect of Smoking.

Introduction: Exfoliative cytology is a non-aggressive, non-invasive procedure with higher patient compliance and is therefore, an attractive technique for the early diagnosis of oral lesions. Th e purpose of this study is to evaluate and compare cytological changes using morphometric analysis of the exfoliated buccal mucosal cells in smokers, with results obtained for non-smokers. Methods: Smears were collected from the clinically normal buccal mucosa of 120 individuals. Age range of subjects taken was 40-60 years. Smears were then stained with Papanicolaou stain. Results: Mean NA for smokers was signifi cantly elevated compared with the mean NA for non-smokers. Mean CA in smokers was decreased as compared to non-smokers but the diff erence was not signifi cant. Also, N/C ratio was signifi cantly elevated in smokers group. With increasing heavy exposure in duration of years, Cytomorphometric changes show signifi cant altered values for all three measured parameters (NA, CA and N/C ratio). Conclusion: Increase in NA and decreased CA as well as altered N/C ratio would appear to be due to smoking tobacco. Cytomorphometric analysis can be used regularly to detect these cell alterations. Th is method can also aid in motivating individuals to withdraw from adverse eff ects of tobacco smoking. Currently, use of exfoliative cytology has increased as an adjunct to screening of precancerous lesions and malignancies of the oral cavity.

Analysis of External Quality Assessment Results for Blood Cytomorphology from 2011 to 2013 in Shaanxi Province / 现代检验医学杂志

Objective To analyse the problems presented in external quality assessment (EQA)for blood cytomorphology and propose measures for improvement.Methods Statistical analysis was performed on EQA results for blood cytomorphology from 2011 to 2013 in Shaanxi Province,including general information of participant laboratories,coincident rate,and reported incorrect results.EQA for blood cytomorphology was held two times every year in Shaanxi province,with ten pictures inclu-ding bone marrow and peripheral blood smear each time.The compact disc including twenty pictures was given to partici-pants by EMS.Participants reported two EQA results in April and September each year.The center statisticed the EQA re-sults and provided the EQA reports to every participants in June and November.Results Participating laboratories increased from 76 in 2011 to 163 in 2013.The ratio of laboratories with the coincidence rate≥80% was 80%,47%,44%,55%,77%and 96% respectively.The number for single cell with the coincidence rate≥80% was 38.The coincidence rate of peripheral blood cells was higher than that of the bone marrow on the whole.Causes of incorrect results included cell lines’misclassifi-cation,growth stage’s misclassification,insufficient identification of abnormal cytomorphology,and so on.Conclusion The identification of blood cytomorphology was unbalanced in different leveled hospitals in Shaanxi Province.To develop EQA of blood cytomorphology definitely has a positive role in improving the experimenters’skill of identifying cytomorphology.

Study on the relationship between myelodysplastic syndrome with normal karyotype and abnormal karyotype / 中国基层医药

Objective To investigate the characteristics of the abnormal karyotype and normal karyotype with myelodysplastic syndrome(MDS).Methods A retrospective analysis of 131 MDS patients was conducted.The cell morphology between abnormal karyotype and normal karyotype was compared.Results Of 131 MDS patients,71 cases (56.5％)had clonal chromosomal abnormalities.Pelger nuclear myeloid and lymphoid small megakaryocytes in abnormal karyotype group was significantly higher than the normal karyotype group (P ＜ 0.05).Megaloblastic erythroid-like change,double-nucleated red blood cells,multinucleated red blood cells,the petals nuclear,nuclear fragmentation;the myeloid uneven particle distribution,nuclear pulp imbalance,megaloblastic degeneration,vacuoles,AUER,dual-core; single-round,multi-roundnuclear megakaryocytes,the two groups showed no significant differences (P ＞0.05).Conclusion Pelger nuclear myeloid,lymphoid small megakaryocytes had significantly higher incidence of abnormal karyotype MDS compared with normal karyotype cell dysplasia,there was some correlation between abnormal karyotype and cell morphology.

Cytomorphological analyses of malignant lymphomas in serous effusions / 国际检验医学杂志

Objective To study the effect of cytomorphological analyses of malignant lymphomas in serous effusions .Methods Aspirating serous effusion were analyzed immediately ,then centrifugated ,stained with Wright-Giemsa ,and observed under micro-scope .The cytomorphological characteristics of lymphomas in serous effusions was analysed .Results 62 cases of malignant lym-phomas were found in 1 440 cases of the serous effusion .The diagnosis efficiencies of lymphomas were 89 .55% for sensitivity , 99 .85% for specificity ,96 .77% for positive expectant value ,99 .49% for negative expectant value and 99 .38% for total effective rate .Lymphoma cells were watched more in pleural effusion(46 cases) than in ascites(18 cases) and pericardial effusion(3 cases) . Cytomorphology of lymphomas included vacuoles ,large cells ,small cells and irregular cells .Conclusion The cytomorphological analysis of malignant lymphomas in serous effusion has an instructive significance to the clinical auxiliary diagnosis .

Cytomorphology and Molecular Characterization of CLTC-ALK Rearrangement in 2 Cases of ALK-Positive Diffuse Large B-cell Lymphoma with Extensive Bone Marrow Involvement / 대한진단검사의학회지

Aanaplastic lymphoma kinase (ALK)-positive diffuse large B-cell lymphoma (DLBCL) is an unusual disease entity first reported in 1997 as DLBCL with expression of full-length ALK protein. The World Health Organization classification enlists the disease as a rare variant of DLBCL. Herein we describe two cases of ALK-positive DLBCL with cytomorphologic and molecular characteristics for the first time in Korea. The patients were 35-yr-old and 24-yr-old male patients. Immunohistochemical studies on the lymph nodes revealed large sized neoplastic cells with plasmablastic differentiation, which were negative for CD30 and positive for ALK with the characteristic granular staining in the cytoplasmic region. Extensive involvement of bone marrow was observed in both cases showing large, extremely atypical cells. Fluorescence in situ hybridization and molecular studies on the bone marrow aspirate specimens led to the detection of a clathrin (CLTC)/ALK rearrangement. Despite aggressive chemotherapy, the patients died 15 and 17 months after the diagnosis, indicating poor prognosis of the disease entity. This is the first report demonstrating the cytomorphologic findings of ALK-positive DLBCL cells on bone marrow aspirates.

Experimental teaching exploration of practice of bone marrow cytomorphology / 中华医学教育探索杂志

The experimental teaching of morphlogy of bone marrow cytomorphology is the important content in the medical laboratory science.By conducting a series of reforms such as renewing teaching concept,consummating teaching condition,reforming teaching link,recombinating teaching content,establishing examination system about the experimental teaching of bone marrow cytomorphology may remarkably enhance student’s comprehensive ability and teacher’s anthusiasm and build the new type of relationship between teachers and students,which plays an important role in the cultivation of medical laboratory science specialized talents.

The effects of different concentrations of glucagon with or without hyperlipidemic serum on the cytomorphology of smooth muscle cells / 中国糖尿病杂志

A study of the effects of glucagon in concentrations of 100,1000 and 10000 ng/L with or without hyperlipidemic serum(HLS)on the cytomorphology and cytodynamics of cultured rabbit arterial smooth muscle cells(SMC) was carried out by light microscopy,transmission electron microscopy and isotope technique,The results were as follows:①No effect of glucagon in concentration of 100 ng/L on SMC in both cytomorphology and cytodynamics was found.②Glucagon in concentration of 1000 or 10000 ng/L caused slight damage of SMC,and tended to inhibit the multiplication rate of DNA,a parameter of cytodynamics.Furthermore,lipidic substance in SMC was found under such concentrations of glucagon without HLS,which was favorable for formation of foam cells,③There was positively synergistic effect between glucagon and HLS in the development of atherosclerosis.Our results suggest that to keep lower levels of plasma glucagon and lipids in diabetic patients may delay the development of atherosclerosis.

The effect of different concentrations of glucose with or without hyperlipidemic serum on the cytomorphology of arterial smooth muscle cells / 中国糖尿病杂志

The observations on cytomorphology and cytodynamics of cultured rabbit arterial smooth muscle cells(SMC)under concentrations of glucose 5.55,11.1,16.7,33.4 and 55.5 mmol/L with or without hyperlipidemic serum(HLS)were carried out by light microscopy and transmission election microscopy. The results showed that①The extent of disruption in SMC was positively correlated with concentrations of glucose,and negatively correlated with the multipication ralte of DNA,a parameter of cytodynamics.②There was no synergistic effect between glucose and HLS in the development of atherosclerosis.③In high glucose concentration groups(glucose 16.7mmol/L)a calcifies particle of high electronic density like substance,probably the core of atherosclerosis was found in SMC. Our results suggest that to keep lower levels of blood glucose and blood lipids may delay the development of atherosclerosis.