Rapid rescreening of cervical smears by cytopathologists: experience at a WHO collaborating centre for research in cytology.

The conventional 10% random full rescreening of cervical smears has been criticized as a quality assurance measure as it is not scientifically based and tends to detect only a few false negative cases. Rapid rescreening (RR) of negative cervical smears seems to be a viable alternative, especially in developing countries, as it picks up more positive lesions, reduces the false negative rate and is cost effective. We performed rapid review on 12374 cervical smears received under a hospital based cervical cancer screening programme. An additional 498 lesions were picked up on RR including a sizeable number of low and high grade lesions as well as 2 malignant cases. Thus RR led to an increase in efficiency of our laboratory.

Role of guided fine needle aspiration cytology in diagnosis and classification of liver malignancies.

Ultrasound or CT-guided fine needle aspiration was performed on 212 patients with space occupying lesions of the liver during a period of 5 years (1986-1990) to study the utility of fine needle aspiration (FNAC) in the diagnosis of hepatic malignancies. The initial FNAC diagnosis was malignancy in 91 cases. However, following review of the smears by one of the investigators (DKD) 93 (43.9%) cases were found to be malignant. Age of the patients with malignancy ranged from 20 days to 85 years. Male to female ratio was 57:36. The clinical diagnosis was malignancy in 58% which improved to 72% following imaging whereas nonspecific diagnosis was reduced from 34% to 20%. The primary malignancies consisted of 21 cases of hepatocellular carcinoma (HCC) and 7 hepatoblastomas. There were 61 metastatic lesions which included 43 adenocarcinomas, 6 small cell anaplastic carcinomas, 3 leiomyosarcomas, 2 cases each of malignant melanoma, paraganglioma and germ cell tumour, and one case each of squamous cell carcinoma, neuroendocrine tumour and undifferentiated carcinoma/soft tissue sarcoma. In two cases decision between HCC and secondaries was not possible. There were also two cases of non-Hodgkin's lymphoma. Thirty six percent of primary malignancies and 58% of secondaries were correctly diagnosed or suggested as one of the possibilities by combined clinical examination and imaging prior to FNAC. Thus, US/ CT guided FNAC played an important role in diagnosis and classification of malignancies of liver.

Ultrasound guided percutaneous fine needle aspiration cytology of pancreas: a review of 61 cases.

The study includes 61 cases which were subjected to ultrasound (US) guided fine needle aspiration cytology (FNAC) to find out the utility of this technique in the diagnosis of pancreatic lesions. Age of the patients ranged from 23 to 85 years with a median of 50 years. Male to female ratio was 36:25. One or more clinical diagnoses were offered in 16 and in 9 of these, the disease was related to pancreas. Subsequent to US, the lesions were localized to pancreas in 57 and the nature of pathology in the pancreatic lesion could be diagnosed in 31. By FNAC, 31 cases (50.8%) were diagnosed to have pancreatic malignancy which included adenocarcinoma (23 cases), papillary cystic tumour (1), muco-epidermoid carcinoma (1), acinic cell carcinoma (1), islet cell tumor (1), and non Hodgkin lymphoma (4). FNAC of liver in 2 cases and retroperitoneal lymph node in a case of pancreatic adenocarcinoma revealed metastasis. During follow up, 1 case of non Hodgkin's lymphoma showed CSF involvement. Three cases (4.9%) were suspected to have epithelial malignancy of which one was confirmed as an adenocarcinoma following surgery and histology. Four (6.6%) were benign lesions which included nonspecific inflammation (2 cases), tuberculous pancreatitis (1) and pseudopancreatic cyst (1). The remaining 23 cases (37.7%) had normal or inadequate cytology. Of these, FNAC of liver showed metastasis in 2 cases and one case each were diagnosed as adenocarcinoma and pseudopancreatic cyst respectively following surgery. None of the patients had any complication following FNAC. We recommend US guided FNAC to be routinely used for diagnosis of pancreatic lesion.

Tuberculous lymphadenitis: correlation of cellular components and necrosis in lymph-node aspirate with A.F.B. positivity and bacillary count.

Cytomorphologic features of tuberculous lymphadenitis cases as observed in lymph-node aspirates were analysed and correlated with AFB positivity and bacillary count. Cytologic features were categorized under three major groups, viz. epithelioid granuloma without necrosis, epithelioid granuloma with necrosis and necrosis without epithelioid granulomas. These three major groups showed a distinct trend in respect of their cellular constituents. While cases with appreciable lymphocytic and multinucleated giant cells component showed a significant decreasing trend, cases with neutrophilic infiltration showed an increasing trend (P less than 0.001). In the above three groups, 9.1 percent, 64.7 percent and 77.4 percent respectively showed AFB positivity, the difference being highly significant (P less than 0.001). All 14 cases with very high bacillary count (greater than 50 bacilli per 500 oil immersion field) were associated with necrosis and 71.4% of them neutrophilic infiltration. A univariate analysis revealed that in presence of lymphocytes, epithelioid cells and Langhan's giant cells, AFB positivity was significantly lower while the picture was just the reverse in presence of necrosis and neutrophilic infiltration (P less than 0.001). The odd's rations for all these variables were highly significant (P less than 0.001). However, a multivariate regression analysis revealed that necrosis was the only independent contributing factor towards AFB positivity.