Ultrasound-guided fine-needle aspiration cytology of gallbladder masses – A solution to diagnostic dilemmas

Background: Advances in medical technology has revolutionized patient care. Ultrasound (USG)-guided fine-needle aspiration cytology (FNACs) is enlarging the realm of diagnostic cytology. This merger has increased the diagnostic accuracy especially in inaccessible body sites like the gall bladder (GB) masses. Impalpable, deep, and small lesions are now no longer a dilemma, thanks to image-guided FNACs. Objectives: The objective of the study was to study the ultrasound-guided FNACs of GB masses for a 10 year period and evaluate the efficacy of ultrasound-guided FNACs in GB lesions. Materials and Methods: USG-guided FNACs were collected and analyzed over a 10 year period (2007–2016) in the Department of Pathology North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. This is a retrospective study and is in accordance with the ethical standards as laid by the Helsinki Declaration, 2000. Descriptive statistics were used for analysis. Results: The age ranges from 27 to 83 years and the mean age was 53.2 years. The majority were females which constituted around 94.3% (50) and males constituted around 5.7% (3). Out of all the adequate cases (42 in number) that were evaluated, 37 (88%) were malignant and 5 (12%) were benign and inflammatory; 11 out of 53 cases (20.8%) were inadequate. Conclusion: Although FNAC is established as a reliable diagnostic method, our study of 10 years has further proven that this test has stood the test of time, and with our high diagnostic yield and in the hands of a dedicated radiologist and cytopathologist, it will prove to surpass its expectations.

Efficacy of FNAC in early diagnosis of prostatic carcinoma

Background: Prostatic carcinoma is one of the most important causes of mortality in elderly men mainly because of the late detection despite of the fact that it is a potentially curable disease. Fine needle aspiration cytology (FNAC) is an easy to perform outpatient procedure requiring no expensive equipment or anesthesia. Objectives: The present study was carried out in an attempt to evaluate the fine needle aspiration cytology in the diagnosis of carcinoma prostate. Materials and methods: The present study was performed on 27 patients admitted in the surgical wards, with complaints suggestive of prostatic disease, in whom there was found to be a suspicion of malignancy of the prostate gland. Results: Among 27 patients, 14 patients were diagnosed as prostatic malignancy on per rectal FNAC whereas, 19 patients were confirmed with prostatic cancer histologically. Out of 19 histologically confirmed cancer cases, 16 were also positive on FNAC i.e. 84.21% accuracy of FNAC in detecting prostatic malignancy. Conclusion: Fine needle aspiration cytology is easily available and inexpensive procedure. It is a reliable method in the diagnosis of prostatic cancer. Its positive results are relatively more reliable than the negative ones. It is an effective method in follow up of the cancer cases.

To evaluate the role of sputum in the diagnosis of lung cancer in south Indian population.

Background: The main advantage of sputum cytology is its simplicity, non-invasiveness and minimal discomfort to the patient. Though, the sputum is evaluated in the diagnosis of lung cancer, the report on the same in the South Indian population was lacking. Therefore, the present study has been undertaken to evaluate the role of sputum in the diagnosis of lung cancer in South Indian population. Methods: The material consisted of sputum samples from 133 patients and was collected in clean wide mouthed disposable plastic containers. Patients were asked to collect sputum the next morning after washing the mouth properly. The sputum was immediately brought to the laboratory and poured into a watch glass. Four smears were prepared from each sample, out of which two smears were immediately fixed in methanol and the other two were air-dried. The methanol fixed smears were stained with Papanicolaou stain. Out of the two air dried smears, one was stained with May Grunwald Giemsa and the other with Gabbot's method for AFB. The smears were screened for malignant cells and a cytological diagnosis was made. The cytological diagnosis was correlated with the histopathological diagnosis. The data obtained were represented as mean percentages. Results: The observation of sputum smears showed numerous pleiomorphic keratinized squamous cells, keratinized squamous cell with hyper chromatic nucleus in well differentiated squamous cell carcinoma, pleiomorphic cells having vacuolated cytoplasm and vesicular nucleus with prominent nucleoli as in adenocarcinoma of the lung, cells arranged in small clusters and having scanty cytoplasm in small cell carcinoma and cells are slightly larger than lymphocyte with scanty cytoplasm and hyper chromatic, grooved nuclei in small cell carcinoma. Conclusion: Cytology of sputum is extremely useful and highly sensitive. The diagnostic accuracy is directly proportional to the number of samples. Sputum cytology is highly sensitive for the centrally located squamous cell carcinoma rather than the peripherally located adenocarcinoma. Properly collected, simple sputum examination alone can give results similar to other highly expensive methods like bronchoscopic material for the diagnosis of lung cancer.

Diagnostic importance of serous fluid examination for detection of various pathological conditions - A study of 355 cases.

Background: Cytological examination of exfoliated cells is very challenging and of paramount importance for diagnosis, staging and prognosis as the finding of cancer cells in such a specimen denotes that the patient has advanced and incurable cancer. Aims & Objective: To study serous effusion for various pathological conditions. Material and Methods: The study was performed on serous effusions. Serous effusions from pleural, pericardial and peritoneal fluid were included and all other fluids were excluded. Their clinical history and other relevant parameters were noted. Collection was performed with 18-gauge needle under local anaesthesia and sterile conditions. When delay, samples were stored at 2-6 ͦC. Conventional smear and or Cytospin method were performed. Ether alcohol (wet fixed) and air dried smears were used. H & E stain, papanicolaou stain and MGG stain were done. Results: Out of total 355 cases, 186 were of pleural fluid, 164 of peritoneal fluid and 5 were of pericardial fluid. 288 cases were benign, 24 cases were malignant effusion, 17 cases were suspicious of malignancy and 26 cases were degenerated. Transudate, haemorrhagic and straw coloured fluid were more common. Conclusion: Benign effusions are common in younger whereas malignant effusions are common in older people. A combined approach to morphology by may-grunwald giemsa, papanicolaou with haematoxylin and eosin stain was better than individual method. Recurrent hemorrhagic effusions are more common in malignant effusions. Conventional smear method can yield good result. Scattered cells are indicative of benign effusions and clusters, 3 D balls, papillary patterns indicate malignant effusions.