Application of the Milan System for Reporting Salivary Gland Lesions and Its Cytohistological Correlation for Risk Stratification: A Single-Institution Experience.

INTRODUCTION:  Salivary gland tumors are known to have a heterogeneous profile with variable clinical presentation and a wide variety of histological subgroups of prognostic significance. Immunocytochemical markers that aid in the diagnosis and characterization of the cell type of origin are critical for this heterogeneous group of malignancies. AIMS AND OBJECTIVES: To study the application of The 'Milan System' for Reporting Salivary Gland Cytology and the diagnostic utility of a panel of immunocytochemical markers in the diagnosis of salivary gland neoplasms and their cytohistological correlation for their risk stratification. MATERIALS AND METHODS: This was a prospective study carried out in which a total of 60 patients were enrolled in the study. Fine-needle aspiration cytology (FNAC) smears and cell blocks were prepared with standard techniques and staining procedures. Immunocytochemistry (ICC) was performed on cell block sections by immunoperoxidase procedure. Immunocytochemical (ICC) stains were used for the differentiation of the lesions in cell blocks. Histopathology was also studied if the patient underwent excision of salivary gland lesions. DISCUSSION AND RESULTS: Almost 60 cases were studied under FNAC and cell block evaluation, as well as ICC, among those five (8.33%) samples were inadequate, eight (13.3%) were non-neoplastic, 27 (45%) were benign, one (1.7%) was neoplasm with uncertain malignancy potential, one (1.7%) was suspected of malignancy, and 19 (31.7%) were malignant. The histopathological diagnosis was confirmed in 47 cases. Of these, 24 (51.1%) were benign and 23 (48.9%) were malignant. The malignancy rate for Milan Categories I, II, III, IVa, IVb, V, and VI was 0%, 0%, 100%, 24%, 50%, 80%, and 84.6%, respectively. The study showed that malignancy risk stratification could be further improved by using cell block with immunocytochemistry as a complementary diagnostic modality. CONCLUSIONS: The present study was carried out to assess the usefulness of the Milan system to report salivary gland cytology results. Thus, the findings of the present study show that the Milan system is helpful in stratifying the risk of malignancy in salivary gland tumors.

Cost-effectiveness of population-based screening for oral cancer in India: an economic modelling study.

Background: Oral cancer screening reduces mortality associated with oral cancer. The current study evaluated the cost-effectiveness of commonly used screening techniques, namely conventional oral examination (COE), toluidine blue staining (TBS), oral cytology (OC), and light-based detection (LBD) in the Indian scenario. Methods: The study used a Markov modelling approach to estimate the cost and health outcomes of four different approaches (COE, TBS, OC, and LBD) for screening oral cancer over time from a societal perspective. The discount rate was assumed as 3%. The outcomes estimated were oral cancer incident cases, deaths averted, and quality-adjusted life years (QALYs). To address the high burden of risk factors (tobacco and/or alcohol) in India, two Markov models were developed: Model A adopted a mass-screening strategy, whereas Model B adopted a high-risk screening strategy versus no screening. Probabilistic sensitivity analysis (PSA) was undertaken to address any parameter uncertainty. Findings: Mass-screening using LBD at three years had the least incident cases (3271.68) and averted the maximum number of oral cancer deaths (459.76). High-risk screening using COE at ten years interval incurred the least lifetime cost of 2,292,816.21 US$ (182,794,468.26 INR). The high-risk strategies (US$/QALY), namely COE 5 years (-29.21), COE 10 years (-90.68), TBS 10 years (-60.54), and LBD 10 years (-13.51), were dominant over no-screening. Interpretation: The most cost-saving approach was the conventional oral examination at an interval of 10 years for oral screening in high-risk populations above 30 years of age. Funding: Department of Health Research, Ministry of Health & Family Welfare, Government of India.

Analysis of image quality by regulating beta function of BSREM reconstruction algorithm and comparison with conventional reconstructions in carcinoma breast studies of PET CT with BGO detector.

BACKGROUND: The study aimed to evaluate the beta penalization factor of the BSREM reconstruction algorithm on a five-ring BGO-based PET CT system and compared it with conventional reconstructions. METHODS: Retrospective study involves 30 breast cancer patient data of 18F-fluorodeoxyglucose ( 18 F-FDG) PET CT for reconstruction with OSEM, OSEM + PSF, and BSREM under variable ß factors ranging from 200 to 600 in the steps of 50. Liver noise, lesion SUVmax, SBR, and SNR for each reconstruction were calculated. Quantitative parameters of each beta factor of BSREM were compared with OSEM and OSEM + PSF, using the Wilcoxon sign rank test with Bonferroni correction, a value of P < 0.002 was considered statistically significant. Visual scoring by two readers was also evaluated. RESULTS: Thirty lesions of mean size 1.91 ± 0.58 cm range (0.7-3.6 cm) were identified. Liver noise and SBR were reduced, whereas SNR was increased with an increasing ß value of BSREM. In comparison with OSEM, liver noise was not significantly different from ß200 and ß250. SNR of OSEM was significantly lower than any other ß factors and SBR of ß factor less than 500 was significantly higher than OSEM. In comparison with OSEM + PSF, liver noise was not significantly different from ß400 and ß350-500 do not show a significant difference in SNR and SBR compared with OSEM + PSF. ß350 scored highest under visual scoring with a moderate agreement. CONCLUSION: The study quantitatively indicates the optimum beta range of ß250-450 and the qualitative evaluation indicates that ß350 is an optimum beta factor of BSREM in breast cancer cases for 18 F-FDG WB-PET CT.

Diagnostic Accuracy of Screening of Lip and Oral Cavity Cancers or Potentially Malignant Disorders (PMD) by Frontline Workers: A Systematic Review and Meta-Analysis.

BACKGROUND: Oral cancer screening strategies help reduce associated mortality and could be performed by a trained frontline health worker (FHW). The present review aims to assess the diagnostic accuracy of commonly used screening modalities for oral cancer performed by FHW in apparently healthy individuals. METHODS: Electronic databases PubMed, Scopus, Embase, Cochrane Library, and Google Scholar, were searched. The review included studies conducted where apparently healthy adult individuals were screened by the FHW for cancer or PMD of the lip and oral cavity by any of the four commonly used techniques - Conventional Oral Examination (COE), toluidine blue staining (TBS), Oral Cytology (OC), and Chemiluminescent Illumination (CLI). FINDINGS: A total of 2,413 potentially relevant articles were retrieved from the search, among which five studies for COE were included in the review. Four out of those five studies were done before the year 2000. None of the studies fitted the inclusion criteria for TBS, OC, and CLI. Pooled sensitivity of oral screening by COE performed by an FHW (n=5) was 88.8% (95% CI: 71.6-96.1), whereas pooled specificity was 91.9% (95% CI: 78.3-97.3). On subgroup analysis, the pooled sensitivity and specificity of studies where the prevalence of disease was <50% (n=4) was 84.5% (95% CI: 62.6 - 94.7) and 94.1% (95% CI: 82.2 - 98.2), respectively. INTERPRETATION: COE by trained FHW had high pooled sensitivity and specificity for screening of oral cancer and PMDs. The screening techniques TBS, OC, and CLI, were not studied for mass screening by trained FHW. COE by trained FHW could be utilized for oral screening in limited-resource settings. However, the FHW should be sufficiently trained to get the desired benefits of early detection. FUNDING: Department of Health Research, Ministry of Health & Family Welfare, Government of India.

Correlation of Endometrial Thickness with the Histopathological Pattern of Endometrium in Postmenopausal Bleeding.

BACKGROUND: Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Bleeding that occurs 12 months after the last menstrual period is labeled as postmenopausal bleeding. AIMS & OBJECTIVES: The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial aspiration and histopathological pattern of the hysteroscopic directed biopsy. RESULTS: Sixty patients presenting with postmenopausal bleeding in outpatient department, after applying both inclusion and exclusion criteria, were enrolled in the present study. Majority (38.33 %) of patients had atrophic endometrium or normal endometrium. Endometrium was hyperplastic in 18 (30 %) patients, polyp in 6 (10 %) patients, and growth in 7 (11.67 %) patients. On histopathology, majority of patients (38.33 %) had atrophic endometrium. Endometrial hyperplasia was detected in 14 (23.33 %) out of which 11 had simple hyperplasia while 3 had atypical hyperplasia. Endometrial cancer was detected in 8 (13.33 %) patients. Out of 8 cases of endometrial malignancy, one case was confirmed as endometrial adenocarcinoma on histopathology. CONCLUSION: Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with comorbid conditions. Histo-pathological evaluation is mandatory for ruling out malignancy in selected cases of PMB through hysteroscopy.