Validation of digital image slides for diagnosis in cervico-vaginal cytology.

OBJECTIVE: To test the diagnostic concordance between microscopic (MI) and digital (DG) observation of cervico-vaginal (CV) cytology in a validation study of the technique. METHODS: Five cytotechnologists (CT) reviewed 888 routine CV cytology cases from the Cervical Pathology Unit of our center over a 2-week period of time. The cases were first observed by MI and at the end of the day the cases were observed by DG. STATISTICAL ANALYSIS USED: Agreement calculated using the Kappa index. RESULTS: Most of the diagnoses corresponded to benign (64%) or inflammatory conditions (14%) and 24% corresponded to the intraepithelial lesion or malignancy (ILM) category. The overall kappa coefficient of concordance was strong (0.87). Among the different CTs it was almost perfect in two, strong in two and moderate in one. In 18 cases (10%) there were discrepancies between techniques in the category of ILM. In 10 (56%) cases there was an overdiagnosis in DG and in 8 (44%) an overdiagnosis in MI. Only in two cases, the diagnostic discrepancy exceeded one degree of difference between lesions, and they were ASCUS or AGUS for DG and CIN 2 for MI. CONCLUSIONS: In this validation test in which routine cases during a two-week period have been used, observing the cases with both techniques on the same day, we have obtained a strong degree of concordance. The discordances obtained have not been considered relevant.

Developing indicators for quality assurance in cytopathology. Catalan Society of Cytopathology.

BACKGROUND: Quality control in cytology must be established through reliable and easily measurable indicators. METHODS: From the Catalan Society of Cytopathology a group of experts has been established to write a document with 13 indicators that cover the entire cytological process, based on its Cytopathology Quality Guide. It has been elaborated through guides and documents with scientific evidence and DELPHI methodology in order to reach a structured consensus on the opinions of a group of experts. RESULTS: Thirteen indicators, covering all the cytologic process are expressed in worksheets specifying all their characteristics. CONCLUSION: This document allows the control of all stages of the cytological process.

Punción-aspiración con aguja fina en patología mamaria: evaluación de la utilización de citología líquida / Fine-needle aspiration in breast disease: Usefulness of liquid-based cytology

Objetivo: La citología líquida (CL) permite estudiar la muestra mejor preservada y con menos artefactos que la citología convencional (CC). El objetivo de este estudio es evaluar los resultados de la técnica de CL en un periodo de un año desde su implantación en nuestro laboratorio. Pacientes y métodos: Se comparan los resultados de una serie de 1.573 punciones de mama con CL realizadas en un año y 3.033 con CC en 2 años, con los hallazgos en las biopsias cuando se dispuso de estos. Resultados: Los diagnósticos obtenidos en CL fueron: insuficiente en 208 (13,2%) casos, benigno en 1.160 (73,7%), hiperplasia en 70 (4,5%), sospechoso en 45 (2,9%) y maligno en 90 (5,7%). En 264 casos (17%) de CL existió correlación histológica. La concordancia en el diagnóstico de benignidad fue del 74%, en hiperplasia del 75% y en malignidad del 92%. En la serie de CC hubo correlación en 350 casos (11%), la concordancia en el diagnóstico de benignidad fue del 80%, en hiperplasia del 81% y en malignidad del 92%. La sensibilidad diagnóstica de la CC fue del 78%, la especificidad del 95%, el valor predictivo positivo del 94% y el valor predictivo negativo del 79%. La sensibilidad de la CL fue del 85%, la especificidad del 91%, el valor predictivo positivo del 87% y el valor predictivo negativo del 89%. Conclusión: La CL disminuye el número de diagnósticos insuficientes pero incrementa el de hiperplasia y sospechosos. La eficacia en el diagnóstico de malignidad entre ambas técnicas es similar (AU)

Objective: Liquid-based cytology (LBC) improves specimen preservation and produces fewer artefacts than conventional cytology (CC). The objective of this study was to evaluate the results of LBC in our laboratory after one year of its use. Patients and methods: The results of a series of 1,573 biopsy specimens prepared with LBC in a one-year period were compared with a series of 3,033 specimens prepared with CC in a 2-year period and with histological features, when available. Results: The diagnoses obtained with LBC were insufficient in 208 (13.2%) cases, benign in 1,160 (73.7%), hyperplasia in 70 (4.5%), suspicious in 45 (2.9%) and malignancy in 90 (5.7%). A histological correlation with the diagnosis was obtained in 264 LBC samples (17%). The concordance was 74% in the diagnosis of benign lesions, 75% in hyperplasia, and 92% in malignant lesions. In the CC series, there was correlation in 350 samples (11%). The concordance was 80% in the diagnosis of benign disease, 81% in hyperplasia, and 91% in malignant disease. The diagnostic sensitivity of CC in malignant disease was 78%, specificity was 95%, positive predictive value was 94%, and negative predictive value was 79%. The sensitivity of LBC in malignant disease was 85%, specificity was 91%, positive predictive value was 87%, and negative predictive value was 89%. Conclusion: LBC decreases the number of insufficient samples but increases diagnosis of hyperplasia and suspicious lesions. Efficacy in the diagnosis of malignancy is similar between the 2 techniques (AU)

Encuesta nacional sobre el estado actual del estudio citológico de la patología mamaria / A national survey on the present use of cytology in breast pathology

Objetivo. La punción aspiración con aguja fina (PAAF) es un método sencillo, rápido y eficaz para el diagnóstico de lesiones mamarias. No obstante, su utilización ha cambiado por el incremento en el uso de la biopsia por punción (BPP), que ofrece una mayor eficacia diagnóstica. El objetivo de este estudio es establecer el papel actual de la citología en el diagnóstico combinado y multidisciplinar de la patología mamaria en las unidades de mama españolas. Métodos. Estudio descriptivo a partir de los datos obtenidos en una encuesta de 16 preguntas dirigida a 153 unidades de mama españolas. Resultados. Se obtuvieron 30 respuestas, principalmente de centros públicos (97%) en los que mayoritariamente se estudiaban entre 250 y 500 casos anuales, de los cuales entre 150 y 300 eran cánceres. En el 77% de casos la PAAF formaba parte de los protocolos de actuación de la unidad y su uso se combinaba con el de la BPP. En el 86% de centros se utilizaba para el estudio de la axila. Conclusiones. La PAAF, por su sencillez y efectividad, forma parte de la mayoría de protocolos de actuación de las unidades de mama españolas encuestadas, sobre todo para establecer el estatus ganglionar prequirúrgico para la indicación de la técnica de la biopsia selectiva del ganglio centinela. El estudio de las lesiones mamarias tiende a efectuarse mediante BPP, aunque en muchas ocasiones se lleva a cabo de forma combinada con la PAAF (AU)

Aim. Fine needle aspiration (FNA) is a safe, rapid and minimally invasive technique for the diagnosis of breast lesions. However, its role has altered due to an increase in needle core biopsy (NCB) which has a higher diagnostic accuracy. The aim of this study is to establish the present use of FNA in the combined and multidisciplinary diagnosis of breast lesions in national breast clinics. Methods. Descriptive study of data obtained in a 16 question survey carried out in 153 Spanish breast clinics. Results. Thirty answers were obtained, mainly from public health service centres (97%) where between 250 and 500 cases were studied annually and of which 150-300 were malignant. In 77%, FNA was incorporated into the unit's guidelines, mainly in combination with NCB. In 87% of the centres FNA was performed for axillary staging. Conclusions. The accuracy and simplicity of FNA make it a useful factor in the basic protocol of the national breast clinics taking part in this survey, mainly for presurgical axillary staging and indication for sentinel lymph node biopsy. NCB, sometimes in combination with FNA, is more generally used in the study of breast lesions (AU)

Lymphohistiocytoid mesothelioma of the pleura: a case report with cytological findings.

Lymphohistiocytoid malignant mesothelioma is an infrequent variant of sarcomatoid mesothelioma representing approximately 0.5-3.3% of malignant mesotheliomas. It has been related to asbestos exposure. The tumor is characterized by a diffuse large histiocyte-like cells proliferation mixed with an inflammatory infiltrate of lymphocytes and plasma cells. Its cytological diagnosis is difficult. We present a case of a 67-year-old female with lymphohistiocytoid mesothelioma involving the left pleura. The cytological, histological, and immunohistochemical features are discussed.