An Investigation on the Results of Cytopathologic Tests of Pancreatobiliary System Performed in the Pathology Department in Iran.

BACKGROUND & OBJECTIVE: Pancreatobiliary system disorders commonly include inflammatory diseases and tumors. Diagnosis of pancreatic cancer is challenging and is mostly achieved when the disease has extensively progressed, and metastasis has occurred. Therefore, this study was performed to evaluate cytopathology in the diagnosis of Pancreatobiliary malignancies, which can improve diagnostic adequacy and accuracy. METHODS: A total of 116 cytopathologic results of the Pancreatobiliary system, performed in the Pathology Department of Taleghani Hospital, Tehran, Iran during 2017-2018 were selected and examined in this observational study. The frequency of different results was determined and compared with other variables. RESULTS: The most common location of the lesions was the pancreas (47%). The lesions were categorized as malignant, benign, negative, suspicious for malignancy (SFM), and atypical in 28%, 10%, 24%, 14%, and 9% of the cases, respectively. In other cases, lesions were considered non-diagnostic. Rapid on-site evaluation (ROSE) was conducted in 25% of patients. Compatibility of the initial and final diagnoses was 100%, 50%, and 60% in cases with "malignant", "benign", and "negative" diagnoses, respectively. The sensitivity, specificity, as well as positive and negative predictive values of cytopathology in the diagnosis of Pancreatobiliary lesions were 75.8%, 92.3%, 95.9%, and 61.5%, respectively. CONCLUSION: Our findings indicated that half of the lesions of the Pancreatobiliary system were positive, SFM, and atypical. Fine-needle aspiration (FNA) and endoscopic ultrasound-guided FNA (EUS-FNA) were effective modalities in diagnosing Pancreatobiliary malignancies. The most important point in our experience is the increase in diagnostic sensitivity in the presence of ROSE. Therefore, the simultaneous use of ROSE and EUS-FNA can reduce the need for re-sampling.

The Expression of p53, CD44, Ki-67, and HER-2/neu Markers in Gastric Cancer and Its Association with Histopathological Indicators: A Retrospective Study.

BACKGROUND AND OBJECTIVES: Gastric cancer is known as one of the most common cancers and causes of deaths. Early and proper diagnosis is one of the most important things for treatment response. Therefore, this study aimed to determine the expression of p53, CD44, Ki-67, and HER-2/neu markers in the gastric cancer and its relationship with histopathological indicators. METHODS: This is a descriptive-analytical study, in which 60 patients with cancer who underwent gastrectomy surgery in 2011-2016 in Shohadaye Tajrish Hospital. The participants were investigated for p53, CD44, Ki-67, and HER-2/neu markers' staining plus demographic characteristics, rate of survival, and histopathological features of the tumors. RESULTS: The mean age of the participants (44 males and 16 females) was 60.25±1.29 years. The patients' survival rate was 23.82±1.56 months on average. The tumor size was reported as 6.09±2.61 mm and the major tumor type reported was intestinal type (n=40, 66.7%). The level of expression of Ki-67 and CD44 makers was recorded as 33.75 and 24.50%, and p53 and HER-2/neu genes were positive in 25 (41.7%) and 20 (33.3%) patients, respectively. The expression of p53 and CD44 markers had no significant relationship with the demographic characteristics, rate of survival, and histopathological features of the tumor of patients (all p>0.05). The expression of p53 gene was associated with the lower rate of survival (p=0.014), while the expression of HER-2/neu was associated with higher probability of developing intestinal type of stomach adenocarcinoma (p=0.010) and ulcerative macroscopic view (p=0.034). CONCLUSION: This study illustrated that p53 and CD44 markers did not have any diagnostic value in predicting the biological behavior of gastric cancer. In fact, incidence of p53 gene was associated with the lower rate of survival, and the expression of HER-2/neu was associated with higher probability of developing the intestinal type of stomach adenocarcinoma and ulcerative macroscopic view.

Inter-observer Variability in Histomorphological Evaluation of Non-neoplastic Liver Biopsy Tissue and Impact of Clinical Information on Final Diagnosis in Shahid Beheshti University of Medical Sciences Affiliated Hospitals.

BACKGROUND & OBJECTIVE: Liver biopsy is the main method for grading and staging liver disorders, but the effects of clinical information and optimal biopsy specimen size on interpretation remain contentious. The aim of the study was to evaluate the impact of clinical information and quality of liver specimen on inter-observer agreement for liver disease. METHODS: A total of 289 consecutive biopsy specimens from 2010 to 2017 were re-evaluated by five pathologists using the modified Ishak and non-alcoholic fatty liver diseases (NAFLD) activity score (NAS) systems. Detailed clinical information was extracted from medical records of patients and the size of all liver biopsy samples was recorded. RESULTS: Full agreement between primary diagnosis and final diagnosis was obtained in 214 cases (74%). The remaining cases, namely 22 (7.6%) and 53 (18.3%) biopsies had minor and major diagnostic discrepancies, respectively. The results showed that the overall agreement was significantly higher in cases with complete clinical information than patients without any clinical information and even with partial clinical information (P<0.001). Interestingly, no significant difference in inter-observer agreement was achieved with a length over 20 mm (P=0.181). However, the inter-observer variation significantly decreased when the number of portal tract was more than 10 (P=0.001). CONCLUSION: This study identified the impact of clinical information and the number of portal tracts as the key factors to diagnosis. Therefore, request forms for liver biopsies should always be accompanied with the clinical history. Moreover, adequacy of biopsy specimens is very useful for accurate evaluation of samples by pathologists.

Evaluation of the Standardization in Semen Analysis Performance According to the WHO Protocols Among Laboratories in Tehran, Iran.

BACKGROUND AND OBJECTIVE: Infertility refers to the failure in achieving pregnancy of a couple after one year of regular sexual intercourse without using a protection method. The purpose of this research work was to evaluate the current status of the test and quality control performance in semen analysis in selected laboratories. MATERIAL AND METHODS: The semen analysis was performed in the Laboratory of Andrology in terms of macroscopic examination which include volume, color, viscosity, pH and acidity, and in terms of microscopy: the rate of sperm movement, the exact number of sperms per ml of semen, the percentage of sperm viability and movement, the presence of germ cells and white blood cells. Several questions for each part of the test were selected and answered by the director of the laboratories or andrology section supervisor. RESULTS: There was a wide range in the performance of selected medical laboratories in Tehran regarding the standards of semen analysis according to the World Health Organization (WHO) Laboratory Manual for the examination and processing of human semen, fifth edition in 2010. They followed the instructions related to the sample collection in about 70% of the evaluated parameters, initial macroscopic examination in about 87% of the selected subjects, and the microscopic evaluation of sperm in about 65% of the test parameters. CONCLUSION: some laboratories do not follow the instructions of the WHO in performing semen analysis, and most of them do not follow the suggested methods in all parts of the test.

Clinicopathologic Features of Colorectal Polyps in Shahid Beheshti University of Medical Sciences (SBMU).

Aim: This study was designed to report epidemiologic findings of polyps in Iranian patients, and predict histology of polyp regarding to demographic and colonoscopic findings. Background: Classification of colorectal polyps had been revised in the past two decades and there is a need for polyp categorization in the Iranian Health System. Patients and methods: In this retrospective study, the medical records of patients with colonoscopic diagnosis of polyp in pathology departments of SBMU affiliated teaching hospitals were reviewed. Patient's slides evaluated and demographics findings were assessed. The anatomical location, macroscopic appearance including size and histological assessment of all polyps were recorded. Results: From total number of 1106 polyps (detected in 862 patients), adenomatous polyps (638 [57.7%]) were the most prevalent findings, followed by colon mucosal tag (184[16.6%]), hyperplastic and serrated polyps (122[11%]), inflammatory polyps (110[9.9%]), hamartomatous (21[1.9%]), and malignant lesions (13[1.2%]). Multivariate logistic regression showed age (each one year increasing age; odds ratio [OR] = 1.026, 95%confidence interval [CI] = 1.016­1.036, p < 0.0001), location of polyp (right colon; OR = 1.905, 95%CI = 1.366­2.656, p < 0.0001), and polyp size of 5-10 mm (OR = 1.662, 95%CI = 1.214­2.276, p = 0.002), and polyp size of >10 mm (OR = 2.778, 95%CI = 1.750­4.411, p< 0.0001) were independently associated with neoplastic polyps. Also, polyp size of >10 mm (OR= 2.613, 95%CI= 1.083-6.307, p=0.033), tubulovillous pattern of polyp (OR= 3.508, 95%CI= 1.666-7.387, p=0.001) and villous pattern of polyp (OR= 10.444, 95%CI= 4.211-25.905, p<0.0001) were associated with high grade dysplasia in neoplastic polyps. Conclusion: Increased age, location of polyp (right colon), increased size of polyp and villous component of polyp could classify patients in high risk groups.