Utility of immediate cytologic diagnosis of lung masses using ultrafast Papanicolaou stain.

PURPOSE: At Kagawa University Hospital we conduct immediate cytology using ultrafast Papanicolaou (U-Pap) stain when collecting cytology specimens by bronchoscopy or CT-guided needle aspiration, and report here an investigation of its utility. METHODS: The subjects were 503 patients for whom a final histopathological diagnosis could be made, taken from among 568 immediate cytology patients between July 2000 and June 2008. In immediate cytology at our hospital, a cytotechnologist goes to the bronchoscopy room just before tissue is collected. U-Pap stain is done immediately and examined microscopically. A tentative report is made orally on the spot as to the specimen adequacy, whether it is benign or malignant, and the presumed histopathological type. RESULTS: Of the 503 patients, the sample was inadequate in only two cases and there were no false positives. With respect to diagnostic accuracy, sensitivity was 82.9%, specificity was 100%, and the correct diagnosis rate was 85.6%. For lesions ≤3 cm, sensitivity was 77.2%, specificity was 100%, and the correct diagnosis rate was 81.3%, and for lesions ≤2 cm sensitivity was 74.7%, specificity was 100%, and the correct diagnosis rate was 81.3%. Diagnostic accuracy was thus maintained even for small lesions. No false positive case was detected. CONCLUSION: Because immediate cytology enables more precise sample collection, it is thought to be a useful technique that leads to improved diagnostic accuracy, while also improving the technical skill of the doctor collecting samples through immediate feedback.

Cytologic diagnosis of vulvar Paget's disease by means of brushing smear: report of a case.

Paget's disease of the vulva is a rare entity; since it may show the same clinical symptoms as benign chronic vulvitis, it may result in a delayed diagnosis. A 63-year-old woman was found to have an eczematoid pink to red lesion located in the vulva. Scraping cytology of the vulva showed isolated malignant cells of Paget type. The patient underwent wide local excision of the vulvar tumor and histopathological examination of resected specimens revealed that Paget cells were distributed singly or tended to form small nests in the epidermis. We consider vigorous brushing cytology to be a useful initial study for cancer screening of patients for any suspicious vulvar lesions.