Analysis of ThinPrep cytology in establishing the diagnosis of small cell carcinoma of lung (original) (raw)
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The value of cytological diagnosis of small cell lung carcinoma
Pneumonologia i alergologia polska: organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc
Introduction: Small cell lung carcinoma (SCLC) is a very aggressive neoplasm. Accurate and quick diagnosis is crucial to initiate proper treatment. The aim of this study was to establish the value of initial cytological diagnosis and to present typical cytological features of SCLC. Material and methods: We reviewed 116 cases of SCLC confirmed by cytology in: bronchial brushings, pleural fluids, and fine needle aspiration biopsies (FNAB). Results: In 77% of SCLC cases, the diagnosis was established only by cytology; in 23% of cases, both cytological and histological recognition was possible. Cytology of SCLC was initially uncertain in 12%, and histology was uncertain in 30% of the cases. The morphology of SCLC cells was not uniform, and often a mixture of non-small atypical cells and bronchial epithelial cells with signs of metaplasia was observed. There were four cases of combined cell type with large cell carcinoma and two with adenocarcinoma. The main diagnostic problem was to distinguish small cell lung carcinoma from lymphomas, and from cancer consisting of small cells with the cytological features of non-small cell carcinoma. Conclusion: Diagnosis of SCLC in cytological smears is accurate, and final diagnosis is based on light microscopy. In the differential diagnosis, other tumours of small cells have to be taken into account.
Issues in Cytologic Screening and Evaluation
Surgical Oncology Clinics of North America, 1999
The key to getting helpful results from cytologic specimens is to know your laboratory and pathologist(s). Specimen submission requirements, processing, and terminology vary among laboratory settings. Similar to other anatomic pathology disciplines, there is also interobserver variability in diagnostic assessment, especially for low-grade malignancies, precancers, and proliferative disorders.24 In this sense, cytologic evaluation differs from most clinical laboratory tests because the final diagnosis is the result of human judgment and the application of criteria that are almost never "black and white." Surgeons should call the laboratory in advance with questions concerning specimen submission. Correcting problems later may be difficult, especially because cytologic specimens are often small and may be difficult to replace. If estrogen receptors or other special stains are desired, the laboratory may need to make special cell preparations at the time of initial processing. Flow cytometry for lymphoma markers requires unfixed specimens, preferably submitted in cell culture media. Surgical oncologists may be required to use a number of cytology laboratories because of insurance or managed care coverage. A manual that includes specimen instructions, submission requirements, pathology telephone numbers, and cytology requisitions should be accessible to physicians and office staff. Clinical history is critical for proper interpretation. Prior chemotherapy or radiation may induce changes that mimic malignancy. Similarly,
Value of cytology in small cell lung carcinoma diagnostic--single-center study
Collegium antropologicum, 2014
Small cell carcinoma of the lung (SCLC) together with the large cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC), and atypical carcinoid (AC) make a group of morphologically identifiable neuroendocrine tumors. The differential diagnosis of SCLC includes, first of all, other neuroendocrine tumors, and primary or metastatic non-small cell carcinomas. Although the criteria for the morphologic separation from other tumors of the lung are defined, in everyday practice it can be a problem, both in cytology and with histological samples. Accurate and early differentiation of the SCLC is important because it exhibits aggressive behavior, rapid growth, early spread to distant sites, but also exquisite sensitivity to chemotherapy and radiation. The study included 127 patients who underwent bronchoscopic examination or percutaneous transthoracic fine-needle aspiration (PTTFNA) during the period from early 2003 to 2007 in University Hospital Center Osijek whose cytological diagnosi...
2000
The improvement in quality of cytologic preparations with the use of the ThinPrep® methodology has been well-documented, but the cytologic artifacts resulting from this technique have not been adequately described. This study describes and illustrates the cytologic artifacts introduced by the ThinPrep technique when used on fine-needle aspirates (FNAs), and evaluates these artifacts as potential diagnostic pitfalls. We reviewed a total of 120 FNAs simultaneously processed by both conventional smears and ThinPrep. FNAs were obtained from the following sites: lymph node (27), breast (23), soft-tissue sites (20), salivary glands (13), gastrointestinal tract (10), lung (9), thyroid gland (13), liver (3), adrenal gland (1), and kidney (1). The ThinPrep smears were consistently devoid of obscuring elements, and the cells were adequately preserved and evenly dispersed. However, we noted some cytomorphologic alterations that should be recognized to avoid erroneous diagnoses. The size of cell clusters was decreased, large branching sheets were fragmented, and there were more single cells, resulting in apparent discohesion. Small cells such as lymphocytes tended to aggregate. All cells were generally smaller and occasionally spindled, the chromatin detail was attenuated, and nucleoli were more prominent. Intranuclear inclusions were difficult to visualize. Background matrix was often altered in both quantity and quality. Extracellular particles, small mononuclear cells, red blood cells, and myoepithelial cells were markedly decreased in number. The pathologist should be cautious in interpreting FNAs prepared using ThinPrep if that is the only methodology employed. Familiarity with artifacts is essential to avoid misinterpretations.
Diagnostic Cytopathology, 2000
The improvement in quality of cytologic preparations with the use of the ThinPrep® methodology has been well-documented, but the cytologic artifacts resulting from this technique have not been adequately described. This study describes and illustrates the cytologic artifacts introduced by the ThinPrep technique when used on fine-needle aspirates (FNAs), and evaluates these artifacts as potential diagnostic pitfalls. We reviewed a total of 120 FNAs simultaneously processed by both conventional smears and ThinPrep. FNAs were obtained from the following sites: lymph node (27), breast (23), soft-tissue sites (20), salivary glands (13), gastrointestinal tract (10), lung (9), thyroid gland (13), liver (3), adrenal gland (1), and kidney (1). The ThinPrep smears were consistently devoid of obscuring elements, and the cells were adequately preserved and evenly dispersed. However, we noted some cytomorphologic alterations that should be recognized to avoid erroneous diagnoses. The size of cell clusters was decreased, large branching sheets were fragmented, and there were more single cells, resulting in apparent discohesion. Small cells such as lymphocytes tended to aggregate. All cells were generally smaller and occasionally spindled, the chromatin detail was attenuated, and nucleoli were more prominent. Intranuclear inclusions were difficult to visualize. Background matrix was often altered in both quantity and quality. Extracellular particles, small mononuclear cells, red blood cells, and myoepithelial cells were markedly decreased in number. The pathologist should be cautious in interpreting FNAs prepared using ThinPrep if that is the only methodology employed. Familiarity with artifacts is essential to avoid misinterpretations.
Journal of the American Society of Cytopathology, 2020
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Liquid‑Based Cytology in the Detection of Premalignant Lesions in Patients with “Atypia in Squamous Cells” in Conventional Cytology, 2021
Original Article introduction Cervical cancer is the fourth most common cancer in women globally and predominantly affects middle-aged women in underdeveloped countries. [1-3] In Latin America, it continues to have a significant impact despite the implementation several decades ago of screening programs based on conventional PAP smear (CPS). [4,5] In Colombia, the screening program for precancerous cervical lesions recommends using high-risk human papillomavirus (HR-HPV) DNA detection tests, and CPS or liquid-based cytology (LBC) for the diagnostic classification of HR-HPV-positive women. [6] A critical component of uterine cancer prevention programs is the appropriate management of patients with cytological reports of atypical squamous cells (ASC), including ASC of unknown significance (ASC-US), and atypia in squamous cells. It is not possible to rule out high-grade lesion (ASC-H). The fundamental premise to treat or follow them is based on the risk of the existence of a high-grade squamous intraepithelial lesion (HSIL), which is minimal in ASC-US and greater in ASC-H. [7] Since the implementation of LBC, multiple studies have evaluated its diagnostic efficacy, obtaining variable results, [8-16] with scarce evidence of the performance of this test in Colombian patients. [17] The evaluation of the LBC performance Background: The management of patients with "Atypical Squamous Cells" (ASC) in conventional papanicolaou smears (CPS) is based on the risk of high-grade squamous intraepithelial lesion (HSIL). The efficacy of liquid-based cytology (LBC) to detect this premalignant lesion is variable, with little evidence of its performance in Colombian patients. Aims: The aim of this study is to determine the performance of LBC in the detection of premalignant lesions, in patients with ASC in CPS. Materials and Methods: Were obtained patients who attended colposcopy clinic due the result of ASC in CPS. An LBC was taken, which was interpreted by two pathologists without access to other results. The performance of LBC to detect HSIL, was determined, considering as a gold standard: histopathological study/negative-satisfactory colposcopy. Results: Were included 114 patients, with a mean age of 38.4 years (SD ± 13.3). LBC had abnormal results in 40.36% (n = 46), with a slightly higher proportion of low-grade squamous intraepithelial lesion (LSIL) than HSIL. The total of abnormal diagnoses by colposcopy and/or biopsy was 51.75% (n = 59), with a predominance of LSIL (36.84%). The sensitivity of the liquid-based cytology to detect premalignant lesions was 76.5%, specificity: 66.0%, positive predictive value: 28.3% and negative predictive value: 94.1%; The Cohen's kappa index of LBC for detecting HSIL was 0.2492 for the total population and 0.2907 for ≥30 years. Discussion: Although LBC decreases abnormal cytology and increases the detection of HSIL, which improves diagnostic accuracy; sensitivity and predictive values for detecting HSIL are not significantly different between CPS and LBC.
Cytologic features of small-cell carcinoma on ThinPrep®
Diagnostic Cytopathology, 2003
The use of ThinPrep (TP) technology for fine-needle aspiration (FNA) cytology has become widely accepted. However, some literature suggests that small-cell carcinoma may present a diagnostic pitfall due to morphologic alterations. In this study, we retrospectively compared 14 FNA of small-cell carcinoma prepared using TP with corresponding conventional smears (CS). We also examined the TP appearance of 23 other small round-cell lesions in order to determine if differential diagnostic features were preserved. TP and CS were evaluated semiquantitatively for background, architecture, chromatin quality, nuclear molding, nuclear smearing, nucleolar prominence, amount of cytoplasm, nuclear size, and single-cell necrosis. The data were analyzed using the McNemar 2 test. TP slides of small-cell carcinoma showed a cleaner background than CS (P Ͻ 0.005). Although some degree of nuclear molding was preserved, it was decreased in amount (P Ͻ 0.025) and subtler in quality. Similarly, nuclear smearing was present but decreased in amount (P Ͻ 0.05), and less prominent qualitatively. The amount of discernible cytoplasm was greater on TP (P Ͻ 0.005). No significant differences were found for any of the other parameters studied. The presence of nuclear molding was the single most useful feature in differentiating small-cell carcinoma from other small round-cell tumors on TP. Small-cell carcinoma may be diagnosed with confidence by FNA using TP. However, pathologists should be aware of certain morphologic alterations in order to avoid diagnostic pitfalls. Diagn.
Acta Cytologica, 2006
consecutive fine needle aspiration biopsies were processed with both conventional smears (CSs) and TLC diagnosed by a single pathologist; 113 required immunocytochemical study. CSs were fixed in ethanol whereas TLC slides were processed with the Thin-Prep 2000™ method (Cytyc Co., Marlborough, Massachusetts, U.S.A.); both were stained with Papanicolaou stain. ICC staining was carried out on only TLC slides. , whereas it was inconclusive in 9. The cytologic diagnoses were histologically confirmed in 46 of 50 cases (92%).
Archives of Pathology & Laboratory Medicine, 2018
Context.—Fine-needle aspiration cytology has been increasingly used as the first tool in the evaluation of several diseases. Although cytology has a relevant role in the discrimination between benign and malignant lesions, conventional slides cannot lead to 100% conclusive results. It was hoped that the introduction of liquid-based cytology (LBC) would improve the efficacy of cytology through standardization, quality improvement, and the possibility of carrying out ancillary techniques on the residual stored material. In recent decades, the application of genomic alterations has been studied on cytologic samples with feasible and reliable results. The molecular analysis offers a powerful aid to define the best clinical or surgical approaches and follow-up for patients. In recent years, the application of different ancillary techniques has been carried out on conventional slides even though LBC represents a useful additional and alternative method for molecular testing.Objective.—To ...