Journal of Cytology
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AWARDS  
Year : 2022  |  Volume : 39  |  Issue : 5  |  Page : 1-7
Nalini Bai Thakkar Award



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Date of Web Publication28-Oct-2022
 

How to cite this article:
. Nalini Bai Thakkar Award. J Cytol 2022;39, Suppl S1:1-7

How to cite this URL:
. Nalini Bai Thakkar Award. J Cytol [serial online] 2022 [cited 2023 Feb 5];39, Suppl S1:1-7. Available from: https://www.jcytol.org/text.asp?2022/39/5/1/359848





   NPP-1: A Study on Utility of Cell Blocks From Lymph Node Aspirates in Addition to Fine Needle Aspiration Cytology to Improve the Diagnostic Accuracy Top


Upajna Pal, Dipanwita Nag; Medical College Kolkata, Kolkata, West Bengal, India

Background: Lymphadenopathy is a frequently observed clinical presentation in various clinical presentations. FNA has been the primary modality of preoperative diagnosis with its own share of fallacies and pitfalls. Cell block can be done in the same sitting and it gives the advantage of architectural assessment with easy subjectivity to serial sections for special stains and other ancillary tests. In this study, we have attempted to find out if cell block actually helps in improving the preoperative diagnostic accuracy of lymph node lesions, and the utility of doing IHC staining on suspected cases of malignancies. Materials and Methods: 50 patients with visible lymphadenopathy were subjected to FNAC from the lymph nodes followed by cell block in the same sitting. IHC was done from the cell blocks in suspected cases of malignancies and lymphoproliferative disorders. Cell block findings were correlated with clinical and radiological findings, and histopathological examination and IHC/special stains on biopsy from the lymph nodes. Results: Total 50 cases were studied. 95.24% of infective cases, 95% of lymph node metastases, 78% of lymphoproliferative disorders could be diagnosed on cell block. Conclusion: Cell blocks can be efficiently utilised from lymph node aspirates in addition to Fine Needle Aspiration Cytology to improve the diagnostic accuracy.


   NPP-2: Artificial Neural Network to Predict The Risk of Malignancy in Category III Bethesda Thyroid Lesions Top


Tarunpreet Saini

Background: The atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) diagnosed by fine-needle aspiration(FNAC) cytology poses a challenging arena for cytopathologists. Aims: In this paper, we determined to construct an artificial neural network (ANN) model to predict risk of malignancy in FNAC cases of AUS/FLUS in thyroid lesions based on cytological features. Materials and Methods: We included two groups of AUS/FLUS cases: (1) A total of 29 cases of histopathology proven malignancy and (2) 32 cases of either histopathological proven benign or follow up with no progress of malignancy in last 2 years. Cytological characteristics were analysed semi-quantitatively. Based on this data, we tried to generate an artificial neural network model to differentiate these two groups. The performance of the ANN was assessed by seeing the confusion matrix and receiving operator curve. Results: There were 29 malignant cases of AUS/FLUS (histopathology proven) and 32 benign/follow up cases in this study. There were 41 cases in the training set, 9 cases each in validation and 11 test sets. In the test group, ANN model successfully distinguished both benign (5/5) and malignant cases (6/6). Conclusion: The present ANN model is well structured and coherent to distinguish malignant versus benign outcome of AUS/FLUS cases on cytology smears with no error. This is an open ended ANN model and more parameters and more cases can be included to make the model more robust.


   NPP-3: Cervical Cytology – Analytic Quality Control and Performance Indicators: Experience From an Accredited Cytology Laboratory Top


Aishawarya Warke, M M Kamal, Shubhangi Belekar; Government Medical College, Nagpur, Maharashtra, India

Context: The performance parameters of cervical cytology in any accredited cytology laboratory requires implementation of quality control exercise which ensures acceptable performance by a laboratory. This study aims to assess the analytical aspect of quality control measures by evaluating the frequency and accuracy of epithelial abnormalities as detected in cervical  Pap smear More Detailss using histopathological diagnosis as the gold standard. Methods: A retrospective diagnostic test study from 2018-2020 was conducted. Out of the total 6000 Pap smears, histopathological correlation was available in 150 cases in the form of colposcopic directed biopsy (CDB) and LEEP tissue in 105 cases. The quality control measures analysed were ASC:SIL ratio, cytohisto correlation and study parameters like sensitivity, specificity, positive predictive value and negative predictive value of Pap smears as against CDB and LEEP. Results: 4.5% smears were reported as inadequate, 92.3% as NILM followed by epithelial abnormality in 3.21%. ASC:SIL ratio was 1.3:1. Concordance rate against CDB was 100% in SCC, 82.35% in HSIL, 82% in ASC-US, 65.6% in LSIL and 50% in ASC-H. Total concordance rate was 84.15%. Sensitivity of Pap smear was 65% for LSIL and 82% for HSIL. Specificity, positive predictive value and negative predictive value were 63.63%, 90% and 75% respectively. Concordance rate was 96% with LEEP. Conclusion: Quality control measures give an insight of performance of any accredited cytology laboratory. This exercise needs to be conducted on regular basis so that relevant steps can be taken in case of major discrepancy.


   NPP-4: Comparison Of Clinical and Cytomorphological Features Between Triple Negative Breast Cancer (TNBC) and Nontriple Negative Breast Cancer (NONTNBC) Top


Tohfa Haque, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India.

Background: In women, breast cancer is one of the most common malignancy and comprise 14% of all cancers .Triple negative breast cancers (TNBC) are defined as those cancers with negative expression of all three immunohistochemical markers (ER, PR, HER 2). Fine needle aspiration cytology (FNAC) is useful for early diagnosis of breast cancer as part of triple assessment. Aims and Objectives: Evaluation of clinical and cytomorphological features on FNAC of breast cancer patients and compare between TNBC and NON TNBC category. Materials and Methods: A total of 50 cases with cytological diagnosis of breast cancer on FNAC with detailed cytomorphological features, clinical details, consecutive biopsy and immunohistochemistry status (ER, PR, HER2) were included in study. Data was analysed between TNBC and NON TNBC category. Results: There were 36% of TNBC cases and 64% of NON TNBC cases. Amongst the cytomorphological features: less or absent tubules formation, 3 D syncytial clusters formation, marked nuclear atypia, ill-defined cell borders and necrosis were the features significantly associated with TNBC when compared with NON TNBC. Conclusion: There was increased prevalence of TNBC cases. However, no significant difference of clinical parameters was noted when compared to NON TNBC. Five cytomorphological features on FNAC proved useful for predicting TNBC.


   NPP-5: Cytological Evaluation of Spectrum Of Image M Guided Hepatobiliary and Pancreatic Mass LesionS Top


Junu Devi, Ekaparna Hazarika; Gauhati Medical College and Hospital, Guwahati, Assam, India

Introduction: Hepatobiliary and Pancreatic mass lesions are commonly occurring intra-abdominal space occupying lesions. Image guided FNAC enables exact localization of lesion, assessment of nature and invasion and is a useful tool in the diagnosis of such lesions. Aim: The present study aims to evaluate the spectrum of hepatobiliary mass lesions diagnosed by Image guided FNAC. Materials and Methods: We have conducted a retrospective study in Department of Pathology, Gauhati Medical College & Hospital, Guwahati, for a period of 5 years, including patients of all ages and both sexes presenting with clinical and radiological suspicion of hepatic, biliary or pancreatic mass lesion. Under aseptic conditions USG guidance FNAC was done from the appropriate site and smears were examined. Results and Discussion: Out of the total 135 patients, there were 70 cases of Hepatic lesions (51.8%), followed by 54 cases taken from Gall bladder (GB) (40%), 5 cases from Common Bile Duct (CBD) (3.7%) and 6 cases (4.44%) from Pancreatic lesions. There were 51 cases of hepatic malignancies, 36 GB malignancies, 4 cases each of CBD and pancreatic malignancies. The most common Hepatic malignancies were Metastases followed by Hepatocellular carcinoma. The most common GB malignancy was Adenocarcinoma, followed by Cholangiocarcinoma. There was 1 case each of Solid Pseudopapillary Neoplasm of Pancreas, Acinar Cell carcinoma, Mucinous Adenocarcinoma and HCC. These findings were in concordance with our reference studies. Conclusion: Image guided FNAC has proved to be a versatile tool in provide an early and accurate diagnosis of hepatobiliary and pancreatic mass lesions.


   NPP-6: Diagnostic Accuracy of Fine Needle Aspiration Cytology Combined With Flow Cytometry in Hematolymphoid Lesions Top


Roobashri Murugan, Debasis Gochhait, Prabhu Manivannan; Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry, India

Introduction: Utility of FNAC in diagnosing and subclassifying hematolymphoid lesions is less established. Thus, flow cytometry can be used as an adjunct to FNAC. Aims and Objectives: To assess the diagnostic accuracy of fine needle aspiration cytology combined with flow cytometry in confirming and categorizing hematolymphoid lesions in comparison with gold standard. Materials and Methods: This was a cross sectional study. All patients with suspected hematolymphoid lesions (both nodal and extranodal lesions) and reactive lesions were enrolled in the study. Combined FNA/FCM diagnosis was compared with gold standard which was either biopsy or cell block or flow cytometry of peripheral blood/bone marrow aspirate. Results: There were 67 suspected lymphoma cases and 67 reactive cases included in the study. There were also 29 cases which yielded non-contributory flow cytometry findings. In lymphoma group, 10/67 cases were extranodal. 4/67 cases had discordant findings between FNA and FCM. 5/56 cases had discordant findings between combined FNA/FCM and gold standard. We were able to subclassify according to WHO based on morphology alone (FNA) in 11/67 cases and in 34/67 cases based on combined FNA/FCM. Of 67 reactive cases, five cases had discordant findings between FNA and flow cytometry. Diagnostic sensitivity and specificity of combined FNA/FCM was 86.7% and 98.4% respectively. Non-contributory FCM was attributed to either the presence of large cells/ necrosis/ NLPHL/ metastasis/ castleman disease/ technical problem. Conclusion: Combining FCM with FNA enhances diagnostic accuracy and helps in subclassifying lymphoma. In future, this can replace excision biopsy especially in recurrent cases.


   NPP-7: Diagnostic Efficacy of Bronchial Washing Cytology and Bronchoscopic Needle Aspiration Cytology in the Evaluation of Mass Lesions of Lungs – An Observational Study in a Tertiary Care Hospital Top


Rahul Kumar Bharti, Agartala Government Medical College & Govind Ballabh Pant Hospital, Agartala, Tripura

Introduction: Lung cancer is the most common cancer diagnosed worldwide. It is also the foremost contributor to cancer-related mortality, resulting in 1.38 million deaths per year worldwide. There are various diagnostic modalities for lung mass lesions including bronchial washing (BW), trans-bronchial needle aspiration (TBNA) and bronchoscopic biopsy (BB). This study was done to study the different cytomorphological pattern of various lung mass lesions and to find out individual and combined efficacy of BW and TBNA in the diagnostic evaluation of lung masses. Objectives: To determine sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of both bronchial washing cytology and bronchoscopic needle aspiration cytology as individual test, taking BB results as gold standard. To determine sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of combined BW and TBNA, taking BB results as gold standard. Materials and Methods: This was an observational cross-sectional study conducted in the Department of Pathology, AGMC over a period of two years (July 2020 to June 2022). 55 cases of lung mass lesions underwent BW, TBNA and BB during the study period & were analyzed. Results: The study found highest sensitivity in combined TBNA & BW (95%), highest specificity in TBNA (81%), highest PPV in TBNA (95%) and highest NPV in combined TBNA & BW (88%). Conclusion: This study concluded that TBNA is better diagnostic modality than BW, and if BW is done it should always be supported with TBNA which contribute to more precise diagnosis.


   NPP-8: Evaluation of Fish in Improving the Diagnostic Performance of Urine Cytology in the Atypical Urothelial Cell Category and High-Grade Urothelial Carcinoma Top


K C Sharan, Manish Rohilla, Radhika Srinivasan, Pranab Dey, Nandita Kakkar, S M Ravimohan; Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background: Urine cytology along with FISH may help earlier picking up of Urothelial carcinoma (UC). We evaluated multicolor (UroVysion) FISH assay (U-FISH) in improving diagnostic performance of urine cytology in atypical urothelial cell category (AUC) and highgrade urothelial carcinoma (HGUC). Methods: This is a retrospective study (June 2016-July 2020). U-FISH was performed on 50 cases comprising three cohorts, 15 cases of HGUC-MI (muscle-invasive), 15 of HGUC-MF (muscle-free), and 20 cases of AUC-Neoplastic outcome on histopathology. U-FISH was done on destained Papanicolaou slides. U-FISH was evaluated for the diagnostic purpose by manufacturers and modified criteria and muscle invasion and tumor stage prediction by UroVysion FISH score (UFS). Results: U-FISH was done successfully in 41/50 cases. Fourteen, 12, and 15 cases were conclusive in HGUC-MI, HGUC-MF, and AUC-Neoplastic group (11 HGUC & 4 LGUC cases) respectively. All 41 cases were reported as positive by both criteria for diagnostic purposes. All cases showed hyperploidy of ≥2 chromosomes. Homozygous loss of chr9p21 was seen in 2 and 1 cases of HGUC-MI and HGUC-MF groups respectively. Hyperploidy of Chr3 was statistically significant in differentiating HGUC-MI from HGUC-MF and LGUC cases. Chr3 signals with a cut-off of 6 signals could identify myoinvasion with a sensitivity of 80.95% and specificity of 41.94%. UFS predicted the myoinvasion with sensitivity, specificity, PPV, and NPV of 78.9%, 59.1, 62.5, and 76.5% respectively. UFS of HGUC-MI group was significantly higher than HGUC-MF, hence, UFS helps in pre-operative tumor staging as well. UFS showed no statistical significance in predicting recurrence or progression of disease.


   NPP-9: Role of Touch Imprint Cytology of Core Needle Biopsy in Evaluation of Breast Lesions – A Study in Changing Trends of Rapid Onsite Evaluation Top


Ph Priyanca Singha, Barnali Maiti, Shreosee Roy, Anup Kumar Boler

Background: Touch imprint cytology (TIC) of trucut biopsy specimen is an easy method of rapid on-site evaluation (ROSE) which aids in the rapid diagnosis of breast lumps by cytological analysis.Aims and Objectives: To evaluate the efficacy of touch imprint cytology in assessment of adequacy of needle core biopsy of breast lumps and its diagnostic accuracy for malignancy. Materials and Methods: This study was done in Burdwan Medical College and Hospital over a period of two years on 46 patients who had presented with breast lump and had given consent for Trucut biopsy for diagnosis. Results: Out of 46 cases, satisfactory material on touch imprint were obtained in 45 cases. Only one case did not yield satisfactory material and hence was excluded from the analysis. Total 27 cases were malignant, and 19 cases were either benign or inflammatory on trucut biopsy. Twenty- three cases were accurately diagnosed as malignant by TIC and 17 cases were accurately diagnosed as benign by TIC. Overall sensitivity of TIC was 85.18%, specificity was 94.44%, Positive Predictive Value was 95.83%, Negative Predictive Value was 80.95% and overall Accuracy was 84.78%. Conclusion: Touch Imprint Cytology of trucut biopsy is a rapid, reliable and accurate method for early cytological diagnosis of symptomatic breast lesions. It can be used routinely at the site of biopsy to evaluate the adequacy of material obtained during core needle biopsy and to plan for further workup in case of malignant breast lesions.


   NPP-10: Yokohama System of Reporting Breast Fnacs – A Step Forward Top


Kirti Hada, Sanjeev Narang, Rahul Karode, Anjali Singh; Index Medical College, Indore, Madhya Pradesh, India

Introduction: Increasing rate of incidence of breast cancer among females in recent years has raised red flag. It is affecting about 2.1 million women each year globally amongst all the modalities. Breast FNAC has shown promising results in early diagnosis and management of breast lesions from many years and thus preventing fatalities caused due to delay in diagnosis. Aim: Main aim of our study was to reclassify the already diagnosed cases of breast FNAC as per the new IAC Yokohama system and to study whether it helps in increasing the diagnostic accuracy of the same as compare to conventional system. Materials and Methods: We had retrieved the old cases from January 2021 - December 2021 presented in the Department of Pathology, IMCHRC and classified them according to the new proposed IAC Yokohama system of reporting. A total of 68 cases were studied retrospectively for the same duration. Results: Out of 68 cases which were reclassified according to new system as insufficient, benign, atypical, suspicious and malignant 12 were unsatisfactory, 26 were benign, 8 were atypical, 8 were suspicious and 14 were malignant. Conclusion: IAC-Yokohama System which was introduced in the year 2016 has revolutionized the breast FNAC reporting system and took it to new altitude in aiding the diagnosis. FNAC plays a pivotal role in Breast lesions diagnosis due to its high sensitivity and specificity. With this new Yokohama system it has become more helpful in diagnosing the breast lesions and providing better management options to the clinicians.


   NPP-11: Signet Ring Cell Morphology: A Diagnostic Challenge in Fluid Cytology Top


Mihira Gannavaram, Navatha Vangala, Monalisa Hui, Pramod Kumar Pamu, Megha S Uppin, Shantveer G Uppin, Tara Roshni Paul; Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Introduction: Tumors with signet-ring morphology are most commonly seen in gastrointestinal tract, however carcinomas of breast, lung, pancreaticobiliary tract, Mullerian tract and reactive mesothelial cells also show this morphology. Aims and Objectives: To study the frequency of various primaries with signet-ring cell morphology in fluid cytology. To assess the utility of IHC to further assign the primary site in cases with signet-ring cell morphology. Materials and Methods: This was a retrospective study from 2020 to 2022. All cases of malignant effusions diagnosed on ascitic and pleural fluid cytology exclusively with signetring cell morphology were included. Clinical, morphological data including cell block sections with IHC analysis of each case were reviewed. Results: A total of 73 cases of malignant effusions showed signet-ring cell morphology of which 49 cases had biopsy/cell block confirmation. Among the pleural effusions (n=25) most common primary was pulmonary adenocarcinoma (n=15) and among peritoneal effusions (n=24) most common primary was carcinoma stomach (n=10) followed by carcinoma ovary (n=5). Discussion: Signet-ring morphology is due to the result of cellular alterations such as loss of cell-to-cell adhesion, enhancement of mucin production, and disruption of mucin secretion, regardless of primary site. However, they typically retain expression of markers from their site of origin. Our study emphasiszes the role of IHC in distinguishing tumors with signet-ring morphology. Conclusion: Signet ring morphology is not confined to tumors of GIT and IHC is a useful tool in confirming the primary origin.


   Col. D.B. Nayar Award Top



   DPP-1: Anaplastic Lymphoma Kinase (ALK) and ROS1 Gene Rearrangements and Programmed Death Ligand-1 (PD-L1) Expression in Cytological Samples of Nonsmall Cell Lung Carcinoma Top


Jesty Pullattu Tom, Parikshaa Gupta, Nalini Gupta, Radhika Srinivasan, Navneet Singh, Divya Khosla; PGIMER, Chandigarh, India

Background: Cytological samples are invaluable for establishing tissue diagnosis in patients with non-small cell lung carcinoma (NSCLC). Furthermore, to select patients for personalized targeted therapies, testing for EGFR mutations and ALK and ROS1 rearrangements can be successfully done using cytologic preparations. The present study was conducted to assess the prevalence of ALK and ROS1 gene rearrangements in the cytologic samples from patients with NSCLC. Materials and Methods: This was a 5-year retrospective study performed on all the cytologic samples tested for ALK, ROS1 gene rearrangements and PD-L1 immunoexpression, from patients with NSCLC. Immunocytochemistry (ICC) was used for ALK (D5F3 clone), ROS1 (D4D6 clone) and PDL1 (SP263 clone) testing using Ventana automated immunostainer. Tumor proportion score (TPS) was calculated for PD-L1 evaluation. Results: During study period, a total of 314 NSCLC cytologic samples were tested for ALK [successful testing in 306 (97.5%)], 148 [successful testing in 142 (95.9%)] samples for ROS1 gene rearrangements, and 79 [successful testing in 74 (93.7%)] samples for PD-L1 expression. ALK immunopositivity was noted in 4.6% (n=14/306) cases; ROS1 was positive in 0.7% (n=1/142) cases while >1% PD-L1 TPS was noted in 49.3% (n=37/75) cases [>50% PD-L1 in 14.7%]. ALK and ROS1 positive cases lacked EGFR mutations. Majority of ALK positive cases were males (66.7%), with adenocarcinoma (91.7%), and acinar-predominant architectural pattern (91.7%) on cytology. Conclusions: Present study reiterates high diagnostic utility and feasibility of molecular testing on the cytologic samples. Our results indicate that ICC is a rapid and an accurate method for detection of ALK, ROS1 gene rearrangements, and PD-L1 expression in NSCLC patients.


   DPP-2: Can Cell Block Study Be a Self-Independent Diagnostic Tool for Prognostication and Therapeutic Decision? – Our Experience in Comparative Study of Cell Block and Resected Specimens of Breast Carcinoma Top


Ankita Chakraborty, Anup Kumar Boler, Shreosee Roy; Burdwan Medical College, West Bengal University of Health Sciences, Burdwan, West Bengal, India

Background: Fine-needle aspiration cytology (FNAC) is most practiced initial method for evaluation of breast lesions. Cell blocks (CB) are prepared from aspirated materials of FNAC. Optimally cellular cell block can provide both cytological and architectural details and very useful for immunohistochemistry (IHC). Aim: The aim of this present study is to compare morphological and immunohistochemical findings of cell blocks with corresponding resected specimens of breast carcinoma. Materials and Methods: Over a period of 1 year, fifty consecutive specimens were obtained by fine-needle aspiration of palpable breast lesions. Cell block preparation and morphological examination was performed on all 50 cases. The morphological and immunohistochemical findings on cell blocks and resected specimens were compared using appropriate statistical methods. Results: Morphology of cell blocks for tubule formation and nuclear pleomorphism show good agreement with corresponding histology sections, whereas mitotic activity show poor agreement (60%). IHC on cell blocks and histology sections show good agreement for ER (estrogen receptor), PR (progesterone receptor) and HER2 (human epidermal receptor protein-2). Concordance rate for ER, PR and HER2 was 94%, 90% and 92%, respectively. Conclusions: Morphologic and IHC study performed on CB are substantially approximate to the morphologic characteristics and status of prognostic/ predictive markers on resected specimens. Thus extensive study on cell block can lead to emergence of diagnostic workup in determining therapeutic strategy and prognostication of breast carcinoma.

[TAG:2]DPP-3: Correlation to Find Efficacy of Computed Tomography-Guided Fine Needle Aspiration Cytology Alone And With Cell Block as an Adjunct, in Comparison to Core Needle Biopsy in Classification and Diagnosis of Lung Tumours in a Tertiary Care Hospital in North Bengal[/TAG:2]

Deep Banerjee1, Bidyut Krishna Goswami1, Pranati Bera1, Indranil Chakrabarti2, Vaswati Das1, Narayan Pandit1; 1North Bengal Medical College and Hospital, Siliguri, West Bengal, India, 2All India Institute of Medical Sciences, Kalyani, West Bengal, India

Background: Computed tomography (CT)-guided percutaneous lung fine needle aspiration (FNA) is a convenient method to obtain samples from Lung tumours. FNA has a lower rate of complications than the use of a core needle biopsy, but is more difficult for the diagnosis of cytological samples. We use Cell Block (CB) and Immunohistochemistry (IHC) to improve the accuracy of cytological diagnoses based on CT-guided percutaneous lung FNA. Methods: We initially collected 165 samples obtained using CT-guided percutaneous lung FNA at North Bengal Medical College & Hospital from January 2021 to June 2022. CBs were created from these samples, and IHC was performed to help the further histological classification and confirmation of tumor in respect to the Histopathology which we have considered Gold standard. Results: Cytological and Histopathological correlation showed a Sensitivity – 86.56%, Specificity – 75%, Positive predictive value – 96.66%, Negative Predictive value-60%, Accuracy – 85.33% . While a correlation between Cell Block and IHC with Sensitivity – 94.77%, Specificity- 81.25%, Positive Predictive value- 97.69%, Negative Predictive value-65% Accuracy- 93.33% with a p value of <0.05 in both cases. Conclusion: Thus we can conclude that CT guided FNAC individually is having a good efficacy which is even complemented by Cell Block and IHC put together when compared to Histopathology. There are quiet a number of indeterminate overlaps for which further evaluation is required.


   DPP-4: Cytological and Cell Block Analysis of Gamut of Malignant Pleural Effusion With Application of Immunohistochemistry in Selected Cases: A Hospital Based Study of North East India Top


Junu Devi, Nayana Bora; Gauhati Medical College and Hospital, Guwahati, Assam, India

Introduction: With an incidence of 150,000 new cases a year, malignant pleural effusion has long been recognized as a cause of significant morbidity in cancer patients. The cell block (CB) technique is one of the oldest methods for the evaluation of body cavity fluids. The principal advantage of cell block over conventional smears are morphological preservation of tissue architecture and obtaining multiple sections for ancillary tests such as immunohistochemistry (IHC). Aims and Objectives: The aim of our study is to evaluate the aetiology of malignant pleural effusions for a period of fourteen months in patients of North East India. Materials and Methods: This study is a hospital-based cross-sectional study which was conducted for a period of 14 months. A comparative study of conventional smear and cell blocks was done in cases of malignant pleural effusion. IHC was performed in selected cases. The results of conventional smear and cell block were statistically analysed using SPSS version 25 software. Results: cell block method has a higher sensitivity, specificity and accuracy in detecting malignancy in MPE with lung adenocarcinoma being the most common aetiology of MPE. Conclusion: Cell block method is practical and profitable for resource restricted hospitals and low-income countries. IHC on CB not only help us classify the primary sites of the tumor but also reduce the morbidity of cancer patients by aiding treating clinician to initiate therapy at the earliest.


   DPP-5: Epithelial Cell Adhesion Molecule on Flow Cytometry for the Detection of Metastatic Carcinoma in Lymph Node Top


Nupur Pradhan, S Susheilia, Parikshaa Gupta, Reetu Kundu, Sangamitra Rajasekaran, Pranab Dey; PGIMER, Chandigarh, India

Background: Micro metastasis in the lymph node may be missed in routine fine needle aspiration cytology (FNAC). There are limited studies on the role of epithelial cell adhesion molecule (EpCAM) to detect metastatic carcinoma in the FNAC of lymph nodes by flow cytometry (FCM). Aims: To detect metastatic carcinoma in the fine needle aspiration cytology (FNAC) with the help of EpCAM in flow cytometry. Materials and Methods: In this prospective study, successive 36 cases of lymph nodes were subjected to FNAC followed by flow cytometry for the detection of EpCAM. The sample was used for cytology and flow cytometry (using CD 45, CD14 and EpCAM antibodies tagged with different fluorochromes). EpCAM percentage was calculated. The percentage of EpCAM-positive cells was compared in the metastatic carcinomas and reactive lymphoid hyperplasia (RLH) cases. Results: There were 26 cases of metastatic carcinoma and 10 non-neoplastic cases (9 RLH and one granulomatous inflammation). The average EpCAM percentage of metastatic carcinoma and reactive lymphoid cells was 12.05 and 1.310 respectively. The independent sample t-test showed a significant difference (0.001) in EpCAM percentage in the two groups. The cut of value of 3% EpCAM picked up all but one case of metastatic carcinomas. Conclusion: The percentage of EpCAM in FCM is helpful to detect metastatic carcinoma in the lymph node. The FCM is a rapid and quantitative test with high sensitivity and specificity.


   DPP-6: Fluorescence In Situ Hybridization for ETV6 Gene Rearrangements on Cytological Specimens: Role in Diagnosis of Secretory Carcinoma of Salivary Gland Top


Ria Mahendru, AIIMS, New Delhi, India

Introduction: Fine-needle aspiration cytology (FNAC) is the first-line diagnostic procedure for salivary gland (SG) masses. Secretory carcinoma (SC) is characterized by ETV6 and RET rearrangements, which are detected by fluorescence in-situ hybridization (FISH) or reverse transcriptase PCR, optimized for paraffin-embedded tissue and fresh frozen tissue, respectively. We conducted this study to evaluate whether FISH could be performed on cytological material for accurate diagnosis of SC. Methods: FNACs in which SC was a diagnostic consideration, and cases diagnosed as SC on histology and having corresponding FNAC with any diagnosis were evaluated for ETV6 rearrangement by FISH. Where Acinic cell carcinoma (ACC) was a differential diagnosis and ETV6 rearrangement was absent, NR4A3 FISH was performed. Results were compared with those on final histological specimens, where available. Results: Fourteen cases were included. FISH on three cell blocks did not yield good results, and was then performed on direct smears. Results were interpretable in 13 cases (92.8%). ETV6 rearrangement was identified in six (42.9%), and NR4A3 rearrangement in two cases (14.3%). Performing FISH on FNAC smears resulted in an accurate diagnosis in 57.1% of cases. Complete correlation was seen with FISH results on histological specimens. Conclusion: ETV6 FISH testing on cytological smears in cases suspected to be SC improves the diagnostic accuracy of FNAC, and helps to lower the proportion of cases signed out as SUMP. With minor modifications, the FISH procedure can be optimized for FNAC smears, with results comparable to those on histological specimens. FISH on cytological specimens maximizes the diagnostic information gained from these less-invasive samples, and aids in planning patient management.


   DPP-7: Molecular Diagnosis Of Lymphoma – Conjunction of Knowledge and Techniques Top


Bholay Sharada Shreeram, M Kodate Purnima, M Makde Manjiri, M Kamal Meherbano, Shroff Vrushali, Tijare Jayashree, T Kumbhalkar Dinkar; Government Medical College, Nagpur, Maharashtra, India

Introduction: Lymphoblastic lymphoma (LBL) accounts about 2% of all lymphoma. Recognition of T/ B LBL albeit of their rareness is very important as they present as localised disease with low tumour burden. They can present both at nodal and extranodal sites. Limitation of diagnosis and classification of lymphoma on FNA can be minimized by clubbing it with Flowcytometric Immunophenotyping (FCI) to ensure diagnostic accuracy rapidly. Objective: Study of series of 18 cases of LBL to assess utility of FCI on FNA and effusion samples in extramedullary LBL. Materials and Methods: FCI was done on FNA and effusion samples from 120 morphologically diagnosed/ suspicious cases of lymphoreticular malignancy, followed by peripheral blood and bone marrow (BM) examination. The patients diagnosed to have B/T LBL, on the basis of the WHO 2017 classification, were selected for further analyses. Results: FCI of 120 cases showed 91 Mature and 18 Precursor lymphoid neoplasms. These 18 cases were from lymph nodes (11), Pleural fluid (03) and soft tissue masses (04). Peripheral blood and BM of 15/18 cases were normal of which FCI revealed T-LBL (11) and B-LBL (04). 02 cases (both T LBL) showed BM involvement (<25%) while 01 case of B-LBL which was misdiagnosed as mature lymphoma by immunohistochemistry evolved as B ALL. Conclusion: Diagnosis of extramedullary B/T LBL needs comprehensive evaluation of clinical presentation, cytomorphology and immunophenotyping. FCI on fine needle aspirate and effusion samples allow rapid and accurate diagnosis, thus early appropriate treatment help to avoid leukemic dissemination and advanced stage lymphoma.


   DPP-8: Molecular Testing on Cell Free DNA Extracted From Malignant Pleural Effusion Supernatants: An Untapped Gold Mine Top


Shilpi, All India Institute of Medical Sciences

Background: Molecular profiling using cell free tumor DNA (cfDNA) from liquid biopsies (most commonly being patient plasma) is the most demanding yet exciting attribute in the field of theranostics. Aim: To assess the yield of and sensitivity/accuracy of molecular testing on cell free tumor DNA from malignant pleural effusion (MPE) supernatants. Methods: The study was of prospective design (January-August 2022). MPE supernatants from patients confirmed as primary lung adenocarcinoma and where patient matched MPE sediment/ biopsy/ plasma were tested for EGFR mutations were selected for cfDNA extraction. Supernatant cfDNA was subjected to EGFR mutation analysis by qPCR. Concordance of EGFR mutations results on MPE supernatant cfDNA were assessed in comparison with the paired tissue/ plasma results. Results: A total of 298 pleural effusions prospectively collected included 64 MPEs. Thirteen MPE supernatants from lung adenocarcinoma patients met inclusion criteria. EGFR mutations were detected in 10 MPE supernatant cfDNA, all of which positively correlated with matched tissue/plasma mutation results (100% positive predictive value). In one of these cases, supernatant cfDNA yielded unequivocal positive results for the presence of T790M mutation whereas the corresponding tissue results were negative. Only one supernatant cfDNA tested negative for EGFR mutation while the matched sediment DNA showed presence of EGFR mutations (9% false negative rate, 1/11). The overall concordance of mutation results between MPE supernatant cfDNA and tissue/plasma results was 92% (12/13). Conclusion: Expanding the spectrum of cytology samples for molecular testing, cfDNA from MPE supernatants serve as a viable source for molecular testing as exemplified by the current study.


   DPP-9: Epidermal Growth Factor Receptor Mutation Profiling Among the Primary and Metastatic Nonsmall Cell Lung Carcinomas: A Prospective Comparative Analysis on the Cytologic Samples Top


Loomila Loordudasan, Parikshaa Gupta, Nalini Gupta, Radhika Srinivasan, Navneet Singh, Divya Khosla; 1Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 2Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 3Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background: Cytological samples are not only a vital diagnostic tool; they can also be successfully used for comprehensive molecular profiling and therapeutic decision-making in non-small cell lung carcinomas (NSCLC). Although the mutational profiling in NSCLCs has been the subject of current research, the differences in mutation profiles of primary and metastatic NSCLCs have not been elucidated so far. Materials and Methods: This was a 5-year prospective comparative study on all the cytologic samples tested for EGFR mutations using real-time PCR, from patients with primary non-metastatic NSCLC (pNSCLC), patients with regional lymph nodal spread (nNSCLC), and those with metastatic NSCLC (mNSCLC). The presence and relative frequencies of individual EGFR mutations were compared amongst the pNSCLC, nNSCLC, and mNSCLC groups. Results: Of a total of 468 cytologic samples tested for EGFR mutations, there were 210 pNSCLC, 49 nNSCLC, and 209 mNSCLC cases. Significant difference was noted in the overall frequency of EGFR mutations among the 3 groups (pNSCLC=38.2%; nNSCLC=6.6%; mNSCLC=55.3%; P=0.004). Significant difference was also noted in the frequency of exon 19 deletion among the 3 groups (pNSCLC=29.3%; nNSCLC=6.1%; mNSCLC=64.6%; P< 0.0001). Additionally, females had a significantly higher incidence of any EGFR mutation (OR=2.13, 95% CI=1.37–3.32; P=0.003) with exon 19 deletion being the commonest (OR=3.36; 95% CI=1.91–5.71; P< 0.0001). Complex EGFR mutations were noted in 10 samples; more common in mNSCLC (n=6; 60%) than pNSCLC (n=4; 40%). Conclusions: Ours is a first of its kind study and the results indicate that EGFR mutations in NSCLC are associated with a higher risk of distant metastasis, thereby reiterating the need for early EGFR mutation analysis in all NSCLC cases for prompt management and better clinical outcomes.


   Jwala Devi Award Top



   JPP-1: A Comparative Study of Modified Ultra Pap Staining with Conventional and Ultra Pap Staining Method in Cervical Smear in an Under Resourced Laboratory Top


Ritam Dutta, Mona Tirkey, Sutapa Chaudhuri; North Bengal Medical College, Siliguri, West Bengal, India

Background: Pap stain, an universal stain, used for cytology smear gives a polychromatic transparent reaction with crisp nuclear and cytoplasmic features. Aims and Objectives: To compare the staining quality of modified ultra pap stain with the conventional and ultra pap stain in cervical smear. Methodology: Total five hundred cases were studied. Three smears were prepared from each sample and labelled as “A”, “B” & “C”. Smears with “A” marking of the samples were stained as per conventional Pap stain procedure. Similarly Smears with “B” marking were stained using ultra pap guideline, a method for rapid pap staining. Third smears of the all the samples, marked as “C” were stained by modifying the Ultra pap rapid staining procedure, where time for nuclear and cytoplasmic stains were further reduced. Then the stain quality and diagnostic accuracy of Smears marked “C” were compared with Smears marked “A” and “B” for each and every samples. Results: Staining quality of modified staining procedure is compared with other two standard procedures. Results show staining quality remains unchanged even after modification of the standard procedures. Conclusion: The modified ultra pap staining method can be utilized for mass screening and as a bedside procedure without compromising the staining quality.


   JPP-2: Determine Whether Use of Anticoagulation, Presmearing or Postsmearing Haemolytic Techniques as Per Indian Academy of Cytologists Guidelines Improve Morphological Assessment and Reproducibility in Fluid Cytology Top


Lata1, Meetu Agrawal1, Mukul Singh1, M K Lal2, Sarita Shyamsundar Kale3, Bhoomika Gupta4, Sunil Ranga1; 1Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Introduction: Fluid cytology is an indispensable investigation in the work up of body cavity effusion specimens. The Indian Academy of Cytologists (IAC) published guidelines for collection, preparation, interpretation and reporting of serous effusion specimens.(1) The 3 main categories of these guidelines are essential, optimal and optional. Moreover, with most centres becoming aware of quality implementation and undergoing accreditation (including ours), the application of optimal guidelines would soon be inevitable. Aims and Objectives: To determine the effect of anticoagulation, pre-smearing acetic acid treatment technique and saline rehydration technique on morphological assessment, reproducibility and reporting in fluid cytology. Materials and Methods: The study was carried out in the Cytology Laboratory, Department of Pathology, Safdarjung Hospital and VMMC. In this study, we have analysed 100 effusion samples received over 2 months (April – May 2022). These included both exudates and transudates. Heparin of 3 units/ ml was prepared as per standard guidelines and pre-added to the sample collection containers to ensure prompt anticoagulation. For 33 hemorrhagic specimens, an extra smear was prepared from the sediment and was subjected to the saline rehydration technique as per the IAC guidelines. Forty random specimens were subjected to pre-smearing 1% acetic acid treatment as per the IAC guidelines. These smears were independently reviewed by 2 pathologists and evaluated for background and cytology characteristics. Results: A comparative analysis between heparinized and nonheparinized specimens has been studied. In addition, the acetic acid pretreatment and saline rehydration post smearing has been analyzed.


   JPP-3: Feasibility of Cell Block Preparation Using Egg Albumin Top


Neelam Prabhudesai, S Pathuthara, O Shetty, V Mayekar, S Chavan, M Prajapati, H Shigvan, D Shinde, K Deodhar, S B Desai; Department of Cytopathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

Introduction: Cell blocks (CB) are important adjuncts in diagnostic cytopathology for ancillary tests. Though conventional plasma thrombin (PT) method is effective, Thromboplastin is expensive. Also, presence of genomic DNA and bio-contamination through plasma or epithelial cells in thromboplastin are risk factors for molecular testing on CBs. The need of specimen-specific cell block approaches are essential. Aim: To evaluate feasibility of cell block preparation using egg albumin (EA) for cytology samples. Materials and Methods: 50 CBs from 25 cytology samples were analyzed. Two sets of CB were prepared from all samples. A set of PT CB was made for routine diagnosis. The remaining sample was utilized for EA CB. EA Method: Samples were centrifuged at 2000 rpm for 10 minutes, supernatant was discarded. 95% ethyl alcohol was added in equal quantity of the sediment & centrifuged at 2000 rpm for 1 minute. Supernatant was removed. EA was added to sediment, mixed well and let it stand. The clot formed was processed as CB. HE stained sections of EA CB were compared with those of PT CB on the basis of criteria of cell yield, cytomorphology and cost. Ancillary tests were performed on CBs in relevant cases. Results: In 24 out of 25 EA CB, cellularity & cyto-diagnosis were comparable to that of PT CB. One EA CB showed scanty cell yield and was non-diagnostic compared to PT CB. EA CB was remarkably less expensive than PT CB. Conclusion: EA CB is a simple, rapid and cost effective technique with reliable results.


   JPP-4: Utility of Cell Block in Cytopathology – Experience of a Cancer Care Institute in Eastern India Top


Surjendu Das, Rikta Nandi, Anand Bardia, Divya Midha; Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India

Introduction: Fine needle aspiration and effusion cytology are an important diagnostic and screening tool in cancer care patients, especially in the modern era of minimally invasive interventions and molecular pathology. However, it may not be possible to subtype or definitely categorize many neoplasms on cytology smears alone. Obtaining adequate diagnostic material is often a problem. In such cases, cell blocks made from cytology material may serve as a useful adjunct. Aim: To study the value and limitations of cell blocks in adding diagnostic information to cytology smears. Materials and Methods: 1932 consecutive cases of cytology smears having concomitant cell blocks were reviewed. The cases were evaluated for the extent of adequacy, of definite benign/malignant categorization and of definite subtyping in malignant tumors in these cases. The proportion of cases in which cell blocks added information to smears alone for the above parameters were calculated. Results: Cell blocks provided additional information in 449 out of 1932 cases. Cell blocks were necessary for subtyping 434 malignant tumors, and increasing adequacy in 15 cases. A total of 326 samples were inadequate in cellularity and a definite diagnosis could not be offered in 201 cases inspite of adding information from cell blocks to smears. Conclusion: Cell blocks added clinically significant information to cytology smears and should be used routinely. To make it more useful, alternative methods of cell block preparation (including proprietary methods) may be evaluated.



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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.359848

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