Journal of Cytology
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 Table of Contents    
ABSTRACTS  
Year : 2022  |  Volume : 39  |  Issue : 5  |  Page : 8-25
Abstracts: Oral Presentations



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Date of Web Publication28-Oct-2022
 

How to cite this article:
. Abstracts: Oral Presentations. J Cytol 2022;39, Suppl S1:8-25

How to cite this URL:
. Abstracts: Oral Presentations. J Cytol [serial online] 2022 [cited 2023 Feb 5];39, Suppl S1:8-25. Available from: https://www.jcytol.org/text.asp?2022/39/5/8/359849





   OP-1: Application of International Academy of Cytology Yokohama System in Liquid Based Cytology of Breast Lesions Top


R Indhumathi, Priyanka Singh, Juhi Shahab, Mukul Singh, Sunil Ranga; Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Background: The international academy of cytology (IAC) Yokohama system has developed a standardized system of breast cytology by classifying them into five categories- insufficient, benign, atypical, suspicious for malignancy and malignant. Fine needle aspirate cytology (FNAC) and liquid based cytology (LBC) are reliable technique for diagnosis of breast lesions. It is a widely accepted system for breast reporting. Aim: To categorize LBC smears of breast lesions according to recently proposed IAC Yokohama system. Materials and Methods: FNAC of fifty cases of breast lesions were evaluated using LBC (SurePath) technique and categorised as per IAC Yokohama system. Immunocytochemistry was applied wherever required. Results: Most of the patients belong to 3rd decade. Only one patient presented with bilateral breast lump. Majority of the cases as per IAC Yokohama system fall under benign category followed by malignant category. Fifty breast LBC smears were categorized as follows: Insufficient- 2 (4%); Benign-30 (60%); Atypical-2 (4%); Suspicious for malignancy- 4 (8%) and Malignant-12 (24%). Conclusion: The IAC Yohokama reporting system for breast cytology provides a uniform platform with better reproducibility and it is satisfactorily applicable on LBC smears too.


   OP-2: Breast Cytopathology in Relation to Yokohama Reporting System Top


Tanima Mandal, Institute of Medical Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Introduction: The International academy of Cytology (IAC) Yokohama system has developed standardized system for reporting FNAC of breast. The 2016 International Congress of Cytology started the initiative in Yokohama. Breast Cytology have been divided into five categories which include Inadequate, Benign, Atypical, Suspicious and Malignant. Each category has specific definition, risk of malignancy and suggested management options. Aims and Objectives: Retrospective study carried out in the Department of Pathology and the IAC Yokohama system was applied for diagnosis and correlation with histopathology examination. Materials and Methods: 6 month archival data (March 2022 to August 2022) of breast FNAC was retrieved from departmental records. 150 cases of breast FNAC were re-evaluated. Age and demographic profile were noted and cases assigned according to the Yokohama System and correlated with histology and radiological data wherever available. Results: Of the 150 cases evaluated 146 cases (97.3%) were female and 4 cases (2.7%) male. Maximum numbers of the cases evaluated were in the age group of 21 to 30 years (30.6%). 82 cases (54.6%) were done from right breast, 63 cases (42%) were from left breast and in 5 cases (3.40%) bilateral FNAC was done. Classification of cases by Yokohama system showed 7 cases in Inadequate category (4.6%), 108 cases for the Benign category (72%), 10 cases in Atypical category (6.6%), 4 cases in Suspicious category (2.8%) and 21 cases in Malignant category (14%). Conclusion: Incorporation of Yokohama system of reporting helps standardize reporting terminology and help to predict risk of malignancy which guides better patient management and follow up.


   OP-3: Breast Fna with Cell Block – Equally Efficient as CNB – A Paradigm Shift? Top


Brijdeep Singh, Manish Rohilla, Veenu Singla, Tulika Singh, Amanjit Bal, Siddhant Khare, Radhika Srinivasan; PGIMER, Chandigarh, India

Introduction: Minimally invasive sampling by CNB or FNAB forms an important component of “triple assessment” approach to the diagnosis of breast lumps. In India, CNB has replaced FNAB even for palpable lumps citing their reliability for performing pre- operative molecular testing. Hence, this study was planned to evaluate FNAB with cell blocks as an alternative to CNB for molecular typing. Materials and Methods: 15 female patients presenting with breast lesions were subjected to palpation-guided FNAB and USG guided CNB in the same sitting. FNAB was reported as per the Yokohama system. Cell blocks prepared by sodium-alginate method were assessed for adequacy. Immunocytochemistry for ER/PR/Her2-neu was performed on CNB and FNA- CB using Ventana Benchmark XT© and molecular phenotype compared. Results: Mean age of the patients was 47.2 years. CNB revealed 14 cases of invasive ductal carcinoma (IDC), NST and 1 DCIS. Corresponding FNA was concordant in 13 cases; In 1 case of IDC, FNA was C1 (Unsatisfactory) and other was C4 (suspicious for malignancy). DCIS on CNB was signed out as ductal carcinoma on FNA and patient had lymph nodal metastases. Cell blocks from FNA were adequate for ICC in 12/15 (80%). In 7 cases, paired molecular typing results revealed concordant results in 3 Luminal A, 2 luminal B, and 1 triple negative breast carcinoma; the single discordant case showed HER2 enriched phenotype in FNA-CB and luminal B on the CNB. Conclusion: Preliminary analysis of the ongoing study revealed that molecular phenotyping on FNA-CB shows good concordance with CNB and may serve as a reliable alternative to CNB.


   OP-4: Cytologic Spectrum of Breast Lesions with Histopathological Correlation With Respect to the IAC Yokohama System for Reporting Breast Fine Aspiration Cytology – A Tertiary Care Center Experience Top


Vishal Seth, Asha Borah, Assam Medical College and Hospital, Dibrugarh, Assam, India

Introduction: The new International Academy of Cytology (IAC) Yokohama System for Reporting Breast FNABC, supported by IAC and developed by an International “Breast Group”, was proposed to establish a comprehensive structured approach for performance and reporting of breast cytology to standardize the diagnostic approach and improve reproducibility. Aim: To categorize the breast FNAB samples according to this new system of Reporting and to assess various statistical parameters including the Risk of Malignancy. Materials and Methods: Breast FNAB specimens obtained in the Cytology section of the Department of Pathology, AMCH were Reported using the newly proposed IAC Yokohama System. The statistical parameters of Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) as well as Risk of Malignancy (ROM) were calculated using SPSS software. Histopathology was taken as the Gold Standard. Results and Observations: A total of 160 cases of breast FNAC (which also had histopathological correlation) were included, of which 14 (8.75%) cases were categorized as Inadequate, 82 (51.25%) as benign, 2 (1.25%) as atypical, 9 (5.62%) as suspicious for malignancy and 53 (33.12%) as malignant. When only malignant cases were considered positive, the Sensitivity was 92.86%, Specificity 98.98%, PPV 97.50%, NPV 97%, and Diagnostic Accuracy 97.14. The ROM for Category 1, 2, 3, 4, 5 were 21.4%, 2.43%, 50%, 88.8% and 98.11 % respectively. Conclusion: FNAC is an essential component in the preoperative management of breast lesions and the IAC Yokohama system for Reporting Breast FNAB cytology effectively stratifies breast lesions thus providing guidance to both cytopathologists and clinicians leading to standardized diagnostics and enhanced patient care.


   OP-5: Cytological Evaluation of Pathological Male Breast Lesions Top


Ritu Roy, Mala, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India

Objective: This study aimed to determine the cytological spectrum of various male breast lesions, which were corroborated on histopathology and describe cytomorphology of some uncommon pathological lesions. Materials and Methods: A one and half year study was done on male breast lesions presenting to the Department of Pathology, MGM Medical College, Kishanganj; Bihar. A total of 30 cases were evaluated initially by fine needle aspiration cytology (FNAC) which was followed with histology for further diagnostic evaluation. Confirmatory histopathology was obtained in 22 cases only. Results: In FNAC out of 30 cases, 22 cases were diagnosed as benign (73.3%). Gynecomastia was most common presentation (56.6%) among the benign entities. Malignant features seen in 5 cases (16.6%), 2 cases were suspicious of malignancy. Most common malignancy was invasive ductal carcinoma of no special type (NST), 2 cases were being reported as suspicious of malignancy which was histologically proven to be case of sarcoma, very rare in occurrence. Considering the ease of statistical analysis cases were divided as benign and malignant which includes suspicious cases. Senstivity of FNAC was found to be 100%, NPV100%. Conclusion: Cytological evaluation of male breast lesions provide highly sensitive and specific results with excellent histologic reproducibility. Thus, it should be the ideal pretherapeutic diagnostic procedure for male breast lesions. This study aimed to cytologically evaluate various pathological lesions of male breasts and to validate the diagnostic accuracy of FNAC against the histopathology wherever practicable.


   OP-6: Cytological Study of Palpable Breast Lumps Presenting in Northern Coalfield Area Top


Rajat Kumar, NSC, NCL, Singrauli, Madhya Pradesh, India

Introduction: Benign as well as malignant breast lesions are quite common in Indian population. It is the second most common cancer site after cancer cervix. Fine-needle aspiration cytology (FNAC) is safe, reliable, and time saving outdoor procedure with little discomfort to the patient. FNAC is useful in diagnosis and further planning of treatment without need for biopsy. The current study was carried out with aims of studying the frequency of various breast lesions on FNAC in Central Hospital, Northern Coalfield Ltd. (NCL), Singrauli. Materials and Methods: This was 02 years prospective study carried out from August 2019 to July 2021. Physical examination of breast mass by palpation was done. Smears were stained with Rapid H& E, Giemsa and Papanicolaou stain. Results: Of the 125 cases, 100 were in the benign category and 20 belonged to the malignant category, while the cytology study of 05 cases was unsatisfactory. 15 cases were available for histological correlation. Out of 100 cytological benign cases, 76 were confirmed as benign, but 3 turned out to be malignant. Out of 20 cytological malignant cases, 17 were confirmed as malignant. FNAC was 88.37% sensitive and 96.42% specific in diagnosing malignant lesions. Conclusion: Fine-needle aspiration cytology is a rapid and effective method for the primary categorization of palpable breast lumps into benign, malignant, atypical, suspicious, and unsatisfactory categories. Benign breast lesions are common than malignant lesions. Histological correlation indicated FNAC to be a good diagnostic tool.


   OP-7: Fibroblast Growth Factor Receptor 2 Gene Polymorphism in Breast Lump – A Study on Cytological Material Top


Anjali Mittal, Meeta Singh, Shyam Lata Jain, Binita Goswami, Lucy Chawisangzeli, P Lal; Maulana Azad Medical College, New Delhi, India

Introduction: Several studies have been done on the application of cytology material in molecular profiling. Fibroblast Growth Factor Receptor 2 (FGFR2) gene has been recently acknowledged to be highly associated with breast cancer. We hereby compare blood and fine needle aspiration cytology material from breast lump for molecular profiling and thereby prove their equivalent efficiency which might have great promise in optimizing patient care and translational research. Aim: Association of Fibroblast Growth Factor Receptor Receptor 2 (FGFR2) gene polymorphism (rs2981582) with breast cancer. Materials and Methods: A total of 50 Fine Needle Aspiration Cytology slides were obtained from 50 patients comprising of 25 benign breast lump cases and 25 malignant lump cases confirmed by histopathology and 50 venous blood sample obtained from the same patient underwent DNA extraction. Subsequently, Restriction Fragment Length Polymorphism Polymerase Chain Reaction (RFLP PCR) was done on each separate DNA material obtained from that of cytological and blood specimen. The samples were analyzed for specimen adequacy, PCR success, and DNA quality. Results: All 50 cytology samples and 50 blood samples met the DNA quality threshold with adequate yield for RFLP PCR as evident by clearly distinguishable bands on Gel Documentation System. On comparison of genotype polymorphism frequency in benign and malignant breast lump cases, we found that the frequency of CC/TT/TC genotype polymorphisms among different groups is not significant in this study. Conclusion: Archival FNAC material from breast lump might inherently be of sufficient purity for genomic scale molecular profiling.


   OP-8: Fine Needle Aspiration Cytology of Extra Mammary Neoplasm in Breast: A Case Series Of 4 Cases Top


Garvita, Maulana Azad Medical College, New Delhi, India

Introduction: Metastatic Malignancies in the breast are extremely rare accounts form 1.2%-2% of all malignant breast malignancies. Materials and Methods: The study was conducted over a period of 8 years (2014-2022). 6,453 breast FNACs were performed during this time period, out of which 5940 were benign and 513 were malignant. Out of 513 malignant cases 509 were primary carcinoma and 4 were secondary. We herein describe these four cases of metastatic breast malignancies. Results: The incidence of intramammary secondaries were 0.8% of all the malignant masses and 0.06% of all the FNAC's performed over 8 years. Case 1: 23 years old female known case of Diffuse Large B Cell Lymphoma. Presented with left breast and ipsilateral axillary lymph node swelling. FNAC performed showed similar findings immunocytochemistry confirmed on cell block immunocytochemistry, immunohistochemistry and flowcytometry. Case 2: 35 years old female known case of nasopharyngeal carcinoma presented with metastasis in breast and liver. FNAC breast and guided liver FNA both show similar features as nasal mass. Confirmed on immunocytochemistry and cell block immunohistochemistry. Case 3: 40-year-old female known case of papillary carcinoma of the thyroid (PCT) presented with breast lump. FNAC breast showed PCT with prominent intranuclear inclusions. Case 4: 55 years old known case of esophageal squamous cell carcinoma diagnosed with secondaries in breast. FNAC breast lump showed squamous cell carcinoma. Conclusion: Metastatic breast malignancies are extremely rare, and amenable to aspiration. Thus FNAC immunocytochemistry can serve as good adjunct to diagnosis.


   OP-9: Prognostication According to Robinson'S Grading in Breast Carcinoma Top


Shirish Nandedkar, Manju Purohit, Gautam G Bhagwat, Shradha Saxena;

R. D. Gardi Medical College, Ujjain, Madhya Pradesh, India

Introduction: Breast carcinoma is the second most common malignancy in India after cervical carcinoma. Robinson's cytology grading allows assessment of the biological aggressiveness of the tumor which allows selection of the most suitable treatment and avoids morbidity associated with overtreatment of low grade tumors. We aim to correlate Robinson's cytology grading for breast carcinoma with Modified Scarff Bloom Richardson (SBR) histology grading. Materials and Methods: Fine needle aspiration smears and subsequent Modified radical mastectomy specimen sections (H&E stained) from 50 patients (47 females and 3 males) suspected with breast carcinoma were studied. Smears were stained with Diff-Quik and Papanicolaou stain and graded according to the Robinson score and Modified SBR grading was done on each section. Results: All Grade III (9/50) cases of cytology correlated with histology while 65% cases of Grade I and 90% of Grade II correlated with histology SBR grading. Among seven Grade I cases of cytology six cases revealed Grade II and one case Grade III on histology. Two discrepant cases of Grade II on cytology were Grade III on histology. Conclusion: We demonstrated an acceptable correlation between Robinson's score and SBR suggesting that Robinson's score is a helpful tool in predicting prognosis and should be included in routine reporting of breast carcinoma cases.


   OP-10: Utility of Fine Needle Aspiration Cytology in the Follow-Up of Patients With Breast Carcinoma Top


Kusum Kapila, Kuwait University, Kuwait City, Kuwait

Introduction: Core Needle Biopsy (CNB) is replacing fine needle aspiration cytology (FNAC) in breast clinics in the West due to its inability to definitively diagnose invasion and provide valuable markers for management. However, FNAC is effective for women with fluid filled cysts, in preoperative staging of screen detected breast carcinoma and in postoperative management. Aim of this study was to document the utility of FNAC in follow-up of patients with breast carcinoma. Methods: Over a three year period 535 breast cancer patients had undergone a FNAC during routine follow up in Hussain Makki Al Juma Centre. Their age ranged from 28 to 86 years with a mean of 51.48 years. Results: Recurrence/ metastatic sites aspirated were 224 breast, 209 lymph nodes, 53 scar nodules, 35 others and in 14 patients multiple sites were aspirated. Of the 535 aspirates, 101 were unsatisfactory. Of 434 satisfactory aspirates, 236 were benign, 18 atypical cytology, 19 suspicious cytology, 160 carcinoma and 1 Non-Hodgkins Lymphoma. In 250 aspirates, the same side as the primary breast carcinoma had a recurrence (left 114 and right 136) while in 132 the contralateral side was involved. Lymphnodes involved were axilla 180, (contralateral 51, ipsilateral 129). Other metastatic sites were bone (9), liver (6), soft tissues (13), lung (3), mediastinum (1), pleural fluid (1) and neck (2). Conclusions: FNAC is used less frequently in centres where CNB is routinely performed for breast carcinoma. However, it is found to be of great value in documenting recurrence/ metastasis in the follow of patients.


   OP-11: Utility of Pre-Stained Cytology Smears for Immunocytochemical Evaluation of Hormone Receptors in Breast Carcinoma: A Pilot Study Top


Sramana Mukhopadhyay, Vaishali Walke, Deepti Soni, Hemlata Panwar, Tanya Sharma, Neelkamal Kapoor, Swagata Brahmachari; All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Objectives: To develop and standardize the protocol of immunocytochemistry (ICC) for estrogen (ER) and progesterone receptor (PR) expression on pre-stained cytology smears of invasive breast carcinomas and compare its expression with Allred scores obtained on immunohistochemistry (IHC). Methods: Thirty cases with a cytological and confirmatory histological diagnosis of invasive breast carcinoma were retrieved for this pilot study. Presence of adequate number of pre- stained cytology slides with sufficient material for ICC following archiving was a prerequisite. Routinely stained slides were de-stained, treated for antigen retrieval and immunocytochemistry was done on Ventana automated machine using monoclonal ER/PR antibody. The results of ICC were compared to those obtained on IHC which included assessing the cellularity and grading the number of positive cells and staining intensity. Cases of fibroadenoma served as positive control. Results: A high concordance was observed in this study for Allred scores on ICC and IHC. Discordance was mostly noted in cases where ICC was done on cytological smears stored for more than 3 months giving either a false negative result or low concordance with Allred scores obtained on IHC. Conclusion: ICC on pre-stained slides offers a simple, cost-effective tool with rapid turnaround time, avoids additional sampling and is amenable to use on archived material. Performance of ICC on pre-stained slides also ensures adequacy of diagnostic material compared to that on stored unstained smears. Antigen loss due to fixation and processing can also be minimal.


   OP-12: Can FNA With Cell Blocks Replace Core Needle Biopsy of Breast Mass Lesions: A Prospective Pilot Study on Evaluation of Immunohistochemical Markers for Molecular Typing of Breast Cancer? Top


Anuradha Talukdar1, Monoj Kumar Deka1, Poulome Mukherjee1, Ravi Kannan1, Partha Basu2, Radhika Srinivasan3; 1Cachar Cancer Hospital and Research Center, Silchar, Assam, India, 2International Agency for Research in Cancer, Lyon, France, 3Postgraduate Institute of Medical Education and Research, Chandigarh, India

Objective: Core needle biopsy (CNB) breast have replaced FNAC as a diagnostic modality of breast lumps suspicious of cancer as they allowed the application of immunohistochemical markers ER, PR, Her2Neu & Ki-67 for determination of the molecular phenotype pre-operatively or pre-chemotherapy in locally advanced breast cancer. The objective of this study was to evaluate if cell blocks (CB) from FNAC can provide this information. Study Design: A total of 50 cases of breast lump were subjected simultaneously to FNAC and CNB. The cytomorphology, grade and immunohistochemistry on CB for ER, PR, Her2/Neu & Ki-67 were compared with CNB. Results: Adequately cellular CB was available in 96% cases. There was a excellent concordance for ER, PR, HER2/neu and Ki-67 between FNA CB and CNB. Conclusion: FNA with cell block is an excellent and cost-effective alternative to core biopsies in low resource areas for diagnosis and application of immunohistochemical markers for molecular typing of breast carcinoma.


   OP-13: A Retrospective Study on Cervical Cancer Screening Done in a Newly Opened Tertiary Care Hospital of Eastern India Top


Deepika Pandey, Santosh Kumar Mondal, Tummidi Santosh, Sujaya Mazumder, S Prasath, Indranil Chakrabarti, Rama Saha; All India Institute of Medical Sciences, Kalyani, West Bengal, India

Introduction: Cervical cancer is most common cause of death among women in developing countries. Papanicolaou smear is a basic test for detection of infections and premalignant conditions. The aim of this study is to understand the role of cervical screening to detect premalignant, malignant and non-neoplastic lesions and also prevalence of various lesions by conventional pap stain procedure. Materials and Methods: Women in the age group of 21-65 years who attended Outpatient department of obstetrics and gynecology department of AIIMS, Kalyani and those who gave consent for screening by  Pap smear More Details test were screened. Results: Of 472 cases, majority of the cases were benign comprising negative for intraepithelial neoplasia (NILM) of about 456 (96.61%) and 218 (46.98%) inflammatory cases. 58 cases (12.5%) had Bacterial vaginosis, 10 cases (2.16%) showed Trichomonas vaginalis and 23 cases (4.96%) showed Candida species. Epithelial cell abnormalities include Atypical glandular cells in 3 (0.64%), Atypical squamous cells of undetermined significance (ASCUS) in 2 (0.42%), Atypical squamous cells cannot exclude HSIL (ASC-H) in 1 (0.21%), Low-grade squamous intraepithelial lesion (LSIL) in 8 (1.7%) and High-grade squamous intraepithelial lesion (HSIL) in 2 (0.42%) women. Conclusions: Conventional Pap smear test is an easy and cheap diagnostic tool to detect premalignant, malignant and non-neoplastic lesions and also to determine prevalence of various lesions. As per The American College of Obstetricians and Gynecologists (ACOG) pap smear should start from 21 years and to be done till 65 years (repeated after every 3 years).


   OP-14: Analysis of ASC: Sil Ratio in Conventional Pap Smears as a Quality Indicator in Cytopathology Laboratory at a Tertiary Cancer Care Centre: A 10-Year Study Top


Saleem Pathuthara, Maya Uke, Rekha Patel, Irene Ruben, Neha Mittal, Santosh Menon, BharatRekhi, Kedar Deodhar; Tata Memorial Centre, Tata Memorial Hospital, Mumbai, Maharashtra, India

Background: Monitoring the relative frequency of atypical squamous cells (ASC) and squamous intra-epithelial lesions (SIL) has been proposed as a quality control measure. Generally ASC rate should not exceed 2 to 3 times the rate of SIL, leading to the current recommendation that laboratories should maintain ASC: SIL ratio of less than 2-3:1. Aim: To analyse the efficacy of ASC: SIL ratio as a quality indicator. Materials and Methods: ASC:SIL ratio was calculated monthly and the data of 10-year period (2012-2021) were analysed for trends, deviations with regard to patient population, changes in sample collection methods and personnel, types of sample processing, cyto-screeners, reporting pathologists, follow-up and final diagnosis. Results: The study included women from opportunistic screening as well as symptomatic and treated cervical cancer patients. The year-wise average ASC:SIL ratios for the year 2012 to 2021 (39304 samples) were 0.82:1, 0.75:1, 0.58:1, 1.2:1, 0.6:1, 0.34:1, 0.29:1, 0.54:1, 0.33:1, 0.59:1 respectively. The frequency of ASC was 0-13 while SIL was 1-31. There was no change in collection, processing, screening and reporting. Screening/interpretation errors were minimal (0.001%). Conclusions: ASC:SIL ratio remained within the recommended limit of 3:1 during the study period indicating the standard operating procedures practiced were compliant. The consistent low frequency of ASC was due to proper collection, careful processing, 2-tier screening and interpretation by trained cytotechnologists, reporting by specialty pathologists and regular audits. Increased frequency of SIL was due to a mixed patient population. Periodic monitoring and analyzing the trends of ASC: SIL ratio constitutes a robust quality indicator.


   OP-15: Atypical Glandular Lesions on Cervical Cytology Top


Aanchal, Poonam Abhay Elhence, Sudeep Khera, Deepak Vedant, Divya Aggarwal, T Balamurugan, Pratibha Singh, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Introduction: Diagnosis of atypical glandular cells on cervical cytology (AGCs) is challenging due to overlapping features of various neoplastic and nonneoplastic lesions. The incidence of squamous cell carcinoma of cervix has decreased with advent of Pap smear, whereas, incidence of glandular abnormalities, has increased with greater sensitivity. A high degree of suspicion, good clinical history and presence of diagnostic cytomorphological findings are essential for proper interpretation of glandular cell abnormalities. The aim of this study was to assess the utility of conventional Papanicolaou (Pap) smears and liquid based cytology (LBC) smears in detecting uterine glandular lesions. Materials and Methods: Smears for cervical cytology are collected using either Pap or LBC smear from patients in the age group of 20-75 years with complaints of abnormal bleeding. In AIIMS Jodhpur, from January 1, 2021 to July 31, 2022 a total of 46 patients had a diagnosis of AGC made by conventional cervical Pap or LBC smear interpretation. 37 (80.43%) patients had subsequent histological examination. Results: 29.7% (11/37) were associated with tissue- proven precancerous and/or cancerous lesions. 70% (26/37) of all AGC-patients were asymptomatic. Conclusion: As 29.7% of the patients in our series had significant cancerous and precancerous conditions found, patients with not qualified AGC-diagnosis require complete and careful evaluation and may need to be on follow-up.


   OP-16: Comparative Analysis of Different Cervical Screening Methods with Special Reference to Who Recommended Human Papilloma Virus Detection at a Rural Tertiary Care Centre – A Pilot Study Top


Sourav Roy, Jaya Bagchi (Samaddar), Rupsha Dutta (Pal), Biswajit Halder, Bidyut Krishna Goswami; North Bengal Medical College and Hospital, Siliguri, West Bengal, India

Introduction: Cervical cancer is the 4th common cancer with a high mortality rate. Human Papilloma Virus (HPV) being responsible in most cases with long latent period to progress from preinvasive to invasive cervical cancer can well be prevented by high performance economical screening procedures like visual inspection with acetic acid (VIA), conventional cervical PAP smear (CP), liquid-based cytology (LBC) and HPV-hr (high risk) detection (WHO's 1st line method) along with vaccination. Objectives: To determine the socio-demographic profile and the most cost-effective statistically significant community screening method with high sensitivity, specificity, positive, negative predictive values (PPV, NPV). Methods: A prospective observational study with 80 symptomatic women of reproductive, peri/postmenopausal age groups attending gynaecology OPD, who underwent VIA, CP and LBC and thereby detected positive were tested for HPV-hr detection (1/1/2022 - 4/1/22). Results were compared amongst different methods, gold standard being cervical biopsy. Statistical software used - GraphPad Prism 9 (p<0.5 significant). Results: Mean age was 43.3 yrs. Multiparity and early marriage seen in 80% and 45% respectively. Sensitivity and specificity were VIA (86.6%,60%)>HPVhr>LBC>CP. PPV was LBC (84.6%)>VIA>HPVhr>CP. NPV was highest in CP (70%). Inflammatory lesions were best diagnosed by CP; epithelial cell abnormality and more satisfactory smears by LBC (P < 0.05). Conclusion: Considering the high expenditure, inadequate community level expertise and non- availability of mass HPV-hr kits, VIA (NPCDCS recommended) with CP/LBCs found to be effective in this study which may also prove helpful for screening and vaccination in developing countries like India.


   OP-17: Comparative Evaluation of Cost-Effective Liquid Based Preparation Technique with Conventional Cytology for Cervico-Vaginal Smears: A Pilot Study Top


Vaishali Walke, Jai Kumar Chaurasia, K Pushpalatha, Hemlata Panwar, Sramana Mukhopadhyay, Neelkamal Kapoor; All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Background: Cervical cancer is fourth most common malignancy in women worldwide. The sensitivity of conventional cervical smears has been reported as low owing to the presence of obscuring haemorrhage, inflammation, mucus and cell overlapping, causing difficulty in morphological interpretation. Liquid-based cytology (LBC) offers several advantages as the cells are monolayered avoiding the obscuring factors. In present study, authors have evaluated the performance of cost-effective LBC technique, EziPREP (EP) against conventional preparations (CP) for cervical cancer screening. Methods: Women attending gynaecology outpatient department and undergoing cervico- vaginal (Papanicolaou, PAP) smear screening were included. PAP smear was collected using Ayre's spatula and cervical brush provided in EP kit. Initially, conventional smear was prepared, followed by sampling with cervical brush, detaching its head and dropping into EP preservative solution for LBC. The sample was processed as per manufactures protocol (EP) and stained with PAP stain. The smears were examined and graded for cell borders, cytoplasmic staining, nuclear borders, chromatin, diagnosis and screening time. The data was analysed through statistical methods and χ2 test. Results: The study revealed that EP had relatively shorter screening time, superior cellular details like cell borders and chromatin and improve detection of infections, epithelial cell abnormalities as compared to CP. Conclusions: The low-cost EP, India make device holds promise in providing cervical smears with better morphology than CP and may pay way in programmatic inclusion of cytology-based screening of cervical cancer on larger scale.


   OP-18: Inter-Observer Variability and Comparison Between Liquid-Based Cytology and Conventional Pap Smears For Cervical Cancer Screening in High-Risk Population – A Study From a Tertiary Care Centre Top


S Mariana Chartian, Meeta Singh, Gautam Chellani, Garima Rakheja, Rachita Garg, Gurmeet Singh, Gauri Gandhi, Shramana Mandal, Shyama Jain; Maulana Azad Medical College, New Delhi, India

Introduction: Pap smear although regarded as the most effective screening tool in preventing cervical cancer, is increasingly being scrutinized about its validity and reproducibility due to growing awareness. Aim: To study the inter-observer variability and compare the diagnostic accuracy of LBC and CPS in cervical cancer screening of high-risk patients. Materials and Methods: Split smears of CPS and LBC were prepared from 402 high-risk cases and stained with Papanicolaou stain. All CPS and LBC slides were reported by one cytopathologist which were then re-examined by a second cytopathologist, based on the latest Bethesda system. In discordant cases, the opinion of a third (senior) cytopathologist was taken as final. Biopsy was available in 11 cases only. Statistical Analysis: The inter-observer variation was evaluated using Kappa (κ) statistics. Pearson's correlation coefficient (r) was also calculated to determine the intra-observer variation. Results: The strength of inter-observer agreement was found to be very good (κ=0.95) and good (κ=0.79) for LBC and CPS respectively. The strength of intra-observer agreement was noted to be high (r=0.51) and moderate (r = 0.48) for observer-1 and observer-2 respectively. Diagnostic accuracy was calculated to be 100% for LBC and 70% for CPS. Conclusion: Inter-observer variation has a vital role in diagnostic error, patient care and prognosis, and bears medicolegal implications as well. Inter-observer variability was found to be more in CPS as compared to LPS.


   OP-19: ALK Gene Mutation in Neuroblastoma: A Study Using Next Generation Sequencing on Cytoscrapes from Fine Needle Aspirates Top


Neha Bhardwaj, Upasana Gautam, Manish Rohilla, Nandita Kakkar, Deepak Bansal, Amita Trehan, Radhika Srinivasan

Introduction: Neuroblastoma, a common pediatric malignancy originates from neural crest cells. Anaplastic Lymphoma kinase (ALK) gene and protein Alk are important for neural crest development. Point mutations in the ALK gene are reported in familial/sporadic neuroblastoma. We evaluated ALK gene mutations and Alk protein expression in cases of neuroblastoma diagnosed by fine needle aspiration (FNA). Materials and Methods: 22 cases of neuroblastoma diagnosed by FNA over 3 years (2017-2019) were evaluated for cytomorphology, Alk protein immunocytochemical expression (D5F3 clone) on cell block and MYCN amplification by FISH. One representative MGG stained smear was destained, scraped, DNA extracted, quantified by Qubit and library prepared for molecular analysis using Cancer Hotspot panel (version 2) for Next generation sequencing (NGS) on Ion Torrent S5 platform. The data was analyzed by a bioinformatics pipeline on Ion reporter for pathogenic/likely pathogenic mutations reported in COSMIC/ClinVar databases. Results: The amount of DNA extracted ranged from 9.9-39 ng/μl. A total of 2/21 cases showed ALK gene, exon 23 missense mutations on locus Chr2:29443697 (c.3520T>C), chr2: 29443695 (c.3522C>G), both resulting in amino acid change p.Phe1174Leu (F1174L) with allele frequency (AF) of 8 and 54% respectively. Both these cases showed Alk protein expression. They were aged 9 and 60 months, showed poorly differentiated and undifferentiated morphology respectively, with high Mitoses-Karyorrhexis index, MYCN amplification, unfavourable histology as per INPC and died of disease within 1 and 17 months respectively. Conclusion: NGS is feasible on cytoscrapes of FNA material. ALK gene mutations in neuroblastoma portends a poor prognosis and way toward targeted therapy.


   OP-20: Cytodiagnosis of Gastrointestinal Stromal Tumours: A Correlation And Histomorphology with Review of Literature Top


Manjari Bhattacharyya, Rabeya Basari, Biswajit Haldar, Bidyut Krishna Goswami; North Bengal Medical College and Hospital, Siliguri, West Bengal, India

Background: Gastrointestinal stromal tumor (GIST) represent a distinct mesenchymal tumor that is characterised by genetic mutation in the c-kit proto oncogene. Aim: To study the cytological features of gastro-intestinal stromal tumors (gastric and exo-gastric) and correlate with histomorphology and immunohistochemistry. Materials and Methods: A retrospective study conducted on cases diagnosed as GISTs on histopathology from January 2020 to August 2022. Results: Out of 7 patients of GISTs, 4 males, 3 females with mean age of 51 yrs. 2 cases (28.5%) were from stomach, 3 (42.8%) from small intestine, one (14.2%) from colon, one (14.2%) as anal growth. Out of the studied 7 cases, 4 (57.14) cases diagnosed as malignant spindle cell tumor favouring GIST. Two (28.5%) cases diagnosed as benign spindle cell lesion. One (14.2%) was diagnosed as poorly differentiated tumor on cytology turned out to be epithelioid GIST. Cytological feature were studied on Romanowsky stained smear and H&E stained smear. This study illustrates the cytomorphology of GISTs. Immunohistochemical correlation was done wherever possible. Conclusion: With the recent advances GIST is being increasingly recognized.


   OP-21: Diagnostic Efficacy of Image Guided Fine Needle Aspiration in the Assessment of Intra-Abdominal Lesions with Histopathological Correlation: A Cross Sectional Study Top


Deepa Rani, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India

Introduction: Abdominal masses are a group of pathological lesions that can be benign or malignant, solid or cystic, and vary in appearance depending on age, gender, location, and organ or tissue of origin. The appropriate diagnosis of intra-abdominal lesions is difficult and often requires histopathological confirmation. Aim: The study was conducted to determine the diagnostic efficacy of image guided FNAC in the assessment of intra-abdominal lesions and to determine its age and sex distribution. Results: Out of 207 patients, 110 were males and 97 were females with male to female ratio of 1.13:1. The aspirate was satisfactory in 201 (97%) cases. Most common lesions were malignant 170 (82.1%), followed by inflammatory lesions 31 (14.9%). The majority of aspirates were from liver 71 cases, followed by 47 cases from gall bladder and 39 cases from the lymph nodes. Histopathological correlation was done in 57 cases. A true positive diagnosis was made in 34 cases while no single case was included in false positive. 28 cases were true negatives while 3 cases were false negative. The sensitivity of study was 92.8%, while specificity was 100%. The positive and negative predictive values were 100% and 90.3% respectively. The diagnostic accuracy of the study was 95.7%. Conclusions: FNA of abdominal lesions guided by ultrasound is a quick, low-cost, safe, highly accurate, and minimally invasive approach for getting a tissue diagnosis in solid localized lesions of the abdomen.


   OP-22: Diagnostic Utility of Image Guided Fine Needle Aspiration Cytology of Liver Lesions in a Tertiary Care Centre: One Year Study Top


Mona Tirkey, Ranu Roy Biswas; North Bengal Medical College, Siliguri, West Bengal, India

Background: Information Fine needle aspiration cytology (FNAC) has proven to be an effective technique for diagnosis of liver lesion, effectively differentiates neoplastic and non- neoplastic, benign and malignant neoplastic lesions and also primary and secondary malignant lesions. Aims and Objectives: To determine the utility of image guided FNAC of hepatic masses in diagnosis of different types of hepatic lesions. Methodology: A prospective observational study for one year conducted at North Bengal Medical College, 53 patients with hepatic lesions after detailed clinico-radiological assessment, were subjected for USG guided FNAC. Results: Out of 53 cases, the diagnostic yield was obtained in 48 cases (90.56%). Out of 48 cases, 43 (89.58%) were neoplastic and 05 (10.42%) were non neoplastic. All 05 non- neoplastic lesions had infective aetiology. Amongst the 43 neoplastic lesions, 95.35% were malignant, 4.65% benign. In malignant neoplastic tumours, 12.20 % were Hepatocellular carcinoma (HCC)). Metastatic lesions constituted 83.72%, maximum occurrence were in the age group of 60 years and above. Metastatic adenocarcinoma (60.42%) was the most common cytological diagnosis. The majority of metastatic lesions are from gall bladder (10) followed by gastrointestinal tract (05). Conclusion: Image guided FNAC of liver proves to be a minimally isnvasive and cost effective technique to characterize different types of liver masses.


   OP-23: Fine Needle Aspiration Cytology of Ovarian Tumors with Histopathological Correlation: A Revisit to Borderline Category Top


Zoya Hasan, Meeta Singh, Jyoti Singh, Gautam Chellani, Garima Rakheja, Shyama Jain, Nita Khurana, Shramana Mandal, A K Rathi; Maulana Azad Medical College, New Delhi, India

Background: Preoperative cytological diagnosis of Ovarian Tumors has become easier after the improvement of imaging techniques. Histopathology is considered as the gold standard. Objective: The aim of present study is to evaluate the role of US-guided FNAC in pre- operative cytological diagnosis of Ovarian masses in comparison with histopathology, and to assess the pitfalls and limitations of cytological interpretation in cases with Borderline cytology. Materials and Methods: This study was conducted over a 5-year period on 91 cases of ovarian masses, which were evaluated by US-guided FNAC. Sensitivity, specificity and diagnostic efficacy were calculated using histopathology as gold standard. Results: On cytology, Benign Epithelial neoplasm was diagnosed in 10 cases, Borderline in 11 cases, and 60 cases were Malignant. 10 cases were found to be inadequate. Histopathology was available in 29 cases. Out of 60 malignant tumors, 22 were diagnosed as Malignant on histopathology and 16 cases were sent directly to Radiotherapy. Histopathological follow-up was available for 10 cases out of 11 cytologically Borderline cases. On histopathology, 02 cases were reported as Benign, 07 as Malignant and 01 case as Borderline. In the present study, Sensitivity is 97.4%, Specificity is 86%, Positive Predictive Value is 97.4% and Negative Predictive Value is 85.7%. Diagnostic accuracy was 95.5% with respect to the correct diagnosis. A total of 66% of cytologically Borderline cases turned out to be Malignant. Conclusion: USG-guided FNAC is a safe, simple, fast and cost-effective procedure useful in deciding management guidelines prior to any surgical intervention.


   OP-24: Pick Up Rate of Cell Block Preparation in Hepatopancreatico Biliary Neoplasms: An Institution Based Study Top


Bhartendu, Ashok Singh; All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Liver cancer, gallbladder carcinoma, and pancreatic cancer are one of the leading causes of cancer related mortality. The key to prolonging the survival of cancer patients lies in early diagnosis and timely treatment. Most of the mass lesions (both primary and metastatic) of the liver and gallbladder discovered clinically or by imaging techniques are easily assessable to fine-needle aspiration cytology (FNAC). Fine Needle Aspiration (FNA) performed under image (USG) guidance can provide the desired material from the representative site. It is a cost-effective, rapid, minimally invasive, and safe diagnostic procedure for the initial evaluation of the patient and enables the clinician to plan treatment accordingly. However, FNAC sometimes does not yield information for precise diagnosis and there is always the risk of false-negative diagnosis and indeterminate diagnosis. In these cases, cell block preparations may be helpful. It provides the opportunity to assess the tissue architecture and forms a bridge between cytology and histopathology. The cell block sections are also suited for a wide variety of histochemical stains and immunocytochemistry. FNA and CB together can have a major impact on patient management and in many cases, avoid diagnostic surgical procedures and expedite the planning for therapy. My current study aimed at evaluating the pick up rate of cell block preparation in hepatopancreatico biliary neoplasms in comparison with routine smear. Around 125 cases are being evaluated. We are expecting a 10% increase in sensitivity.


   OP-25: Utility And Efficacy of Rapid On-Site Evaluation of Image-Guided Fine Needle Aspiration Cytology From Hepatobiliary Tract Lesions Top


Rohan Das1, Evarisalin Marbaniang1, Vandana Raphael1, Donboklang Lynser2; 1Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India, 2Department of Radiodiagnosis, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India

Background: Fine needle aspiration cytology (FNAC) is broadly accepted method for diagnostic evaluation of pathological lesions. Studies have shown that with the application of Rapid onsite evaluation (ROSE) of smears, there was a statistically significant increase in the diagnostic yield of image-guided FNACs. It is prudent to have data on ROSE of image- guided FNACs from biliary tract lesions given the lack of similar studies in our country. Methods: A prospective study was conducted where in ROSE was performed for FNACs from 50 patients with hepatobiliary tract lesions. The samples were stained with toluidene blue for checking adequacy with a proposed adequacy criteria. The cytological slides were later analysed after staining with May grunwald giemsa and Papanicolaou stains. The results were compared with those obtained from FNAC from previous years without any onsite evaluation to study the efficacy of ROSE. Results: During 2006-2017, of the 330 image-guided FNACs (without ROSE) from hepatobiliary lesions, 47 were non-diagnostic whereas during our study (2021-2022), of the 50 image-guided FNACs (with ROSE) from hepatobiliary lesions, only 2 were non-diagnostic. A significant increase in diagnostic yield of FNAC from 85.76% to 96 % was noted (P = 0.044). Conclusion: ROSE with toluidine blue staining can significantly increase the diagnostic yield of hepatobiliary FNACs and abolish the need of repeat procedure.


   OP-26: A Comparison Between the Conventional and the Milan System of Reporting Salivary Gland Cytology For Cytohistologic and Clinicopathologic Correlation Top


Prabhu Gouda, Neelaiah Siddaraju, Debasis Gochhait, Arun Alexander; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Objective: To compare the conventional versus the Milan system of reporting salivary gland cytopathology (MSRSGC) in diagnosing salivary gland lesions. Study Design: The study conducted over a period of 4 years included the fine needle aspirates from 555 patients that were divided into conventional (diagnosed before implementation of MSRSGC) and MSRSGC groups; the groups comprised 266 and 289 cases respectively. The cases with histopathologic/ cell block diagnoses were statistically evaluated for sensitivity (SN), specificity (SP), diagnostic accuracy (DA), and positive as well as negative predictive values (PPV& NPV). Results: Conventional and MSRSGC groups had a histopathologic correlation in 53 and 57 cases respectively; 47/53 (conventional) & 55/57 (MSRSGC) had cyto-histologic concordance. Discordant cases in the conventional group included two cases each of non- neoplastic lesions, benign and malignant neoplasms. The MSRSGC group had 2 discordant results with one each in category-II and category-VI. The SN, SP, PPV, NPV & diagnostic accuracy between conventional and MSRSGC groups were 92.85% & 95.65%, 94.85% & 100%, 86.67% & 100%, 97.37% & 97.14% and 94.33% & 98.24% respectively. Conclusion: Despite the lack of statistically significant results between two groups, the MSRSGC categories “atypia of undetermined significance” (AUS) and “salivary gland neoplasm of uncertain malignant potential” (SUMP) proved 'beneficial' in resolving the preoperative cytopathologic diagnostic issues.


   OP-27: A Repertoire of Salivary Gland FNAC and Their Assortment Via the Milan System of Reporting: Drawing Parallels for Histopathological Diagnosis Top


Suha Akhtar, Pinki Pandey, Asttha Kapoor, Mohd Azfar Jamal, Kapil Trivedi, Savita Agarwal, Roopak Aggarwal, Vineet Chaturvedi; Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India

Objective: Salivary gland lesions sometimes pose a challenge for diagnosis in cytopathology. MILAN reporting system was introduced to increase the efficacy of diagnosis. A practical classification system and a uniform reporting system that improves communication between pathologists and clinicians facilitate cytologic - histological correlation and promote research. This study was conducted to evaluate the efficacy of the MILAN system in diagnosing salivary gland lesions and to calculate the risk of malignancy for each category. Materials and Methods: FNA was carried out in 150 cases with salivary gland enlargement, slides were retrieved, reassessed, and cases were distributed into 6 categories using the 'Milan system of reporting salivary gland cytopathology' (MSRSGC). Category 1: Non-diagnostic (ND); Category 2: Non-neoplastic (NN); Category 3: Atypia of undetermined significance (AUS); Category 4a: Neoplasm: benign (NB); Category 4b: Neoplasm: salivary gland neoplasm of uncertain malignant potential (SUMP); Category 5:Suspicious for malignancy (SM); Category 6: Malignant (M). Results: Total of 150 cases were evaluated cytologically, and histological follow-up was available in 81 cases. Distribution of the specimens according to the Milan system was as follows: 7.27% (ND), 33.63% (NN), 4.54% (AUS), 30% (NB), 3.63% (SUMP), 4.54% (SM), and 16.36% (M). Overall ROM reported were 25%, 8.3%, 20%, 4.75%, 33.3%, 75%, 92.8%., respectively for each category. Overall, sensitivity was 82.21%, specificity was 96.32%, positive predictive value was 91.71%, and negative predictive value was 90.17%. Conclusion: MILAN system for reporting Salivary gland cytopathology confirms its utility and fulfills the need for a uniform and internationally acceptable reporting system.


   OP-28: Classification of LBC Smears of Salivary Gland According to Milan System for Reporting Salivary Gland Cytopathology Top


Shaikh Sadiya, Priyanka Singh, Juhi Shahab, Mukul Singh, Sunil Ranga; Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Background: With the advent of Liquid Based Cytology in 1930s, it has been an upcoming and useful technique in both gynecological and non-gynecological specimens. Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) published in 2018 and aims to standardize reporting terminology by categorizing salivary gland aspirates into: Non diagnostic (Category I); Non neoplastic (Category II); Atypia of Undetermined Significance [AUS] (Category III); Neoplasm: benign (Category IVa); Neoplasm: Salivary gland neoplasm of Uncertain Malignant Potential [SUMP] (Category IVb); Suspicious for malignancy (Category V) and Malignant (Category VI). Aim: To categorize the salivary gland LBC smears according to newly introduced Milan System. Materials and Methods: LBC smears of thirty salivary gland aspirates were evaluated and classified according to Milan system. Immunocytochemistry was applied whenever needed. Results: The age of patients ranged from 21-70 years and most of the patients were male. The mean age at presentation was 38 years. The parotid gland was the most common salivary gland involved. Thirty LBC smears were categorized by Milan system as follows: Category I- 4 (13.3%); Category II -2 (6.6 %); Category III -1 (3.3%); Category IVa-17 (56.6%), Category IVb- 1 (3.3 %); Category V -2 (6.6%) and Category VI, 3 (10%). Conclusion: The Milan System for Reporting salivary Gland Cytopathology is satisfactorily applicable for LBC smears of salivary gland.


   OP-29: Cytologic Spectrum of Salivary Gland Lesions with Histopathological Correlation with Respect to Milan System of Reporting Salivary Gland Cytopathology – A Tertiary Care Center Experience Top


Sunita Naiding, Pranita Medhi; Assam Medical College and Hospital, Dibrugarh, Assam, India

Background: FNAC of suspected salivary gland lesions is an efficient tool for the preoperative diagnosis and management of patients due to low cost, minimum morbidity, rapid turnaround time, high specificity and sensitivity., “The Milan system for reporting salivary gland cytopathology” (MSRSGC) was introduced for diagnosis and management and establishing the risk of malignancy (ROM) in different categories. The present study was conducted to grade the salivary gland lesions according to Milan system of reporting and to correlate with their histopathological findings. Methods: In this prospective study, a total of 49 salivary gland lesions were examined clinically over a period of two years, correlated with imaging findings, palpated and aspirated and cytological features were evaluated and categorized according to MSRSGC and correlated with histopathological findings. Results: The cases were evaluated cytologically, and histological follow-up was available in 37 cases. The distribution of cases into different categories were as follows: non-Diagnostic (2.04%), non-Neoplastic (20.4%), Atypia of Undetermined Significance (0%), Neoplastic-Benign (57.1%), Salivary gland neoplasm of Uncertain Malignant Potential (SUMP) (2.04%), Suspicious of Malignancy (0%) and Malignancy (18.3%). Risk of malignancy was observed in the SUMP and Malignant categories and were both 100 %. Sensitivity of FNAC in diagnosing salivary gland lesions was 85%, specificity 97%, positive predictive value 95%, and negative predictive value 92% with an accuracy of 93%. Discussion: Milan System is a standardized, tiered diagnostic framework of reporting which emphasizes on risk stratification rather than specific diagnoses and improves communication with clinicians and hence standardizing overall patient care.


   OP-30: Cytological Spectrum of Major Salivary Gland Lesions on the Basis of Milan'S Criteria – A Retrospective Study of 60 Cases Top


Tushar Ghosh, Agartala Government Medical College and GBP Hospital, Agartala, Tripura, India

Introduction: Fine needle aspiration cytology is a rapid, cost effective & safe technique for diagnosing salivary gland lesions. The Milan System for Reporting Salivary Gland Cytology (MSRSGC) provides a risk stratification based classification system for each diagnostic category, which aims to furnish useful information to the clinicians.

Objectives:

  • To evaluate varied cytological spectrum of salivary gland lesions
  • To assess the diagnostic utility of MSRSGC.


Materials and Methods: This is a retrospective study carried from December 2020 to August 2022 at the Department of Pathology, AGMC, Agartala, Tripura. FNAC was done in 60 cases. Slides were retrieved and re-evaluated and final cytodiagnosis were given. Other parameters like age, sex, ethnicity, site of lesion and laterality were taken into account. Results: The cases belong to the following categories: 10 cases were non- diagnostic (16.67%), 18 were non-neoplastic (30%), 3 were atypia of undetermined significance (3%), 23 were benign neoplasm (38.33%), 0 were salivary gland neoplasm of uncertain malignant potential (0%), 1 was suspicious for malignancy (1.67%), 5 were malignant (8.33%). The most common benign tumor of salivary gland is pleomorphic adenoma and mucoepidermoid carcinoma was the most common malignant tumor. The most common major salivary gland involved is parotid gland of left side. The most commonly involved age group was 51-60 and Men were more commonly involved. Conclusions: Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC. We conclude that in spite of few diagnostic pitfalls FNAC still plays a vital role in differentiating neoplastic from non-neoplastic salivary gland lesions to provide guideline for appropriate patient management.


   OP-31: Diagnostic Role of Cytomorphometric Image Analysis in Cytology of Salivary Gland Neoplasms Top


Jai Chaurasia, Vipul Mayank, Ishan Raj Tiwari, Vikas Gupta, Deepti Joshi, Garima Goel, Neelkamal Kapoor; All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Background: Fine needle aspiration cytology is an important diagnostic tool in salivary gland cytopathology. However, cytology of salivary gland neoplasms is challenging because of morphological overlap, heterogeneity and subjective variability. Cytomorphometric image analysis turns the subjective variablilty into quantitative parameters which may aid not only in differentiating between benign and malignant tumours but also can aid in categorising challenging cases with morphological overlap. Methods: A retrospective analysis of Papanicolaou stained fine needle aspirate smears from 50 patients with salivary gland neoplasms, with available follow-up histopathology, was performed. The aspirates were categorized in to three neoplastic categories of Milan System for reporting salivary gland cytology (MSRSGC) i.e. Benign neoplasm, Salivary gland neoplasm with uncertain malignant potential (SUMP), and Malignant. The smears were subjected to cytomorphometric image analysis using Image software. Each nucleus was analysed for 13 parameters including aspect ratio, intensity, diameter, perimeter, roundness, area, feret diameter, circularity, radii, fournier description and chromatin texture characteristics such as margination, heterogeneity and clumpiness. The data obtained was compared through relevant statistical methods. Results: The comparative morphometric data obtained for parameters using ANOVA, for the three categories showed statistically significant P values (<0.001). The Post-hoc test (Games-howel) test also showed significant P values (<.001). Conclusion: Cytomorphometric image analysis is an important tool in diagnosis of salivary gland neoplasms and can improve the diagnostic accuracy for better treatment and improved prognosis. However, more studies with larger sample size may be needed in future for further affirming its role.


   OP-32: Usefulness of Extracellular Matrix and Background Material in Diagnosis of Salivary Gland Lesions in The Era of Milan – Clues From the Hues Top


K Amita, M Sanjay, Geethanjali, T Rajini; Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, Mandya, Karnataka, India

Introduction: Salivary gland (SG) lesions are challenging at cytology. We previously introduced pattern-based analysis for diagnosing salivary gland lesions with high efficacy. In the present study, the primary aim was to determine the utility of background elements, which include different types of extracellular matrix and background material, in distinguishing various salivary gland lesions. The secondary objective was to examine individual lesions in detail and discuss the challenging cases and propose solutions for the same. Materials and Methods: Retrospective diagnostic analytical study involving SG lesions, aspirated over a duration of five years. All the cases were reviewed and classified based on the predominant background extracellular matrix and background material. The cellular details were then taken into consideration and a final cytological diagnosis was rendered. All cases were classified into six groups as follows group I- the absence of extracellular matrix (clean background), group II- chondromyxoid fibrillary stromal matrix, group III- mucin, group IV-hyaline basement membrane material, group V- proteinaceous material and group VI-necrotic/dirty background. Results: Total of 233 FNAC cases were included. Histopathology correlation was obtained in 118 cases. False positives were two and false negatives were seven. Concordance was noted in 102 cases and discordant diagnosis in 16 cases. Sensitivity, specificity, and diagnostic accuracy were 79.4%, 97.6%, and 92.3% respectively. Conclusion: The high efficacy of FNAC, obtained by classifying lesions based on background elements like different types of extracellular matrix material and other background material, establishes the utility of this method in reporting SG lesions.


   OP-33: Accuracy of Fine Needle Aspiration Cytology in Defining the Variants of Papillary Thyroid Carcinoma: Utility of an Algorithmic Approach Top


Neha Nigam, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Introduction: Papillary thyroid carcinoma is the commonest thyroid malignancy, with the classical variant being the most prevalent subtype. PTC classification is often difficult to diagnose on fine-needle aspiration cytology (FNAC) alone due to overlapping cytologic features and heterogeneity of lesions. This study aimed to classify the PTC cytology cases into a particular cytological variant by applying an algorithmic approach. Methods: This was a retrospective study from Jan 2014 to Dec 2019 that included all histopathologically confirmed cases of PTC variants. FNA samples of thyroid nodules were blindly reviewed and classified into different morphological variants using a stepwise algorithmic approach based on architectural, nuclear, and cytoplasmic features. Results: A cytology review of 77 histologically proven cases of PTC variants was done. One case was inadequate (TBSRTC I), 9 were benign (TBSRTC II), 2 were FLUS/AUS (TBSRTC III), and 65 cases were suspicious or definite for papillary thyroid carcinoma (TBSRTC V/VI). Retrospective algorithmic cytopathological analysis of 65 cases (TBSRTC V/VI) showed classical PTC (5), follicular variant (FV-PTC) (35), tall cell variant (20), diffuse sclerosing variant (1), warthin-like variant (2), and solid variant (2). Diagnostic accuracy of cytopathology in diagnosing the PTC variants varied from 81.3% to 100% (mean 78.9%). Conclusion: It is possible to subclassify PTC into different variants on cytology based on this algorithmic approach, or into an aggressive and non-aggressive variant based on certain more frequently observed features in each variant.

[TAG:2]OP-34: Clinicopathological Study of Cytologically Indeterminate Thyroid Nodules With Braf (V600E) Expression On Cell Blocks and its Correlation Of Histopathological Tumor Types in a Tertiary Care Hospital of Northern Districts of West Bengal, India[/TAG:2]

Shampa Mondal, Vaswati Das, Sutapa Chaudhuri, Bidyut Krishna Goswami; North Bengal Medical College, Siliguri, West Bengal, India

Background: Thyroid cancers are the most common Endocrine malignancy worldwide. Papillary Thyroid Carcinoma being the commonest histological type. As the mortality is low for well differentiated Thyroid Carcinoma, their cytological preoperative diagnosis needs to be further strengthened by molecular study. In this study we have evaluated the BRAF mutation on the cell block of indeterminate thyroid nodules (category III and V) comparing risk of malignancy (ROM) between cell block with and without BRAF molecular study and histopathological categorization in a certain geographical area. Methods: This cross sectional study including 61 indeterminate thyroid nodules out of total 121 nodules. The BRAF V600 mutation from cell block of FNAB sample was confirmed by PCR-based method (Sanger Sequencing combined with Allele-specific real-time PCR) followed by thyroidectomy with histopathological evaluation. Results: Most common entity found to be Papillary Thyroid carcinoma with BRAF mutation. The BRAF mutation was positive in 07/61 cases (11.5%), with diagnostic values of 16.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 82.8% negative predictive value (NPV) in AUS compared to 33.5% sensitivity, 100% specificity, 100% PPV, and 20% NPV in suspicious category. Conclusion: The BRAF mutational expression is found to be 100% specific though sensitivity for the indeterminate nodules is less. Nevertheless, the method can also be used in selected cases, where such PTC and variants are more prevalent like our locoregional area. In addition, the costs–benefits ratio of the tests should be assessed.


   OP-35: Comparison of Liquid-Based Cytology and Conventional Smears in Fine Needle Aspiration Cytology of Thyroid Samples Top


Ankita Kumari, Brig J K Bhatia, Neha Mala Krishna, Col. P Sengupta, Lt Col. Kanwaljeet Singh; 1Command Hospital, Kolkata, West Bengal, India, 2AHRR, CHEC, Kolkata, West Bengal, India

Background: Liquid-based cytology (LBC) is fast becoming a useful method in evaluating fine needle aspiration (FNA) cytology. Even distribution of cells, decreasing the obscuring background elements (blood and mucus), well preserved nuclear and cytoplasmic details and rapid fixation helps in better visualization of cells. Its utility in thyroid lesions is being explored. The aim of this study is to analyze cytomorphological features of LBC smears in thyroid nodules and to examine, compare and correlate adequacy and accuracy of diagnosis with conventional smears and histological diagnosis when applicable. Methods: This was a prospective study with split samples in 40 thyroid FNACs which were reported as per the Bethesda system. In each case, two passes were performed. The first pass was for conventional preparation (CP) and the second pass yielded material for LBC preparation. The smears were reported by two pathologists independently as per the Bethesda system. Both CP and LBC smears were compared for cellularity, background blood and necrotic cell debris, cell architecture, nuclear and cytoplasmic details. Descriptive statistics were used for comparison between conventional and LBC smears. Results: Cellularity was comparable in both conventional and LBC smears. Diagnostic accuracy was better in LBC smears compared with CP smears due to lack of background debris and better cell morphology. Conclusions: LBC is a reliable technique and offers the advantage of easy identification aiding in diagnostic accuracy.


   OP-36: Correlation of Ultrasound Based Tirads and Bethesda System of Cytology Reporting of Thyroid Lesions: A Study in Tertiary Care Centre Top


Lity Dhar, Meeta Singh, Ata Mohammed, Gautam Chellani, Shyam Lata Jain, Jyoti Kumar, Ravi Meher, Nita Khurana; Maulana Azad Medical College, New Delhi, India

Background: The age standardised incidence rate of thyroid cancer in India is 89.4 per 1 lac population.[1] This increased incidence is mainly attributed to better detection methods of small thyroid lesions that were missed in the past.[2],[3] Two such methods include Ultrasound based TIRADS and The Bethesda System for Reporting Thyroid Cytopathology. Aims and Objectives: To study the correlation of TIRADS and The Bethesda System for Cytology Reporting of Thyroid Nodules and Histopathology. Materials and Methods: Thyroid cytopathology cases were retrieved from January 2019 to July 2022. The TIRADS score and The Bethesda category were noted. Histopathology specimens were also traced. Results: The study comprised of 1010 cases with 872 females and 138 males with M: F=1:6.3 and age ranging between 7-80 years. The TIRADS scoring was available for 923 cases. Histopathology was available for 231 cases. Highest TIRADS scoring (4 and 5) was seen in Bethesda category V (84.5%) and VI (96.9%). When compared to histopathology, The Bethesda system and TIRADS had sensitivity of 69.4% and 65.8%, specificity of 99.3% and 96.5%, PPV of 98.3% and 91.8% and NPV of 84.7% and 84.4% respectively. ROM and ROC will be calculated. Conclusion: The TIRADS and The Bethesda system of categorization of thyroid lesions can help improve the overall survival rate of patients with thyroid malignancies.


   OP-37: Cytomorphological Features of Chronic Lymphocytic Thyroiditis and its Association with Thyroid Hormone Profile, Anti Thyroid Peroxidase Antibody and Procalcitonin Top


Anjnee Sharma, Prajwala Gupta, Bindu Kulshreshtha, Shalini Malhotra; ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India

Background: Chronic lymphocytic thyroiditis (CLT) is organ specific, immunologically mediated inflammatory disease. The most common circulating antibodies in CLT are anti- thyroglobulin (TG) and anti–thyroid peroxidase antibody (TPO). Procalcitonin (PCT) is produced in thyroid C cells and converted to calcitonin, hence no PCT is generally released into the blood. Aims and Objectives: Evaluation of cytomorphological features in CLT and its association with thyroid hormone profile, anti-TPO antibody and PCT. Materials and Methods: This study was conducted in the Department of Pathology, Department of Microbiology and Endocrinology in ABVIMS, Dr Ram Manohar Lohia Hospital between November 2019 and March 2021. A total of 44 cases of thyroid FNAC which presented with palpable or ultrasonographically detected thyroid swelling and diagnosed as chronic lymphocytic thyroiditis on cytology, were included in the study with their thyroid hormone profile, anti TPO antibody and PCT levels. Results: In present study mostly patients were female and euthyroid, followed by hypothyroid. Sensitivity of anti- thyroid peroxidase antibody was 68.2%. Most common cytomorphological grading was grade III. Anti-TPO antibody was found to be increased with higher grades. Procalcitonin was elevated in 2 cases. Plasma cells mostly seen in grade III cases. 8 cases of preclinical CLT were diagnosed on FNAC. Conclusion: FNAC is a gold standard in diagnosing CLT especially with preclinical CLT. Anti TPO antibody was associated with higher cytomorphological grades of thyroiditis. There was no association seen between cytomorphological grade, thyroid hormone profile and procalcitonin. Although procalcitonin is an inflammatory marker, meagre number of cases with raised procalcitonin could not establish its association with CLT.


   OP-38: Liquid-Based Cytology Categorisation of Thyroid Lesions Aspirate According to Bethesda System for Reporting Thyroid Cytopathology Top


Rita Rathore, Priyanka Singh, Juhi shahab, Mukul Singh, Sunil Ranga; VMMC and Safdarjung Hospital, New Delhi, India

Background: Liquid based cytology for solid lesion aspirate has come in use due to the advantages of lesser screening time, clearer background and potential application of ancillary techniques. The Bethesda system for reporting thyroid cytopathology (TBSRTC) is an international reporting system for thyroid cytology and categorises into: Nondiagnostic (TBS I), Benign (TBS II), Atypia of undetermined significance/Follicular lesion of undetermined significance [AUS/FLUS] (TBS III), Follicular neoplasm/suspicious for a follicular neoplasm [FN/SFN] (TBS IV), Suspicious for malignancy (TBS V) and malignant (TBS VI). Aim: To classify liquid-based cytology smears as per the Bethesda system for reporting thyroid cytopathology (TBSRTC). Materials and Methods: Fifty thyroid lesions aspirates were analyzed and categorised by the Bethesda system. The residual material from LBC was used for ancillary testing such as Immunocytochemistry whenever required. Results: The age of patients ranged from 21 to 55 years with female predominance. The 50 thyroid FNAC's were categorized as follows: ND, 3 (6%); Benign, 29 (58%); AUS/FLUS, 2 (4%); FN/SFN, 1 (2%), SFM, 7 (14%), malignant, 8 (16%). LBC smears demonstrated better cellular preservation and clear background. The reduction of colloid and lymphocytes was a disadvantage in interpretation of LBC smears. Conclusion: The Bethesda system for reporting thyroid cytopathology standardize thyroid reporting system and is an outstanding system in classifying thyroid aspirates thereby reduces interobserver variability in reporting thyroid FNAC's.


   OP-39: Morphology to Morphometry; is it Really Helpful in Cytological Evaluation of Thyroid Lesions? Top


Nidhi Verma, Sompal Singh, M Bharanidharan, Gauri Kumari; Maulana Azad Medical College, New Delhi, India

Background: Differential diagnosis of thyroid lesions is one of the most common problems in thyroid cytology. Therefore development of more objective and reproducible tools for diagnosis is needed. Aims: To evaluate the role of nuclear morphometry in differential diagnosis of different thyroid lesions on fine needle aspirate samples. Materials and Methods: Morphometric analysis was done on aspiration smears from 32 thyroid lesions. The study included adenomatous/ colloid goiter (12 cases), follicular neoplasm (12 case) and medullary carcinoma thyroid (8 cases). Giemsa-stained FNAC smears were analyzed using Image J software, a Java-based image processing program developed at the National Institutes of Health and the Laboratory. Nuclear morphometric parameters like nuclear size (area, perimeter, major and minor axis), shape (circularity, roundness and aspect ratio) and density parameters (solidity) were measured. Statistical Analysis: Statistical evaluation was carried out using Mann Whitney test for all the eight variables. The result was considered significant when P < 0.05. Results: The papillary carcinomas had highest mean area, perimeter, major and minor axis, A/R (Aspect ratio) compared to other groups while these parameters were least in follicular neoplasms. Roundness and circularity was maximum in follicular neoplasms. Standard deviation in nuclear area was most in adenomatous goiter/ colloid goiter group suggesting that nuclear size are most variable in this group. These differences were statistically significant. Conclusion: When correctly applied, quantitative estimation of cytological nuclear features can play an important role in preoperative assessment and can complement morphological features in thyroid lesions.


   OP-40: Thyroid Gland Metastasis Top


Chanchal Rana1, Shipra Agarwal2, Neha Nigam3, Poorvi1, Isha Makker1; 1Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India, 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, India, 3Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background: Despite its rich vascular supply, thyroid is an uncommon organ to harbor metastatic diseases, such that majority of tumors identified are inherent. Incidence of metastatic infiltration in thyroid gland have been reported to be as low as 2-3% of all thyroid malignancies. Materials and Methods: Pathology database of KGMU, Lucknow, AIIMS, New Delhi and SGPGIMS, Lucknow from July 2016 to December 2021 was searched. Cases harboring metastasis to thyroid gland were included in study. Results: Among a total of 5958 pre-operative cytology and 2276 surgical specimen, 412 cases were reported as malignant lesions of thyroid. When reviewed 15 patients were diagnosed with metastasis to thyroid gland, accounting for 3.6% of all thyroid malignancies and 0.6% of all surgical specimens. Majority of these patients presented with neck swelling which was usually associated with compressive symptoms. All these 15 patients were diagnosed cytologically with histological evaluation in 7 cases. Immunohistochemistry was performed in 5 cases. In more than half of the cases primary lesion was in lung (n = 8; 53.3%). Other primary locations included cervix, uterus, gall bladder and esophagus. However, in 3 cases no primary could be identified. Conclusion: Metastasis to thyroid is rare with lung being the most common primary site of origin.


   OP-41: Application of the Sydney System for Reporting Lymph Node Cytopathology in Assessment of Risk of Malignancy in Pediatric Lymph Node Aspirates: A Preliminary Analysis Top


Selvan Pandiyan, Parikshaa Gupta, Nalini Gupta, Malvika Shastri, Amanjit Bal, Reetu Kundu, Manish Rohilla, Pranab Dey, Radhika Srinivasan, Deepak Bansal, Amita Trehan; PGIMER, Chandigarh, India

Background: Fine needle aspiration cytology (FNAC) is one of the most commonly used techniques for evaluating lymphadenopathy. Recently, the Sydney system was proposed for performance, classification and reporting of lymph node (LN) cytopathology. The present study was conducted to assess the risk of malignancy associated with each of the diagnostic categories of the proposed Sydney system in pediatric nodal aspirates. Methods: This was a two-year retrospective study performed on pediatric LN-FNAs; the cytologic diagnoses were categorized in accordance with the Sydney system for LN cytopathology. Cytological diagnoses were correlated with the corresponding histopathological diagnoses to assess diagnostic accuracy and risk of malignancy for each diagnostic category. Results: Of a total of 23,335 FNAs during the study period, 6983 (30%) were performed on LNs. There were 109 pediatric LN-aspirates with subsequent histopathology available. Ancillary techniques including flow cytometric immunophenotyping and immunocytochemistry were performed in 30 (27.5%) cases. A total of 5 (4.6%) aspirates were reports as non-diagnostic/ inadequate (L1); 68 (62.4%) were reported as benign (L2); 5 (4.6%) as atypical cells of undetermined significance (L3), 6 (5.5%) as suspicious for malignancy (L4) and 25 (22.9%) as malignant (L5). On cyto-histopathologic correlation, 98 (89.9%) were concordant and 11 (10.1%) discordant. The risk of malignancy was 20% for non-diagnostic category, 7.3% for benign, 80% for atypical, 83.3% for suspicious and 100% for malignant category. Conclusion: FNAC has high diagnostic accuracy for the diagnosis of pediatric LN pathologies. Application of the proposed Sydney system can help in achieving uniformity, reproducibility, and risk-stratification in pediatric LN-cytology.


   OP-42: Comparison of Reporting of Lymph Node Fine Needle Aspiration Cytology Based on the Sydney System and the Conventional System Top


Sreoshi Paul, Nidhi Verma, Sarika Singh, Vikas Malhotra, Meeta Singh; Maulana Azad Medical College, New Delhi, India

Introduction: For enlarged lymph nodes (LN), FNAC is considered as a very inexpensive and rapid diagnostic procedure. Sydney system for LN-FNAC can help in bringing uniformity and easy reproducibility in the diagnoses. Thus it will help in risk stratification based on cytological diagnoses. Aims: To classify LN FNAC based on The Sydney system of reporting and compare it with conventional system to find out degree of agreement between the two systems. Materials and Methods: LN FNAC was performed in 400 patients followed by ancillary techniques which included special stains like AFB stain, Immunocytochemistry, cell block and flow cytometry. These techniques could be performed in 174/400 patients. Biopsy was considered gold standard for malignant and suspicious of malignancy cases. Discussion: All 400 cases were reported by conventional and by Sydney system. In the conventional system, 292 cases were benign (73%), 74 were malignant (18.5%), 5 were suspicious for malignancy (1.3%), 1 case atypical lymphoid cells (0.3%) and 28 (7%) were non diagnostic. In the Sydney system, 30/400 cases (7.5%) were Category I (Inadequate), 284/400 (71%) were Category II (Benign), 4/400 (1%) were Category III (ALUS/AUS), 4/400 (1%) were Category IV (Suspicious) and 78/400 (19.5%) were Category V (Malignant). The Risk of Malignancy in each category of Sydney System were 1.1% (catI), 1.6% (CatII), 50% (CatIII), 100% each for catIV and V. The degree of agreement between the two systems was excellent. The sensitivity of conventional and Sydney System were 89.74% and 97.40% respectively, thus supporting that Sydney System if brought into practice would help the clinicians in better risk stratification of the patients.


   OP-43: Diagnostic Relevance of Sydney System in Classification and Reporting Of Lymph Node Cytology Top


Mala, Asitava Deb Roy, Barnik Choudhury; 1 Mata Gujri Memorial Medical College and LSK Hospital, Kishangunj, Bihar, India, 2 Lab Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India

Objective: Fine-needle cytology (FNAC) is a useful ancillary tool to evaluate lymphadenopathy of unknown etiology. Nevertheless, owing to different factors it is not uniformly accepted mainly because of the lack of standardized guidelines. Recently, an expert panel published the proposal of the Sydney system for performing classification and reporting of lymph node cytopathology. We, therefore, planned the index study to evaluate the applicability of this system in a peripheral setup of Northern Bihar. Methods: A one-year retrospective study of lymph node FNAC was done in the Department of Pathology of a tertiary care teaching hospital of Northern Bihar. Cytological diagnoses of all lymph node aspirates were categorized as per the proposed Sydney System. Results: Three hundred cases of FNACs were selected during this study period. Of these 300 cases, n = 15 cases (5%) were categorized as L1-inadequate/non-diagnostic; n = 110 (36.7%) as benign (L2); n = 45 (15%) as atypical (L3); n = 35 (11.7%) as suspicious (L4), and n = 95 (31.6%) as malignant (L5). FNAC diagnoses were correlated with histopathology to assess the diagnostic accuracy. Statistical analysis showed high sensitivity and negative predictive value. Conclusion: The idea of this study was to emphasize the need for a standardized procedure for quality reporting and interpretation of lymph node aspirates. This system may lead to a greater acceptance and utilization of lymph node aspirations in peripheral set-ups where other ancillary investigations may not available all the time.


   OP-44: Application of the Sydney System for Reporting Lymph Node Cytology with Cytohistologic Correlation Top


Oshin Mehendiratta, Anurag Gupta, Namrata Awasthi, Pradyumn Singh, Nuzhat Husain; Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background: Fine-needle aspiration (FNA) cytology is one of the most commonly used techniques for evaluating lymphadenopathy in underdeveloped nations. However; due to lack of a standardized reporting system, there is no uniformity in the reporting of lymph node cytology which leads to difficulty in the interpretation and the management of such cases. Here, we present a study performed to evaluate application of recently proposed “the Sydney system for reporting lymph node cytology”. Materials and Methods: We analyzed 1420 FNA cases of lymph nodes retrospectively from June 2018 to December 2020 with histology follow-up in 268 (18.9%) cases. Of 1420 FNA cases, 152 were performed under ultrasound guidance. Lymph node FNAs were categorized as per the newly proposed Sydney system for reporting lymph node cytology. Cytohistologic correlation was done to assess diagnostic accuracy and risk of malignancy was calculated for each diagnostic category. Results: Overall, n = 147 cases (10.3%) were categorized as L1-inadequate/non-diagnostic; n = 818 (57.6%) as benign (L2); n = 09 (0.6%) as atypical (L3); n = 21 (1.5%) as suspicious (L4), and n = 425 (29.9%) as malignant (L5). Statistical analysis showed the following results: Sensitivity 99%, specificity 100%, positive predictive value 100%, negative predictive value 91.3%, and diagnostic accuracy 99.2%. The ROM was 25% for the category L1, 8.7% for L2, 75% for L3, and 100% for L4 and L5. Discussion and Conclusion: The study demonstrated high FNA diagnostic accuracy. Understanding the risks of malignancy associated with each diagnostic category of Sydney system will help to guide optimal patient management.


   OP-45: Use of Flow Cytometry in the Diagnosis of Lymphoprolifertive Disorder Top


Vandana, Anjali Sharma, Mukul Singh, Sunil Ranga; VMMC and Safdarjung Hospital, New Delhi, India

Background: Flowcytometric immunophenotyping on cytological samples obtained from suspected lymphoma cases can play an important role in confirming lymphoproliferative disorders and their further categorization. Aim: To diagnose lymphoproliferative disorders by flow cytometry on cytological samples (fine needle aspirates and body fluids). Materials and Methods: This observational study include five clinically and cytological suspected cases of lymphoproliferative disorders. The fine needle aspirates and body fluid samples were collected in 1 ml sheath fluid. Flow cytometry was performed using the lymphoma panel which includes anti lambda, anti kappa, CD19, CD23, CD10, CD5, CD20 and CD45 for confirmation and further categorization. Results: Flow cytometry antibody panel were analysed and it was observed that most of the cases of lymphoproliferative disorders were of Chronic Lymphocytic Lymphoma. Conclusion: In the current era of minimally invasive procedures, we saw that flow cytometry stands out as a valuable modality to accurately diagnose and categorize lymphoproliferative disorders on cytological samples.


   OP-46: Application of the Five Parameter System for Cytological Diagnosis of Metastatic Squamous Cell Carcinoma Top


T Rajini, K Amita; Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India

Introduction: Cervical lymph node metastasis of squamous cell carcinoma (SCC) pose diagnostic challenge at fine needle aspiration cytology (FNAC) in situations like cystic change and abscess formation. Many benign conditions like an infected keratinous cyst or squamous metaplasia mimic well differentiated SCC. Repeat aspirate or guided FNAC may demand time, cost and expertise. Recently, five parameter system focusing on cytoplasmic features was introduced in differentiating oral SCC with and without nuclear atypia. Present study aimed to determine the utility of five parameter system in diagnosing metastatic SCC showing secondary changes like cystic degeneration or abscess formation. Materials and Methods: FNAC of 70 cases of metastatic SCC (56 well differentiated and 14 poorly differentiated) to cervical lymph nodes with cystic change or abscess formation, with biopsy confirmation, were reviewed. 45 cases of inflamed non-neoplastic cyst were used as control. The five parameters system was assessed in all cases and compared among the three categories. Results: Concentric arrangement, large number of keratinous cells, kerato-globules and dyskeratotic cells were seen more frequently in well differentiated SCC (8.9%, 89.2%, 3.5%, 83.3%) as compared to that of poorly differentiated SCC (7.8%, 57.1%, 0%, 21.4%) respectively except for bizarre shaped cells which was more frequent in poorly differentiated SCC (62.5% versus 78.5%). None of the inflamed non-neoplastic cyst showed any of the five parameters. Conclusion: Application of five parameter system can serve as a powerful tool in diagnosis of metastatic deposits of well differentiated SCC in challenging situations like in the presence of cystic change and abscess formation.


   OP-47: Cytomorphological Analysis of HPV Positive and HPV Negative Metastatic Head and Neck Squamous Cell Carcinoma Using P16 Immunocytochemistry at a Tertiary Care Hospital Top


Vibhuti Mathur, Subrat Chandra, Anurag Gupta, Pradyumn Singh, Nidhi Anand, Nuzhat Husain; Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background: HPV positive and negative head and neck squamous cell carcinoma (HNSCC) are now considered as two separate entities. Major changes have been incorporated in the 8th edition of the American joint committee on cancer (AJCC) staging system for oropharyngeal squamous cell carcinoma staging, based on HPV status. Studies have advocated p16 as a reliable surrogate marker of HPV. We conducted a study to compare sociodemographic and cytomorphological features of HPV positive and negative metastatic HNSCC, by means of p16 immunocytochemistry. Methods: A prospective study was carried on 81 patients by using fine needle aspiration cytology with metastatic squamous cell carcinoma (SCC) in head and neck region. Cellblocks were prepared for p16 immunocytochemistry. Sociodemographic and cytomorphological analysis was done for p16 positive and negative cases. Results: Out of 81, only 8 (9.9%) cases were positive for p16. Mean age of presentation was 51.07 (SD 12.55) years, with male preponderance (92.5%). p16 negative cases were associated with older age of presentation (p=0.01), history of tobacco use (p=0.007) and irregular, non cystic appearance on radiology (p<0.001). No gender preponderance was noted between p16 positive and p16 negative cases. Significant cytomorphological (keratinizing versus non keratinizing) differences were noted between p16 negative and positive specimen (p=0.007). Conclusion: Although p16 is being advocated as a marker for Human Papilloma Virus, the prevalence of HPV associated head and neck carcinoma, among Indian population, is significantly low. Sociodemographic and cytomorphological differences exist between HPV positive and HPV negative HNSCC which can help to triage specimen for HPV testing.


   OP-48: Claudin-4 Immunocytochemistry is Highly Specific and Sensitive for the Diagnosis of Malignant Carcinomatous Effusions: Results of a Pilot Study Spanning 3 Months Top


Vanlalhruaii, Vindhya Prabha, Aruna Nambirajan, Sandeep Mathur, Venkat Iyer, Deepali Jain; All India Institute of Medical Sciences, New Delhi, India

Background: Although many immunocytochemistry (ICC) markers are available for the differentiation among reactive mesothelial effusions, mesotheliomas, and metastatic carcinomas, no single marker is 100% effective. Claudin-4 is a tight junction associated protein that is specifically expressed in epithelial cells and has been purported as a highly specific and sensitive marker for epithelial malignancies. Aims: To assess the utility of claudin 4 immunohistochemistry in diagnosis of malignant effusions. Methods: Study spanned 3 months (June – August 2022). Claudin-4 (3E2C1 clone, Invitrogen, 1:500 dilution) ICC was performed prospectively in effusion cell blocks (CB) where other ICC markers were being performed as part of reporting (cohort 1) and in cases reported as inconclusive for malignancy with or without ICC (cohort 2). Results: In cohort 1, 80 cell blocks were included comprising of metastatic ADCAs with primaries from ovary (n=14), lung (n=13), breast (n=12), gastrointestinal tract (n=8), unknown (n=4), squamous cell carcinomas (n=4), small cell lung carcinoma (n=4), lymphomas (n=2), melanomas (n=2), reactive effusions (n=15), and mesotheliomas (n=2). Claudin 4 was positive in 47/49 (96% sensitivity for ADCA) ADCAs with one case each of gall bladder and breast primary being negative while all squamous cell carcinomas were positive. Small cell carcinomas were negative. All reactive effusions, mesotheliomas, lymphomas, and melanomas were negative (100% specificity for carcinoma). In cohort 2, claudin-4 positivity upgraded the diagnosis to positive for epithelial malignancy in 13/24 cases. Conclusion: Claudin-4 as a single marker is highly sensitive and specific for epithelial malignancies and is a valuable addition to the ICC armamentarium.


   OP-49: Cytomorphological Study of Ascitic Fluid and its Correlation with Serum Ascitic Albumin Gradient in the Evaluation of Differential Diagnosis of Ascites Top


Sudeshna Chelleng, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Introduction: Ascites is the pathological accumulation of fluid other than blood in the peritoneal cavity.[1] The usual purpose of cytological investigation is to determine the presence or absence of tumour cells. Serum Ascitic Fluid Albumin Concentration Gradient (SAAG) has been reported to provide differentiation between portal hypertension related and non-related ascites.[2] Aim: (1) To study the Cytomorphology of ascitic fluid. (2) To study the correlation between cytomorphology of Ascitic Fluid with SAAG for evaluation of differential diagnosis of Ascites. Materials and Methods: A hospital-based cross-sectional study of ascitic fluid received in cytology section of department of Pathology for a duration of 1 year was conducted. Cytological examination and SAAG was calculated of the study samples. Results: Of the 127 patients included in the study, 38.5% were males and 61.4% were females. A spectrum of disease etiology was found according to the cytomorphological examination. The patients were divided in 2 groups according to SAAG value. In Group 1, there were 46 (36.2%) patients with SAAG<1.1 g/dl and in Group 2, there were 81 (63.7%) patients with SAAG>=1.1 g/dl. Group 1: In 31 (67.4%) of 46 patients, positive malignant cytology was present (p<0.0001). In 15 (32.6%) patients, benign cytology was seen. Group 2: 79 (97.5%) of 81 patients had benign cytology and 2 (2.5%) patients had malignant cytology. Conclusion: There was correlation between malignant cytology of ascites with SAAG<1.1 g/dl. Cirrhosis (45.5%) and Ovarian malignancy (48.4%) were found to be the most common causes of benign and malignant ascites respectively.


   OP-50: Flow Cytometry of Cerebrospinal Fluid: Big Value From Small Volumes Top


Sangamitra Rajasekaran, Manish Rohilla, Parikshaa Gupta, Reetu Kundu, Nalini Gupta, Pranab Dey, Radhika Srinivasan, Paramjeet Singh, Manish Modi, Vivek Lal; Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background and Aim: Distinction of cerebrospinal fluid (CSF) infiltration of by lymphoreticular malignancy from reactive lymphocytosis or pleocytosis on cytomorphology is often challenging. The utility of Flow Cytometry (FCM) in this setting is not well documented. Methods: Retrospective analysis of all adult cases (n=26) referred for CSF FCM were retrieved from the database and detailed evaluation of cytospin smears and FCM findings were performed. CSF FCM was performed using the lymphoproliferative disorder panel on BD FACSCanto. The initial cytomorphological impression was correlated to the FCM findings. Results: Of the 26 cases of CSF evaluated by FCM, 2 cases showed infiltration by B-acute lymphoblastic leukemia and Burkitt lymphoma respectively, both on morphology and FCM. One case with clinical suspicion of CNS infiltration by smouldering myeloma showed plasma cells admixed with mature and activated lymphocytes, monocytes, neutrophils; FCM showed lack of cytoplasmic light chain restriction in the plasma cells excluding infiltration. In the remaining 23 cases, 11 showed lymphocytic pleocytosis on cytospin smears and were confirmed as reactive by FCM. Out of 12 cases which showed atypical looking lymphoid cells on morphology, FCM was conclusive of reactive lymphocytosis in all but 1 case where a myeloproliferative disorder was not excluded. Overall, in the 22 cases with reactive lymphocytosis, FCM revealed T-cell predominance (54-97%) which was rich in CD4 cells. Conclusion: Flow cytometry on low volume precious sample like CSF can help distinguish infiltration by lymphoreticular malignancy from reactive lymphocytic infiltrates and is especially valuable when the cytomorphology is equivocal.


   OP-51: Malignant Pleural Effusion and Ascites as Initial Presentation in Hematologic Malignancy Top


S Sri Gayathri, K Krishnaratnam, Febe Renjitha Suman, G Bharathi, Sandhya Sundaram, Priyathersisni Nagarajan; Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Hematologic malignancy usually present as leucocytosis, pancytopenia, anemia, thrombocytopenia, lymphadenopathy or splenomegaly. We report a 20 yrs male patient with abdominal discomfort and found to have ascites and pleural effusion. Pleural fluid cytology and mesenteric tissue was sent for histopathology. Later during the course of stay in the hospital he had leukocytosis. He was in poor general condition and acute renal failure due to tumour lysis syndrome. Atypical Lymphoid cells were noted in the pleural fluid cytological examination. Mesenteric tissue and cell block from pleural fluid showed numerous degenerated cells. IHC in cell block revealed that the degenerated cells were positive for CD45 and MPO. 13 % Myeloid blasts were noted in the Pleural fluid Flowcytometry. Morphology of bone marrow showed 80% blasts. Flowcytometry of bone marrow showed acute myeloid leukemia with monocytic differentiation. Karyotyping revealed Inversion 16. Tumour lysis was managed with hemodialysis and Rasburicase. Sepsis due to gram negative infection with antibiotics. As the general condition of the patient was poor initial treatment for AML was two cycles of low intensity chemotherapy with Azacytidine. After the patient was stabilised, standard AML regime with Daunorubin and Cytosine was given. Three months after chemotherapy his counts were normal and the patient was in remission. Pleural effusion and Ascites caused by leukemic infiltration is an unusual extramedullary manifestation of AML. We report this case for its rare presentation and to emphasise the importance of Flowcytometry in the diagnosis of malignant effusion and intricacies in management of AML.


   OP-52: Medulloblastoma Intruding into Cerebrospinal Fluid: Case Series with Correlation to Histopathology And Outcome Top


Nithye Parvathy, Neha Bhardwaj, Manish Rohilla, Nalini Gupta, Pranab Dey, Kirti Gupta, Nandita Kakkar, Amita Trehan, Deepak Bansal, Ankur Jindal, Paramjit Singh, Sunil K Gupta, Radhika Srinivasan; Departments of Cytology and Gynecological Pathology

Introduction: Medulloblastoma is the most common pediatric malignant embryonal tumor of cerebellum. Approximately 30-35% patients present with leptomeningeal spread at time of diagnosis. Radiologically, medulloblastoma appear as an ill-defined mass protruding into the ventricle and in suspected cases of CSF metastasis lumbar puncture is performed. Materials and Methods: Retrospective 5-year audit (2017-2022) was performed for all cases of medulloblastoma on histopathology and with positive CSF cytology. The histomorphology and immunohistochemistry for YAP, GAP and beta-catenin were reviewed along with detailed evaluation of cytomorphological features (cellularity, cytomorphology, background) and correlated with outcome. Results: A total of 250 cases of medulloblastoma were evaluated involving the posterior fossa including the cerebellum, Vermis and 4th ventricl. CSF cytology was reported positive for infiltration in 3.2% (8/250) cases. The age range was between 2-24 years with male predominance (3:1). Cellularity was high, moderate and low in 3, 3, and 2 cases respectively. Clusters of malignant cells ranging from 20-500 cells were seen in all but 1 case with only dispersed cells admixed with inflammatory cells. The tumour cells showed high N/C ratio and prominent nuclear molding. Anaplasia or mitosis was not seen. Nucleoli was inconspicuous in 7 cases and was prominent eosinophilic in 1 case. Background was hemorrhagic in 6 cases. At follow up, 6 died within weeks of positive CSF cytology and 2 recently diagnosed patients are alive with disease, but with poor treatment response. Conclusion: CSF infiltration in medulloblastoma portends a poor prognosis. Cytomorphological features includes clustering, high N/C ratio and nuclear molding.


   OP-53: Morphological Challenges in the Analysis of Effusion Fluids by Liquid Based Cytology Top


Ayushi Agarwal, Priyanka Singh, Mukul Singh, Meetu Agrawal, Sunil Ranga; VMMC and Safdarjung Hospital, New Delhi, India

Introduction: The International system for reporting Serous fluid cytopathology (TIS) categorizes the fluid aspirates into five diagnostic categories – Non-Diagnostic (I), Negative for malignancy (II), Atypia of Undetermined significance [AUS] (III), Suspicious for malignancy (IV) and Malignant (V). The detection of malignant cells in effusion fluids is critical as it determines the stage of disease. Cytology of effusion fluids is an important diagnostic and minimally invasive tool when other diagnostic tests cannot be performed. In most of the laboratories, the effusion fluid samples are analyzed by the direct smear preparation and cytospin technique. Aim: To evaluate the morphology of effusion fluids by liquid based cytology and cytospin technique. Methods: Sixty effusion fluids samples were processed by both cytospin and LBC (SurePath) techniques and slides prepared by both the techniques were evaluated for cellular preservation, cellular details, architecture and background. Immunocytochemistry and flow cytometry was performed wherever needed. Fluid aspirates were categorized according to the TIS system. Results: The samples comprised of 24 pleural, 35 ascitic and 1 pericardial fluid. The fluid aspirates were categorized as per TIS: ND 9 (15%); NFM 36 (60%); AUS 3 (5%); SFM 5 (8%) and Malignant 7 (12%). Obscuring elements like RBCs, mucous, inflammatory cells etc. were reduced in LBC. The fair preservation and even dispersion of cells was an advantage in LBC smears. Cell shrinkage leading to artefactual high N/C ratio, nuclear hyperchromasia and cytoplasmic processes were found to be the major diagnostic challenges while assessing LBC smears. Conclusion: There are inherited cytomorphological alterations in LBC smears, therefore it should be used only as an adjunct to conventional smears for better interpretation.


   OP-54: Reproducibility of the Papanicolaou Society of Cytopathology System for Reporting Respiratory Cytology and Comparison with Modified System – A Study From Tertiary Care Cancer Hospital in South India Top


C Aparna Devi, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

Introduction: Papanicolaou Society of cytopathology (PSC) proposed a classification scheme consisting of six categories for reporting respiratory cytology samples. Risk of Malignancy (ROM) is poorly documented for these categories. Objectives: To reclassify all lung FNA, bronchial aspirates, and sputum samples according to the PSC system for reporting respiratory cytology and test its reproducibility and compare it with the modified system. Methods: This retrospective study included all lung FNA, bronchial aspirates and sputum samples received from January 2019 to December 2021. All these samples were classified into six categories according the original and modified PSC system for reporting respiratory cytology specimens. Modified PSC considers only the cytological findings irrespective of radiology when categorising non diagnostic and negative categories. Sensitivity, specificity, and ROM was calculated. Results: 430 lung FNA, 249 bronchial aspirates and 30 sputum samples were reviewed. Lung FNA, Bronchial aspirates, and sputum samples were categorised into non diagnostic (22.09 %/52.21%/83.33%), negative for malignancy (16.74%/23.29%/6.67%), atypical (6.74%/ 8.84%/ 10%), benign (0.23%/ 0%/ 0%), suspicious for malignancy (2.33%/ 4.42%/ 0%), and malignant (51.86%/ 11.24%/ 0%) categories according to original PSC system respectively. Sensitivity and specificity for bronchial aspirates and lung FNA were 29.11%/ 91.45% and 92.68%/ 98.77% respectively. Modified system showed significant increase in ROM in negative category- 73.19% for bronchial aspirates and 17.39% for Lung FNA as compared to original system – 22.50% for bronchial aspirates and 1.39% for lung FNA. Conclusion: Bronchial aspirates and lung FNA have higher specificity than sensitivity. The 'Benign' category was hardly encountered in our study.


   OP-55: Risk Stratification of Serous Effusions Based on the International System for Reporting Serous Fluid Cytopathology in a Tertiary Care Centre: A Retrospective Analysis Top


Priyanka Agarwala, Anjana Mittal, Anitha Seervi, Maneesh Vijaywargia, Arpita Mathur; Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India

Background: Fluid cytology is a widely accepted and important tool for initial diagnostic evaluation of serous cavity effusions. The international system for reporting serous fluid cytopathology (TISRSFC) forms uniform reporting terminologies for serous effusions. Aim: The present study is to evaluate the practical utility of TISRSFC by re-categorizing serous effusions and assessing the risk of malignancy (ROM) for each of the categories. Materials and Methods: All serous cavity effusion samples (pleural, peritoneal and pericardial) received in the Department of Pathology from July 2021 to June 2022 were retrospectively reviewed. The cases were re-categorized according to TISRSFC. Clinico-radiological and/or histopathological correlation was done. ROM was calculated for all the diagnostic categories. Results: In the present study, which included 1070 cases, 8.5% were non-diagnostic (ND), 85.3% cases were negative for malignancy (NFM), 1.49% were atypia of undetermined significance (AUS), 0.74% were suspicious for malignancy (SFM), 3.92% were malignant (MAL). Overall, the ROM for ND, NFM, AUS, SFM, MAL categories were 0%, 2.84%, 18.75%, 62.5% and 100% respectively. Conclusion: TISRSFC provides a uniform reporting platform with greater reproducibility thereby improving clinical decision making and treatment outcomes.


   OP-56: Role of Ancillary Techniques in Reporting Serous Fluid Cytology – “Redefining Categories, Refining Diagnosis” Top


Shilpa Kapoor, Trupti Patel, Kanwalpreet Kaur, Priti Trivedi; Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India

Background: Recently “International system of reporting serous fluid cytology (TIS)” was introduced which together with cytomorphology advocates use of ancillary techniques to resolve difficulties faced while reporting serous fluid cytology. Our aim is to emphasize on the role of ancillary techniques, in improving reporting of uncertain categories along with refining diagnosis in malignancies and its impact on clinical management. Materials and Methods: Prospective study from Jan to Dec 2021. Study includes pleural, ascitic and pericardial fluid samples, reported according to 'TIS'. Ancillary techniques including immunohistochemistry on cell blocks and flowcytometry were done in cases categorized as AUS, suspicious or malignant, provided that the material was adequate with preserved cell morphology. Malignant cases with available past history did not require further assessment. Results: 730 serous fluid effusion samples from 567 cases were evaluated including 323 pleural, 2 pericardial and 405 ascitic fluid samples. Ancillary studies were beneficial in 18% (4/22) AUS cases, 26% (11/42) suspicious cases and 33.8% (95/281) malignant cases. In AUS and suspicious category together, 13 cases were upgraded to malignant and 1 case in each of two categories was downgraded to benign. In malignant category ROM remained 100% but it helped refining tumor characteristics. Discussion/Conclusion: In AUS and suspicious category though diagnostic yield is increased but studies with larger number of cases are required to reach firmer results. In malignant category it serves well for theranostic purposes. Serous fluid is an easily obtainable sample that can provide opportunities for newer ancillary testing techniques with direct clinical implications.


   OP-57: A Case Series – An Attempt to Correlate Cytopathological Grading of Cutaneous Soft Tissue Sarcoma With Ki-67 Labelling Index Top


Tanmay Das Mahapatra, Vaswati Das, Kalyan Khan, Ranu Roy Biswas, Bidyut Krishna Goswami; Department of Pathology, North Bengal Medical College, Siliguri, West Bengal, India

Background: Cutaneous soft tissue neoplasms constitute a rare heterogenous group of superficial sarcomas; >50 different tumor entities and cytologically relatively undiscovered entirely. This category comprise <1% of all cutaneous neoplasm. Though FNAC of these tumors, a sensitive mode of diagnosis, Ki-67 labelling as an adjunct show high reproducibility in respect of conventional FNCLCC grading. Objectives: To compare between cytopathological grading of cutaneous soft tissue sarcoma (STS) with histopathological grading and an attempt to compare indirectly Ki-67 labelling to enhance preoperative multidisciplinary management protocol. Methods: A prospective study was done in NBMC&H for 18 months. 11 (STS) Out of total 35 cases of cutaneous malignant tumors were selected. A standardised cytolopathological grading followed by histopathological grading and manual Ki-67 labelling index (low vs. high-30%) was done. Results: Spindle cell sarcoma with high cytological grading was most frequently found entity (82.1%). Subsequent histopathological grading and Ki-67 labelling show discordance in 2 cases (18%) only. Conclusion: Though FNAC is a sensitive mode of early diagnosis of cutaneous soft tissue sarcomas when provided with cytological grading and indirectly well corroborated with Ki-67 labelling index which is further matched with final histopathological FNCLCC grade and hence we can go one step further to stratify preoperative multidisciplinary management.

By clinicians and pathologists. However This study aims to study the cytomorphological spectrum of GIST, creating awareness amongst cytopathologists regarding the management of same.


   OP-58: Setting Up Cytology Services in a Newly Developed Government Run Tertiary Care Institute in India: Trifles, Troubles, Tips and Tricks From a Novice Perspective Top


Shruti Gupta, Niraj Kumari, Pawan Kumar; AIIMS, Raebareli, Uttar Pradesh, India

Setting up a cytopathology laboratory in a newly developed government run tertiary care institute in India can be both rewarding and challenging. Any tertiary care medical institute cannot run efficiently without diligent diagnostic services. The branch cytology can cater to wide range of surgical and medical specialities and form the basis of diagnostic support and guide treatment. Cytopathology is relatively low cost and easy to start in hands of a skilled cytopathologist. However, for novice residents priming themselves to consultancy, its an arduous task to understand the process of procurement of adequate infrastructure, acquisition of consumables, reagents through the Gem portal, developing standard operating protocols, maintain good lab practices and offer precise diagnosis. We aim to review our experience and develop algorithmic approach to sensitize the uninitiated, right from laboratory design to development of standard operating protocols, acquisition of instruments catering to fulfil the present need and a futuristic approach.


   OP-59: A Retrospective Study of Usg And Ct-Guided Fine Needle Aspiration Cytology in a Tertiary Health Care Center Top


Santosh Jayant, Sudha Iyengar, Rajesh Gaur; Gajraraja Medical College, Gwalior, Madhya Pradesh, India

Background: Ultrasonography and computed tomography guided fine needle aspiration cytology has emerged as an important diagnostic tool for deep- seated and non-palpable lesions. It has high accuracy and efficacy. Aim: To study the spectrum of USG and CT- guided aspirations. Most common site aspirated, age & sex distribution was presented in our result. Materials and Methods: We did retrospective study of 248 guided aspirates received in the department of pathology, Gajraraja Medical College for a period of 1.4 years from January 2021 to April 2022. Cytological diagnosis was correlated with clinical and radiological data to arrive at a final diagnosis. Results: The most common organ aspirated was liver (47 cases). Adenocarcinoma (69 cases, 39.4%) was the most common malignancy diagnosed with maximum cases in Lungs (20, 11.42%). In breast lesions, fibroadenoma was more common as a benign lesion and ductal cell carcinoma as malignancy. In lymph nodes, granulomatous lymphadenitis and metastasis of squamous cell carcinoma were commonest inflammatory and malignant conditions respectively. In thyroid lesions, follicular neoplasm was common. CT guided aspiration from spine showed 9 cases of pott's spine and 5 cases of plasmacytoma. Some rare and deep seated pathologies like benign histiocytic tumor of breast, GIST, Chondroma of sacral region and neuroendocrine tumor of lung were also reported. Conclusion: Ultrasonography and computed tomography guided fine needle aspiration is effective in final diagnosis of various benign and malignant deep-seated lesions.


   OP-60: Accuracy of Intra-Operative Rapid Diagnosis by Squash Smear in CNS Lesions – An Early Institutional Experience Top


Amit Rajan, Military Hospital, Pathankot, Punjab, India

Introduction: Squash smear preparation is a fairly accurate, simple and reliable tool for rapid intra- operative diagnosis of central nervous system lesions. It is based on two essential factors: (1) Availability of very small tissue fragments & good preservation of fine cellular details. (2) Not effected by edema, hemorrhage, necrosis & calcification. Materials and Methods: It is a Prospective study included 118 patients from October 2012- October 2014. All patients operated for CNS mass lesions were included. Squash cytology was reported by pathologists. All were subjected for routine histopathological processing. Results: The most common age group affected was 21-30 yrs, while female being more affected than male. Out of 118 CNS lesions most common site involved was cerebral hemisphere 41.5%, and the least common involved was spinal cord 11.8%. On clinical diagnosis out of 118 CNS lesions most common were glioma 36.4%, while 5.1% were non specific diagnosis. Introperative squash smear cytology showed 30.5% glioma while the least were aspergillosis being 1.7%. Histopathological diagnosis showed 28.8% glioma while aspergillosis were 1.7%. The cytohistological correlation showed Glioma 66.6%, Meningioma 88.2%, Schwanoma 87.5%, Metastasis 90% while Tuberculosis and Aspergillosis showed a correlation of 100%. Conclusion: The cytohistological correlation of all 118 lesions diagnosed on cytology was 89.7%. The common reasons for no opinion on cytology were fibrosis, inflammation, calcification, necrosis and lack of definite cytologic criteria. The common causes for erroneous diagnosis on cytology were increased fibrous component, biopsy from cyst wall, increased and morphology obscuring inflammation and necrosis, lack of architecture on cytology, reactive changes, resistance to desegregation.


   OP-61: Crush Smear Cytology: An Expeditious Diagnostic Tool for Central Nervous System Tumors Top


Nazia Manzoor Walvir, Rumana Makhdoomi, Nayil Khursheed Malik; Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India

Background: Intraoperative crush cytology is an indispensable tool for diagnosing the lesions of the central nervous system (CNS). Despite the development of newer and advanced imaging techniques along with minimally invasive/ stereotactic neurosurgical techniques, direct evidence from a pathologist during the operation guides the neurosurgeon, thus giving distinguished benefit to the patients. Aims: We evaluated the crush cytology in 435 cases where neurosurgical intervention was performed. The aim of this study is to correlate intraoperative squash cytology and final histopathological diagnosis to find out efficacy and reliability of squash as a diagnostic tool. Materials and Methods: All the neurosurgical cases received for both intra-operative diagnosis and histopathology sample over the period of 3 years were included. Tissue sent was taken intraoperatively and was crushed between two slides. 4-5 smears prepared and stained by rapid H & E stain. The slides were then evaluated by two pathologists. The remaining sample was subjected to histopathological examination. The results were correlated with the histopathological diagnosis. Results: We evaluated a total of 435 cases of CNS lesions. The mean age was 44.98 years with 187 (42.99%) females and 248 (57.01%) males. Diagnostic accuracy of squash smear technique was 95.67% when compared with the histological diagnosis. Conclusion: We conclude that intraoperative crush cytology is a rapid and cost-effective routine diagnostic technique in differentiating CNS lesions. It can achieve targeting of the lesion and provide guidance to the neurosurgeon in modifying the surgical approach.


   OP-62: Cytomorphology of Skin Adnexal Tumours and its Correlation with Histopathology in a Tertiary Care Centre: A Case Series Top


Smriti Sharan, Juhi Shahab, Mukul Singh, Charanjeet Ahluwalia, Sunil Ranga; VMMC and Safdarjung Hospital, New Delhi, India

Background: FNAC can be successfully used for describing the cytomorphology of skin adnexal tumours and can help in identification of them as benign or malignant. However, histopathology remains the gold standard in confirmation of diagnosis. Skin adnexal tumours are a large and diverse group and are less commonly encountered in routine practice, hence knowledge of cytological features of these lesions is crucial so that they can be easily diagnosed with minimally invasive techniques. Aim: To study the cytomorphological features of skin adnexal tumours on FNAC smears and its correlation with histopathology. Materials and Methods: This is a retrospective study of FNAC of 60 cases of subcutaneous and dermal swellings over a period of 5 years from August 2017 to August 2022 in a tertiary care centre. Most cases were within the 2nd to 6th decade with male predominance. Results: The FNA smears were helpful in picking up the nature of skin adnexal tumours, as, in our case series malignant lesions were 8% and benign were 92%. On confirmation with histopathological correlation, it was found that these lesions hold true to their cytological categorization and no discrepancy in the reports were noted. Conclusion: Even though histopathology remains the gold standard for confirmation of diagnosis, in the current era of minimally invasive procedures FNAC stands out a valuable modality and can be a promising tool to diagnose skin adnexal tumours and to understand their cytomorphology, as the data on this is limited.


   OP-63: FNA Cytology and Histological Correlation in Malignant Bone and Soft Tissue Tumors: Diagnostic Merits and Pitfalls a Retrospective Review in a Tertiary Care Hospital Top


Pramod Kumar Pamu1, Aruna Prayaga2, Ashwani Tandon3; 1Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India, 2Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, 3AIIMS, Bhopal, Madhya Pradesh, India

Introduction: FNAC simple, valuable tool in diagnosis of malignant bone and soft tissue tumors, plays a role in patient early diagnosis and recurrence in patient management. Aims: To compare cytology and histology correlation malignant soft tissue, musculoskeletal neoplasms. To assess accuracy, sensitivity, specificity, positive and negative predictive value. Materials and Methods: Retrospectively reviewed 11 yrs. (2010-2021). FNA cytology correlated with cellblocks or surgical biopsies for histological diagnosis. Patient's clinical information and ancillary studies data collected. Wet-fixed, Air-dry smears stained with PAP, MGG, H&E and IHC stains used. Results: Total 441 cases malignant soft tissue and bone tumors reported, M:F is 1.8:1, age range (5-75) yrs, mean age 48.4 yrs. Commonly first two decades 40%. Among soft tissue lesions: spindle cell 48%, round cell 32% morphology predominates. Among 239 cases malignant bone tumors osteoid type (36%) followed by malignant round cells (35%). A comparative analysis done between the cytology report and histopathology diagnosis. Total 262 /441 (60%) had histopathological correlation. The diagnostic accuracy in bone lesions 98%and soft tissue sarcomas 94%. The sensitivity, specificity, PPV, NPV and diagnostic accuracy were 98%, 94.59%, 98.9%, 95.74% and 96.7% respectively. Metastatic lesions detected with 100% accuracy. Conclusion: Increased experience and routine auxiliary methods make cytopathology promising in assessment of musculoskeletal and soft tissue tumors. However, limitations like morphologic heterogeneity and sampling yield can affect interpretation of histological typing and grading. FNA adds information to the clinician to make decision regarding appropriate therapy.


   OP-64: Intraoperative Squash Smear in Central Nervous System Lesions and its Correlation with Histopathology Top


Vijayalaxmi Patil, Surekha B Hippargi

Background: Space occupying lesions (SOLs) of central nervous system (CNS) constitute important cause of neurological morbidity and mortality. Intraoperative squash smear cytology is a simple and reliable technique for rapid intraoperative diagnosis of neurosurgical specimens. It has shown to play an important role especially in the diagnosis of CNS tumors and also helps the surgeon to plan the extent of surgery. The study was designed to assess the accuracy of intraoperative squash smear in the diagnosis of central nervous system (CNS) space-occupying lesions. Materials and Methods: Thirty one cases of CNS space-occupying lesions were studied retrospectively over a period of 3 years. Smears were prepared from the biopsy sample obtained at the time of operation and were stained with rapid hematoxylin and eosin method. Intra-operative squash cytology diagnosis was performed and was correlated with histopathology diagnosis as gold standard. Results: Twenty five cases showed complete correlation with histopathology, four cases showed partial correlation, and two cases were discrepant. The diagnostic accuracy was 84 % by complete concordance and increased to 93.5% on applying partial concordance criteria. Conclusion: Intraoperative squash smear thus provides diagnosis with fair accuracy in brain lesions especially brain tumors and is of great value in intraoperative consultation.


   OP-65: Role of Cytology in Categorization of Primary Skin Tumors Top


Shabnam Singh, Shyam Lata Jain, Nidhi Verma, Meeta Singh, Bijaylaxmi Sahoo; Maulana Azad Medical College and Associated LNH, New Delhi, India

Introduction: The skin & adnexal tumors often pose diagnostic challenge to cytopathologists owing to their wide spectrum and overlapping morphological features. Aims and Objectives: To assess the role of cytology in categorization of Primary Skin Tumors and to correlate the cytological diagnosis with the histopathology. Materials and Methods: It was a prospective study over 1.5 years. All cases presenting with skin nodules; clinically and/or cytologically suspected of primary S&ATs were included with exclusion of metastatic and non-neoplastic lesions after subsequent histopathological confirmation. Cytological diagnosis was correlated with final histopathological diagnosis. Results: Out of a total 69 enrolled cases, 33 cases with confirmed histopathology were included and analysed. On comparison with histology, FNAC was correctly able to differentiate between benign and malignant cases with 100% sensitivity and 82.1% specificity. Further categorization of primary diagnosis was possible in 17/33 cases (complete concordance). In 7/33 cases, subtyping could not be done (partial concordance) and 9/33 cases were discordant. Conclusion: FNAC is a minimally invasive and patient friendly OPD procedure. Malignant skin tumors can be detected on FNAC with high sensitivity. Relevant clinical details assist significantly in forming the final diagnosis.



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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.359849

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