Journal of Cytology
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   Table of Contents - Current issue
July-September 2022
Volume 39 | Issue 3
Page Nos. 91-136

Online since Thursday, August 18, 2022

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Correlation between fine-needle aspiration cytology, cell block cytology, and histopathology in the diagnosis of thyroid lesions p. 91
Mohit Jambhulkar, Jasvinder K Bhatia, Samresh K Singh
Context: Fine-needle aspiration cytology is considered the gold standard screening test in the evaluation of a thyroid nodule. We studied whether cell block cytology can be used in addition to conventional smears for the evaluation of tissue from fine-needle aspirations or fluid aspirations and also compared it with histopathological diagnosis. Aims: The primary aim of this study was to know the utility of cell blocks in the diagnosis of thyroid lesions. Settings and Design: This was a prospective observational study conducted from June 2018 to September 2020 at a tertiary Care Hospital in Eastern India. Ethical approval was obtained from the Ethics Committee of the institution. Patients above 18 years who presented with goiter were included in the study. Thirty patients were enrolled in the study after informed consent. Methods and Material: Smears prepared from the aspirates were stained with Leishman-Giemsa (LG) and Pap stain. The remnant from the needle hub was transferred to a sterile container. Cell blocks were prepared from the remnants. Smears were scored based on cell obscuration by blood, cellularity, cell degeneration, and cell architecture. The results were compared with histopathology. Statistical Analysis Used: Data were recorded using Microsoft Excel. Descriptive statistics, frequency, and proportion were used to describe demographic variables. Results: The majority of the patients (23.3%) were in their third decade of life, followed by 16.7% of the patients in their fourth and fifth decades. The patient age ranged from 25 to 80 years, with a mean age of 50.83 years and a standard deviation of 16.72. The largest number of patients were females accounting for 80% (24/30) of the total participants. The majority of the patients (36.7%) (11/30) had thyroid gland enlargement for a period of 15 days to three months. 14% of the participants were not able to recall its duration. The majority (60%) (18/30) had left lobe lesions, followed by 33.3% (10/30) who had right lobe lesions, and 6.7% (2/30) who had bilateral lobe swelling. The mean size of the lesion was 2.84 cm. 50% were found to be Bethesda II lesions, while 13.3% were Bethesda IV, and 36.7% were found to be Bethesda VI lesions. The cell block score (7) was found to be better compared to Fine Needle Aspiration Cytology (FNAC) (4.7). Tissue Coagulum Clot and Clot Scrape methods were found to yield better results compared to the Cytocentrifuge method. The P value was found to be significant (<0.001). Conclusions: Cell blocks were found to improve the cell morphology compared to FNAC alone and can be used as an adjunct to FNAC in the diagnosis of various thyroid lesions.
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Reclassification of salivary gland aspirates based on “The Milan system for reporting salivary gland cytology”: A five-year retrospective study p. 98
Saloni Pahwa, Poonam Panjwani, V Gnanapriya
Introduction: The Milan System for reporting salivary gland cytopathology helps standardize reporting systems across institutions, improve communication between clinicians and pathologists and guide the clinical management of patients. Aims: This study was undertaken to evaluate the utility of the Milan system classification in cytology reporting. Settings and Design: The present study is a retrospective study conducted over a period of five years in tertiary care centre. Methods and Materials: All the cases of salivary gland aspirates were reviewed and reclassified into six diagnostic categories according to the Milan system of reporting salivary gland cytology (MSRSGC). Cytological diagnosis was correlated with the histopathological diagnosis wherever available. Results: A total of 258 cases were classified using the Milan system as non-diagnostic (20.9%), non-neoplastic (26.3%), atypia of undetermined significance (4.7%), neoplasm benign (37.5%), neoplasm of uncertain malignant potential (3.5%), suspicious for malignancy (0.4%), and malignancy (6.6%). Cytohistological discordance was noted among 8/76 cases (10.5%). The sensitivity and specificity of FNAC were 75% and 98.5%, respectively. The risk of malignancy was 14.2% for Category I, 9% for II, 50% for III, zero for IVA and IVB, and 83.3% for category VI. Conclusions: The new classification system helps pathologists to standardize reporting leading to better clinical and surgical management.
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Cytological diagnosis of malignant mesothelioma: A case series p. 105
Sakshi Dahiya, Meeta Singh, Shyama Jain, Bembem Khuraijam, Naman Suroya, Shramana Mandal
Background: Mesotheliomas are neoplasms of the serosal lining of the body cavities. Diagnosis requires a multimodal approach of clinical findings, cytology, and histopathology with immunohistochemistry (IHC). The published sensitivity of cytology for diagnosing mesothelioma ranges from 30% to 75%. Aim and Objectives: This study aimed to calculate the incidence of malignant mesothelioma (MM) at our institute and to study the cytological features of MM. Materials and Methods: A retrospective study of pleural, peritoneal, and pericardial fluids submitted at our institute was done. The duration of the study was 8 years (2011–2019). Apart from examining Giemsa smears, a panel of immunocytochemical (ICC) and cell block immunohistochemical (IHC) markers was applied to achieve the diagnosis. These included calretinin, mesothelin, CK5/6, Hector Battifora mesothelial cell antibody (HBME), WT1, MOC31, CK7 and CK20. Histopathological correlation was done wherever possible. Result: In the present study, we compiled four cases of MM over 8 years diagnosed on serous effusion cytology and confirmed by immunocytochemistry (ICC)/cell block immunohistochemistry (IHC)/biopsy. This indicates a rare incidence of MM. The Cytological features of MM were studied. Conclusion: The diagnosis of MM is difficult, especially cytologically. It was found to be a rare entity in the malignant cases diagnosed on effusion cytology.
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Diagnostic accuracy and agreement between inter- and intra-observers in the absence of clinical history for liquid-based preparation of gynecology specimens p. 110
Nur Amirah Roslan, Mohd Nazri Abu, Farid Ridhuan Ismail
Context: The clinical history in cytology is the best source of information to ensure the accuracy of diagnosis, facilitating a slide observer to interpret and relate their findings in screening gynecology slides. Aims: This study aims to evaluate the performance of slide observers to screen-blinded gynecology slides without providing any information on clinical history. Setting and Design: A correlational study design was conducted at the cytology laboratory, Universiti Teknologi MARA Selangor, Puncak Alam Campus. Methods and Materials: Fity-seven liquid-based preparation slides from gynecology specimens were screened blindly by five slide observers among Medical Laboratory Technology students who completed the enrollment of the cytology course. Statistical Analysis Used: The inter- and intra-observer reliability testing was measured using the kappa value of Fleiss' and Cohen's kappa value, respectively, while the diagnostic accuracy without a clinical history was determined by the receiver operating characteristic (ROC) curve. Results: The value of Fleiss' kappa (κ) was 0.221—this represents a fair strength of agreement between inter-observers. An intra-observer reliability test for each slide observer was analyzed using Cohen's kappa statistic and revealed that the kappa value varied between 0.116 and 0.696, indicating slight-to-substantial agreement between intra-observers. Additionally, the sensitivity value of 94.28%, specificity value of 72.40%, a positive predictive value (PPV) of 37.28%, a negative predictive value (NPV) of 72.40%, a likelihood ratio of 14.43, and the diagnostic accuracy of 75.09% were recorded. Conclusions: In conclusion, the students (slide observers) from the Centre of Medical Laboratory Technology Studies who took part in this study were able to interpret, classify, and diagnose the LBP gynecologic cytopathological cases into several categories (NILM and ECA) based on the 2001 Bethesda System reporting guideline.
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Critical analysis of laboratory requisition forms received in a cytopathology laboratory of a tertiary care centre: An audit and review of literature p. 116
Shivali Sehgal, Sujata Jetley, Zeeba S Jairajpuri, Sabina Khan
Background: A laboratory requisition form (LRF) is the main communication link between the laboratories and the clinicians. In a cytopathology laboratory, incomplete forms with inadequate information significantly impact the quality of the results and waste precious time of the lab. Aims: The aim of this study was to audit the LRFs for adequacy of demographic and clinical data and to analyze the reasons for the same. Settings and Design: A retrospective study was conducted in the cytopathology laboratory of a tertiary care center. Materials and Methods: All the original LRFs received for Pap smears and FNACs of 1-month duration were retrieved. The forms were scrutinized for the presence of specific parameters which were classified as patient information, clinician information and clinical information. In addition to the completeness of the form, clarity of the data was also noted. Statistical Analysis: The data were entered on excel worksheets and percentage of Pap smear and FNAC forms lacking information of various parameters was calculated. Results: A total of 431 LRFs were received in the month of January 2020. These included 274 Pap smear LRFs and 157 FNAC LRFs. Patient information was mentioned in predominantly all the forms, however, clinician and clinical information, which is indispensible for reporting, was missing in a significant proportion of the Pap smear and fine needle aspiration cytology (FNAC) forms. Conclusions: Receiving inadequately filled LRFs has been an age-old problem in all medical laboratories. Audit of inadequacy of LRFs helped in assessing the prevailing practices in the hospital and gave an insight into the quality of information available to the cytologists for reporting. Many clinicians withhold information out of ignorance about its importance or due to lack of time to fill up the details on the LRF. Also, filling out a LRF is a task usually delegated to the junior doctor in the OPD and the significance of filling the LRF correctly and comprehensively is often not emphasized upon adequately by the senior clinicians. This audit helped us taking preventive action by giving feedback to the clinicians and emphasizing to them the importance of clinical data on the LRF and in improvising the LRF using a more objective and user-friendly format.
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The Indian academy of cytologists guidelines for reporting serous effusion (IACGRSE): An interobserver agreement analysis p. 121
Vaishali B Nagose, Meharbano M Kamal, Surbhi S Kathuria, Shraddha A Laddhad
Context: The Indian Academy of Cytologists published Guidelines and categories for Reporting Serous Effusions (IACGRSE) in 2020 to improve consistency and reproducibility of fluid cytology reporting and to guide patient management. Aims: To evaluate category-wise agreement while using IACGRSE 2020 categories. To analyze interobserver agreement among participants with different level of training and years of experience. Settings and Design: A retrospective interobserver variability study. Methods and Material: Study was done with four participants: an expert cytopathologist and three cytopathology fellows with varying experience. Fluid smears from 60 cases with clinical and/or radiological evidence of malignancy were categorized into one of the five IACGRSE 2020 categories. The interpretations of expert cytopathologist were taken as standard. Statistical Analysis Used: Interobserver agreement was analyzed using Kappa statistics. Results: Previous cases without definitive category got classified into “Atypical cells NOS” (3.33%) and “Atypical cells, Suspicious of Malignancy” (15%). Agreement analysis for IACGRSE 2020 categories showed better concordance for inadequate (I), malignant (V), and benign (II) categories. The range of Kappa for interobserver agreement of fellows was fair to substantial (range 0.1692–0.7249). The participant with substantial diagnostic agreement with expert (κ = 0.729, 88.3%) had the most experience. Causes of major discordance were pertaining to paucity and distribution of cells, and to misinterpretation of reactive mesothelial cells. Conclusions: IACGRSE 2020 categories and participants' experience were important determinants in classifying the effusion fluid cytology smears and interobserver agreement; emphasizing the need to use IACGRSE2020, and sufficient time and training required for accurate diagnosis of fluid specimens.
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CSF involvement by nonhematolymphoid malignancies: A descriptive study with emphasis on cytomorphological clues p. 126
Vidhya Vikashini Balasubramaniam, Saranya Mohan, Suganya Kuppovi Reddy, Jinkala Sree Rekha, Debasis Gochhait, Neelaiah Siddaraju
Introduction: Detection of malignant cells in cerebrospinal fluid (CSF) samples in suspected cases of malignancy is critical for the management of patients. CSF involvement by nonhaematolymphoid malignancies is less common. We aimed to study the cytomorphologic characteristics of various nonhaematolymphoid malignancies in CSF. Methods: A retrospective cytomorphological analysis of 27 CSF cytology smears reported as positive or suspicious for nonhematolymphoid malignancies from January 2010 to April 2020 over 10 years was carried out. Smears in all cases were prepared by cytospin technique and stained with May-Grunwald-Giemsa (MGG) and papanicolaou (Pap) staining procedures. Cell immunohistochemistry/immunocytochemistry was done wherever cell block/extra slides were available. Results: Twenty-four of 27 cases were interpreted as “positive,” while three were reported as “suspicious” of malignancy. Nineteen of 27 cases were metastatic adenocarcinomas including three suspicious malignancy cases with the primary sites of origin being the breast (10), stomach (2), rectum (1), gall bladder (1), lung (1), and four cases of unknown primary. Of the remaining positive cases, there were five cases of metastatic medulloblastoma, two cases of metastatic pineoblastomas, and one case of metastatic extraskeletal Ewings sarcoma. Each of these metastatic malignancies had at least a single diagnostic cytomorphological clue, similar to those observed in other body cavities and primary malignancy sites. Conclusion: Nonhematolymphoid malignancies are readily diagnosable on CSF cytology, most of them are metastatic. Identification of malignant cells in CSF is critical, as it has therapeutic and prognostic implications.
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FNA unravelling the mystery behind the cheek mass to pivot to a diagnosis of a primary extracranial-extraspinal-meningioma with intracranial component p. 131
Megha Murali, Ashitha Nanaiah, CP Arpitha, V Srinivas, Usha Kini
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Diagnosis of lung adenocarcinoma with clear cell features in pleural effusion: Cytomorphologic features, immunocytochemical studies, and differential diagnosis p. 134
Senay Erdogan-Durmus, Ozden Yulek, Zeynep Betul Erdem
Clear cell adenocarcinoma (CCA) of the lungs is no longer referred to as a subtype in recent classifications of lung adenocarcinoma. Like signet ring features, clear cell features are regarded as cytological features rather than histological subtypes. Additionally, in serous fluids, adenocarcinoma metastasis with clear cell features is a diagnostic challenging entity due to other tumors that come to mind first during the differential diagnosis. Here we report a case, diagnosed as CCA of lung metastasis in pleural fluid and evaluated its differential diagnosis.
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