Background: Diagnosis of lung cancer can be made in two ways: histopathological and cytopathological. Cytological methods in the diagnosis of lung lesions are generally thought to be one of the most successful tactics. Aims: This study aimed at comparing the efficiency of selected cytological techniques in lung lesions by correlating them with histopathological diagnosis. In addition, we had answered the question whether any of the cytological methods can replace histopathology. Materials and Methods: The study group consisted of 633 patients and 1085 cytological specimens. Cytology samples included: induced sputum, bronchial washing (BW), bronchial brushing (BB), fine needle aspiration (FNA), and cell block (CB). In every case of CB immunocytochemistry (ICC) was performed. For each cytological method sensitivity, specificity, effectiveness, positive predictive value, and negative predictive value were assessed. Results: BW and BB showed the lowest diagnostic parameters. The most valuable diagnostic procedure was CB based on FNA. Close by CB, FNA had the highest diagnostic rate. However, possibility to evaluate tumor cell structure and apply the ICC, give CB an advantage over FNA. Using only morphologic criteria, we had subclassified nonsmall-cell lung cancer (NSCLC) into squamous cell carcinoma (SCC) and adenocarcinoma (AC) as 60.04% of SCC and 32.52% of AC. The use of CB and ICC decreased the NSCLC diagnoses from 22.1% to 2.8% while the percentage of AC and SCC diagnoses increased from 4.11% to 12.64% and from 6.64% to 11.06%, respectively. Metastatic lung tumors were diagnosed based on both the cell morphology and according to the ICC results. Conclusion: Despite the limitations of the cytological procedures, we recommend using CB and ICC to evaluate cytological samples derived from FNA. It can in many cases replace a conventional histopathology.

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Background and Aims: Fine Needle aspiration cytology has emerged as an essential pre-biopsy investigation to rule out or confirm malignancy in superficial as well as deep seated lesions. Radiological assistance has proved to be a blessing for obtaining adequate samples. With unwavering leading position of lung cancer in terms of incidence and mortality, it has become necessary to study the trends of our population and assess the usefulness of techniques aiding in early diagnosis. The objective is to obtain prevalence of lung cancer and utility of various methods in obtaining cytological material for assessment in intrathoracic lesions. Material and Methods: We conducted an observational analytic study at a tertiary care teaching hospital over a period of 3.5 years including a total of 307 patients with suspected lung malignancy. Samples were collected using image guided techniques including Fibre-optic bronchoscopy (FOB), Ultra-sonography (USG) and Computed tomography (CT). The smears were processed as per standard institutional protocol and were evaluated by a senior pathologist. Results: Squamous cell carcinoma was the most frequent type of Primary lung malignancy, followed by adenocarcinoma. The malignancies were more common in males and in age group of 61 to 70 years. Conclusion: Respiratory cytology remains the initial mode of investigation in intra-thoracic malignancies. The high sensitivity, low-cost and rapidity of the results works its advantages for both the patient and the clinician. High cellular yield obtained with the use of trans-bronchial needle aspiration and bronchial brushing rationalizes their use as a screening test to establish both malignant as well as non-malignant diagnoses. Further improvement in utilization of the available modalities and addition of ancillary testing can reduce the need of invasive procedures.

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Background and Aims: Advent of personalised treatment needs correct diagnosis of lung adenocarcinoma with its molecular subtyping. Minimal use of special stain or immunohistochemistry (IHC) in small specimens save material for molecular testing. Various histologic patterns in adenocarcinoma (ADC) subtypes have different prognostic implications and current recommendation is to describe these patterns in small specimens. Aim of this study was to diagnose adenocarcinoma from cytology specimens depending on adenocarcinoma pattern on fine needle aspiration smears and cell blocks. We also studied the additional role of cell blocks as a platform for special stain and IHC. Materials and Methods: Conventional smears and cell block (CB) preparation were examined from transthoracic CT guided FNA samples of suspicious lung malignancy cases. Clear defining architectural pattern and cytomorphological features in favour of adenocarcinoma were evaluated and mucin stain and IHC were used as and when required. Results: A total of 86 cases were included in this study, of which 83 cases were diagnosed as adenocarcinoma, 52 (62.5%) showed clear cut evidence of adenocarcinoma from smears and CBs. CB morphology alone aided the diagnosis in 12. Various ADC patterns in combination or alone were appreciated in these 64 cases. Sixteen needed mucin stain and 3 needed IHC for diagnosis. Forty one were ADC with solid pattern of which 39 showed high nuclear grade. Conclusion: Adequately cellular FNA smears and corresponding cell blocks of optimal quality can aid effectively in diagnosing adenocarcinoma and appreciating its pattern. Therefore, it would minimize the need for special stain and/or IHC with preservation of more material for molecular testing.

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Context: Many contaminants are routinely encountered in cytopathology practice. However, because of lack of familiarity and experience with them, many are unnoticed, neglected, or confused with other structures of major relevance. Aims: The purpose of this study was to intentionally introduce contaminants into the smears and to provide distinctive morphological criteria required for the microscopist to identify them confidently to avoid possible confusion. Settings and Design: Prospective cross-sectional study. Methods and Material: This study included smears prepared from the buccal mucosa of healthy volunteers. Common contaminants were deliberately introduced into the smears, fixed using 90% ethanol, and stained with Hematoxylin and Eosin stain (H and E) and Papanicolaou stain (PAP). The study also included smears from leftover cerebrospinal fluid (CSF) and wet mount preparations. The morphology of these contaminants was studied and the results were tabulated. Statistical Analysis Used: Nil. Results: The vivid morphological appearance of these commonly encountered contaminants were described and many of these mimicked structures of major relevance. Conclusions: Contaminants and mimickers can make the evaluation of cytologic specimens challenging and may necessitate secondary review by another pathologist or further workup. Knowledge and familiarity of these commonly encountered extraneous substances will help to prevent misinterpretation.

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Aims and Objectives: The aim of this work was to study the application of Modified Millipore technique (MMT) as a liquid-based tool to have multiple monolayer cellular smears for the routine cytology and Immunocytochemistry. Materials and Methods: In this study, we included 32 effusion fluid samples and 30 fine-needle aspiration cytology (FNAC) samples. From each of the samples, at first routine conventional smear was prepared. The residual samples were processed by MMT to make multiple smear preparation. Both the conventional and MMT of the monolayer cells were evaluated. The various cytomorphological features including the cellularity, background information, nuclear morphology, and cytoplasmic preservation were compared in these two techniques. Result: There were a total of 15 cases of fluid samples and 27 cases of FNAC. Statistical analysis of Mann–Whitney U test showed that the monolayer preparation by MMT and liquid-based cytology of fluid and FNAC smears are of same quality (P > 0.01). Conclusion: Monolayer preparation by MMT is cheap and effective. This technique can be used in routine laboratory for multiple monolayer cell preparations.

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Context: Intraoperative pathological assessment provides valuable information in a patient's diagnosis and management. Touch imprint/crush cytology is simple, rapid, and cost-effective. Also, imprint smears give excellent cytomorphology. Aims: To assess the utility and feasibility of intraoperative cytology technique as a rapid and reliable method for diagnosis and to compare sensitivity, specificity and diagnostic accuracy with histopathology. Materials and Methods: Cytology smears were collected intraoperatively from 52 cases of suspected/proven malignancy. From tumors, surgical margins, lymph nodes; crush, imprint, and scrape smears were prepared. Smears were taken from specimens before formalin fixation and stained with rapid ultrafast Papanicolaou stain. The slides were compared with the histopathology report which is the gold standard. Statistical Analysis: Sensitivity, specificity, and diagnostic accuracy were used for statistical analysis. Results: Intraoperative cytology report could be given in time for the surgeon to modify margins of resection and the extent of lymph node dissection. It helps the surgeon to modify surgery. The diagnostic test evaluation showed satisfactory results. Conclusion: Intraoperative imprint/crush cytology is a simple, inexpensive, rapid, accurate cytodiagnostic technique in the diagnosis of cancer where frozen section facilities are not available. It can also be used to assess the clearance of surgical margins.

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