Journal of Cytology
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   2018| October-December  | Volume 35 | Issue 4  
    Online since October 19, 2018

 
 
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ORIGINAL ARTICLES
Diagnostic value of S100P, IMP3, Maspin, and pVHL in the differantial diagnosis of pancreatic ductal adenocarcinoma and normal/chronic pancreatitis in fine needle aspiration biopsy
Aysegul Aksoy-Altinboga, Tolga Baglan, Haldun Umudum, Koray Ceyhan
October-December 2018, 35(4):247-251
DOI:10.4103/JOC.JOC_18_17  PMID:30498299
Introduction: Differentiation between pancreatic ductal adenocarcinoma (PDAC) from benign mimickers is a well-known problem in cytological materials. Recent studies incorporated biological markers into this question and some studies showed that expression of S100P, IMP3, and maspin as well as nonexpression of von Hippel-Lindau gene product (pVHL) were significantly correlated with PDAC. In this study, we aimed to investigate diagnostic value of maspin, IMP3, S100P, and pVHL immunostaining in fine needle aspiration biopsies (FNABs) of pancreatic lesions. Materials and Method: In all, 33 cases of FNAB cell blocks of PDAC and 34 cases of surgical non-neoplastic pancreas specimens which were retrieved from the archives slides from 2007 to 2011 were included in this study. All the cases were stained with maspin, IMP3, S100P, and pVHL. Expression patterns of markers were scored and compared with benign mimickers. Test performance of each antibody and possible antibody combinations were also evaluated. Results: The study was composed of 33 PDAC and 34 control cases (8 chronic pancreatitis, 3 mucinous cystic neoplasm, and 23 nontumoral pancreatic tissue of PDAC). Diagnostic sensitivity for malignancy in S100P, IMP3, and maspin was 84.8%, 81.8%, and 87.5%, respectively. Specificity of these three markers was 100%. Sensitivity and specificity of pVHL for detecting nontumoral pancreatic tissue were 100% and 81.8%, respectively. When maspin, IMP3, and S100P expression were used together as triple test, sensitivity was 62.5% and specificity 100%. However, when any two of each three markers were evaluated (triple test/dual response), sensitivity reached 93.8% and specificity 100%. Conclusion: We observed that dual response in triple test (positive staining with two of these three markers) of maspin, IMP3, and S100P immunocytochemistry is very sensitive and specific in differential diagnosis of PDA and non-neoplastic pancreatic lesions. pVHL may have an additional role, when triple assessment is not satisfactory.
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Evaluation of estrogen and progesterone receptors and Her-2 expression with grading in the fine-needle aspirates of patients with breast carcinoma
Pampa Ch Toi, Siddaraju Neelaiah, Kadambari Dharanipragada, Kumar Surendra
October-December 2018, 35(4):223-228
DOI:10.4103/JOC.JOC_127_17  PMID:30498294
Background: There has been a limited literature with regards to comparison between the pre-operative hormonal/Her-2 neu assessment by immunostaining on fine-needle aspiration (FNA) versus core needle biopsies (CNBs) and their correlation with grading of breast carcinoma. Materials and Methods: Two hundred fifty FNAs and 201 CNBs from 252 patients with breast carcinoma were subjected immunocytochemical/histochemical (ICC/IHC) staining along with the grading by the Robinson cytologic and modified Scarff-Bloom-Richardson scoring systems, respectively. Depending on the material adequacy, IHC was also performed on cell blocks. Sensitivity, specificity, and predictive values of ICC were calculated. The kappa statistics was performed to see the power of the study. Cytologic versus histologic gradings were compared and analysed by percentage analysis. Results: Sensitivity of ICC on FNAs for ER, PR, and Her-2neu was 49%, 28.8%, and 46%, respectively, while specificity was 84.5%, 90.6%, and 86.6%, respectively, with a fair agreement on kappa statistics. Her-2neu positivity on CNB versus FNA had a moderate agreement. Her-2neu staining of 3+ was seen in most of the Grade-2 tumours on FNA. Conclusions: Fairly reliable results on grading and hormonal/Her-2neu status are possible when ICC is performed on qualitatively superior FNA material. This is particularly useful in the management of patients in certain settings like inoperable cases.
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Role of rapid on-site evaluation in CT-guided fine needle aspiration cytology of lung nodules
KR Anila, Nileena Nayak, M Venugopal, K Jayasree
October-December 2018, 35(4):229-232
DOI:10.4103/JOC.JOC_134_17  PMID:30498295
Objective: To prospectively investigate the value of rapid on-site evaluation (ROSE) in transthoracic fine needle aspiration cytology (FNAC) of patients with pulmonary nodules. Computed tomography (CT)-guided FNA is commonly employed for the diagnosis of lung lesions and the most common reason for not being able to provide a diagnosis in FNA is inadequacy of samples. Materials and Methods: This was a prospective study conducted in the departments of pathology and radiology of our cancer centre. This study had approval from the institutional review board and ethical committee of our institute. Fifty consecutive cases undergoing CT-guided transthoracic FNAC in our centre were included in the study. The smear submitted for ROSE was stained using toluidine blue stain. The specimen adequacy and diagnosis in ROSE was compared with that of the final cytology report, and the concordance regarding adequacy and diagnosis were noted. Results: Smears were adequate in 34 cases (68%) and inadequate in 16 cases (32%) Out of the 16 inadequate cases, 5 (31%) were converted to adequate due to the application of ROSE, thus increasing the adequate number of cases to 39 (78%). A diagnosis of malignancy was made in all 39 adequate cases. Sensitivity of ROSE in determining adequacy was 92% and specificity was 100%. The most common malignancy was adenocarcinoma in 26 cases. Pnemothorax occurred in 2 cases. No significant complications occurred in other cases. Conclusion: CT-guided FNA with ROSE is a safe and useful tool in the diagnostic work-up of lung cancer patients. A multidisciplinary approach along with onsite evaluation of adequacy will increase the diagnostic utility of cytology in lung lesions.
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Micronuclei as a predictor for oral carcinogenesis
Kamini Kiran, Padmanidhi Agarwal, Shailesh Kumar, Kanav Jain
October-December 2018, 35(4):233-236
DOI:10.4103/JOC.JOC_141_17  PMID:30498296
Objectives: The aim of the study was to provide a quantitative evaluation of oral mucosal micronuclei (MN) frequency as a biomarker for oral cancer susceptibility in carcinogenesis progression. Methods: 60 patients were included in the study. 30 patients with biopsy proven epithelial dysplasia (ED, 15) and oral squamous cell carcinoma (OSCC, 15) comprised the study group and 30 patients with normal buccal mucosa, reporting for minor surgical procedures formed the controls. After informed consent, exfoliated cells were collected from the affected site using a premoistened wooden spatula and spread on precleaned slides, fixed, stained using modified rapid Papanicolaou method and subjected to microscopic examination. MN were identified and scored according to Tolbert et al. criteria. Results: Maximum patients with ED and OSCC were males and in age groups of 20–40 and 40–60 years, respectively. The most common site was the buccal mucosa. The maximum of MN count/500 cells in OSCC group was 11.93, 4.0 in ED and 1.46 in controls, with the mean and mean MN index ± SD distribution in the three groups showing high statistical significance (P = 0.000). A significant difference between mild and moderate ED and between moderately and well-differentiated OSCC was also observed. Conclusion: MN assays can help in early detection of premalignant and malignant lesions, thereby improving survival and reducing morbidity associated with treatment. MN index is thus a feasible and economical method for screening high-risk populations of oral cancer, to be able to timely identify genomic damage in order to prevent the cancer epidemic.
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Immunocytochemistry using liquid-based cytology: A tool in hormone receptor analysis of breast cancer
Kalpalata Tripathy, Aparajita Mishra, Ajit K Singh, Pragnya L Panda, Arup Mahapatra, Anusaya Lenka
October-December 2018, 35(4):260-264
DOI:10.4103/JOC.JOC_23_18  PMID:30498302
Context: Efficacy of immunocytochemistry (ICC) in determining molecular biomarkers like estrogen receptor (ER), progesterone receptors (PRs), and human epidermal growth factor receptor-2 (HER2). Aims: To evaluate biomarkers using ICC in breast cancer as per American Society of Clinical Oncology/College of American Pathology (ASCO/CAP) guidelines. Settings and Design: The study was conducted over a period of 2 years from September 2012 to August 2014 and is the first such study in eastern India. Materials and Methods: Fine needle aspiration cytology (FNAC) was done for suspected cases of breast cancers and slides were prepared using ThinPrep (TP) technology of liquid-based cytology (LBC) for ICC and corresponding biopsy specimens were processed as formalin fixed paraffin embedded (FFPE) sections for comparison. Both the LBC slides and tissue sections were subjected to immunostaining for ER, PR, and HER2. ICC was evaluated by Allred Scoring and IHC by Quick Scoring. Statistical Analysis Used: Statistical analysis done by Wilconxon Signed rank test on the SPSS program, Chicago, Illinois, USA. The results of ICC and IHC were compared by evaluation of sensitivity, specificity, kappa-value (k-value), positive predictive value (PPV), and negative predictive value (NPV). Results: The comparison of ICC with immunohistochemistry (IHC), ER, and PR showed very good correspondence rate, sensitivity, specificity, NPV, PPV, and agreement with k-value; whereas for HER2 the results were only good. Conclusion: ICC using LBC can be a useful tool in assessing biomarkers in advanced cases of breast cancer where surgery is not possible or cases where ASCO/CAP guidelines for management are not followed.
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LETTER TO EDITOR
Development of a cost-effective method for cell block preparation: A simple way of tumor representation
Anup K Boler, Abhishek Bandyopadhyay, Arghya Bandyopadhyay, Shreosee Roy
October-December 2018, 35(4):265-266
DOI:10.4103/JOC.JOC_8_18  PMID:30498303
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ORIGINAL ARTICLES
Prevalence of human papilloma virus types in Turkish and Albanian women
Veysel Sabri Hancer, Murat Buyukdogan, Ilta Bylykbashi, Burcu Oksuz, Muradiye Acar
October-December 2018, 35(4):252-254
DOI:10.4103/JOC.JOC_162_17  PMID:30498300
Background: Human papilloma virus (HPV) infection is the major etiologic agent of cervical carcinoma. The aim of this study was to determine the prevalence of HPV infection and genotype distribution in cervical swabs from 2,234 Turkish and 357 Albanian women with similar lifestyles from two different countries. Materials and Methods: HPV detection and typing were performed by type specific multiplex fluorescent PCR and fragments were directly genotyped by high resolution fluorescence capillary electrophoresis. Results: The most common type was HPV 16 and the second one was HPV 6 for both country. The third common type was 39 and 18 for Turkish and Albanian women, respectively. Conclusions: When we compare our results with other studies, there are differences between the frequency and order of the HPV genotypes detected at the second and subsequent frequencies. This may due to differences in the quality and type of samples analyzed, as well as the HPV detection methods.
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Neoplastic meningitis: A study from a Tertiary Care Hospital from coastal India
Pooja K Suresh, Jyoti Ramanath Kini, Sridevi H Basavaiah, Hema Kini, Urmila N Khadilkar, Shrijeet Chakraborti
October-December 2018, 35(4):255-259
DOI:10.4103/JOC.JOC_167_17  PMID:30498301
Introduction: Neoplastic involvement of cerebrospinal fluid (CSF) secondary to known or unknown primaries elsewhere is a poor prognostic factor and is equivalent to stage IV disease. Aim: The aim of the study is to analyse the cytological features of neoplastic meningitis in a tertiary care center. Materials and Methods: A retrospective study of 400 consecutive CSF samples was done in the cytology laboratory of our hospital. The fluid obtained by spinal tap was sent for microbiological, biochemical and cytological evaluation. Smears that showed the presence of malignant cells were included in this study. Results: Out of 400 cases, 36 (9%) showed neoplastic meningitis. Of which, 13 cases (36%) revealed leukemic infiltration, 2 (6%) lymphomatous infiltration and 21 (58%) carcinomatous meningitis. The leukemia cases included seven cases of acute lymphoblastic leukemia and six cases of acute myeloid leukemia. Among the carcinomatous meningitis cases, eight were metastasis from carcinoma breast, six from lung carcinoma and one each from malignancies of gallbladder, stomach and retinoblastoma. Four cases were metastatic adenocarcinoma from unknown primary. Pleocytosis was a significant finding seen in 58% cases (n = 21). Elevated protein and hypoglychorrhachia was noted in 68% cases (n = 18). Conclusion: A combined diagnostic approach including biochemical, microbiological and pathological evaluation was useful in eliminating infectious meningitis and confirming neoplastic meningitis in these cases. Cytology should be performed on cerebrospinal specimens from all patients with known or suspected malignancy with meningismus. Detection of malignant cells on cytological examination of CSF is the diagnostic gold standard for neoplastic meningitis.
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Utility of FNAC in dermatological manifestations of metastatic cancer with the review of the literature
Barkha Gupta, Varuna Mallya, Shyama Jain, PN Agarwal
October-December 2018, 35(4):237-241
DOI:10.4103/JOC.JOC_158_17  PMID:30498297
Objectives: Cutaneous metastasis (CM) though rare, indicates a terminal event in any malignancy and has a grave outcome. The present study reiterates the role of fine needle aspiration cytology (FNAC) in the diagnosis of metastatic cutaneous nodules. Materials and Methods: From 2015 to 2017, the department received 22,000 cases for FNAC. Among these cases, aspirations from the skin and subcutaneous region were performed on 6,083 cases. After excluding primary tumors of skin/subcutis, 25 cases on cytology were suggestive of metastasis. Clinicoradiological and histopathological profiles in these cases were reviewed. Results: Among these 25 patients, the male to female ratio was 1:1.09 (F, 12; M, 13) in the age group of 18–72 years. Most common primary malignancy in females was of breast and in males was gall bladder. The most common manifestation was a palpable skin nodule, with the abdominal wall being the predominant site. The most common diagnosis, on cytology, was metastatic adenocarcinoma. Conclusion: FNAC is a minimally invasive method, which aides in prompt detection and appropriate management of cases presenting with skin nodules and clinically unsuspected of malignancy. Whereas in known primary tumor, it indicates dismal prognosis by diagnosing CM; in cases with unknown primaries, cytomorphology in conjunction with clinicoradiological findings often gives a clue to the possible primary site.
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Use of sialic acid as a complementary method in the cytological diagnosis: Preliminary study
Adriana E Rocher, Anabela A. G. Angeleri, Fernando Guerra, Luis A Palaoro
October-December 2018, 35(4):242-246
DOI:10.4103/JOC.JOC_161_17  PMID:30498298
Introduction: Cellular morphology does not allow, in many cases, to safely establish a diagnosis of malignancy or benignity. Sialic acid is found in the membranes of well-differentiated mature cells, normally located in the alpha-2,3 position. During tumor progression, changes occur in glycosylation of proteins and lipids, including alterations in the sialylation patterns of tumor cells. Objective: To confirm the overexpression of alpha-2,6 sialinization in exfoliated cells of body fluids and bronchoalveolar lavage (BAL) as a malignant indicator mechanism, using glycan-binding lectins. Materials and Methods: Thirty samples (20 effusion liquids and 10 BAL) diagnosed by Giemsa and Papanicolaou staining as negative and positive for malignancy, were studied. They were then stained with fluorescein-labeled Sambucus nigra lectin (Sigma Chemicals, USA), which specifically recognizes sialic acid in alpha-2,6 position. The fluorescence obtained at 515 nm evidenced the presence of sialic acid in the 2,6 position. Results: Negative body fluids for malignancy showed a fine and homogeneous fluorescence pattern for reactive mesothelial cells. Neoplastic cells revealed a thick, heterogeneous pattern. In BAL, benign hyperplastic cells showed a homogeneous fine pattern while neoplastic cells showed a thick and heterogeneous fluorescence pattern. The pattern described was observed in all cases in the cell membrane. Conclusion: It was observed that the change in sialic acid conformation detected through Sambucus nigra Lectin could be used as a complementary method for the diagnosis of malignancy in different cytological samples.
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Cytomorphological study of medullary carcinoma of breast in comparison to infiltrating ductal carcinoma
Sajjan M Netra, BR Vani, V Srinivasa Murthy
October-December 2018, 35(4):195-198
DOI:10.4103/JOC.JOC_160_17  PMID:30498288
Introduction: Medullary breast carcinoma (MBC) is one of the rare variants of breast carcinoma, accounting for less than 5% of invasive breast carcinoma. MBCs relatively appear a decade earlier when compared to invasive ductal carcinoma (IDC NOS), which is more prevalent in the elderly age. Subjects and Methods: A retrospective study was conducted in the Department of Pathology from 2009 to 2016. Fine needle aspiration cytology slides of MBCs and IDCs were retrieved, studied microscopically, and reviewed to compare the cytological features. Results: During the study period, MBC cases were 12 and IDC were 319. Random 12 cases of IDC NOS were taken up for comparative cytological evaluation. Various cytological features are assessed and compared using chi square test and independent t test ratio. On comparison of IDC NOS and MBC cases in relation to the parameters like: syncytial clusters and nature of inflammatory infiltrate; the number of positive category was higher in MBC group (83.3%). In contrast, parameters like three-dimensional clusters, acinar pattern, and necrosis; the number of positive category was higher in IDC NOS group with a percentage of 91.7%, 100%, and 67%, respectively. Ratio of lymphoplasmacytic cells to tumor cells between the two showed that the ratio was higher in MBC group. This comparison was statistically significant with a P value of <0.001. Conclusion: Though few variants of breast carcinoma contain lymphoplasmacytic infiltrate, the intensity and pattern of distribution of these lymphocytes and plasma cells in relation to tumor cells helps in distinguishing MBC from other breast carcinomas commonly IDC NOS on cytology. Also MBCs have a better prognosis when compared to IDC NOS.
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Rehydration of air-dried smears with normal saline: An alternative for conventional wet fixation method in cervical cytological study
Sachin Shivaji Kapse, Surekha U Arakeri, Divya P Yerranguntla
October-December 2018, 35(4):199-203
DOI:10.4103/JOC.JOC_186_17  PMID:30498289
Context: Papanicolaou (Pap) smear is an effective exfoliative cytological investigation done for early recognition of cervical cancer. It also plays role in diagnosis of inflammatory lesions of cervix. Aims: The aim of this study is (1) to compare the cytomorphological features in conventional Pap smear (C-PAPS) and rehydrated air-dried Pap smear (RADPS) and (2) to evaluate the efficacy of RADPS in cytodiagnosis of cervical lesion by comparing with cytomorphological features of conventional wet-fixed Pap smear. Subjects and Methods: Paired cervical smears were prepared for 247 patients. One was labeled as C-PAPS and another was labeled as RADPS. Comparison of both smears was done for various cytomorphological parameters. Results: Out of 247 smears, 2.4% RADPS and 7.3% C-PAPS were reported as unsatisfactory. Red blood cell (RBC) background was present in 2% of RADPS and 42% of C-PAPS. Cytolysis and air-drying artifact were observed more in C-PAPS amounting to 2% and 4% in RADPS and 11% and 15% in C-PAPS. Cytoplasmic staining (97% RADPS vs. 94% C-PAPS) was superior in RADPS. Cell border, nuclear border, and chromatin of squamous and endocervical cells were better appreciated on RADPS compared to C-PAPS, and also statistically significant difference was observed. Conclusion: Rehydrated air-dried technique can be satisfactory alternative for conventional wet fixation method which can be followed routinely or in conjugation with C-PAPS, especially in cervical screening programs.
  - 10,387 377
Cyto-histopathological correlation of skin adnexal tumors: A short series
Amita Arora, Annu Nanda, Sangeeta Lamba
October-December 2018, 35(4):204-207
DOI:10.4103/JOC.JOC_63_17  PMID:30498290
Background: Skin adnexal neoplasms are relatively rare and thus uncommonly encountered in routine pathology practice. Aims: The present study was conducted with the aim to diagnose various skin adnexal tumors on fine-needle aspiration cytology (FNAC) followed by confirmation on histopathology and immunohistochemistry of the excised tumor. Materials and Methods: A total of 11 cases of superficial nodular swellings of the skin were studied over a period of 2 years from 2015 to 2016. FNAC of the swelling was performed and slides were stained with Giemsa stain. Following FNAC, the swelling was excised and subjected to histopathological examination. Immunohistochemistry was performed in some cases for confirmation. Results: It was observed that overall incidence of adnexal tumors (ATs) encountered on FNAC was very low. Typing of ATs on cytology was possible in 82% cases (9/11 cases) with diagnostic accuracy of 88% (8/9 cases). Most common tumor encountered in the study was nodular hidradenoma followed by pilomatrixoma, trichoepithelioma, cylindroma, chondroid syringoma, and trichilemmal cyst. Majority of the cases were benign except one case, which subsequently turned malignant. Conclusion: FNAC is a simple, safe, and cost-effective tool in diagnosing skin ATs. Cytological diagnosis of these lesions is depends on clinical correlation and cytomorphological features. FNAC in lesions suspected to be malignant can guide the surgeon regarding extent of excision.
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Cytomorphological differences between liquid-based cytology and conventional smears in fine-needle aspirates of thyroid lesions
Shuchita Sharma, Shilpi Agarwal, Manjula Jain, Gautam Bir Singh, Manoj Andley
October-December 2018, 35(4):208-211
DOI:10.4103/JOC.JOC_150_17  PMID:30498291
Background: Liquid-based cytology (LBC) is becoming an independent processing modality for cytology specimens. Decreased obscuration, single-slide examination, lesser screening time, and potential application of ancillary techniques are the various advantages it offers. Aim: To study and compare the cytological features of fine-needle aspirates from thyroid swellings on LBC with conventional smears (CS). Materials and Methods: Fine-needle aspiration was performed on 150 patients with thyroid nodule. The aspirate was first used to prepare a minimum of two CS and the remaining aspirate was used to prepare one SurePath smear. The final diagnosis was given according to the Bethesda system for reporting thyroid cytopathology (2007). Cytomorphological parameters were semi-quantitatively scored. Pearson's Chi-square test was used and P value was calculated. A P value <0.05 was considered significant. Cytohistological correlation was done wherever possible. Results: LBC showed higher nondiagnostic rate than CS. Significant cytomorphological differences on LBC included: (i) higher frequency of single, naked nuclei; (ii) lesser nuclear and cytoplasmic details; (iii) decreased colloid which appeared differently (as napkin fold and dense droplet); (iv) increased cyst macrophages; and (v) decreased obscuration by blood. Conclusion: LBC can supplement CS but cannot replace it.
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Cytopathology of pulmonary lesions: A tertiary care center experience
Supriya Ghildiyal, Seema Acharya, Brijesh Thakur, Jagdish Rawat, Rajnish Kumar
October-December 2018, 35(4):212-216
DOI:10.4103/JOC.JOC_51_18  PMID:30498292
Background: Cytological evaluation of specimens from respiratory tract is the initial investigation in patients suspected to have pulmonary diseases. The various cytological specimens submitted for analysis include bronchoalveolar lavage, bronchial wash, brush smears, transbronchial needle aspiration, guided fine needle aspiration cytology (FNAC) smears and pleural fluid. Present study was undertaken to study the spectrum of lesions diagnosed by cytomorphological analysis of various cytological specimens. Materials and Methods: Centrifuged and direct smears from received samples were stained with MGG and PAP stain. Special stains (ZN and PAS) were used wherever required. Cytohistological correlation was done wherever biopsy was available. Results: This study included 671 samples from 583 patients suspected clinicoradiologically of having a respiratory pathology. A male preponderance (65.87%) was noted with 73.59% of patients in age group 40–80 years. Cytological diagnoses were classified as non-diagnostic (14.90%), negative for malignancy (59.76%), specific benign lesions (5.22%), positive for atypical cells (3.87%) and malignant (16.25%). Tuberculosis (TB) was found in 17 cases. Adenocarcinoma (both primary and metastatic) was the commonest malignancy of the 99 cases positive for malignancy. Incidence of primary lung adenocarcinoma and squamous cell carcinoma were found to be equal. Conclusion: Lung carcinoma is presently the leading cause of cancer deaths while TB is still a common cause of death in developing countries. Cytopathology has a definite role in diagnosis of malignant lesions and also contributes in diagnosis of unsuspected chronic infections. Cytological diagnosis is fairly accurate if the specimen obtained is adequate and representative.
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Cytological scoring of breast lesions and comparison with histopathological findings
Betty Abraham, TR Sarojini
October-December 2018, 35(4):217-222
DOI:10.4103/JOC.JOC_84_17  PMID:30498293
Context: Cytological assessment using various morphological parameters helps segregate breast lesions in fine-needle aspiration cytology (FNAC) into different categories. The prognosis and the line of management of each category differ accordingly. Aims: This study aims at assessing the validity of Modified Masood's Scoring Index (MMSI) by the evaluation of cytomorphological features of various breast lesions compared with histopathological findings. Settings and Design: This is a cross-sectional study done in 65 female patients with palpable or nonpalpable breast lesions, undergoing FNAC and biopsy over a period of 18 months from December 1, 2012, to May 31, 2014. Materials and Methods: MMSI categorizes breast lesions, based on six cytological parameters into different categories such as nonproliferative breast disease (NPBD), proliferative breast disease (PBD) without atypia, PBD with atypia, and malignancy. The findings are compared with gold standard histopathological diagnosis. Statistical Analysis Used: Percentage of agreement, Kappa statistics, and Chi-square test. Results: Of the total 65 cases, all cases in MMSI category I and IV showed good histopathological correlation. The agreement between MMSI and histopathology was 93.8% which is more when compared with 72.3% agreement between cytology without scoring and histopathology. MMSI has increased the diagnostic accuracy of FNAC to 93.8% from 80%. Conclusion: The scoring system is easily reproducible, simple, and reliable. MMSI proved good histopathological correlation in category I and IV. This scoring technique has clearly demarcated those cases requiring surgical management. It is applicable for palpable and nonpalpable cases.
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