Journal of Cytology
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   2021| July-September  | Volume 38 | Issue 3  
    Online since August 27, 2021

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Fine-Needle Aspiration Diagnosis of Lymphoma Based on Cytomorphology Alone: How Accurate is it? - A Cyto-Histopathology Correlative Study
Sumit Garg, Manish Rohilla, Radhika Srinivasan, Amanjit Bal, Ashim Das, Pranab Dey, Nalini Gupta, Parikshaa Gupta, Arvind Rajwanshi
July-September 2021, 38(3):164-170
Context: Fine-needle aspiration cytology (FNAC) is a rapid and accurate first-line diagnostic modality in lymphadenopathy. Aims: To determine the utility of FNAC for the diagnosis of lymphoma and highlight the various pitfalls in morphological interpretation. Settings and Design: This was a retrospective study of 3 years duration in which cytology diagnosis was compared with the follow-up histopathology diagnosis wherever available. Results: A cytodiagnosis of lymphoma was made in a total of 868 cases (2.8%) out of nearly 33,000 FNAC performed during the study period; 556 (64.1%) cases were diagnosed as non-Hodgkin lymphoma (NHL), 198 (22.8%) as Hodgkin lymphoma (HL), and in 114 (13.1%) cases, a cytological diagnosis of lymphoma without further categorization was given. Histopathological reports were available in 348 cases, with an overall concordance rate of 93.1% (324), which was slightly higher in the HL cases (95.8%) as compared to NHL (91.7%). Twenty-four cases (6.9%) showed discordant cytological diagnosis with subsequent histopathology. The main reasons for the erroneous diagnosis were the over-interpretation of the germinal center cells as atypical lymphoid cells, over-interpretation of immunoblasts with prominent nucleoli as Hodgkin cells, and sheets of monomorphic lymphoid cells interpreted as low-grade lymphoma. Conclusion: Cytomorphology alone can make a correct basic diagnosis of lymphoma with a high degree of accuracy. The errors in interpretation can be further reduced by careful attention to the diagnostic pitfalls and common differential diagnoses.
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Role of Endobronchial ultrasound guided transbronchial needle aspiration with cellblocks in diagnosis and subtyping of intrathoracic lesions: Two year experience from a tertiary care center
Vikrant Verma, Ajmal Khan, Ram Nawal Rao, Alok Nath, Zia Hashim
July-September 2021, 38(3):120-126
Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) allows precise real-time sampling of intrathoracic lesions and is a minimally invasive, safe, and cost effective technique with high diagnostic yield. The aim of the current study is to evaluate utility of EBUS-TBNA cytology with cellblocks (CBs) in the diagnosis and subtyping of the intrathoracic lesions. Materials and Methods: It was a prospective study conducted from October 2015 to October 2017. We received 233 cases of intrathoracic lesions for EBUS-TBNA, of which CB was made in 217 cases. A flexible endobronchial ultrasound scope was used to sample the lesions. Results: There were 89 females and 128 males amongst the total 217 patients (age range: 14–85 years, mean age: 48.35 years). The smears from EBUS-TBNA contained adequate material in 137/144 [95.1%] non-neoplastic cases and 34/36 [94.4%] of the neoplastic cases, whereas the CBs provided adequate material in 94/144 [65.3%] non-neoplastic cases and 37/40 [92.5%] neoplastic cases. The CB helped subtyping the malignancy in 19 cases and of these immunohistochemistry (IHC) was done on the CB in 15 cases. The biopsy was non-diagnostic in 17/36 cases of granulomatous pathology and 4/18 neoplastic cases diagnosed with EBUS-TBNA.3. Conclusions: EBUS-TBNA provides rapid diagnosis through cytology and the material recovered in the same setting for the CB preparation can be used for immunohistochemical analysis and it may at times provide the diagnosis in cases where the smears are non-diagnostic.
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Doing more with less: Fine needle aspiration cytology in pediatric neoplasms
Priya Dharmalingam, Malathi MukundaPai, Ashwini Nargund, G Champaka, BL Kavitha, Geeta V Patil Okaly, SD Madhu, AR Arun Kumar
July-September 2021, 38(3):127-132
Background: Cancer is one of the leading causes of death in the pediatric age group following infections. Among the diagnostic modalities, fine needle aspiration cytology (FNAC) is increasingly recognized as it permits rapid diagnosis with low cost and complication. In this study, we emphasize the diagnostic value of FNAC and describe the cytomorphological spectrum of tumors diagnosed on FNAC in pediatric patients with or without the aid of ancillary tests. Materials and Methods: This retrospective study included a total of 614 patients under the age of 15 years for whom fine needle aspiration (FNA) was done during a period of 3 years with or without guidance. The cytology smears were reviewed, and the morphological spectrum was analyzed with the ancillary studies. Results: Aspirates from children constituted around 3.5% of the total FNAC performed in our Institute. Of the 614 cases, 336 were male, and 278 were female with age under 15 years. Neoplastic cases constituted around 72%, which included benign (2%) and malignant (98%) tumors. The spectrum include hematolymphoid neoplasms in 39.3%, small round cell tumors (SRCT) in 24.9%, Wilms tumor in 9.2%, germ cell tumors in 4.8%, spindle cell neoplasms in 4.8%, hepatoblastoma in 3.2%, and osteosarcoma in 3% of the cases. The metastatic lesions constituted 8.1% of the cases diagnosed by FNA. Conclusion: FNA proves to be a reliable and efficien modality in diagnosing pediatric neoplasms in the hands of a skilled cytopathologist.
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Categorization of breast fine needle aspirates using the international academy of cytology yokohama system along with assessment of risk of malignancy and diagnostic accuracy in a tertiary care centre
Sana Ahuja, Avneesh Malviya
July-September 2021, 38(3):158-163
Context: The International Academy of Cytology Yokohama System has developed a standardized system of reporting breast cytology by classifying them into five categories – insufficient, benign, atypical, suspicious, and malignant. Numerous studies conducted at different centers are required to confirm the risk of malignancy of the different categories. Aims: The main objectives of our study were to classify breast fine needle aspirates according to the IAC Yokohama system and assess the risk of malignancy, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Settings and Design: It was a retrospective study done over a period of 2 years from January 2018 to December 2020. Materials and Methods: All breast FNAs done in the above period were retrieved and classified into five categories according to the Yokohama system. Histopathological diagnosis was also retrieved wherever available. Statistical Analysis Used: Using a histopathological diagnosis as the gold standard, sensitivity, specificity, PPV, NPV, and diagnostic accuracy were calculated. For each of the five categories, the risk of malignancy was also assessed. Results: Out of the 554 breast fine needle aspirates, 242 had histopathological correlation. The risk of malignancy for insufficient, benign, atypical, suspicious, and malignant categories were 5%, 1.5%, 17.4%, 81.8%, and 100%, respectively. Maximum sensitivity (97.2%) was achieved when atypical, suspicious, and malignant cases were considered as positive test results. The highest specificity (100%) was observed when only malignant cases were considered as positive test results, whereas maximum diagnostic accuracy (96.4%) was noted when the malignant and suspicious category was included in positive test results. Conclusion: The IAC Yokohama system is an excellent system for accurately diagnosing breast fine needle aspirates with greater reproducibility of reports and better communication between the pathologist and clinician.
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Cytological diagnosis of ocular metastasis of squamous cell carcinoma cervix
Deepak Vedant, Vijay Kaushal, Anchana Gulati
July-September 2021, 38(3):171-173
Ocular metastasis is considered a rare phenomenon. Metastatic spread of tumors in the eyeball is usually discovered only when it affects the visual acuity. In women, breast tumors are to known metastasize in and around the eyeball. Cervical carcinomas are rarely known to metastasize in the eyeball. We present here a rare case of ocular metastasis, diagnosed on fine-needle aspiration cytology, in a known case of squamous cell carcinoma of the cervix.
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Diagnostic efficacy of brafv600e immunocytochemistry in thyroid aspirates in bethesda category iv and papillary thyroid carcinoma
Nidhi Anand, Tushar Agrawal, Anurag Gupta, Saumya Shukla, Roma Pradhan, Nuzhat Husain
July-September 2021, 38(3):113-119
Background: In papillary thyroid carcinoma (PTC), BRAFV600E is a common mutation and is associated with aggressive clinical behaviour. Immunocytochemistry (ICC) and molecular testing are recommended in the Bethesda System for Reporting Thyroid Cytopathology 2017 (TBSRTC) category III, IV and V. Aims: The current study aimed to evaluate the diagnostic efficacy of conventional FNAC versus FNAC with BRAFV600E immunostaining in cases of TBSRTC category IV, cases of suspicious for PTC and cases of PTC. Methods and Material: The study included a prospective case series of 45 patients with clinically palpable thyroid nodules with TBSRTC category IV, category V (suspicious for PTC) and PTC. The corresponding histology specimens of all the 45 cases were also analyzed. Immunostaining for BRAFV600E was performed on FNAC cell blocks and their corresponding histology sections using anti-BRAF (VE1) clone (Ventana). The diagnostic efficacy of the BRAFV600E immunostaining was compared on cytological specimens with histological specimens Results: BRAFV600E immunostaining helped to improve the sensitivity of the cytology to confirm the PTC as a diagnostic aid for thyroid FNAs. Cytology alone had a sensitivity of 62.96% and a lower specificity of 60.70%. The combination of both the tests together provided 84.62% sensitivity and much higher specificity of 100%. PPV was also increased to 100% and NPV was raised 94.12%. Conclusions: The performance of BRAFV600E immunostaining on the cytological specimen is a rapid, simple and cost-effective test and could be considered in TBSRTC category IV and suspicious and malignant cases of PTC.
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Comparison of diagnostic performances of urine cytology before and after the use of the paris system criteria: An institutional experience from Turkey
Sevgen Onder, Olcay Kurtulan, Altan Kavuncuoglu, Bulent Akdogan
July-September 2021, 38(3):133-139
Background: Urine cytology remains to be the test of choice in the detection of high-grade urothelial carcinomas (HGUC) due to its favorable sensitivity. However, a significant rate of cases is reported under atypical/indeterminate categories, which result in a decrease in its specificity. Providing standardized cytologic criteria, one of the aims of The Paris System (TPS) is to reduce the use of indeterminate diagnoses and provide a higher predictive value in these categories. Aims: We compared the diagnostic performances of TPS and our original reporting system, and also investigated the interobserver reproducibility of the cytologic criteria used. Materials and Methods: A total of 386 urine samples were reviewed retrospectively. Original cytologic diagnoses have been made using similar cytologic features proposed by TPS. All slides were recategorized after the use of the cytologic criteria as described by TPS guideline. Results: After TPS, specificity of the test increased from 39.6% to 63.5, sensitivity decreased from 92.5% to 88.8%, and diagnostic accuracy increased from 63.6% to 75%. The use of negative category increased threefold. Frequencies of indeterminate categories of atypical urothelial cells (AUC) and suspicious for HGUC (SHGUC) decreased by 36% and 56.5%, respectively. A subsequent detection of HGUC after AUC and SHGUC categories increased by 38% and 64%, respectively. Interobserver agreement for TPS categorization was 39%. Conclusions: TPS improved diagnostic accuracy of urine cytology by reducing the use of indeterminate categories, and resulted in increase in their predictive value for subsequent diagnosis of HGUC. However, reproducibility of diagnostic categories seemed to be imperfect.
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The value and limitations of cell blocks in endobronchial ultrasound-guided fine-needle aspiration cytology: Experience of a tertiary care center in North India
Vandna Bharati, Neha Kumari, Shalinee Rao, Girish Sindhwani, Nilotpal Chowdhury
July-September 2021, 38(3):140-144
Background: Endobronchial ultrasound (EBUS)-guided fine-needle aspiration cytology (FNAC) is recommended for diagnosing bronchial neoplasms and evaluating mediastinal lymph nodes. However, it may not be possible to subtype or definitely categorize many bronchial neoplasms on FNAC smears alone. Obtaining adequate diagnostic material is often a problem. In such cases, cell blocks made from FNAC material may serve as a useful adjunct. Aim: To study the value and limitations of cell blocks in adding diagnostic information to EBUS guided FNAC smears. Material and Methods: One hundred and eighty-five cases of EBUS guided FNAC having concomitant cell blocks were reviewed. The cases were evaluated for the extent of adequacy, of definite benign/malignant categorization and of definite subtyping in malignant tumors in these cases. The proportion of cases in which cell blocks added information to FNAC smears alone for the above parameters were calculated. Results: Cell blocks provided additional information in 31 out of 185 cases. Cell blocks were necessary for subtyping 24/59 malignant tumors, definite categorization into benign and malignant in 10/140 adequate samples, and increasing adequacy in 6/185 total samples. A total of 45 samples were inadequate in spite of adding information from cell blocks to smears. Conclusion: Cell blocks added clinically significant information to EBUS guided FNAC and should be used routinely. To make it more useful, alternative methods of cell block preparation (including proprietary methods) may be evaluated.
  - 1,962 194
Diagnostic utility of ultrasound-guided fine-needle aspiration cytology in gall bladder lesions: an experience from a tertiary care cancer center in Eastern India
Niranjan Rout, Subhransu Kumar Hota, Sashibhusan Dash, Sagarika Samantaray, Rabi Narayan Mallik, Omprakash Agrawal
July-September 2021, 38(3):145-150
Introduction: Gallbladder cancer (GBC) is the most common malignancy, representing 80–95% of biliary tract cancers. Although ultrasonography-guided fine-needle aspiration cytology (USG-FNAC) has emerged as an effective diagnostic the tool for the precise diagnosis of gallbladder lesions, data on its diagnostic utility and cytomorphological categorization of gallbladder lesions are lacking. Aims: To study the diagnostic utility of USG-FNAC in gallbladder lesions. Materials and Methods: This study was the conducted prospectively on patients who came with clinical and radiological evidence of gallbladder space-occupying lesion and then advised to USG-FNAC over 2 years and 6 months from January 2018 to June 2020. Results: A total of 314 cases were included. The mean age was 56 years, with a range of 17–88 years. Women predominated over men (Male:Female = 1:2.3). Primary adenocarcinoma of the gallbladder was most common. On cyto-histological correlation, the sensitivity, specificity, and diagnostic accuracy of USG-FNAC of gallbladder lesions were found to be 98.82, 87.23, and 96.3%, respectively. Conclusion: The USG-FNAC of gallbladder lesion was found to be an easy, quick, cost-effective, and presumptive diagnostic procedure. It should be opted as an initial preoperative diagnostic modality in high incidence areas to avoid inappropriate management with unnecessary morbidity and cost. Moreover, a close cytological examination of the architectural pattern and the cytomorphological features would help in the sub-typing and prognosticating the tumor.
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Immunoexpression of ttf1 and p63 differentiates lung adenocarcinomas in sputum samples
VS Veena, VN Saritha, Preethi Sara George, K Rajan, K Jayasree, K Sujathan
July-September 2021, 38(3):151-157
Context: Differentiating NSCLC as either adeno or squamous type and identification of Epidermal Growth Factor Receptor (EGFR) mutations is clinically relevant for lung cancer patients for selecting treatment. Thyroid transcription factor-1 (TTF-1) and p63 were demonstrated as useful markers for histologic typing of lung cancer. Mutation and overexpression of EGFR has been reported in a subset of non-small cell lung cancers. If these markers can be validated for the differential diagnosis of adenocarcinoma in a sputum sample itself, it will be highly beneficial for lung cancer patients. Aims: To evaluate whether immunocytochemical expression of TTF-1, p63, and EGFR proteins in sputum samples can be used for differential diagnosis of lung adenocarcinoma by comparing with that of the corresponding tissue samples. Settings and Design: Ninety sputum samples and matched tissue samples were used for the study. Subjects and Methods: Monolayered smears and cell blocks of sputum and the corresponding tissue samples were immunostained with the standard ABC method. The expression patterns of these markers were analyzed statistically and compared with clinic-pathological parameters. Statistical Analysis Used: Chi-square test and paired t-test. Results: The p63 protein had a positive expression in 73.9% of SCC whereas TTF1 had positive expression in 75.8% of ADC. The EGFR expression was positive in 27 cases of adenocarcinoma, 21 cases of SCC and 19 cases of NSCLC. Conclusions: Immunocytochemistry of the aforementioned antibodies in sputum samples can be used as supplementary evidence for the subtyping of NSCLC.
  - 2,044 210
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