Risk-based Stratification of Salivary Gland Lesions on Cytology: An Institutional Experience.

BACKGROUND & OBJECTIVE: Fine needle aspiration cytology (FNAC) of salivary gland lesions is an accepted and useful diagnostic tool to differentiate between benign and malignant lesions. Majority of the neoplasms are benign, and specific diagnosis on cytology can be made in most of the cases. However, the utility is limited by the overlapping and heterogeneous morphological features of benign and malignant neoplasms. The current study aimed at investigating the cytomorphological features of salivary gland lesions with histopathological correlation and performing risk based stratification of these lesions using the recommended Milan system for reporting of salivary gland cytopathology (MSRSGC). METHODS: The current study was conducted on 192 retrospective and prospective cases of salivary gland lesions over a period of three years from October 2014 to September 2017. Cytohistopathological correlation was observed in 62 cases. Subsequently,cytomorphological features were further revaluated, classified according to MSRSGC into six groups, and correlated with clinico-histopathological features. RESULTS: Diagnostic sensitivity and specificity of FNAC for salivary gland lesions was 63.16% and 97.62%, respectively. The positive predictive value was 92.31% and negative predictive value was 85.42%. The diagnostic accuracy to differentiate between benign and malignant lesions was 86.88%.The number of cases in each diagnostic category and the risk of malignancy (ROM) were as follows: nondiagnostic - three cases (ROM - 33.33%), nonneoplastic - 14 cases (ROM - 7.14%), atypical - one case (ROM - 100%), benign - 28 cases (ROM - 7.14%), NUMP - one case (ROM - 100%), suspicious - one case (ROM -100%), and malignant - 13cases (ROM - 92.30%). CONCLUSION: Risk based stratification scheme as recommended by MSRSGC can provide a standard method to analyse the results and help to plan the management of salivary gland lesions.

Triple negative breast cancer in people of North East India: critical insights gained at a regional cancer centre.

BACKGROUND: Breast cancer is a heterogeneous disease comprising of distinct biological subtypes with many targeted prognostic biomarkers having therapeutic implications. However, no specific targeted therapy for triple negative breast cancer has been discovered to date and hence further research is needed. AIM: The aim and objectives of the present study were to examine the prevalence of triple negative breast cancer (TNBC) in North-East India and to compare the clinicopathological parameters in two study groups defined by immunohistochemistry (IHC) -"TNBC" and "Others". MATERIALS AND METHODS: We carried out a retrospective study in a cohort of 972 patients diagnosed with invasive breast carcinoma in the Department of Pathology, Dr. B. Borooah Cancer Institute, a Regional Cancer Centre for treatment and research, Guwahati, for a period of 3 years and 10 months from January 2010 to October 2013. Based on IHC findings, patients were divided into two groups - "TNBC" and "Others". All relevant clinicopathological parameters were compared in both. TNBC were defined as those that were estrogen receptor (ER), progesterone receptor (PR), and HER2/neu negative while those positive for any of these markers were defined as "Others". RESULTS: In this study, out of total 972 cases 31.9% (310 cases) were defined as TNBC and 662 cases (68.1%) as "Others" based on IHC markers. Compared to the "Others" category, TNBC presented at an early age (mean 40 years), were associated with high grade large tumours and high rate of node positivity, IDC NOS being the most common histological subtype in TNBC. CONCLUSIONS: TNBC accounts for a significant portion of breast cancers in this part of India and commonly present at younger age and tend to be large high grade tumours.

Hybrid capture 2 assay based evaluation of high-risk HPV status in healthy women of north-east India.

BACKGROUND: High risk HPV (HR-HPV) testing has been recommended as an effective tool along with cytology screening in identification of cervical intraepithelial lesions (CINs) and prevention of their progress towards invasive cervical cancer. The aim of this study was to assess the HR-HPV DNA status by Hybrid Capture 2 (HC2) assay in healthy asymptomatic women of North-East India. MATERIALS AND METHODS: This study examined cervical cell samples of forty three (n=43) healthy women by HC2 assay. A High Risk HPV DNA kit (Qiagen) was used which can detect 13 high risk HPV types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68. RESULTS: The mean relative light units (RLU) for samples was in the range of 141-5, 94, 619. HR-HPV DNA was confirmed in 16% (7/43) of participant women samples. Among demographic and clinical parameters, menstrual irregularity (p=0.039) and infection history (p=0.028) has shown statistically significant differences between the HR-HPV-positive and negative groups. In the HR-HPV positive group, two women were confirmed for CINs after colposcopy and histopathologic examination. CONCLUSIONS: We suggest that there may be an association between irregular menstruation and infection history of the urogenital tract with HR-HPV DNA prevalence in North-East Indian asymptomatic women. HC2 assay can be a valuable tool for HR-HPV screening.

Nested multiplex PCR based detection of human papillomavirus in cervical carcinoma patients of North- East India.

BACKGROUND: Persistent infection of one or more of about 15 high-risk human papillomaviruses (HR-HPVs), most commonly HPV types 16/18, has a significant role in cervical cancer initiation and progression. There are limited data available from north-east India about HPV prevalence though this region has high incidence rates of cervical cancer. The aim of this study was to investigate the HPV genotypes prevalent in cervical cancer patients of north-east India. MATERIALS AND METHODS: We analyzed 107 cervical cancer patient samples. Nested multiplex PCR assays were employed for detection of 13 high risk and 5 low risk HPV types. RESULTS: HPV was confirmed in 105 samples. The presence of 6 'carcinogenic' HPV types, HPV-16 (88%), -18 (15%), -31(4%) ,-45 (3%), -59 (4%), -58(1%), and one non carcinogenic, HPV-6/11 (6%), was recorded. Among various demographic and clinical factors only tumour stage showed a statistically significant association with HPV type infection (P=0.019). CONCLUSIONS: We suggest that the most prevalent genotype is HPV-16 followed by HPV-18 in cervical carcinoma patients of the north-eastern region of India. Advanced tumour stage may be associated with increased possibility of harbouring multiple HPV genotypes.

A novel single-port technique for transanal rectosigmoid resection and colorectal anastomosis on an ex vivo experimental model.

BACKGROUND: In the context of natural orifice translumenal endoscopic surgery (NOTES), we developed a new set of rigid instruments according to the principles of transanal endoscopic microsurgery (TEM).These instruments are long, curved, and steerable by rotating two wheels near its handle. Our success in transvaginal cholecystectomy in human with these instruments motivated us to explore the feasibility of rectosigmoid resection through the anus. METHODS: The young bovine large bowel with attached organs is collected en bloc and reintegrated into an anatomically designed trainer to reproduce the human anatomy. The technique comprises the following: (1) closure of the rectal lumen by an endolumenal pursestring suture; (2) transection of the rectal wall 1 cm distal to the pursestring suture and continuation of the dissection toward the fascia and upward excising the mesorectal tissue; (3) inferior mesenteric artery is divided near its origin; (4) the colon is mobilized up to the splenic flexure; (5) the mobilized colon is brought down to the pelvis, ligated twice at the intended proximal resection site, and divided between the ligatures; (6) specimen is delivered transanally; and (7) intestinal continuity is restored by stapled or hand-sutured anastomosis. RESULTS: Twelve rectosigmoid resections, 20 stapled, and 27 hand-sutured anastomoses were performed in two experimental setups. Mean operation time for the resection part was 78.6 min (standard deviation (SD)=9.9). The average specimen length was 37.2 cm. During dissection in the pelvis, as the specimen was pushed upward and toward abdomen, an "empty pelvis" view of the working field was achieved, facilitating dissection. The mean operation time for hand-sutured and stapled anastomoses were 47.7 (SD=6.9) and 43.3 (SD=7.1) min, respectively. Both groups had one anastomotic leak. CONCLUSIONS: Transanal rectosigmoid resection is feasible with TEM technology. The unobstructed "empty pelvis" view is likely to enhance the quality of mesorectal dissection.