Impression cytology of ocular surface in xeroderma pigmentosum.

PURPOSE: To describe cellular alterations detected by impression cytology of the ocular surface in patients with xeroderma pigmentosum. The secondary objective was to assess the reliability of impression cytology in diagnosing ocular surface squamous neoplasia. METHODS: Patients with xeroderma pigmentosum underwent a single-day complete ophthalmological examination and impression cytology for ocular surface evaluation using 13 mm diameter mixed cellulose esters membrane filters and combined staining with Periodic Acid Schiff, Hematoxylin and Eosin, and Papanicolaou stains followed by microscopic analysis. The cytological findings were correlated with the clinical diagnosis. The impression cytology findings at baseline and one-year follow-up were correlated with the clinical course (no tumor, treated tumor, residual tumor recurrent tumor, new tumor). RESULTS: Of the 42 patients examined, impression cytology was performed in 62 eyes of 34 participants (65% females). The mean age of patients was 29.6 ± 17 years (range 7-62). Fifteen eyes had a clinical diagnosis of ocular surface squamous neoplasia. Impression cytology showed goblet cells (47, 75%), inflammatory cells (12, 19%), keratinization (5, 8%), and squamous metaplasia (30, 48%). Impression cytology was positive for atypical cells in 18 patients (12 with and 6 without ocular surface squamous neoplasia). The sensitivity, specificity, positive predictive value, and negative predictive value of impression cytology (at baseline) for diagnosis of ocular surface squamous neoplasia were 80%, 87%, 67%, and 93%, respectively, using clinical diagnosis of ocular surface squamous neoplasia as the reference standard. CONCLUSION: Impression cytology has a moderate positive predictive value for the diagnosis of ocular surface squamous neoplasia in patients with xeroderma pigmentosum. However, the lack of detection of atypical cells on impression cytology has a high negative predictive value for ocular surface squamous neoplasia. Integration of impression cytology in the long-term management of high-risk patients, such as patients with xeroderma pigmentosum, can avoid unnecessary diagnostic biopsies.

Testagem Molecular para Detecção de HPV e rastreamento do câncer do colo do útero / Molecular Testing for HPV Detection and Uterus Colon Cancer Tracking

INTRODUÇÃO: Evidências científicas robustas indicam que o rastreamento com testes moleculares para detecção de HPV oncogênico é mais sensível, eficaz/efetivo e eficiente, em termos do aumento de detecção de lesões precursoras e da redução da incidência e mortalidade por CCU, do que o rastreio com exame citopatológico. Outro aspecto fundamental é a maior detecção de casos de CCU em estágio inicial, precedendo em até 10 anos o diagnóstico pelo exame citopatológico. A detecção precoce leva a tratamentos menos mutilantes e onerosos, com excelente prognóstico e até com possibilidade de cura, impactando positivamente a custo-efetividade do rastreamento. Ademais, por apresentarem maior sensibilidade e valor preditivo negativo (VPN), quando comparados à citologia, os testes para detecção de HPV de alto risco permitem o aumento da idade de início do rastreio e do intervalo de testagem, melhorando a eficiência e otimizando o desempenho dos programas. PERGUNTA: "A testagem molecular para detecção de HPV

Bethesda System Categories of Fine Needle Aspiration Cytology Are Not Associated with Thyroid Nodule Location: A Single Institution Experience.

INTRODUCTION: Thyroid isthmus is defined as the thin band connecting thyroid tissue between both lateral thyroid lobes. Recently, a possible association between thyroid nodules located in the isthmus and malignancy was proposed. The aim of this study was to compare the frequency of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories between nodules from the isthmus and nodules from both thyroid lobes. METHODS: All fine needle aspiration cytology procedures performed between January 2016 and December 2019 at the Pathology Institute of Araçatuba, São Paulo, Brazil, were analyzed. For each nodule, at least 2 conventional slides were produced (1 stained by Giemsa and the other by hematoxylin and eosin). All cases were reported according to the TBSRTC. Clinical information (gender, age, and localization) and ultrasound data (size of nodules) were collected from medical requisition forms. To assess the association between the frequency of TBSRTC categories and nodule location, univariate analysis was performed using the χ2 test or Fisher's exact test, as appropriate. A p value <0.05 was considered statistically significant. Nodules located in transition between the isthmus and a right or left lobe were included in the isthmus group. RESULTS: Considering the p value between the TBSRTC categories and thyroid nodule location, statistic association was not observed: nondiagnostic or unsatisfactory (p = 0.1442), atypia of undetermined significance or follicular lesion of undetermined significance (p = 0.3296), follicular neoplasm or suspicious for a follicular neoplasm (p = 0.0817), suspicious for malignancy (p = 0.8464), and malignant (p = 0.1082). CONCLUSION: In the studied population, nodules located in the isthmus were not related to any Bethesda System category.

Revisión sistemática sobre la efectividad de la Patología Digital como herramienta de diagnóstico asistencial en anatomía patológica y citopatología / Systematic review about effectiveness of Digital Pathology as a diagnostic tool for pathology and cytopathology

INTRODUCCIÓN La Anatomía Patológica (AP) se encarga del diagnóstico de las enfer medades, en base a la integración de las características morfológicas y mo leculares en muestras tisulares (biopsias) y citológicas, ayuda a dilucidar la patogenia de las enfermedades y a determinar su clasificación. Este informe se centra en la patología digital (PD) como el establecimiento de un diag nóstico anatomopatológico a través de imágenes digitales de preparaciones histológicas y citológicas. Los preparaciones histológicas y citológicas ("preparaciones" o "laminillas") son muestras de tejido o de citologías fijadas y teñidas en un portaobjetos de vidrio, con un sistema de cubreobjetos (vidrio, película o gel) que permite su examen microscópico y su conservación a largo plazo. Los sistemas de imagen de PD se basan en preparaciones digitales (PrD), que son imágenes microscópicas digitalizadas del total de la muestra (en inglés, "Whole Slide Images", WSI) disponible en las preparaciones. Estos sistemas constan de escáneres de alta resolución, servidores de al macenamiento y estaciones de trabajo para visualizar las PrD y emitir el diagnóstico. Actualmente, no hay muchos departamentos o servicios de anatomía patológica en los hospitales de España que hayan implementado la PD ínte gramente. Hay algunas experiencias destacables en patología quirúrgica y proyectos piloto en algunas Comunidades Autónomas. El objetivo de presente informe es conocer la efectividad de las herra mientas diagnósticas basadas en sistemas digitales de imagen microscópica, como práctica clínica en los servicios de anatomía patológica. Como objeti vos secundarios se plantean: • Analizar los grados de concordancia y discordancia de los diagnósticos realizados a través de PD en comparación con los realizados con mi croscopio convencional. • Conocer las características principales de los casos de discordancias ma yores en diagnóstico anatomopatológico digital. • Analizar la carga de trabajo en un servicio con patología digital respec to a un servicio sin ella. Se plantea como pregunta de investigación si el diagnóstico en anato mía patológica (incluyendo patología quirúrgica y citología) a través de sis temas de PD no es inferior en concordancia al diagnóstico con microscopio convencional. METODOLOGÍA Se ha realizado una revisión sistemática (RS) de la literatura científica disponible sobre eficacia y seguridad de la PD mediante digitalización com pleta de preparaciones histológicas y citológicas. Se realizó la búsqueda de la literatura científica sobre eficacia, seguri dad, y eficiencia en las siguientes bases de datos electrónicas: Medline, Em base, PROSPERO, DARE (Database of Abstracts of Reviews of Effects), Health Technology Assessment (HTA) Database y NHS-EED (National Health System Economic Evaluation Database) Centre for Reviews and Dissemination (CRD), INAHTA (The International Network of Agencies of Health Technology Assessment), CADTH (Canadian Agency for Drugs and Technologies in Health), AHRQ (Agency for Healthcare research and Quality), NICE (The National Institute for Health and Care excellence) y FDA (US Food and Drug Administration). Se seleccionaron aquellos estudios con metodología de ensayo clí nico aleatorizado (ECA) o RS que tuvieran resultados sobre eficacia y seguridad de la PD en el diagnóstico anatomopatológico en la práctica clínica. Se realizaron tablas de resumen de los resultados de todos los estudios incluidos, recogiendo los valores de concordancia, discordancias menores y discordancias mayores. Se añadieron los datos relativos a la eficiencia de la herramienta diagnóstica de aquellos estudios que los incorporaban. Cuan do fue posible, se realizó una estimación de la media ponderada con sus IC95% para las concordancias en el diagnóstico con ambas intervenciones (diagnóstico con microscopio convencional y diagnóstico digital). RESULTADOS La RS llevada a cabo arrojó un resultado de 1.544 referencias a es tudios, sin contar duplicados. De entre ellas, se seleccionó como fuente de partida una RS de 2020 que permitió restringir la búsqueda a aque llos estudios posteriores a la misma (Azam 2020). Cuando se aplicaron todos los criterios de cribado, se seleccionaron, 3 RS más y 5 estudios individuales. Las características heterogéneas de los estudios incluidos y el tipo de variable de resultado encontrada en la mayoría de ellos, la concordan cia del diagnóstico, no han permitido poder realizar un meta-análisis. No obstante, tal como realizan Azam y cols. en su RS, se ha llevado a cabo un cálculo de la media ponderada, teniendo en cuenta la cifra de concordan cia diagnóstica y el tamaño de la muestra de la que se ha obtenido. Este cálculo resulta en una media de concordancia entre PD y microscopio de 96,17% en un total de 53.535 muestras (preparaciones histológicas y citológicas). La seguridad de estos diagnósticos por PD es adecuada, al no encon trar discordancias diagnósticas mayores (implican diferencias en el trata miento) de relevancia clínica en el total de estudios incluidos. CONCLUSIONES • La patología digital es una técnica diagnóstica efectiva y segura en la práctica clínica. • La concordancia con el diagnóstico con microscopio convencional su pera el 95% • Las discordancias mayores observadas son mínimas. • La implantación de un sistema de PD en un servicio de anatomía pato lógica requiere de un entrenamiento y formación de los profesionales, patólogos y citotécnicos. • Su implementación requiere de la adquisición de equipos y software de calidad que cumplan con las normativas vigentes en la Unión Europea. • Cualquier sistema de PD debe integrarse con los sistemas de informa ción de los servicios de salud, incluida la historia clínica electrónica. • Se necesita un sistema de almacenamiento de imágenes integrado con los sistemas de información y que cumpla con la normativa vigente de protección de datos.

INTRODUCTION Anatomic pathology (AP) is the diagnosis of diseases, based on the integration of morphological and molecular features in tissue (biopsies) and cytological samples, helping to elucidate the pathogenesis of diseases and to determine their classification. In this report, digital pathology (DP) concept is focused on the establishment of a pathological diagnosis through digital imaging of histological and cytological slides. These slides are histological or cytological samples that are fixed and stained on a glass slide, using overslipping methods (glass, film or gels) that allow their microscopic examination and long-term storage. DP imaging systems are based on digital slides that are microscopic digitised images of the whole specimen on a slide (Whole Slide Ima ges: WSI). Digital Pathology systems include high-resolution scanners, storage servers and workstations to visualise the WSI and diagnosis elaboration. Currently, there are not many pathology departments with a full imple mentation of DP services in Spanish hospitals, at least in surgical patholo gy. However, there are some outstanding experiences and pilot projects in some Autonomous Communities. The aim of this report is to know the effectiveness of diagnostic tools based on digital systems of microscopic images as a routine practice in ana tomic pathology departments. Secondary objectives are as follows: • To analyse the degrees of concordance and discordance of diagnoses made using DP compared to those made using conventional microscopy. • To find out the main characteristics of cases of major discordance in digital pathology diagnosis. • To analyse the workload in a department with digital pathology compa red to a department without it. The research question is whether diagnosis in histopathology and cyto pathology using DP systems is not inferior to diagnosis using conventional microscopy. METHODOLOGY A systematic review of the available scientific literature on the efficacy and safety of DP by complete digitisation of histological and cytological slides was carried out. The scientific literature on efficacy, safety and efficiency was searched in the following electronic databases: Medline, Embase, PROSPERO, DARE (Database of Abstracts of Reviews of Effects), Health Technology Assess ment (HTA) Database and NHS-EED (National Health System Econo mic Evaluation Database) Centre for Reviews and Dissemination (CRD), INAHTA (The International Network of Agencies of Health Technology Assessment), CADTH (Canadian Agency for Drugs and Technologies in Health), AHRQ (Agency for Healthcare research and Quality), NICE (The National Institute for Health and Care excellence) and FDA (US Food and Drug Administration). We selected those studies with randomised clinical trial (RCT) or sys tematic reviews (SR) methodology that had results on the efficacy and safe ty of DP in pathology diagnosis in clinical practice. Summary tables were made of the results of all the included stu dies, containing concordance values, minor discordances and major dis cordances. Data on the efficiency of the diagnostic tool were added for those studies that included them. Where possible, an estimate of the wei ghted mean with its 95%CI was made for the diagnostic concordances with both interventions (conventional microscopic diagnosis and digital diagnosis). RESULTS The SR carried out produced a result of 1,544 references to studies, not counting duplicates. From these, a SR from 2020 was selected as the starting source, which allowed us to restrict the search to those studies sub- sequent to it (Azam 2020). When all screening criteria were applied, three more SRs and five individual studies were selected. The heterogeneous characteristics of the included studies and the type of outcome variable found in most of them, diagnostic concordance, did not allow us to perform a meta-analysis. However, as performed by Azam et al. in their SR, a weighted mean calculation has been carried out, taking into account the diagnostic concordance data and the size of the sample from which it was obtained. This calculation results in a mean concordance be tween DP and microscopy of 96.17% in a total of 53,535 samples (histology and cytology slides). The safety of these DP diagnoses is adequate as no major diagnostic discordances (implying differences in treatment) of clinical relevance were found in the total number of studies included. CONCLUSIONS • Digital pathology is an effective and safe diagnostic technique in clinical practice. • Concordance with conventional microscopic diagnosis exceeds 95%. • Major discordances observed are minimal. • The implementation of a DP system in an anatomical pathology depart ment requires training and education of professionals, pathologists and cytotechnicians. • Its implementation requires the acquisition of quality equipment and software that complies with current EU regulations. • Any DP system must be integrated with health service information sys tems, including the electronic medical record. • An image storage system that is integrated with information systems and complies with data protection regulations is needed.

Cytohistological correlation in patients with atypical glandular cells on Papanicolaou test in a Chilean population.

The standard screening test for detecting cervical lesions and cancers is a Papanicolaou (Pap) smear. While squamous cell abnormalities remain the most common positive Pap test result, cytologic findings of glandular cell abnormalities have become more frequent in recent decades. The 2014 Bethesda System for reporting cervical cytology includes the classification "atypical glandular cells" (AGC). AGC have morphological abnormalities that fall outside the range of reactive changes, but are insufficient for a diagnosis of invasive adenocarcinoma. In several histologic follow-up studies, most AGC cases were found to represent a benign condition. In the current study, we evaluate the significance of AGC cytology findings by analyzing the histologic follow-up results of a large number of patients with AGC. Most patients with AGC in this study were found to have a significant lesion on follow-up (63.9%), with negative histologic results in only 36.1% of patients. Among patients with significant lesions, the most common result was low-grade squamous intraepithelial lesion (26.6%), followed by high-grade squamous intraepithelial lesion (23.2%). This provides further evidence to support the Chilean Clinical Guidelines for Cervical Cancer, which recommends diagnostic follow-up studies in all women with AGC to minimize the chance of undetected serious cervical disease.

Infección por virus del papiloma humano en mujeres del Cantón Cañar, Ecuador / Human papillomavirus infection among women from Cañar Canton in Ecuador

Introducción: Existen pocos estudios sobre la circulación del virus del papiloma humano en mujeres ecuatorianas, particularmente residentes en el Cantón Cañar. Objetivo: Determinar la circulación del virus del papiloma humano, las alteraciones en la citología cérvico-vaginal de mujeres cañaríes y el comportamiento de algunas variables sociodemográficas y clínico-epidemiológicas. Métodos: Estudio analítico de corte transversal desde julio 2017-septiembre 2018. Se colectaron células cervicouterinas de 100 mujeres entre 15 y 55 años de edad para determinar la infección viral y alteraciones citológicas. Se investigó la asociación entre variables sociodemográficas y clínico-epidemiológicas con la infección viral. Resultados: El 51 por ciento (51/100) de las mujeres examinadas resultó positivo al virus, con predominio de los genotipos oncogénicos. El genotipo 31 fue el más frecuente (56,9 por ciento; 29/51), seguido por el genotipo 58 (43,1 por ciento; 22/51). Las mujeres mayores de 50 años, tenían una probabilidad menor de estar infectadas (3,9 por ciento; 2/51). La probabilidad de infección fue mayor en mujeres solteras, con antecedentes de infecciones de transmisión sexual, que padecían procesos cervicales inflamatorios, y en las fumadoras. La infección con genotipo 66 estuvo asociada al uso de anticonceptivos hormonales (53,3 por ciento; 8/15); p= 0,045, RP= 3,08 IC95 por ciento (1,00-9,46). Se obtuvo el 97 por ciento de citologías negativas para malignidad; no se diagnosticaron casos con lesiones de alto grado. Conclusiones: La elevada prevalencia de infección con genotipos oncogénicos en contraste con la baja frecuencia de citologías positivas, indica la necesidad de implementar programas eficientes para la detección precoz del cáncer cervicouterino en la población del Cañar y divulgar campañas de educación sexual y reproductiva(AU)

Introduction: Few studies are available about the circulation of human papillomavirus among Ecuadorian women, particularly those from Cañar Canton. Objectives: Determine the circulation of human papillomavirus, alterations in the cervical-vaginal cytology of women from Cañar Canton, and the behavior of some sociodemographic and clinical-epidemiological variables. Methods: An analytical cross-sectional study was conducted from July 2017 to September 2018. Cervical cells were collected from 100 women aged 15-55 years to determine viral infection and cytological alterations. An analysis was performed of the relationship of sociodemographic and clinical-epidemiological variables to viral infection. Results: Of the women examined, 51 percent; (51/100) tested positive for the virus, with a predominance of oncogenic genotypes. Genotype 31 was the most common (56.9 percent;; 29/51), followed by genotype 58 (43.1 percent; 22/51). Women aged over 50 years had a lesser probability of being infected (3.9 percent;; 2/51). Infection probability was greater among single women, with a history of sexually transmitted infections, who suffered from inflammatory cervical processes, and smokers. Infection by genotype 66 was associated to the use of hormonal contraceptives (53.3 percent;; 8/15); p= 0.045, PR= 3.08 CI95 percent; (1.00-9.46). Of the sample cytologies, 97 percent; were negative for malignancy; no case was diagnosed of high-grade lesions. Conclusions: The high prevalence of infection by oncogenic genotypes, as opposed to the low frequency of positive cytologies, points to the need to implement efficient programs aimed at early detection of cervical cancer in the population of Cañar Canton, as well as sexual and reproductive education campaigns(AU)

Assessment of Anal Cancer Screening Tools in Detecting High-Grade Anal Squamous Intraepithelial Lesions in Women.

OBJECTIVE: The aim of the study was to evaluate the validity of anal cytology against high-resolution anoscopy in the detection of anal high-grade squamous intraepithelial lesions (HSILs) among women in a clinical setting in Puerto Rico, alone and in combination with high-risk human papillomavirus (HR-HPV) typing. MATERIALS AND METHODS: A cross-sectional study was done among 128 eligible women who attended the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Center between 2014 and 2019. Kappa (κ) coefficient, sensitivity, specificity, positive predictive value, and negative predictive value were calculated using high-resolution anoscopy with biopsy as the criterion standard test. Poisson regression was used to estimate the adjusted prevalence ratio of anal HR-HPV infection. RESULTS: Overall, 71.1% of women were HIV infected and 78.9% had anal HR-HPV infection. Squamous intraepithelial lesions were detected with anal cytology and histology in 70.3% and 81.3% of women, respectively. The κ statistic between the tests (cytology and histology) was 0.32 (p < .05). Measured against the results from histology, the sensitivity of anal cytology alone to detect HSIL was 85.4% (95% CI = 72.2%-93.9%), whereas specificity was 38.8% (95% CI = 28.1%-50.3%). Although the sensitivity of the 2 tests combined (anal cytology and HR-HPV typing) to detect histologically confirmed HSIL increased (100.0%, 95% CI = 92.6%-100.0%), the specificity decreased (16.3%, 95% CI = 9.0%-26.2%). Meanwhile, women with HSIL had a higher prevalence of anal HR-HPV infection than those with no SIL/LSIL (prevalence ratio = 6.23, 95% CI = 1.50-25.83). CONCLUSIONS: Anal cytology in combination with HR-HPV typing for the screening of anal intraepithelial neoplasia improved the detection of HSIL in women.

Citologia em meio líquido para rastreamento de câncer de colo de útero e lesões precursoras / Liquid-based cytology for screening for cervical cancer and precursor lesions

INTRODUÇÃO: O câncer do colo de útero (CCU) mata mais de 250 mil mulheres por ano no mundo. Na América Latina, a incidência do câncer do colo do útero é considerada uma das maiores do mundo, correspondendo a até 25% de todos os tipos de câncer em mulheres (1). No Brasil, em 2018, estima-se 16.370 casos novos de câncer do colo do útero (2). Para combater o câncer de colo uterino, o Sistema Único de Saúde (SUS) tem concentrado esforços na prevenção secundária, com o rastreamento por meio do exame Papanicolau colhido através do Método de Citologia Convencional (CC) na população feminina sexualmente ativa. A recomendação seguida pelo Ministério da Saúde, desde 1988 é da Organização Mundial da Saúde (OMS), que propõe a realização do exame a cada três anos, para mulheres de 25 a 64 anos, ou antes desta faixa etária, caso já tenha iniciado a atividade sexual, e após dois acompanhamentos anuais negativos (Instituto Nacional de Câncer, 2016). O método de Citologia em Meio Líquido (CML), aprovado para uso clínico desde 1996, veio aperfeiçoar a coleta de material de colo de útero para o exame citopatológico, o pode trazer benefícios em termos de diminuição de amostras insatisfatórias. PERGUNTA: O método de Citologia em Meio Líquido é eficaz, seguro e custo-efetivo, quando comparado com o método citologia convencional (CC) para detectar as lesões e as anormalidades das células endocervicais uterinas? TECNOLOGIA: Método de Citologia em Meio Líquido (Liqui-PREP®). EVIDÊNCIAS CIENTÍFICAS: O demandante realizou revisão sistemática da literatura e incluiu cinco estudos de metanálise ou revisão sistemática de comparação de CML e CC. Apesar da heterogeneidade dos resultados, a maioria dos estudos incluídos mostrou acurácia semelhante entre as técnicas ou pequena vantagem não-significativa em favor da CML, principalmente com relação a sensibilidade. Aparece com mais clareza nos resultados a redução do percentual de amostras insatisfatórias com CML, embora a magnitude dessa diferença tenha variado amplamente entre os estudos. AVALIAÇÃO ECONÔMICA: O demandante realizou análise de custo-minimização, comparando a CML com a CC para o contexto do SUS. O resultado principal foi o custo adicional de R$ 2,78 por amostra coletada. No entanto, é importante considerar que há limitações da metodologia, particularmente com relação aos pressupostos de taxas de exames insatisfatórios e com relação a escolha das fontes e ausência de análises de sensibilidade, tornando limitada a aplicação dos resultados. CONSIDERAÇÕES: Na análise das informações apresentadas no relatório elaborado pelo demandante, alguns pontos merecem destaque. O desempenho do CML, do ponto de vista de acurácia e utilidade diagnóstica, foi semelhante ou marginalmente superior em relação à CC. Esses dados de eficácia são derivados de revisões sistemáticas cujos estudos incluídos foram de qualidade moderada, com alguma heterogeneidade de resultados. Por outro lado, o impacto orçamentário incremental previsto foi de mais de 50 milhões de reais em cinco anos, mesmo na estimativa mais otimista. As análises econômicas apresentadas têm nível de incerteza elevado e potenciais limitações metodológicas sérias. CONSULTA PÚBLICA: A Consulta Pública nº 59/2019 foi realizada entre os dias 10/10/2019 e 29/10/2019. Foram recebidas 38 contribuições, sendo 08 técnico-científicas (38% das contribuições concordavam, 38% discordavam e 24% não concordavam nem discordavam da recomendação preliminar) e 30 de experiência ou opinião (70 % discordavam da recomendação preliminar). Após avaliação das contribuições, discutiu-se que a demanda, em realidade, refere-se à solicitação de incorporação de insumo (Liqui-PREP®) a ser utilizado no processo de coleta de amostra do colo de útero ­ houve recomendação favorável à sua utilização no SUS, mantendo-se os procedimentos atuais na Tabela SIGTAP (de coleta de material e de exame citopatológico cérvico-vaginal), sem alteração de valor e com adequação da descrição dos mesmos, caso seja necessário. RECOMENDAÇÃO FINAL: Os membros da CONITEC presentes na 83ª reunião ordinária, no dia 06/11/2019, deliberaram, por unanimidade, recomendar a incorporação do processo de coleta de amostras citológicas no sistema de citologia em meio líquido, sem a criação de novos procedimentos de coleta de material e de exame citopatológico cérvico-vaginal, para o rastreamento de câncer de colo de útero e lesões precursoras, no Sistema Único de Saúde. DECISÃO: Incorporar a citologia em meio líquido para o rastreamento de câncer de colo de útero e lesões precursoras, no âmbito do Sistema Único de Saúde ­ SUS, de acordo com a Portaria nº 63, publicada no Diário Oficial da União nº 242, seção 1, página 420, em 16 de dezembro de 2019.

Pancreatic islet stereology: estimation of beta cells mass / Estereología de los islotes pancreáticos: estimación de la masa de células beta

Obesity and its comorbidities are becoming epidemic in the Western world. Beta cell mass estimation is an important indicator to track the progression of insulin resistance/type 2 diabetes, particularly in experimental studies, where it can be performed with stereological tools in an unbiased way. In this work, we present a simple protocol that can contribute to doing the practice of estimating the mass of beta cells more frequent and reproducible. As with any quantitative study, the necessary precautions regarding sampling and randomness must be respected.

La obesidad y sus comorbilidades se están convirtiendo en una epidemia en el mundo occidental. La estimación de la masa de células beta es un indicador importante para rastrear la progresión de la resistencia a la insulina/diabetes tipo 2, particularmente en estudios experimentales, donde se puede realizar con herramientas estereológicas de manera imparcial. En este trabajo presentamos un protocolo simple que puede contribuir a que la práctica de estimar la masa de células beta sea más frecuente y reproducible. Como en cualquier estudio cuantitativo, deben respetarse las precauciones necesarias con respecto al muestreo y la aleatoriedad.

Citología aspirativa con aguja fina transbroncoscópica guiada por ultrasonido endobronquial / Endobronchial ultrasound-guided transbronchoscopic fine needle aspiration cytology

Introducción: El enfrentamiento diagnóstico de las lesiones sospechosas de cáncer pulmonar ha cambiado en los últimos años. Objetivo: Describir el primer caso diagnosticado en Cuba de carcinoma de pulmón por aspiración transbronquial por aguja fina guiada por ultrasonografía endobronquial. Presentación del caso: Se presenta un caso de carcinoma indiferenciado de células pequeñas. El diagnóstico se obtiene mediante la realización de una citología aspirativa con aguja fina de ganglios mediastinales, transbroncoscópica y guiada por ultrasonido endobronquial. Conclusiones: El uso de EBUS-TBNA es una herramienta con un alto rendimiento diagnóstico, con escasas complicaciones descritas y debe considerarse como una posibilidad en el estudio de lesiones adyacentes a la vía aérea central(AU)

Introduction: The diagnostic confrontation of lesions suspected of lung cancer has changed in recent years. Objective: To describe the first case of lung carcinoma, diagnosed in Cuba by endobronchial ultrasound-guided transbronchoscopic fine needle aspiration cytology. Case report: A case of undifferentiated small cell carcinoma is reported. Diagnosis is obtained by performing a fine needle aspiration cytology of the mediastinal lymph nodes, transbronchoscopic and guided by endobronchial ultrasound. Conclusions: The use of EBUS-TBNA is a tool with high diagnostic yield, with few described complications and should be considered as a possibility in the study of lesions adjacent to the central airway(AU)

Precision cytopathology: expanding opportunities for biomarker testing in cytopathology.

Precision cytopathology refers to therapeutically linked biomarker testing in cytopatology, a dynamically growing area of the discipline. This review describes basic steps to expand precision cytopathology services. Focusing exclusively on solid tumors, the review is divided into four sections: Section 1: Overview of precision pathology- opportunities and challenges; Section 2: Basic steps in establishing or expanding a precision cytopathology laboratory; Section 3: Cytopathology specimens suitable for next generation sequencing platforms; and Section 4: Summary. precision cytopathology continues to rapidly evolve in parallel with expanding targeted therapy options. Biomarker assays (companion diagnostics) comprise a multitude of test types including immunohistochemistry, in situ hybridization and molecular genetic tests such as PCR and next generation sequencing all of which are performable on cytology specimens. Best practices for precision cytopathology will incorporate traditional diagnostic approaches allied with careful specimen triage to enable successful biomarker analysis. Beyond triaging, cytopathologists knowledgeable about molecular test options and capabilities have the opportunity to refine diagnoses, prognoses and predictive information thereby assuming a lead role in precision oncology biomarker testing.

Feline Sporothrix spp. detection using cell blocks from brushings and fine-needle aspirates: Performance and comparisons with culture and histopathology.

BACKGROUND: Sporotrichosis is an emerging zoonotic mycosis that presents as a cutaneous lymphatic or disseminated disease, caused by fungi from the Sporothrix schenkii (S schenkii) clinical clade. Its importance is growing, primarily due to an outbreak that occurred in Brazil, affecting mainly cats and people. OBJECTIVES: In Brazil, an S schenkii diagnosis is often made using cultures, which allows genus identification and sufficient growth to perform molecular biology testing. Despite its advantages, fungal cultures are slow to develop and can delay public health measures, highlighting the importance of developing additional diagnostics techniques. METHODS: Cell block cytology (CBLC) is an older method that regained importance after liquid-based cytology (LBC) was introduced, and it has been previously and successfully applied to veterinary diagnostics. We aimed to standardize and compare CBLC from cervical brush exfoliation of open wounds and fine-needle aspirates with culture and immunohistochemistry of skin biopsies for sporotrichosis in cats, as a novel method. RESULTS: For this purpose, we selected 40 cats with skin lesions suspected of having sporotrichosis in Guarulhos city, São Paulo state, Brazil. We achieved 97.5% and 95% positivity using CBLC and culture, respectively, and 100% of feline skin biopsies were positive for Sporothrix spp on histopathology/immunohistochemistry. CONCLUSIONS: Cell block cytology is an efficient and rapid tool to diagnose sporotrichosis in cats, particularly during epidemics.

Impact of Brush Cytology Analysis for the Diagnosis of Esophageal Squamous Cell Carcinoma: The Quality of Liquid-Based Preparation of Cytological Slides.

OBJECTIVES: The diagnostic performance of cytology in esophageal squamous cell carcinoma (ESCC) is meticulously described. METHODS: Cytological and biopsy specimens were prospectively taken during esophagogastroduodenoscopy of 123 individuals in 2013 and 2014. Cytology samples were maintained in preservative fluid until processing and biopsies were formalin-fixed and paraffin-embedded. RESULTS: Based on endoscopic biopsy results, 70 cases were positive for ESCC whilst 53 were negative for cancer. In addition, brush cytology showed high sensitivity and specificity (98.57 and 96.23%, respectively) in detecting the disease, and high accuracy (97.5%) comparable to that provided by histopathology which is the accepted gold standard. CONCLUSION: Brush cytology specimens preserved in liquid medium may be a good alternative for ESCC diagnosis.

Brush Biopsy Sample Quality: Preliminary Investigation of a Metal Brush Prototype

Objective: To qualitatively investigate whether a prototype brush composed of metal bristles collects oral epithelial cells effectively for cytological evaluation of oral mucosal lesions. Material and Methods: Twenty patients with suspicious oral mucosal lesions were enrolled. Patients were asked to gargle with saline and to deposit the oral rinse into specimen cup. Then, oral mucosal cell samples were collected using a metal oral brush, via sweeping motion. Punch biopsy was performed for histological examination. All samples were evaluated with liquid based cytology (LBC) according to the cellularity, the depth of the epithelial layer, cellular integrity by an oral pathologist. Results: Oral rinse provided samples with 100% cellular integrity and cellularity, mostly from the intermediary layers. With metal brush, both inadequate cellularity and cellular integrity was observed in 25% of the cases. Cellular integrity was adequate in 65%, cellularity was adequate in 45% of the lesions. Samples were dominantly from the intermediary layers, but in one case, metal brush collected cells from the parabasal layer. Conclusion: The narrow spiral pitch and width of metal bristles may have resisted to release the cellular samples collected. With adjustment of the spiral pitch and diameter of metal brush bristles, its' efficacy could be enhanced.

Comparative study of metachromatic staining methods in assessing the exfoliative cell types during oestrous cycle in Sprague-Dawley laboratory rats / Estudio comparativo de los métodos de tinción metacromática en la evaluación de los tipos de células exfoliativas durante el ciclo estral en ratas Sprague-Dawley de laboratorio

This study was aimed at comparing the commonly used metachromatic stains viz., Papanicolaou stain, WrightGiemsa, Toluidine blue and Methylene blue in the assessment of cell types of the oestrous cycle in rats. Eight female Sprague-Dawley rats aged 8-9 weeks were used for this assessment. Cotton Swabs were gently inserted in the animals vagina to obtain cells from which they were then transferred to glass slides for staining and evaluation under microscopy. The different cell types were compared for their morphological features and clarity of cellular detail under all four stains. The application, advantages and limitations of all stains were then discussed. It was concluded that the selection of the most effective stain in the assessment of vaginal cytology depends on their application to clinical or research which was based on the cellular detail of interest, time, cost and availability of each staining procedure.

El presente estudio tuvo como objetivo comparar las tinciones metacromáticas comúnmente utilizadas, Wright's-Giemsa, azul de toluidina, azul de metileno y tinción de Papanicolaou, en la evaluación de los tipos de células del ciclo estral en ratas. El estudio se realizó en ocho ratas hembras SpragueDawley, con edades entre 8 y 9 semanas, y se usaron hisopos vaginales de algodón para preparar portaobjetos. Los diferentes tipos de células se compararon por sus características morfológicas y claridad en las cuatro tinciones. La aplicación, ventajas y limitaciones de todas las tinciones fueron discutidas. Se concluye que la selección de la tinción más efectiva en la evaluación de la citología vaginal depende de su uso, es decir, clínico o de investigación, el detalle celular de interés, tiempo, costo y disponibilidad.

Optical techniques for the diagnosis and treatment of lesions induced by the human papillomavirus - A resource letter.

Human papillomaviruses (HPV) are the most common sexually-transmitted virus, and carcinogenic HPV strains are reported to be responsible for virtually all cases of cervical cancer and its precursor, the cervical intraepithelial neoplasia (CIN). About 30% of the sexually active population are considered to be affected by HPV. Around 600 million people are estimated to be infected worldwide. Diseases related to HPV cause significant impact from both the personal welfare point of view and public healthcare perspective. This resource letter collects relevant information regarding HPV-induced lesions and discusses both diagnosis and treatment, with particular attention to optical techniques and the challenges involved to the implementation of those approaches.

Prediction of CD4+ Cells Counts in HIV/AIDS Patients based on Sets and Probability Theories.

BACKGROUND: Previous studies have developed methodologies for predicting the number of CD4+ cells from the total leukocyte and lymphocytes count based on mathematical methodologies, obtaining percentages of effectiveness prediction higher than 90% with a value of less than 5000 leukocytes. OBJECTIVE: To improve the methodology probabilities prediction in 5000-9000 leukocytes ranges. METHOD: from sets A, B, C and D defined in a previous study, and based on CD4+ prediction established on the total number of leukocytes and lymphocytes, induction was performed using data from 10 patients with HIV, redefining the sets A and C that describe the lymphocytes behavior relative to leukocytes. Subsequently, we evaluated with previous research prediction probabilities parameters from a sample of 100 patients, calculating the belonging probability to each sample and organized in predetermined ranges leukocytes, of each of the sets defined, their unions and intersections. Then the same procedure was performed with the new sets and the probability values obtained with the refined method were compared with respect to previously defined, by measures of sensitivity (SENS) and Negative Predictive Value (NPV) for each range. RESULTS: probabilities with values greater than 0.83 were found in five of the nine ranges inside the new sets. The probability for the set A∪C increased from 0.06 to 0.18 which means increases between 0.06 and 0.09 for the intersection (A∪C) ∩ (B∪D), making evident the prediction improvement with new sets defined. CONCLUSION: The results show that the new defined sets achieved a higher percentage of effectiveness to predict the CD4+ value cells, which represents a useful tool that can be proposed as a substitute for clinical values obtained by the flow cytometry.

DNA detection of JC and BK virus in archival urine cytospin slides.

To identify decoy cells, cytological examination was performed in urine cytospin slides. Decoy cells are related to Polyomaviruses (JC virus [JCV] and BK virus [BKV]), which are recognized worldwide due to potential infection and morbidity in kidney transplant recipients. Cytologically, it is difficult to evaluate the cytopathic effect of JCV and BKV in urine of patients with urothelial neoplasia. For this reason, there is a need for molecular approaches. To evaluate the incidence of BKV and JCV DNA in archival slides of urine cytospin material with benign and malignant characteristics. A total of 176 urine specimens were used for cytological examination of neoplastic or decoy cells. The samples were analyzed for the presence of JCV and BKV, by polymerase chain reaction (PCR) in DNA Isolated from archival slides of urine cytospin material. A typical samples (n = 48) were compared with the remaining 128 samples without atypia/neoplasia for the presence of JCV or BKV DNA. A statistically nonsignificant result was observed correlating the presence of JCV or BKV. The results show that DNA Isolated from archival slides of urine cytospin material can be used for detection of BKV and JCV.