A comparative analysis of core needle biopsy and repeat fine needle aspiration in patients with inconclusive initial cytology of thyroid nodules.

Purpose: To assess and compare the effectiveness of ultrasound-guided core needle biopsy (CNB) in comparison to repeat fine-needle aspiration(rFNA) for thyroid nodules that yield inconclusive results following the initial fine-needle aspiration (FNA). Methods: A cohort of 471 patients who received an inconclusive cytological diagnosis following the initial FNA were included in this study. These patients subsequently underwent either CNB (n=242) or rFNA (n=229). The inconclusive FNA results encompassed categories I, III, and IV of The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC), as well as the ultrasound images indicating malignancy despite FNA results falling under TBSRTC category II. This study assessed the sampling satisfaction rate, diagnostic efficacy, and complications associated with CNB compared to rFNA. Additionally, the impact of repeat puncture time and nodule size on diagnostic efficacy was analyzed. Results: Following repeat punctures, the satisfaction rate of the CNB sampling was found to be significantly higher than that of rFNA (83.9% vs 66.8%). The diagnostic rate in the CNB group was significantly greater compared to that of the rFNA group (70.7% vs 35.8%). In patients with nodule maximum diameters ranging from 5 mm to 20 mm, the diagnostic accuracy was significantly higher in the CNB group compared to that in the rFNA group. In patients with intervals less than 90 days, between 90 days and one year, the diagnostic rate in the CNB group was found to be higher compared to that in the rFNA group. In CNB, not immediately adjacent to the capsule was a risk factor for nodular puncture bleeding (37.0% vs 22.7%.). Conclusion: CNB demonstrated higher rates of satisfaction and diagnosis compared to the rFNA. The diagnostic effectiveness of CNB was not influenced by the time interval or the size of the thyroid nodule. Therefore, in cases where the initial FNA diagnosis of thyroid nodules is inconclusive, CNB should be considered as a viable option for re-puncture.

Effectiveness of Cytological Diagnosis with Outer Cannula Washing Solution for Computed Tomography-Guided Needle Biopsy.

RATIONALE AND OBJECTIVES: We evaluated the availability of cytological diagnosis with outer cannula washing solution (C-OCWS) as a clinical diagnostic tool for computed tomography (CT)-guided needle biopsy. MATERIALS AND METHODS: We retrospectively assessed 109 consecutive patients (71 males, 38 females; median age 68 years), who underwent CT-guided needle biopsy. In all patients, the specimens sampled by the inner needle were used for histological diagnosis, and those taken from the outer cannula were rinsed with 0.9% saline solution: outer cannula washing solution for cytological diagnosis. The accuracy of C-OCWS in addition to histological diagnosis were compared with that of histological diagnosis alone. We used binary logistic regression analysis to determine the variables associated with diagnostic accuracy for malignancy and lesion characteristics. RESULTS: The C-OCWS method precisely diagnosed 7 (6.4%) malignant lesions (i.e., effective cases) in the 109 patients characterized as "negative for malignancy" via histological diagnosis alone. The accuracy of the combination of C-OCWS and histological diagnoses was significantly higher than that of histological diagnosis alone (0.95 vs. 0.89, respectively; p = 0.023). Multivariate logistic regression analysis showed that increasing only a marginal ratio (failure rate for proper position of biopsy needle within the tumor) was independently associated with a high rate of effective cases (p = 0.003). CONCLUSION: C-OCWS may be helpful for improving the quality of CT-guided needle biopsy, and is a simple method that may not necessarily increase the patients' physical burden.

Applying Probe Electrospray Ionization Mass Spectrometry to Cytological Diagnosis: A Preliminary Study by Using Cultured Lung Cancer Cells.

OBJECTIVES: Cytology and histology are 2 indispensable diagnostic tools for cancer diagnosis, which are rapidly increasing in importance with aging populations. We applied mass spectrometry (MS) as a rapid approach for swiftly acquiring nonmorphological information of interested cells. Conventional MS, which primarily rely on promoting ionization by pre-applying a matrix to cells, has the drawback of time-consuming both on data acquisition and analysis. As an emerging method, probe electrospray ionization-MS (PESI-MS) with a dedicated probe is capable to pierce sample and measure specimen in small amounts, either liquid or solid, without the requirement for sample pretreatment. Furthermore, PESI-MS is timesaving compared to the conventional MS. Herein, we investigated the capability of PESI-MS to characterize the cell types derived from the respiratory tract of human tissues. STUDY DESIGN: PESI-MS analyses with DPiMS-2020 were performed on various type of cultured cells including 5 lung squamous cell carcinomas, 5 lung adenocarcinomas, 5 small-cell carcinomas, 4 malignant mesotheliomas, and 2 normal controls. RESULTS: Several characteristic peaks were detected at around m/z 200 and 800 that were common in all samples. As expected, partial least squares-discriminant analysis of PESI-MS data distinguished the cancer cell types from normal control cells. Moreover, distinct clusters divided squamous cell carcinoma from adenocarcinoma. CONCLUSION: PESI-MS presented a promising potential as a novel diagnostic modality for swiftly acquiring specific cytological information.

Cellular composition research of serous pleural effusion fluids. Conceptual issues of preanalytics.

The purpose of this work was to show the effectiveness of the cytological method on a small number of observations, excluding all possible errors of the preanalytical stage. The paper presents several simple and easily reproducible algorithms for the cytological study of serous pleural effusions with small cellular content. On the example of 20 observations of the study of the cellular composition of serous exudates, a direct dependence of the research results on the preanalytical stage is shown. A complete study of effusion fluids in compliance with all stages of preanalytics and the use of modern methods of cytological diagnostics makes it possible to nullify the options for false-negative.

The role of cytology in endobronchial ultrasound-guided transbronchial needle aspiration: A study of 813 cases focusing on diagnostic yield, an analysis of misdiagnosed cases and diagnostic accordance rate of cytological subtyping.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for cytological and histological diagnosis. The objective of this study was to explore the role of cytological diagnosis in EBUS-TBNAs. METHODS: Eight hundred and thirteen consecutive cases performed EBUS-TBNA with both cytological and histological diagnoses were retrospectively reviewed. All patients were followed up for clinical data. RESULTS: Before immunohistochemical examination, the cytological sensitivity, specificity, and diagnostic accuracy of EBUS-TBNAs were 92.9% (421/453), 98.9% (348/352), 95.5% (769/805), respectively. After immunohistochemical examination, the sensitivity, specificity, and diagnostic accuracy were 93.0% (423/455), 99.4% (348/350), 95.8% (771/805), respectively. The majority of false-negative were cases whose cytological diagnosis was "atypical" or the cytological diagnosis suggested "inadequate." "Neoplastic" were also prone to false-negative cytology. The diagnostic accordance rate of cytological subtyping was 90.3% for squamous-cell carcinoma, 99.2% for adenocarcinoma, and 98.1% for small-cell carcinoma before immunohistochemical examination, and became 85.9%, 98.5%, and 98.2% after immunohistochemical examination, respectively. CONCLUSION: Cytological diagnosis in EBUS-TBNAs had a good sensitivity and high specificity. The sensitivity and specificity of cytological diagnosis were proved to be higher after the immunohistochemical examination. At the same time, cytology had high accordance rate in subtype diagnosis. False-negative results occurred more commonly in cases whose cytological diagnosis was "atypical" or the cytological diagnosis suggested "inadequate" or the corresponding histological diagnosis was "Neoplastic."

Diagnostic benefit of cytological and histopathological examinations for recurrent vaginal cancer metastasizing to the duodenum: A case report.

This is the first case report of a vaginal squamous cell carcinoma that metastasized to the duodenum. Cytological and histopathological examinations are useful for the diagnosis of a duodenal metastasis.

Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis.

BACKGROUND: Smear cytology (SC) using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the established and traditional choice for diagnosing pancreatic lesions. Liquid-based cytology (LBC) is a novel alternative cytological method, however, the comparative diagnostic efficacy of LBC remains inconclusive. AIM: To examine the diagnostic efficacy of LBC and SC for pancreatic specimens obtained through EUS-FNA via a systematic review and meta-analysis. METHODS: A systematic literature search was performed using PubMed, EMBASE, the Cochrane Library, and Web of Science. The numbers of true positives, false positives, true negatives, and false negatives for each cytological test (LBC and CS) were extracted from the included studies. The pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve (AUC) were calculated, and the AUC was compared by Tukey's multiple comparisons test. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies II tool. RESULTS: A total of 1656 patients in eight studies were included. The pooled sensitivity and specificity and the AUC for LBC were 0.76 (95%CI: 0.72-0.79), 1.00 (95%CI: 0.98-1.00), and 0.9174, respectively, for diagnosing pancreatic lesions. The pooled estimates for SC were as follows: Sensitivity, 0.68 (95%CI: 0.64-0.71); specificity, 0.99 (95%CI: 0.96-100.00); and AUC, 0.9714. Similarly, the corresponding values for LBC combined with SC were 0.87 (95%CI: 0.84-0.90), 0.99 (95%CI: 0.96-1.00), and 0.9894. Tukey's multiple comparisons test was used to compare the sensitivities and AUCs of the three diagnostic methods; statistically significant differences were found between the three methods, and LBC combined with SC was superior to both LBC (P < 0.05) and SC (P < 0.05). The pooled sensitivity and AUC did not change significantly in the sensitivity analysis. CONCLUSION: LBC may be sensitive than SC in the cytological diagnosis of pancreatic lesions, however, the superior diagnostic performance of their combination emphasizes their integrated usage in the clinical evaluation of pancreatic lesions.

The Morphological Analysis of Cells in the Bronchoscopic Brushing and TBNA of Patients with Lung Adenocarcinoma.

Biopsy, brushing, and transbronchial needle aspiration (TBNA) are the most common methods for diagnosis of lung adenocarcinoma and are taken during the same diagnostic bronchoscopic procedure. However, it is not clear what the morphological diagnostic criteria of cytology by brushing or TBNA are. A retrospective analysis was performed on 136 patients who underwent video bronchoscopy examination for diagnostic purposes. All the subjects were performed brushing or TBNA and confirmed as lung adenocarcinoma by biopsy or postoperative pathology. An additional 140 randomly selected patients with benign lung diseases were included in the study and used as a control group. The benign cells usually confused with adenocarcinoma cells were ciliated columnar cells, mucous columnar cells, ciliated cuboid cells, and reactive ciliated cells, respectively. The number of cases diagnosed as adenocarcinoma cells, carcinoma cells, suspicious cancer cells, and atypical proliferative cells by cytology was 101, 11, 20, and 4, respectively. The main basis for the interpretation of adenocarcinoma cells is the enlargement of individual nucleus, the arrangements of multistage papillary, and the general enlargement of nuclei, while the main clue for the interpretation of suspicious cancer cells and dysplasia cells comes from escape cells. The results suggested that the degree of nuclear enlargement, multiple papillary arrangement, and escape cells or escape trend cells are important clues for the interpretation of lung adenocarcinoma cells, while the atypical proliferative cells were similar to escape cells or escape trend cells, which were essentially benign cells beside the cancer.

Transthoracic fine-needle aspiration diagnosis of solid, subsolid, and partially calcified lung nodules: A retrospective study from a single academic center.

BACKGROUND: The large-scale National Lung Cancer Screening Trial demonstrated an increased detection of early-stage lung cancers using low-dose computed tomography scan in the screening population. It also demonstrated a 20% reduction of lung cancer-related deaths in these patients. AIMS: Although both solid and subsolid lung nodules are evaluated in studies, subsolid and partially calcified lung nodules are often overlooked. MATERIALS AND METHODS: We reviewed transthoracic fine-needle aspiration (FNA) cases from lung nodule patients in our clinics and correlated cytological diagnoses with radiologic characteristics of lesions. A computer search of the pathology archive was performed over a period of 12 months for transthoracic FNAs, including both CT- and ultrasound-guided biopsies. RESULTS: A total of 111 lung nodule cases were identified. Lesions were divided into three categories: solid, subsolid, and partially calcified nodules according to radiographic findings. Of 111 cases, the average sizes of the solid (84 cases), subsolid (22 cases), and calcified (5 cases) lesions were 1.952 ± 2.225, 1.333 ± 1.827, and 1.152 ± 1.984 cm, respectively. The cytological diagnoses of three groups were compared. A diagnosis of malignancy was made in 64.28% (54 cases) in solid, 22.72% (5 cases) in subsolid, and 20% (1 case) in partially calcified nodules. Among benign lesions, eight granulomatous inflammations were identified, including one case of solid, five cases of subsolid, and two cases of calcified nodules. CONCLUSIONS: Our study indicates that solid nodules have the highest risk of malignancy. Furthermore, the cytological evaluation of subsolid and partially calcified nodules is crucial for the accurate diagnosis and appropriate clinical management of lung nodule patients.

Cytological features of breast implant-associated anaplastic large cell lymphoma in pleural effusion.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare CD30-positive ALK-negative T-cell non-Hodgkin lymphoma included as a provisional entity in the 2017 WHO classification of lymphoid neoplasms. BIA-ALCL arises as proliferating cells over the surface of the implant. It is generally an indolent disease if confined within the fibrous capsule. In contrast, mass and/or infiltration beyond the capsule is much more aggressive. This report describes a case of infiltrative BIA-ALCL with massive pleural effusion containing hallmark BIA-ALCL cells showing the characteristic morphologic appearance of high-grade anaplastic lymphoma, CD30-positive but ALK-negative with variable staining for T-cell antigens. Detailed cytological features of BIA-ALCL in pleural fluid are described along with the results of a literature search performed for BIA-ALCL cases with pleural effusion. This report expands the spectrum of BIA-ALCL pathology to include chest wall involvement and pleural effusion.

Effects of an Additional Liquid Based Cytology Prepate on Cytological Diagnosis in High-Risk HPV Positive, PaP Test Negative Cases.

OBJECTIVES: To investigate the effects of a second cytology preparation on cytological diagnosis in high-risk HPV positive and PaP smear-negative cases. METHODS: This retrospective study was conducted with 57 cases who underwent cytological evaluation and cotest in our center in 2016-2017. All of these cases were high-risk HPV positive, PaP smear-negative and had a second preparation. All preparations were re-evaluated by a cytopathologist and a pathologist. Twenty-five of the cases who had a positive diagnosis in the second preparation had a cervical biopsy. RESULTS: In 46 (80%) of the cases, the cytological diagnosis was the same and negative in the first and second preparations. Second preparations of 11 cases (19.2%) were positive. Twenty of 25 patients (77%) with cervical biopsy had premalignant lesion. CONCLUSION: In high-risk HPV positive and PaP smear-negative cases, patient management is different from cases where these two tests are positive together. According to our results, 19.2% of high-risk HPV positive and PaP smear-negative cases were given positive cytological diagnosis by second cytology preparation. Biopsy results support our cytological findings. The incidence of positive cytological diagnosis increases in PaP smear with the second preparation. With this protocol, patient management changes, follow-up time and number can be reduced.

Screening system for epidermal growth factor receptor mutation detection in cytology cell-free DNA of cerebrospinal fluid based on assured sample quality.

BACKGROUND: The cobas® epidermal growth factor receptor (EGFR) Mutation Test v2 designed for cell-free DNA (cfDNA) is approved as a companion diagnostic for osimertinib therapy. The aim of this study was to evaluate the concordance of EGFR mutation detection between paired primary or recurrent samples, and cerebrospinal fluid (CSF) cytology samples of lung cancer patients. METHODS: In total, 26 lung cancer patients with supernatant cytology cfDNA in CSF were analysed for EGFR mutations using the cobas® EGFR Mutation Test v2.0 designed for cfDNA, and the concordance rates between CSF cfDNA and primary or recurrent samples were investigated. RESULTS: Of the 26 CSF cytology cfDNA samples, 46.1% (12/26) were valid and 53.9% (14/26) were invalid. Sensitivity, specificity and accuracy between the valid CSF cfDNA samples and primary or recurrent samples for detection of EGFR mutation, including T790M were 87.5%, 100.0% and 91.7%, respectively. Amounts of both inflammatory cells and tumour cells in CSF cytology were higher in the valid evaluation samples than in the invalid samples (P < .05), and mutant EGFR was detected in 80.0% (4/5) of the valid CSF cytology cfDNA samples with a negative cytology diagnosis. CONCLUSIONS: The cobas® EGFR Mutation Test v2.0 can accurately detect EGFR mutations, including T790M, from supernatant cfDNA of CSF cytology samples. Utilisation of supernatant cytology cfDNA in CSF will allow us to perform both EGFR mutation analysis and cytopathological diagnosis at the same time. This represents a new role of cytology in patient treatment, based on assured sample quality.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Lesions of Oral Cavity and Salivary Glands: A Clinico-Pathological Study.

OBJECTIVE: Fine Needle Aspiration Cytology (FNAC) is a rapid, reliable and safe diagnostic tool used for various lesions of the oral cavity and salivary glands. The present study was undertaken to categorize the cytomorphology of the oral cavity and salivary gland lesions on FNAC and to assess the accuracy of FNAC in arriving at a diagnosis. MATERIALS AND METHODS: A prospective study on oral cavity swellings and salivary gland aspirates was done during a 2 year period from August 2015 to July 2017 in which a total of 70 FNAC's were performed. There were 12 aspirates obtained from oral cavity swellings and 58 aspirates were obtained from salivary glands. Histopathological evaluation of 65 lesions was done and was considered as gold standard. Only the lesions undergoing histopathological confirmation were included in the study. The sensitivity, specificity, diagnostic accuracy and clinical utility index were evaluated for accuracy of FNAC. RESULTS: Hard palate (33.33%) was the predominantly aspirated site in the oral cavity. Parotid gland was the predominant gland aspirated (60.32%) among the involved salivary glands. Non-neoplastic lesions constituted 18.47% cases whereas neoplastic lesions were 81.53% (60.00% benign and 21.53% malignant). Pleomorphic adenoma (28.65%) was the most common benign lesion in the oral cavity involving hard palate and as salivary gland neoplasm (70.54%). Squamous cell carcinoma (60%) was the most common malignant lesion of oral cavity involving the tongue and buccal mucosa and adenoid cystic carcinoma (44.45%) was the commonest malignancy in salivary gland malignant neoplasms. The overall sensitivity, specificity and accuracy of FNAC in the present study were 89.5%, 100% and 85% respectively. CONCLUSION: FNAC is a safe, cost-effective and reliable technique effective in diagnosing the spectrum of different lesions in the oral and maxillofacial region.

Diagnostic Utility of HPV16 E6 mRNA or E7 mRNA Quantitative Expression for Cervical Cells of Patients with Dysplasia and Carcinoma.

Current human papillomavirus (HPV)16 DNA testing has high sensitivity but low specificity, while mRNA testing (qualitative) improves the specificity. However, both techniques are not able to discriminate between transient and persistent infections. To overcome the disadvantages, we quantitatively detected E6 and E7 mRNAs by quantitative real-time polymerase chain reaction (qRT-PCR) in cervical brushing cells from 87 HPV16+ and 31 HPV16- patients. Our results showed that the expression levels of E6 mRNA or E7 mRNA were significantly increased in HPV16-positive cases than that in the negative cases. Furthermore, in HPV16+ cases, the expression levels of E6 mRNA were significantly increased in invasive cancer compared with high-grade squamous intraepithelial lesion (HSIL; p < 0.01), and HSIL compared with low-grade squamous intraepithelial lesion (LSIL; p < 0.01). There were no significant changes between LSIL and benign lesions. The expression levels of E7 mRNA presented no significant difference among the above-mentioned four groups. To test whether qRT-PCR can discriminate between transient and persistent infections, 57 HPV16+ patients were followed up for 1 year, and our results demonstrated that the expression levels of both E6 mRNA and E7 mRNA in the persistent infection group were significantly increased relative to the transient infection group ( p < 0.01 or 0.05). Thus, a quantitative detection of the expression levels of E6 mRNA in cervical brushing cells may not only be used as an ancillary tool to cytological diagnosis of cervical neoplasia, but may also help to determine the severity of the lesions and the triage of transient infection.

Valoración de técnicas de citología en mucosa bucal en pacientes con síndrome de Sjögren / Assessment of cytology techniques in oral mucosa of Sjögren's syndrome patients

Resumen El objetivo del presente trabajo es comparar dos técnicas de estudio de citología bucal, la citología exfoliativa y de impresión, para evaluar cambios en la mucosa oral que permitan el diagnóstico no invasivo de síndrome de Sjögren (SS). Pacientes: Se seleccionaron 50 pacientes apareados por sexo y edad, diagnosticados con síndrome de Sjögren según criterios del Consenso Americano-Europeo. Los pacientes fueron distribuidos en tres grupos experimentales: controles sanos (C), n = 14, boca y ojo secos sin SS (BO), n = 13, y con SS n = 23. Material y métodos: Para la citología exfoliativa se utilizó cepillo recolector de células (Citobrush) deslizándolo a lo largo de la lámina de vidrio, fijándose posteriormente en etanol al 95%. En citologías por impresión se utilizó papel de acetato de celulosa (Milipore Hawp 304®), en tiras de un cm de longitud colocadas sobre la superficie de la mucosa bucal sobre el surco vestibular superior inmovilizando el papel y presionando por tres segundos. Se tiñeron con técnica de Papanicolau (PAP). Se valoró la morfología e histomorfometría, estudiando: área citoplasmática (AC), área nuclear (AN), relación núcleo-citoplasma (N:C) y cantidad de células por milímetro cuadrado (mm2). Resultados: Ambas técnicas nos permitieron observar en C: células epiteliales pavimentosas aisladas, basófilos, núcleos centrales normales, 20 a 30 por mm2, relación N/C 1:8. En el grupo BO: células aisladas, agrupadas y plegadas, con citoplasma a predominio eosinófilo, aumento de la cantidad de células 40 por mm2, relación núcleo-citoplasma relación N/C 1:4. En los pacientes SS se observó el área nuclear con cromatina más densa, 400 células por mm2, y relación N/C 1:2 en relación a BO y C. Hubo diferencias estadísticamente significativas entre los grupos en todas las características estudiadas. Conclusión: Podríamos inferir que la citología por impresión puede ser utilizada en el diagnóstico de lesiones orales y sistémicas en pacientes con hiposalivación.

Abstract The aim of the present research project was to compare two techniques for oral cytology study (exfoliative cytology and impression cytology) in order to assess changes in oral mucosa which might allow non -invasive diagnosis of Sjögren's syndrome cases (SS). Patients: 50 patients were selected, patients were paired by age and gender, and had been diagnosed with Sjögren's syndrome according to criteria of the American-European Consensus. Patients were distributed into the following three experimental groups: healthy control group (C), n = 14, Dry mouth and eyes group without SS, (ME) n = 13, and SS group n = 23. Material and methods: A cell harvesting brush (Cytobrush) was used for the exfoliative cytology procedure, sliding it along a glass plate and later fixating harvested cells in 95% ethanol. Cellulose acetate paper (Millipore Hawp 304®) was used for the impression cytology procedure. The paper was in 1 cm long stripes which were placed on the oral mucosa surface above upper vestibular groove; stripes were immobilized and pressure was applied for three seconds. Papanicolau (PAP) technique was used for dyeing. Morphology and histomorphology were assessed studying the following: cytoplasmic area (CA), nuclear areas (NA) nucleus-cytoplasm relationship (N:C) and amount of cells per square millimeter (mm2). Results: Both techniques revealed the following in C: isolated single-layered epithelial cells, basophils, normal central nuclei, 20 to 30 per mm2, N:C ratio 1:8. In the eye and mouth group (EM): grouped and folded isolated cells, cytoplasm with eosinophilic predominance increase of cell amount to 40 per mm2, nucleus-cytoplasm relationship N/C 1:4. SS patients showed the following: nuclear area with denser chromatin, 400 cells per mm2, and 1:2 N/C relationship with respect to mouth and ears and control. Statistically significant differences wereobserved among groups in all studied characteristics. Conclusion: We can infer that impression cytology can be used in systemic and oral lesion's diagnosis in patients afflicted with hyposalivation.

[Possibilities of cytological diagnosis of the nature of the exudate at the stage of emergency.]

Cytological diagnosis by effusions is currently the only reliable method of morphological verification of the diagnosis, it has prognostic significance and determines the choice of treatment strategy. At the same time, the variability of normal mesothelial cells causes significant difficulties in its differential diagnosis with reactive mesothelium, malignant mesothelioma and cancer metastasis, which requires additional analytical methods. A retrospective study of cytological preparations for 2017 was conducted, as well as the effectiveness of the use of fluorescent immunocytochemistry (FITZ) on the test system "biochip" in combination with a traditional cytological study was evaluated. During the period of November 2017 - July 2018, 46 exudates of serous cavities were studied, which showed that 9 patients (19.6%) were diagnosed with metastatic effusion, 31 (66.7%) patients had reactive exudate, suspicion of the malignant nature of serous fluid was expressed in 4 patients (8.7%), and 4.8% of persons (2 samples) failed to make an accurate diagnosis. After an additional FITZ study using the "Biochip" test system, the number of patients diagnosed with metastatic effusion increased to 7 (25.9%) due to a decrease in the percentage of cases of unspecified effusion. The combined use of traditional cytology and fluorescent immunocytochemistry in the diagnosis of effusion fluids at the stage of emergency medical care to the patient complements each other and contributes to a faster and more reliable diagnosis, as it allows to confirm the malignancy of the test material, and to assume the primary focus.

Ultrasonographic characteristic influencing of non-diagnostic results for ultrasound-guided fine-needle aspiration of thyroid nodules / 中华超声影像学杂志

Objective To explore the clinical and ultrasonographic characteristics leading to non-diagnostic results after ultrasound-guided fine-needle aspiration ( US-FNA) in patients with thyroid nodules . Methods One thousand and thirty-four thyroid nodules of 1009 patients who underwent US-FNA from June 2013 to September 2015 in Fudan University Shanghai Cancer Center were included in this study . The ultrasonographic characteristics , cytological and histological diagnosis were collectecl . Univariate and multivariate logistic methods were applied to analyze the factors bringing about non-diagnostic results . Results Of the 1034 nodules ,174 ( 16 .8％ ) had non-diagnostic results and 860 ( 83 .2％ ) had diagnostic results . Age ,echogenicity ,anteroposterior/transverse diameter ratio ( AT ) ,calcification ,margin and depth were associated with nondiagnostic results . Age ≥45 years ,the largest diameter ≤10 mm ,AT <1 ,located at the middle 1/3 and dorsal 1/3 in the cross section of nodules , macrocalcification were proved as independent influencing factors for non-diagnostic results of FNA . Conclusions Age≥45 years ,the largest diameter ≤10 mm ,AT < 1 ,located at the middle 1/3 and dorsal 1/3 in the cross section of nodules , macrocalcification are independent influencing factors of non-diagnostic results . As a result ,for nodules with the characteristics above it may recommend follow up instead of FNA . During follow-up ,it may recommend surgery if the nodule has progressed .

Catch me if you can-How to make the best use of pleural effusion.

Etiology diagnosis of pleural effusion is a commonly encountered yet challenging problem. How to make the best use of pleural effusion evokes thinking. Myelomatous pleural effusion (MPE) is a rare condition and has been reported sporadically. We report an extremely rare case of multiple myeloma (MM) [IgD-lambda (λ) type, stage III B] with MPE as initial presentation and complicated with massive pericardial effusions during the progression of the disease. Cytological identification of malignant plasma cells in pleural effusion is the most direct method to diagnose MPE. What we learn from this case is that cell block can increase the sensitivity of detecting malignancies compared with conventional smear. Doctors should make best use of pleural effusion before further invasive procedure.

Acinic Cell Carcinoma Papillary-Cystic Variant: Diagnostic Pitfalls in Fine Needle Aspiration Cytology.

Acinic cell carcinoma is a rare tumour comprising 1%-3% of all salivary gland neoplasms. Acinic Cell Carcinoma Papillary Cystic Variant (ACC-PCV) is a distinct subtype and shows variegated appearance on cytology. It is important to differentiate it from other malignant lesions because of its poor prognosis. We describe a case of 20-year-old female with swelling on left cheek for the last four months. Fine needle aspiration was done and diagnosed as intermediate grade mucoepidermoid carcinoma on cytology. Histological study of the resected tumour showed features of ACC-PCV. We are presenting this case to illustrate the diagnostic problems encountered in cytology and important points to be kept in mind while reporting FNA of salivary gland tumours.