Efficacy of parathyroidectomy compared with active surveillance in patients with mild asymptomatic primary hyperparathyroidism: a systematic review and meta-analysis of randomized-controlled studies.

OBJECTIVE: Parathyroidectomy (PTx) has an established benefit in patients with symptomatic primary hyperparathyroidism (PHPT). However, its efficacy in mild asymptomatic PHPT has not been proven. This study aimed to systematically review and meta-analyze the best available evidence from randomized-controlled trials comparing the efficacy of PTx over conservative management (non-PTx) on skeletal outcomes [fractures and bone mineral density (BMD)], nephrolithiasis risk and quality of life (QoL) in patients with mild asymptomatic PHPT. METHODS: A comprehensive literature search was conducted in PubMed, Scopus and Cochrane databases, from conception to February 23, 2020. Data were extracted from the studies that fulfilled the eligibility criteria and were synthesized quantitatively (fixed or random effects model) as relative risks and percentage mean differences (MD) with 95% confidence intervals (CI). I2 index was employed for heterogeneity. RESULTS: Four studies were included in the meta-analysis. There was no difference in fracture risk between PTx and active surveillance. The PTx group demonstrated higher BMD [MD 3.55% (95% CI 1.81, 5.29) in lumbar spine and 3.44% (95% CI 1.39, 5.49) in total hip, without difference in femoral neck and forearm] and lower calcium concentrations (MD - 13.26%, 95% CI - 7.10, - 19.43) compared with the non-PTx group. No difference was observed between groups regarding nephrolithiasis or QoL indices, except for general health (higher in PTx group). CONCLUSIONS: In patients with mild asymptomatic PHPT, PTx increases BMD and reduces serum calcium concentrations. However, its superiority over active surveillance in terms of fracture risk, nephrolithiasis and QoL cannot be supported by current data.

Imprint cytology. A rapid, reliable method of diagnosing breast malignancy.

OBJECTIVE: To compare imprint cytology with fine needle aspiration biopsy and histology for the intraoperative diagnosis of breast malignancy. STUDY DESIGN: We evaluated imprint cytology, comparing it with other diagnostic techniques. Three hundred fifty-one cases (180 benign and 171 malignant) were studied by fine needle aspiration cytology, imprint cytology and histopathology. RESULTS: Imprint cytology, as compared to histopathology, had 98.3% accuracy, with 97.1% sensitivity and 99.4% specificity. Aspiration cytology was less accurate than imprint cytology as compared to histopathology (accuracy 94.9%, sensitivity 93.9%, specificity 96.2%). CONCLUSION: These data confirm the value of imprint cytology and suggest that it could be used intraoperatively as an alternative to frozen section if a pathology laboratory is not available.

PAPNET for cervical cytology screening. Experience in Greece.

OBJECTIVE: To validate the efficacy of PAPNET for cervical cytology screening. STUDY DESIGN: From a total of 50,000 gynecologic cases we selected 24 primarily negative smears from patients who, during follow-up, developed a precancerous lesion or cancer in a short time, ranging from a few months to two years. These negative smears were rescreened by the PAPNET automated system and reevaluated by two observers. A third observer blindly reevaluated the same cases manually. RESULTS: Reevaluation after PAPNET screening showed one false negative smear, for a rate comparable to that of manual reevaluation, which also reclassified the same case. The time required to interpret a smear using the PAPNET system was approximately one minute, while the time required for conventional manual screening was approximately five. CONCLUSION: PAPNET is an efficient and fast screener for the detection of precancerous cervical lesions and cancer.

Efficacy of the Isaacs Endometrial Cell Sampler in the cytologic detection of endometrial abnormalities.

The efficacy of the Isaacs Endometrial Cell Sampler to obtain specimens for cytologic examination to detect both hormonal disturbances and precursors of malignancy of the endometrium was assessed in 120 symptomatic women. Correlation of the cytologic results with the histologic diagnosis on curettage specimens showed a diagnostic accuracy of 96.3%. The cytologic criteria for diagnosing samples obtained with the Isaacs device are presented.

A comparative study of the Papanicolaou staining method and the fat stain technique in malignant and non-malignant lesions of the urinary tract.

We have collected urine specimens from cases of malignant and nonmalignant lesions of the urinary system and have proceeded to a comparative study of these cases with their clinicopathologic findings after staining them with the Papanicolaou method and the fat stain method. It was found that the fat stain is not specific for renal cell carcinoma only. However, a combination of fat stain and Papanicolaou stain as a second check up of potential malignancy would be the best way of examination.

Benign phyllodes tumour vs fibroadenoma: FNA cytological differentiation.

The differential diagnosis of fibroadenomas vs phyllodes tumours by fine needle aspiration (FNA) cytology is not possible in the majority of cases. The present study aims to look at common and dissimilar features to allow differentiation, if possible. We reviewed the FNA findings of 18 histologically proven phyllodes tumours and 18 fibroadenomas, checking in each case the epithelial features, the stromal features, and any atypia. Using a semi-quantitative score assessed by two observers we were able in most cases to distinguish a phyllodes tumour from a fibroadenoma. The most important criteria were larger stromal fragments, numerous plump stromal bare nuclei, and the higher ratio of stromal bare nuclei to epithelial bare nuclei in phyllodes tumours. In the present study, an original diagnosis of phyllodes tumour was made in 7/18 (38.9%) cases but with our criteria this could be improved to 15/18 (83.3%) cases. Therefore, the presence of specific stromal features in a dimorphic cellular pattern should suggest the correct diagnosis and differentiate its appearance from a cellular fibroadenoma.

Evaluation of HMFG2 and thyroglobulin in the diagnosis of thyroid fine needle aspiration (FNA).

In order to appraise the usefulness of HMFG2 and thyroglobulin (Tg) as specific markers for the diagnosis of thyroid disease, we studied 63 FNA smears. Cases tested included 30 benign (nine colloid goitres, six cases of Hashimoto's thyroiditis, six Hürthle cell adenomas, nine follicular adenomas) and 33 malignant lesions (nine follicular carcinomas, 12 papillary carcinomas, nine anaplastic carcinomas, three medullary carcinomas). All cases with malignant lesions except the anaplastic carcinomas were positive for HMFG2. Immunoreactive cells to HMFG2 were also found in 15 adenomas out of 30 benign cases. Positive Tg reaction was found in benign and malignant thyroid lesions, except six cases of Hashimoto's thyroiditis, nine anaplastic and three medullary carcinomas. The results obtained indicate that morphology paired with immunocytochemistry can usually depict a more specific profile of thyroid lesions for better evaluation of the pathology.

Detection of c-Ha-ras oncogene expression in pleural and peritoneal smear effusions by in situ hybridization.

This study was undertaken to determine the presence of the c-Ha-ras protooncogene in pleural and peritoneal effusions. Cells from 40 pleural and peritoneal fluids from patients with malignant and nonmalignant diseases were studied by in situ DNA hybridization utilizing a biotinylated probe. The results were correlated with those obtained by conventional cytological methods. A cytological diagnosis of metastatic carcinoma was established in 67% of the patients with malignancy and effusion, and in 6% of the patients with benign disease accompanied by effusion. On the other hand, a relatively high proportion of ras expression was observed in 38% of the cases representing benign and reactive effusions and as high as 88% in the cases with malignant tumor and effusion. These results suggest that the ras oncogene may have an important role in differentially diagnosing benign and reactive mesothelial cells from malignant cells.

Presence of epidermal growth factor receptor in breast smears of cyst fluids: relationship to electrolyte ratios and pH concentration.

The purpose of this study was to evaluate and correlate different high risk factors in breast cysts to produce a more accurate prognosis. We considered the cytology of the lining epithelium (apocrine or flattened), the Na+/K+ ratio (less than 3; greater than or equal to 3), the pH (lower, equal, or higher than 7.30), and the EGFr (present or not) in an attempt to reach better prognoses and diagnoses by evaluating more than one risk factor. Our material of 40 macrocysts consisted of 23 simple cysts with flattened epithelium and 17 complex cysts with apocrine or hyperplastic epithelium. In the simple cysts, the Na+/K+ ratio was greater than or equal to 3, while in the complex cysts the Na+/K+ ratio was, in all cases but one, less than 3. The pH was not significantly lower than neutral in the complex cysts. The EGFr was detected in 5 of 23 simple cysts and in 12 of 17 complex cysts. In conclusion, reaction of EGFr in smears of cyst fluids with the low intracystic electrolyte ratios may provide an explanation of why women with apocrine metaplasia or epithelial hyperplasia may be at higher risk of breast cancer than women with cysts which are lined by flattened epithelium.