Micronucleus Assay in Exfoliated Buccal Epithelial Cells Using Liquid Based Cytology Preparations in Building Construction Workers.

BACKGROUND AND OBJECTIVE: Cytogenetic damage in exfoliated buccal epithelial cells due to environmental and occupational exposure is often monitored by micronucleus (MN) assay using liquid based cytology (LBC) preparations. This study was performed to evaluate MN in exfoliated buccal epithelial cells of building construction workers using LBC preparations. METHODS: LBC preparations of exfoliated buccal epithelial cells from 100 subjects [50 building construction workers (cases) and 50 administrative staffs (controls)] was evaluated by May-Grunwald Giemsa, Hematoxylin and Eosin and Papanicolaou stains. Student's t test was used for statistical analysis and a P value of <0.05 was considered as statistically significant. RESULTS: The mean frequencies of MN for cases were significantly higher than controls regardless of staining methods used. There were statistically significant differences between smokers and non-smokers of the controls as well as duration of working exposure (<5 and >5 years) and smokers and non-smokers of cases (P=0.001). However, there were meaningful differences regarding mean frequencies of MN between smokers, non-smokers, those with alcohol consumption or not in cases and controls using various stains (P=0.001). CONCLUSION: There was an increased risk of cytogenetic damage in building construction workers. However, evaluation of MN of exfoliated buccal epithelial cells in building construction workers serve as a minimally invasive biomarker for cytogenetic damage. LBC preparations can be applied for MN assay as it improves the quality of smears and cell morphology, decreases the confounding factors and reduces false positive results.

Comparative Assessment of Conventional Papanicolaou and Modified Ultrafast Papanicolaou Stains in Fine Needle Aspiration Samples and Body Fluids.

BACKGROUND: Conventional Papanicolaou (Pap) stain has undergone many modifications; of these, ultrafast Pap stain is the most popular as it shortens the turnaround time of reporting. Application of modified ultrafast Pap (MUFP) stain in the evaluation of fine needle aspiration (FNA) samples and body fluids are scanty. AIM: To evaluate the utility of MUFP stain in various FNA samples and body fluids and compare the findings with those of conventional Pap stain. MATERIALS AND METHODS: In this cross-sectional study, two wet-fixed and two airdried smears from each sample [301 samples (255 FNA samples and 46 body fluids)] were prepared and stained by the conventional Pap and MUFP stains, respectively. Concordant and discordant rate was calculated. Quality index (QI) of MUFP stain was assessed by background, overall staining, cell morphology, and nuclear characteristics. MUFP-stained smears were also categorized into excellent, good, and fair. RESULTS: The concordance rate for MUFP stain was 100%. QI of MUFP stain for breast, thyroid, lymph node, soft tissue, salivary gland, and body fluids was 0.9, 0.93, 0.95, 1, 0.94, and 1, respectively. Excellent quality of stain was noted in 53.2% and good in 24.6% of the cases allowing easy diagnosis. In 22.2% of fair cases, diagnosis was possible with some difficulties. CONCLUSION: Our study concluded that MUFP stain could be considered as a rapid and reliable diagnostic tool and can be applied on a regular basis in FNA samples and body fluids to offer immediate diagnosis. However, caution should be taken while reporting certain MUFP-stained smears to avoid over/under diagnosis.

Prevalence and types of preanalytical error in hematology laboratory of a tertiary care hospital in South India.

BACKGROUND: An important component of laboratory medicine is preanalytical phase. Since laboratory report plays a major role in patient management, more importance should be given to the quality of laboratory tests. AIM: The present study was undertaken to find the prevalence and types of preanalytical errors at a tertiary care hospital in South India. MATERIALS AND METHODS: In this cross-sectional study, a total of 118,732 samples ([62,474 outpatient department [OPD] and 56,258 inpatient department [IPD]) were received in hematology laboratory. These samples were analyzed for preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples. RESULTS: The overall prevalence of preanalytical errors found was 513 samples, which is 0.43% of the total number of samples received. The most common preanalytical error observed was inadequate samples followed by clotted samples. Overall frequencies (both OPD and IPD) of preanalytical errors such as misidentification, incorrect vials, inadequate samples, clotted samples, diluted samples, and hemolyzed samples were 0.02%, 0.05%, 0.2%, 0.12%, 0.02%, and 0.03%, respectively. CONCLUSION: The present study concluded that incorrect phlebotomy techniques due to lack of awareness is the main reason for preanalytical errors. This can be avoided by proper communication and coordination between laboratory and wards, proper training and continuing medical education programs for laboratory and paramedical staffs, and knowledge of the intervening factors that can influence laboratory results.

Application of National Cancer Institute recommended terminology in breast cytology.

BACKGROUND: There is a lack of uniformity with regard to the reporting terminology used in breast cytology by pathologists worldwide, resulting in miscommunication of results among health-care providers. AIM: The present study was aimed to assess the accuracy of fine-needle aspiration cytology (FNAC) in the evaluation of breast lesions using the National Cancer Institute (NCI) recommended terminology. MATERIALS AND METHODS: In this prospective study, a total number of 523 breast FNACs were categorized according to the NCI guidelines. Of these, 286 (54.7%) had histopathological follow-up, and their FNAC diagnoses were compared. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence interval (95% CI) and accuracy of FNAC were calculated. RESULTS: Among 286 FNAC cases, 4 were unsatisfactory (C1), 188 were benign (C2), 11 were atypical, probably benign (C3), 21 were suspicious, favor malignancy (C4), and 62 were malignant (C5). On histopathological examination of categories C2 and C3 (total of 199 cases), 193 were confirmed as benign (true negative) and remaining 6 cases were turned out to malignant (false negative). Among categories C4 and C5 (total of 83 cases), 81 were confirmed as malignant (true positive) and remaining 2 were turned out to be benign (false positive). The sensitivity, specificity, PPV, NPV, and accuracy of FNAC were 93.1% (95% CI, 88.2%-95%), 99% (95% CI, 96.8%-99.8%), 97.6% (95% CI, 92.5%-99.6%), 97% (95% CI, 94.9%-97.8%), and 97.2%, respectively. CONCLUSION: Our study concluded that FNAC reporting using NCI guidelines highly correlated with the histopathological diagnosis.

Evaluation of Micronucleus in Exfoliated Buccal Epithelial Cells Using Liquid-based Cytology Preparation in Petrol Station Workers.

BACKGROUND: Liquid-based cytology (LBC) can be used for the evaluation of micronucleus (MN) in exfoliated buccal epithelial cells of populations occupationally exposed to potentially carcinogenic agents. AIM: This study was undertaken to evaluate the frequency of MN of exfoliated buccal epithelial cells using LBC preparation in petrol station workers. MATERIALS AND METHODS: Fifty petrol station workers (cases) and fifty hospital administrative staffs (controls) were recruited and evaluated for MN by May-Grunwald Giemsa, Hematoxylin and Eosin, and Papanicolaou stains using LBC preparation. Statistical analysis was performed with Student's t-test, and P < 0.05 was considered statistically significant. RESULTS: Regardless of staining method used, the mean frequency of MN for cases was significantly higher than that of controls (P < 0.001). CONCLUSION: The present study concluded that petrol station workers are under risk of significant cytogenetic damage. The MN in exfoliated buccal epithelial cells found to be a useful biomarker of occupational exposure to genotoxic chemicals. LBC can be used for sample preparation to evaluate the frequency of MN in those who are occupationally exposed to potentially carcinogenic agents in view of overall improvement on sample preservation and visualization of cell morphology.

Comparative evaluation of various cytomorphological grading systems in breast carcinoma.

BACKGROUND: The diagnosis of breast carcinoma can be reliably made by fine needle aspiration cytology (FNAC). Grading usually done in histological samples for the selection of therapy but not in cytology. Various cytological grading systems have been proposed; however, none of them is presently considered the gold standard to predict the prognosis. AIM: This study was undertaken to evaluate various 3-tier cytological grading systems and to determine the best possible system corresponds to the histological grading proposed by Elston and Ellis based on the method by Nottingham modification of Scarff-Bloom-Richardson (SBR) method. MATERIALS AND METHODS: In this retrospective study, 94 cases of breast carcinoma FNACs were graded using six cytological grading systems and compared with SBR method. Concordance, association, and correlation studies were done to select best possible cytological grading system. The interobserver reproducibility among the six grading systems was also assessed. RESULTS: Robinson method showed best correlation (ρ = 0.801; P = 0.0001 and τ = 0.783; P = 0.0001), maximum percent agreement (83/94 cases; 88.3%), and a substantial kappa value of agreement (κ = 0.737) with the Nottingham modification of SBR grading system followed by Mouriguand method. Taniguchi system showed better interobserver agreement (87.2%; κ = 0.738). CONCLUSIONS: This study showed that all six cytological grading systems correlated positively with SBR method. However, Robinson's grading system demonstrated the best concordance, correlation, and substantial Kappa value of the agreement with the histological grading by SBR method in comparison to other 3-tier cytological grading systems. Hence, in conclusion, this grading should be routinely incorporated in the cytology reports as it correlates well with histological grade. Despite various cytological grading systems, Robinson's method is simple, more objective, and reproducible, hence being preferable for routine use.

Fine needle aspiration cytology of atypical (C3) and suspicious (C4) categories in the breast and its histopathologic correlation.

BACKGROUND: In 1996, National Cancer Institute (NCI) proposed five categories for the diagnosis of breast cytology in order to bring a degree of uniformity to the diagnostic reporting. Of these, categories 3 and 4 were sparsely studied. AIMS: The present study was undertaken for the evaluation of the fine needle aspiration cytology (FNAC) categories of C3 and C4 in the breast lump and its histopathological correlation. MATERIALS AND METHODS: In the retrospective study, a total number of 728 FNACs were categorized according to the NCI; of these, 28 cases of category C3 and 65 cases of category C4 were compared with histopathological diagnoses. RESULTS: On histopathological examination of category C3, 18 (64.3%) cases showed benign lesions and 10 (35.7%) cases showed malignancy and among the C4 category, benign lesions found in nine (13.8%) and malignancy found in 56 (86.2%) cases. There was a significant statistical difference between the number of benign and malignant diagnoses for cytological categories of C3 (64.3%) and C4 (86.2%) (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of C4 category in the diagnoses of malignancy were 84.8%, 66.7%, 86.2%, and 64.3%, respectively. CONCLUSION: FNAC of the breasts is a simple, cost-effective, accurate, quick, and relatively less painful procedure, and it continues to play an integral part in the management of breast lesions. Our study concluded that there was a statistically significant difference between the number of benign and malignant diagnoses for categories of C3 and C4.

Quality Measures in Pre-Analytical Phase of Tissue Processing: Understanding Its Value in Histopathology.

INTRODUCTION: Quality monitoring in histopathology unit is categorized into three phases, pre-analytical, analytical and post-analytical, to cover various steps in the entire test cycle. Review of literature on quality evaluation studies pertaining to histopathology revealed that earlier reports were mainly focused on analytical aspects with limited studies on assessment of pre-analytical phase. Pre-analytical phase encompasses several processing steps and handling of specimen/sample by multiple individuals, thus allowing enough scope for errors. Due to its critical nature and limited studies in the past to assess quality in pre-analytical phase, it deserves more attention. AIM: This study was undertaken to analyse and assess the quality parameters in pre-analytical phase in a histopathology laboratory. MATERIALS AND METHODS: This was a retrospective study done on pre-analytical parameters in histopathology laboratory of a tertiary care centre on 18,626 tissue specimens received in 34 months. Registers and records were checked for efficiency and errors for pre-analytical quality variables: specimen identification, specimen in appropriate fixatives, lost specimens, daily internal quality control performance on staining, performance in inter-laboratory quality assessment program {External quality assurance program (EQAS)} and evaluation of internal non-conformities (NC) for other errors. RESULTS: The study revealed incorrect specimen labelling in 0.04%, 0.01% and 0.01% in 2007, 2008 and 2009 respectively. About 0.04%, 0.07% and 0.18% specimens were not sent in fixatives in 2007, 2008 and 2009 respectively. There was no incidence of specimen lost. A total of 113 non-conformities were identified out of which 92.9% belonged to the pre-analytical phase. The predominant NC (any deviation from normal standard which may generate an error and result in compromising with quality standards) identified was wrong labelling of slides. Performance in EQAS for pre-analytical phase was satisfactory in 6 of 9 cycles. CONCLUSION: A low incidence of errors in pre-analytical phase implies that a satisfactory level of quality standards was being practiced with still scope for improvement.

A correlative study of solitary thyroid nodules using the bethesda system for reporting thyroid cytopathology.

BACKGROUND: Fine needle aspiration cytology (FNAC) is a useful diagnostic modality in the evaluation of solitary thyroid nodules (STN). It can differentiate between benign and malignant lesions in most cases. AIM: This study was undertaken to determine the utility and diagnostic accuracy of FNAC in the evaluation of STN. MATERIALS AND METHODS: In this retrospective study, a total number of 483 thyroid FNACs were retrieved, out of which 209 cases of STN were chosen for this study. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was used for analysis. Their FNACs diagnoses were compared with histopathological diagnoses. RESULTS: Among 209 FNACs, 88 (42.1%) had non-neoplastic lesions, 6 (2.9%) had atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS), 52 (24.9%) had follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), 33 (15.8%) were suspicious for malignancy and 18 (8.6%) had malignant cytology. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC in STN cases were 94.4%, 97.6%, 95.8%, 98.1% and 93.2% respectively. CONCLUSION: Our study concluded that FNAC reporting using TBSRTC highly correlated with the histopathological diagnosis and our results were comparable with published data. The FNAC diagnosis helps in triaging patients with STN and identifies those who require surgical intervention. It is a simple, convenient, cost effective, sensitive, specific, safe and accurate initial diagnostic method for the preoperative evaluation of STN.

Correlation of cytomorphological patterns and acid-fast Bacilli positivity in tuberculous lymphadenitis in a rural population of southern India.

BACKGROUND: One of the most common causes of lymphadenopathy in India is tuberculosis. It can be diagnosed by a minimally invasive procedure known as fine-needle aspiration cytology (FNAC), and thereby unnecessary surgical interventions are avoided. AIM: This study was undertaken to evaluate cytomorphological patterns of tuberculous lymphadenitis including human immunodeficiency virus-positive cases, to correlate the acid-fast Bacilli (AFB) positivity with cytomorphological patterns and also to find out overall AFB positivity. MATERIALS AND METHODS: In this study, a total of 212 cases of cytologically proven tuberculous lymphadenitis were retrieved and analyzed retrospectively between March 2012 and March 2015 for three different cytomorphological patterns (epithelioid granuloma without necrosis [pattern A], epithelioid granuloma with necrosis [pattern B], and necrosis without epithelioid granuloma [pattern C]) and bacillary loads on Ziehl-Neelsen stain (ZN) for AFB. RESULTS: Pattern A through C was observed in 40 (18.9%), 102 (48.1%), and 70 (33%) cases, respectively. AFB positivity was found in 2 (5%) cases of pattern A, 62 (60.8%) cases of pattern B, and 54 (77.1%) cases of pattern C. The highest percentage of AFB positivity (64.7%) was observed in aspirate containing purulent/pus and caseous/cheesy material. The overall AFB positivity was seen in 55.7% (118/212) cases. On grading of AFB positivity, Grade 1+ was observed in 29.7%, Grade 2+ was observed in 28.8%, and Grade 3+ was observed in 41.5% cases. CONCLUSION: FNAC is a sensitive, simple, convenient, safe, minimally invasive procedure to diagnose tuberculous lymphadenitis. Study of both cytomorphological patterns and ZN staining for AFB can improve the diagnostic yield. Regardless of the presence of granuloma, ZN stain must be employed whenever infective pathology is suspected.

A study of malignancy rates in different diagnostic categories of the Bethesda system for reporting thyroid cytopathology: An institutional experience.

BACKGROUND: The Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced to standardize the communication of fine-needle aspiration cytology (FNAC) interpretation between clinicians and pathologists. This study was undertaken to evaluate the diagnostic utility of TBSRTC for reporting thyroid FNACs and rate of malignancy in each diagnostic category of TBSRTC. METHODS: A total of 603 thyroid FNAC results were retrieved retrospectively between July 2012 and January 2015 and reclassified according to TBSRTC. Of these, 392 cases had a histopathological follow-up. The FNACs results were compared to the histopathological diagnoses and the malignancy rates of each diagnostic categories of TBSRTC were calculated. RESULTS: Of the 603 FNACs, nondiagnostic were 16 (2.7%), benign were 393 (65.2%), atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) were 60 (10%), follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) were 64 (10.6%), suspicious for malignancy (SM) were 32 (5.3%), and malignant were 38 (6.3%). In 392 cases, there was follow-up histopathology. The malignancy rate for nondiagnostic, benign, AUS/FLUS, FN/SFN, SM, and malignant categories were 0%, 0.8%, 24.4%, 28.9%, 70.8%, and 100%, respectively. CONCLUSION: Our study validated the efficacy of TBSRTC. In conclusion, the malignancy rate of AUS/FLUS in this study was higher than the risk mentioned in TBSRTC and other published studies. Hence, AUS/FLUS category patients in our setup warrant further workup including ultrasound and/or thyroid scan in addition to immediate repeat FNAC.

Diagnosis of Salivary Gland Lesions By Fine Needle Aspiration Cytology and Its Histopathological Correlation in A Tertiary Care Center of Southern India.

BACKGROUND: Salivary glands may enlarge either due to inflammation or neoplastic conditions and the diagnosis is possible by fine needle aspiration cytology (FNAC). AIM: The present study was undertaken to determine utility of FNAC in the diagnosis of salivary gland lesions. MATERIALS AND METHODS: In this retrospective study, a total of 186 FNACs of salivary gland lesions were retrieved and evaluated. Of these, 146 cases had follow-up histopathological diagnosis. FNAC diagnoses were compared to histopathological diagnoses. RESULTS: The parotid glands were more commonly involved than others. Among the various diagnostic categories used in FNAC reports, Non neoplastic category was seen in 24 (16.4%), benign category in 86 (58.9%) and malignant category in 30 (20.6%) and unsatisfactory category in 6 (4.1%) of 146 cases. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC in the diagnosis of salivary gland lesions were 86.6%, 94.6%, 93.6%, 88.3%, and 94.6% respectively. CONCLUSION: The present study concluded that FNAC in the diagnosis of salivary gland lesions is highly sensitive, specific and accurate method. Hence, FNAC is a useful, quick and reliable diagnostic tool. It also appears to be a safe, cost effective and minimally invasive procedure, which provides information for management of salivary gland lesions.

Hyalinizing clear cell carcinoma of the base of tongue: a distinct and rare entity.

Hyalinizing clear cell carcinoma (HCCC) of tongue is a rare neoplasm originating from minor salivary glands. We present a case of HCCC involving the base of tongue, in a 73-year-old male, clinically diagnosed as fibroma. Laser excision of the mass was done. Histopathological examination showed an infiltrating lesion composed predominantly of clear cells. The differential diagnosis included other salivary gland lesions having a clear cell component and metastatic clear cell renal carcinoma. Immunohistochemistry was useful in ruling out these lesions exhibiting clear cell component from clear cell carcinoma. Imaging studies revealed no lesion in either kidney. Since, HCCC has a better prognosis and the adequate treatment is wide excision, it needs to be differentiated from other carcinomas with clear cells. No further therapy was given to the patient. One year after the surgery, the patient is symptom free without local recurrence and on regular follow up.