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Diagnostic Accuracy of Cytology Smear and Frozen Section in Glioma

Mat Zin AA, Zulkarnain S

Asian Pac J Cancer Prev, 2019 Feb 26;20(2):321-325.
PMID: 30803189

Glioma is the commonest primary intracranial tumour and it has been the most predominant tumour in many studies.
It accounts for 24.7% of all primary brain tumour and 74.6% of malignant brain tumour. Intraoperative diagnosis
plays a crucial role in determining the patient management. Frozen section has been the established technique in
providing rapid and accurate intraoperative diagnosis. However due to some disadvantages like ice crystal artefact,
high expenditure and requirement of skilled technician, there is increase usage of cytology smear either replacing or
supplementing frozen section technique. The aim of this review is to determine the diagnostic accuracy of cytology
smear and frozen section in glioma and to see whether there is significant difference between those techniques. The
overall diagnostic accuracy for frozen section in glioma ranging from 78.4% to 95% while for cytology smear, the
diagnostic accuracy ranging from 50% to 100%. Based on certain literatures, no statistically difference was observed
in diagnostic accuracy of cytology smear and frozen section. Thus, cytology smear provides an alternative method in
establishing intraoperative diagnosis. Both cytology smear and frozen section are complimentary to each other. It is
recommended to use both techniques to improve the diagnostic accuracy in addition with adequate knowledge, clinical
history, neuroimaging and intraoperative findings.

Matched MeSH terms: Cytodiagnosis/methods*
Cytologic appearances in invasive lobular carcinoma of the breast. A study of 21 cases

Jayaram G, Swain M, Chew MT, Yip CH

Acta Cytol., 2000 Mar-Apr;44(2):169-74.
PMID: 10740602

OBJECTIVE: To examine the fine needle aspiration cytologic features of invasive lobular carcinoma of breast and to discuss problems that may occur in cytodiagnosis.

STUDY DESIGN: Fine needle aspiration cytologic smears from 21 cases of invasive lobular carcinoma (ILC) of breast were subjected to detailed cytomorphologic analysis. Features studied included pattern of cells, size of cells, nuclear placement, pleomorphism, presence of intracytoplasmic lumina (ICL) and signet ring cells.

RESULTS: Cellularity was generally moderate or high, and the pattern was predominantly or partly dissociated in 86% of cases. Rosettelike pattern was discerned in alveolar-type ILC. Cell size was usually small or intermediate, with nuclei placed eccentrically in most cases. ICLs with or without signet ring cells were present in 12 cases (57%).

CONCLUSION: A cytologic picture consisting of predominantly dissociated small or intermediate-sized tumor cells with eccentric nuclei, with some of the cells showing ICLs, is highly suggestive of ILC. Indian file pattern, another characteristic feature of ILC, is, however, focal and inconsistent. Variant patterns of ILC may show other cytologic features, such as rosettelike pattern (alveolar variant of ILC) or large cell pattern (pleomorphic variant of ILC) and may consequently be difficult to categorize on cytologic smears.

Matched MeSH terms: Cytodiagnosis
Fulltext 405 cases of bronchial brushing cytology: an evaluation

Ngen RMY, Cheong I, Yahaya O

Med J Malaysia, 1985 Jun;40(2):98-100.
PMID: 3834293

405 cases of bronchial brushing cytology were evaluated for its effectiveness in detecting pulmonary carcinoma. Cytohistologic findings were correlated whenever endoscopic biopsies were performed. Sputum cytological investigations were also included in this paper to examine the total diagnostic sensitivity of all the three methods combined.

Matched MeSH terms: Cytodiagnosis
Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Ang PP, Tan GC, Karim N, Wong YP

Acta Cytol., 2020;64(3):248-255.
PMID: 31352449 DOI: 10.1159/000501406

BACKGROUND: Differentiating reactive mesothelial cells from metastatic carcinoma in effusion cytology is a challenging task. The application of at least 4 monoclonal antibodies including 2 epithelial markers (Ber-EP4, MOC-31, CEA, or B72.3) and 2 mesothelial markers (calretinin, WT-1, CK5/6, or HBME-1) are often useful in this distinction; however, it is not readily available in many resource-limited developing countries. Aberrant immunoexpression of enhancer of zeste homolog 2 (EZH2), a transcriptional repressor involved in cancer progression, is observed widely in various malignancy. In this study, we evaluate the diagnostic value of EZH2 as a single reliable immunomarker for malignancy in effusion samples.
METHODS: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity.
RESULTS: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988.
CONCLUSION: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.

Matched MeSH terms: Cytodiagnosis/methods
Cytological characteristics of gynaecological specimens referred to cytology division, I.M.R. in 1970

Tang SK, Welch QB

Med J Malaya, 1972 Jun;26(4):238-43.
PMID: 5069412
Matched MeSH terms: Cytodiagnosis
Fulltext Carcinoma Ex Pleomorphic Adenoma Presented as a Gigantic Tumor: Treatment and Diagnostic Challenges

Maruthamuthu T, Saniasiaya J, Mohamad I, Nadarajah S, Lazim NM, Wan Abdul Rahman WF

Oman Med J, 2018 Jul;33(4):342-345.
PMID: 30038735 DOI: 10.5001/omj.2018.62

Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.

Matched MeSH terms: Cytodiagnosis
Cytopathology whole slide images and adaptive tutorials for postgraduate pathology trainees: a randomized crossover trial

Van Es SL, Kumar RK, Pryor WM, Salisbury EL, Velan GM

Hum Pathol, 2015 Sep;46(9):1297-305.
PMID: 26093936 DOI: 10.1016/j.humpath.2015.05.009

To determine whether cytopathology whole slide images and virtual microscopy adaptive tutorials aid learning by postgraduate trainees, we designed a randomized crossover trial to evaluate the quantitative and qualitative impact of whole slide images and virtual microscopy adaptive tutorials compared with traditional glass slide and textbook methods of learning cytopathology. Forty-three anatomical pathology registrars were recruited from Australia, New Zealand, and Malaysia. Online assessments were used to determine efficacy, whereas user experience and perceptions of efficiency were evaluated using online Likert scales and open-ended questions. Outcomes of online assessments indicated that, with respect to performance, learning with whole slide images and virtual microscopy adaptive tutorials was equivalent to using traditional methods. High-impact learning, efficiency, and equity of learning from virtual microscopy adaptive tutorials were strong themes identified in open-ended responses. Participants raised concern about the lack of z-axis capability in the cytopathology whole slide images, suggesting that delivery of z-stacked whole slide images online may be important for future educational development. In this trial, learning cytopathology with whole slide images and virtual microscopy adaptive tutorials was found to be as effective as and perceived as more efficient than learning from glass slides and textbooks. The use of whole slide images and virtual microscopy adaptive tutorials has the potential to provide equitable access to effective learning from teaching material of consistently high quality. It also has broader implications for continuing professional development and maintenance of competence and quality assurance in specialist practice.

Matched MeSH terms: Cytodiagnosis*
Fulltext Comparing CxBladder to Urine Cytology as Adjunct to Cystoscopy in Surveillance of Non-muscle Invasive Bladder Cancer-A Pilot Study

Chai CA, Yeoh WS, Rajandram R, Aung KP, Ong TA, Kuppusamy S, et al.

Front Surg, 2021;8:659292.
PMID: 34055868 DOI: 10.3389/fsurg.2021.659292

Purpose: Guidelines advocate cystoscopy surveillance (CS) for non-muscle invasive bladder cancer (NMIBC) post-resection. However, cystoscopy is operator dependent and may miss upper tract lesions or carcinoma in-situ (CIS). Urine cytology is a common adjunct but lacks sensitivity and specificity in detecting recurrence. A new mRNA biomarker (CxBladder) was compared with urine cytology as an adjunct to cystoscopy in detecting a positive cystoscopy findings during surveillance cystoscopy in our center. Materials and Methods: Consented patients older than 18, undergoing CS for NMIBC, provide paired urine samples for cytology and CxBladder test. Patients with positive cystoscopy findings would undergo re-Trans Urethral Resection of Bladder Tumor (TURBT). Results: Thirty-five patients were enrolled from April to June 2019. Seven contaminated urine samples were excluded. The remaining cohort of 23 (82%) and 5 (18%) females had a mean age of 66.69 (36-89). Eight (29%) patients with positive cystoscopy finding underwent TURBT. All 8 patients also had positive CxBladder result. This shows that CxBladder has a sensitivity and negative predictive value (NPV) of 100%, specificity of 75% and positive predictive value (PPV) of 62% in predicting a positive cystoscopy finding. TURBT Histo-pathological findings showed Low-grade Ta NMIBC in one patient (4%), and 7 (25%) patients had inflammatory changes. Urine cytology was only positive in one patient with a positive cystoscopy finding. This led to a sensitivity of merely 13% and NPV of 74%, while specificity and PPV was 100% in predicting a positive cystoscopy finding. Conclusion: CxBladder had high NPV and sensitivity which accurately predicted suspicious cystoscopy findings leading to further investigation. It has great potential for use as adjunct to cystoscopy for surveillance of NMIBC.

Matched MeSH terms: Cytodiagnosis
Fulltext Evaluation of polymerase chain reaction (PCR) method and hybrid capture II (HCII) assay for the detection of human papillomavirus in cervical scrapings

Saini R, Shen TH, Othman NH, Santhanam J, Othman N, Tang TH

Med J Malaysia, 2007 Aug;62(3):206-9.
PMID: 18246908 MyJurnal

In order to investigate the reliability of detecting HPV DNA in cervical smears, we compared the performance of nested MY/GP PCR and FDA approved-Hybrid Capture II (HCII) using clinical cervical scrapings from 40 patients. It was found that PCR was more sensitive (81.8%) in comparison to HCII (36.4%) in detecting HPV although specificity of HCII was much higher (96.6%) than PCR (58.6%). The Negative Predictive Value (NPV) of both the techniques were quite similar but Positive Predictive Value (PPV) of HCII was much higher (80.0%) compared to PCR (42.9%). While the HCII method showed good specificity for HPV detection, its lack of sensitivity as compared to PCR may be a drawback for diagnostic use.

Matched MeSH terms: Cytodiagnosis
The value of cytology in granulomatous mastitis: a report of 16 cases from Malaysia

Yip CH, Jayaram G, Swain M

Aust N Z J Surg, 2000 Feb;70(2):103-5.
PMID: 10711470

BACKGROUND: Granulomatous mastitis is a rare condition of the breast that can mimic a carcinoma. There are characteristic histological features, the most important of which is a predominantly lobular inflammatory process. It must be differentiated from known causes of granulomatous inflammation, such as tuberculosis.
METHODS: In the present paper, the clinical and pathological features of 16 patients with granulomatous mastitis seen over a 3-year period in the University Hospital, Kuala Lumpur, are described.
RESULTS: A clinical suspicion of malignancy was present in 10 cases. One of the patients was nulliparous. One had an associated hyperprolactinaemia, while two had systemic lupus erythromatosis. One of the patients was pregnant at the time of presentation. Four patients had localized lumps excised, five were treated conservatively because the lesion was too extensive to resect, and seven patients required drainage procedures for abscess formation.
CONCLUSION: Awareness of this condition is important because it mimics a carcinoma, and surgery may not be the best treatment for recurrent disease.

Matched MeSH terms: Cytodiagnosis
Combined cytological and histological diagnosis of hepatocellular carcinoma in ultrasonically guided fine needle biopsy specimens

Zainol H, Sumithran E

Histopathology, 1993 Jun;22(6):581-6.
PMID: 7689070

This study evaluates the usefulness of a combined cytological and histological approach to the diagnosis of hepatocellular carcinoma (HCC) when applied to fine needle biopsy specimens obtained under ultrasonic guidance. The material, aspirated from 51 focal liver lesions, was handled in such a way that there was sufficient material for both cytological and histological (cell block) assessment. Of the 29 cases of HCC studied, a confident cytological diagnosis was made in 23 (79%). In the remaining six cases, the cytological features were considered to be suspicious but not diagnostic of HCC. Examination of cell blocks in the six cases enabled a confident diagnosis of HCC to be made in all cases. This was due to the supplementary visual information provided by the histological features, particularly the pattern of arrangement of the tumour cells.

Matched MeSH terms: Cytodiagnosis
Fulltext Primary hepatic angiosarcoma: difficulty in clinical, radiological, and pathological diagnosis

Yang KF, Leow VM, Hasnan MN, Subramaniam MK

Med J Malaysia, 2012 Feb;67(1):127-8.
PMID: 22582567 MyJurnal

Hepatic angiosarcoma is a rare primary mesenchymal malignancy. Prognosis is poor and mortality occurs early. The diagnosis is challenging. Our case was an asymptomatic 70 year-old man referred, with incidental ultrasonography finding of multiple liver nodules. Diagnostic laparoscopic liver biopsy and the histopathological examination reported a haemangioma. Six months later, he became symptomatic and his health condition deteriorated rapidly.

Matched MeSH terms: Cytodiagnosis
Fulltext Pleomorphic Adenoma Originating from Submandibular Salivary Gland in an 8-year-old Girl: A Case Report.

Gani, A.N., Megat Shiraz, M.A.R., Siti Aishah, M.A., Norazizah, M., Mozita, A., Sharifah, N.A.

Medicine & Health, 2007;2(2):164-168.
MyJurnal

Pleomorphic adenoma (PA) typically presents as a benign slow growing, painless neoplasm of the parotid gland. PA arising from the submandibular gland in the paediatric age group is rare. Surgical excision is the treatment of choice. A case of PA in an 8-year-old Malay girl is presented. Clinically she presented with a painless right submandibular mass measuring 2x2cm. A diagnosis of Pleomorphic adenoma was made on Fine Needle Aspiration Cytology (FNAC). She underwent submandibulectomy uneventfully. Postoperatively after two years follow up, she is asymptomatic.

Matched MeSH terms: Cytodiagnosis
Fulltext Fine needle aspiration cytology of metastatic renal cell carcinoma - a case report

Wan Muhaizan Wan Mustaffa, Sharifah Noor Akmal Syed Husain

Medicine & Health, 2006;1(1):75-80.
MyJurnal

Fine needle aspiration cytology under radiologic guidance for diagnosis of renal cell carcinoma is well established and is increasingly utilized. This is because renal cell carcinoma displays fairly characteristic cellular features permitting correct cytologic identification. We present a case of a 66-year-old man who had advanced renal cell carcinoma with spread to aortic and cervical lymph nodes, lungs and liver. Fine needle aspiration cytology of the para-aortic mass showed tight clusters of malignant cells with abundant and vacuolated cytoplasm consistent with renal cell carcinoma. Histology of the left cervical lymph nodes together with immunohistochemistry findings were consistent with the cytologic diagnosis of metastatic renal cell carcinoma. The patient succumb to his illness three years after the diagnosis was made.

Matched MeSH terms: Cytodiagnosis
Fulltext Accuracy of fine needle aspiration cytology in solitary or dominant nodular goitre: a single centre study

Rohaizak, M., Aman Fuad, Y., Naqiyah, I., Saladina, J.J., Shahrun Niza, A.S.

International Medical Journal Malaysia, 2017;16(2):85-88.
MyJurnal

Background: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The
diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard.
The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is
to evaluate the accuracy of FNAC especially in cases of large goitre.

Material and methods: This is a
retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for
solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on
FNAC and histology.

Result: There were 235 patients, but only 161 patients were analysed after excluding
the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the
thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall
accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as
follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%).
This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules
increased in size.

Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre.
Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious
approach should be taken in the management of large goitre and decision should not be based only on the
result of FNAC.

Matched MeSH terms: Cytodiagnosis
VALUE OF EXFOLIATIVE CERVICAL CYTOLOGY IN THE DETECTION OF UNSUSPECTED CARCINOMA OF THE CERVIX

SINNATHURAY TA

Med J Malaysia, 1963 Dec;18:77-82.
PMID: 14117284
Matched MeSH terms: Cytodiagnosis*
Fulltext Diagnostic yield of flexible bronchoscopic procedures in lung cancer patients according to tumour location

Liam CK, Pang YK, Poosparajah S

Singapore Med J, 2007 Jul;48(7):625-31.
PMID: 17609823

This study aims to determine whether the diagnostic yield of flexible bronchoscopy sampling procedures in patients with lung cancer was dependent on tumour location.

Matched MeSH terms: Cytodiagnosis/methods
Dielectric properties of urine in relation to bladder cancer

Zhu CZ, Ting HN, Ng KH, Mun KS, Ong TA

Phys Eng Sci Med, 2024 Mar;47(1):61-71.
PMID: 37843766 DOI: 10.1007/s13246-023-01341-5

Many studies have investigated the dielectric properties of human and animal tissues, particularly to differentiate between normal cells and tumors. However, these studies are invasive as tissue samples have to be excised to measure the properties. This study aims to investigate the dielectric properties of urine in relation to bladder cancer, which is safe and non-invasive to patients. 30 healthy subjects and 30 bladder cancer patients were recruited. Their urine samples were subjected to urinalysis and cytology assessment. A vector network analyzer was used to measure the dielectric constant (Ɛ') and loss factor (Ɛ″) at microwave frequencies of between 0.2 and 50 GHz at 25 °C, 30 °C and 37 °C. Significant differences in Ɛ' and Ɛ″ were observed between healthy subjects and patients, especially at frequencies of between 25 and 40 GHz at 25 °C. Bladder cancer patients had significant lower Ɛ' and higher Ɛ″ compared with healthy subjects. The Ɛ' was negatively correlated with urinary exfoliated urothelial cell number, and Ɛ″ was positively correlated. The study achieved a receiver operating characteristic area under curve (ROC-AUC) score of 0.69099 and an optimum accuracy of 75% with a sensitivity of 80% and a specificity of 70%. The number of exfoliated urothelial cell had significant effect on the dielectric properties, especially in bladder cancer patients. Urinary dielectric properties could potentially be used as a tool to detect bladder cancer.

Matched MeSH terms: Cytodiagnosis
Signet-ring Cell Lymphoma-a Case Report

Masir N, Cheong SK, Noordin K

Hematology, 2001;6(3):187-92.
PMID: 27420125 DOI: 10.1080/10245332.2001.11746571

A case of signet-ring cell lymphoma diagnosed initially by fine needle aspiration cytology is reported. This rare tumor is a variant of follicular lymphoma, which closely resembles metastatic adenocarcinoma and other tumors which exhibit signet-ring cell appearance. Correct diagnosis can be achieved by careful morphologic analysis together with positive reactivity with lymphoid markers. The cytohistologic, immunohistochemical and electron microscopic features are described, and the differ ential diagnostic considerations are discussed in the report.

Matched MeSH terms: Cytodiagnosis
Rapid diagnosis of Helicobacter pylori infection in gastric imprint smears

Kaur G, Madhavan M, Basri AH, Sain AH, Hussain MS, Yatiban MK, et al.

Southeast Asian J. Trop. Med. Public Health, 2004 Sep;35(3):676-80.
PMID: 15689086

The objective of this study was to determine the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of Diff-Quik-stained gastric imprint cytology smears in the detection of H. pylori compared with histology. Air-dried imprint smears of gastric biopsies from 150 patients were stained by the Diff-Quik method in the endoscopy suite and examined for H. pylori, providing results within minutes. The presence of inflammation and intestinal metaplasia were documented. The same biopsy was processed and stained with H&E and Warthin-Starry stains, and reviewed by a different pathologist blind to the imprint cytology results. Ninety-four of the 150 patients were male with a mean age of 50 years. Based on histology, the H. pylori prevalence was very low at 8%. The sensitivity and specificity of imprint cytology in the detection of H. pylori were 83.3% and 100%, respectively. The PPV and NPV were 100% and 98.6%, respectively. There were two false negatives and no false positives. A combination of imprint cytology and histology achieved 100% sensitivity. Imprint smears did not provide added value over histology with regards to inflammation and metaplasia. Gastric imprint smears stained with Diff-Quik method is a rapid, cheap, and reliable method for the detection of H. pylori and have their best results when complemented with histology.

Matched MeSH terms: Cytodiagnosis/methods*

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