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Souza da Silva R, Schmitt F. Minimally Invasive, Maximally Effective: The Power of Precision Cytoanalysis on Effusion Samples-A Comprehensive Exploration from Traditional Methods to Innovative Approaches. Surg Pathol Clin 2024; 17:453-481. [PMID: 39129143 DOI: 10.1016/j.path.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Precision medicine translates through molecular assays and in minimally invasive diagnosis, evident in analyses of effusions that serve therapeutic and diagnostic purposes. This cost-effective and low-risk approach provides advantages, playing a pivotal role in late-stage oncology and frequently standing as the primary resource for cancer diagnosis and treatment pathways. This article outlines the workflow for managing serous fluid and explores how cytology effusion analysis extends beyond immunocytological diagnosis. Combined with current molecular tests it showcases the potential to be a skillful tool in precision cytopathology.
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Affiliation(s)
- Ricella Souza da Silva
- IPATIMUP Diagnostics, IPATIMUP-Institute of Molecular Pathology and Immunology of Porto University, Porto, 4200-135, Portugal
| | - Fernando Schmitt
- IPATIMUP Diagnostics, IPATIMUP-Institute of Molecular Pathology and Immunology of Porto University, Porto, 4200-135, Portugal; Faculty of Medicine of the University of Porto, Porto, 4200-319, Portugal; CINTESIS@RISE (Health Research Network), Porto, 4200-319, Portugal.
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Chen-Yost HI, Hao W, Hamilton J, Dahl J, Jin X, Pantanowitz L. Second opinion for pulmonary and pleural cytology is valuable for patient care. J Am Soc Cytopathol 2024:S2213-2945(24)00042-5. [PMID: 38789337 DOI: 10.1016/j.jasc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Thoracic cytology can be challenging due to limited procured material or overlapping morphology between benign and malignant entities. In such cases, expert consultation might be sought. This study aimed to characterize all pulmonary and pleural cytology consult cases submitted to our practice and provide recommendations on approaching difficult cases. MATERIALS AND METHODS All thoracic (pulmonary and pleural) cytology cases submitted for expert consultation to the University of Michigan (MLabs) from 2013 to mid-2022 were reviewed. Cases where cytology was only part of a hematopathology or surgical pathology consult were excluded. Patient demographics, specimen location, procedure performed, referring diagnosis, and our diagnoses were recorded for each case. Diagnoses were categorized according to the Papanicolaou Society of Cytopathology recommendations for pulmonary and effusion cytology. Discordant diagnoses were stratified as major or minor. Data was analyzed using chi-square analysis and logistic models. RESULTS We received 784 thoracic cytology consult cases, including 530 exfoliative samples and 307 fine-needle aspirations. The most common anatomic locations sampled were the bronchial wall (n = 194, 23%), lung nodule (n = 322, 38%), and pleura (n = 296, 35%). 413 cases had a diagnostic discrepancy (48.3%), with 274 (66%) minor and 139 (34%) major discrepancies. By location, pleural effusion specimens had the highest probability of a discrepant diagnosis (P = 0.003). By specimen type, fine-needle aspiration samples were significantly more likely to have a discrepant diagnosis (P = 0.06). CONCLUSION Nearly half of the thoracic cytology cases submitted for expert second opinion had diagnostic discrepancies. Consequently, consulting a tertiary medical care center with cytopathology expertise for challenging thoracic cytology diagnoses is beneficial.
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Affiliation(s)
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - John Hamilton
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Julia Dahl
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Xiaobing Jin
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Kapoor S, Samanta S, Kaur K. Role of Ancillary Techniques in Reporting Serous Fluid Cytology - "Redefining Categories, Refining Diagnosis". J Cytol 2024; 41:96-104. [PMID: 38779601 PMCID: PMC11108034 DOI: 10.4103/joc.joc_114_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 03/08/2024] [Indexed: 05/25/2024] Open
Abstract
Background The "International System of Reporting Serous Fluid Cytology (TIS)" together with cytomorphology promotes the use of ancillary techniques to resolve difficulties in reporting serous fluid cytology. Objective To classify serous effusion fluid samples received at our department in line with "TIS", indicating the risk of malignancy (ROM), and directing appropriate usage of ancillary testing. Materials and Methods Prospective study carried out from October 2021 to September 2022. The study included all pleural, ascitic, and pericardial fluid samples, reported according to 'TIS'. Flow cytometry and immunocytochemistry were ancillary methods utilized to assist in reporting. Cases with available history and convincing correlations didn't require further assessment. Results A total of 1200 serous effusion samples were evaluated including 604 pleural, 591 ascitic, and 5 pericardial fluid samples. After categorization, there were 23 samples in non-diagnostic (ND, 1.9%), 575 in negative for malignancy (NFM, 47.91%), 44 in atypia of undetermined significance (AUS, 3.66%), 64 in suspicious for malignancy (SFM, 5.33%), and 494 in malignant category (MAL, 41.16%). Ancillary studies were beneficial in the recategorization of 26% (11/44) AUS cases, 29.6% (19/64) SFM cases, and it helped refine tumor characteristics in 35.42% (175/494) cases categorized as malignant. Final ROM calculated for each category: ND 25%, NFM 18.6%, AUS 66.6%, SFM 88%, and MAL 100%. Conclusion Serous fluid is an easily obtainable sample that can provide opportunities for ancillary testing with clinical implications. In AUS and suspicious category although, diagnostic yield is increased however, a larger number of cases are required to obtain definite results.
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Affiliation(s)
- Shilpa Kapoor
- Department of Oncopathology, Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Satarupa Samanta
- Department of Oncopathology, Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
| | - Kanwalpreet Kaur
- Department of Oncopathology, Gujarat Cancer and Research Institute (GCRI), Ahmedabad, Gujarat, India
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Wang C, Wang X, Gao Z, Ran C, Li C, Ding C. Multiple serous cavity effusion screening based on smear images using vision transformer. Sci Rep 2024; 14:7395. [PMID: 38548898 PMCID: PMC10978834 DOI: 10.1038/s41598-024-58151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
Serous cavity effusion is a prevalent pathological condition encountered in clinical settings. Fluid samples obtained from these effusions are vital for diagnostic and therapeutic purposes. Traditionally, cytological examination of smears is a common method for diagnosing serous cavity effusion, renowned for its convenience. However, this technique presents limitations that can compromise its efficiency and diagnostic accuracy. This study aims to overcome these challenges and introduce an improved method for the precise detection of malignant cells in serous cavity effusions. We have developed a transformer-based classification framework, specifically employing the vision transformer (ViT) model, to fulfill this objective. Our research involved collecting smear images and corresponding cytological reports from 161 patients who underwent serous cavity drainage. We meticulously annotated 4836 patches from these images, identifying regions with and without malignant cells, thus creating a unique dataset for smear image classification. The findings of our study reveal that deep learning models, particularly the ViT model, exhibit remarkable accuracy in classifying patches as malignant or non-malignant. The ViT model achieved an impressive area under the receiver operating characteristic curve (AUROC) of 0.99, surpassing the performance of the convolutional neural network (CNN) model, which recorded an AUROC of 0.86. Additionally, we validated our models using an external cohort of 127 patients. The ViT model sustained its high-level screening performance, achieving an AUROC of 0.98 at the patient level, compared to the CNN model's AUROC of 0.84. The visualization of our ViT models confirmed their capability to precisely identify regions containing malignant cells in multiple serous cavity effusion smear images. In summary, our study demonstrates the potential of deep learning models, particularly the ViT model, in automating the screening process for serous cavity effusions. These models offer significant assistance to cytologists in enhancing diagnostic accuracy and efficiency. The ViT model stands out for its advanced self-attention mechanism, making it exceptionally suitable for tasks that necessitate detailed analysis of small, sparsely distributed targets like cellular clusters in serous cavity effusions.
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Affiliation(s)
- Chunbao Wang
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- School of Computer Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiangyu Wang
- School of Computer Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zeyu Gao
- CRUK Cambridge Centre, University of Cambridge, Cambridge, CB2 0RE, UK
| | - Caihong Ran
- Department of Pathology, Ngari Prefecture People's Hospital, Ngari of Tibet, 859000, China
| | - Chen Li
- School of Computer Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Caixia Ding
- Department of Pathology, Shaanxi Provincial Tumor Hospital, Xi'an, 710061, China.
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Seo Y, Prome SA, Kim L, Han JY, Kim JM, Choi SJ. Immunocytochemistry on frozen-embedded cell block for the diagnosis of hematolymphoid cytology specimen: a straightforward alternative to the conventional cell block. J Hematop 2024; 17:1-15. [PMID: 38175379 DOI: 10.1007/s12308-023-00569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Agarose-based cell block (CB) technique can be modified to be combined with the frozen section technique for the preparation of a high-quality frozen-embedded CB (F-CB) from an effusion or fine-needle aspiration (FNA) cytology sample. This combined technique can be effectively used for the immunocharacterization of the hematolymphoid cells on F-CB. To demonstrate the applicability of performing diagnostic ICC on F-CB, we have analyzed the immunophenotype of the hematolymphoid cells in a series of eight cases of effusions and eight cases of FNA cytology specimens by using CB-ICC on sections cut from frozen-embedded CBs. The SurePathTM residue or cytologic material scraped off from the FNA cytology smear that was diagnostic for or suspicious of hematolymphoid malignancy was pelleted and pre-embedded in agarose. Half of the agarose-embedded pellet was frozen-embedded in OCT compound for the preparation of F-CB, while the other half was processed for the preparation of paraffin-embedded CB. Sections cut from the F-CB and P-CB were used for CB-ICC. Panels of ICC on the F-CBs could enable the immunocytochemical differential diagnosis of large cell hematologic malignancies that encompass anaplastic large cell lymphoma and other forms of large-cell hematolymphoid malignancies such as large B-cell lymphomas, anaplastic plasma cell myeloma, myeloid sarcoma, and T-lymphoblastic lymphoma. It also appeared that the small B-cell lymphomas in the effusions or FNAs could be differentially diagnosed with the aid of CB-ICC on the F-CB. A modified agarose-based CB technique can be combined with the frozen-embedded CB method for the preparation of F-CB that can be directly used for the immunocytochemical differential diagnosis of hematolymphoid cytology samples.
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Affiliation(s)
- Youjeong Seo
- Department of Pathology, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
- Department of Medicine, Inha University Graduate School, Incheon, Korea
- Department of Pathology, Inha University College of Medicine, Incheon, Korea
| | | | - Lucia Kim
- Department of Pathology, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
- Department of Medicine, Inha University Graduate School, Incheon, Korea
- Department of Pathology, Inha University College of Medicine, Incheon, Korea
| | - Jee Young Han
- Department of Pathology, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
- Department of Medicine, Inha University Graduate School, Incheon, Korea
- Department of Pathology, Inha University College of Medicine, Incheon, Korea
| | - Joon Mee Kim
- Department of Pathology, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
- Department of Medicine, Inha University Graduate School, Incheon, Korea
- Department of Pathology, Inha University College of Medicine, Incheon, Korea
| | - Suk Jin Choi
- Department of Pathology, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea.
- Department of Medicine, Inha University Graduate School, Incheon, Korea.
- Department of Pathology, Inha University College of Medicine, Incheon, Korea.
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Nikas IP, Park SY, Song MJ, Lee C, Ryu HS. Expression of EGFR, PD-L1, and the mismatch repair proteins before and following therapy in malignant serous effusions with metastatic high-grade serous tubo-ovarian carcinoma. Diagn Cytopathol 2024; 52:69-75. [PMID: 37937321 DOI: 10.1002/dc.25248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
AIM To compare the immunochemical expression of EGFR, PD-L1, and the mismatch repair (MMR) proteins MLH1, PMS2, MSH2, and MSH6 between matched malignant effusions obtained before and following the administration of chemotherapy in patients with high-grade serous tubo-ovarian carcinoma (HGSC). METHODS In the enrolled HGSCs, matched formalin-fixed and paraffin-embedded cell blocks (CBs) from effusions sampled before (treatment-naïve patients) and during recurrence (following chemotherapy administration), in addition to their matched HGSC tissues obtained from the ovaries at initial diagnosis (treatment-naïve patients), were subjected to EGFR, PD-L1, and MMR immunochemical analysis. RESULTS EGFR was more often overexpressed in effusions obtained after chemotherapy administration compared to both effusions (100% vs. 57.1%) and their matched tubo-ovarian tumors (100% vs. 7.1%) from treatment-naïve patients, respectively. EGFR immunochemistry was concordant in just 9.1% of the effusions sampled during recurrence and their paired ovarian samples before recurrence. Whereas all HGSC treatment-naïve samples (ovarian lesions and effusions) were PD-L1 negative, 3/11 (27.3%) malignant effusions obtained during recurrence showed PD-L1 overexpression. Lastly, none of the tested HGSC samples exhibited MMR deficiency. CONCLUSION Measuring biomarkers using CBs from malignant effusions may provide clinicians with significant information related to HGSC prognosis and therapy selection, especially in patients with resistance to chemotherapy.
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Affiliation(s)
- Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Soo-Young Park
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Ji Song
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Nikas IP, Lim S, Im SA, Lee KH, Lee DW, Lee H, Ryu HS. Discrepancies in Hormone Receptor and HER2 Expression between Malignant Serous Effusions and Paired Tissues from Primary or Recurrent Breast Cancers. Pathobiology 2023; 91:169-179. [PMID: 37816333 DOI: 10.1159/000533912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Immunohistochemistry (IHC) for the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) biomarkers has prognostic and therapeutic value in breast cancer. This study aimed to compare the expression of ER, PR, and HER2 between paired malignant effusions and tissue samples of breast cancer. METHODS Our electronic archive was searched for all effusions diagnosed as breast carcinomas within a pre-defined period (January 2018-October 2021). Next, their cell blocks (CBs) were subjected to ER, PR, HER2 IHC, or in situ hybridization, in addition to EGFR IHC. The expression of hormone receptors (HRs) and HER2 was subsequently compared between tissue and effusion cytology samples derived from the same patients. RESULTS Only 2/76 (2.6%) of the breast cancer patients analyzed showed a malignant effusion at their initial presentation. ER, PR, and HER2 discordance rates between paired malignant effusions and tissue samples obtained at initial diagnosis were 24.3% (17/73), 40.8% (29/71), and 9.1% (6/66), respectively. The HR-/HER2- status was found more often at effusions compared to paired tissue biopsies obtained at initial diagnosis (30/70 vs. 17/70; p < 0.001). In addition, the HR-/HER2- status was significantly associated with an earlier development of a malignant effusion, when found at initial diagnosis (p < 0.001; log-rank test), first recurrence/metastasis (either solid or effusion) (p = 0.012; log-rank test), effusion samples (p = 0.007; log-rank test), and any tumor sample obtained (p = 0.009; log-rank test). Lastly, EGFR overexpression in the HR-/HER2- effusion samples was significantly associated with a shorter post-effusion survival (p = 0.019; log-rank test). CONCLUSION Serous effusion cytology provides high-quality material for ancillary techniques, especially when CBs are prepared, reflecting cancer heterogeneity.
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MESH Headings
- Humans
- Breast Neoplasms/pathology
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Female
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/metabolism
- Receptors, Progesterone/metabolism
- Receptors, Progesterone/genetics
- Receptors, Estrogen/metabolism
- Middle Aged
- Biomarkers, Tumor/metabolism
- Biomarkers, Tumor/genetics
- Aged
- Neoplasm Recurrence, Local/pathology
- Immunohistochemistry
- Pleural Effusion, Malignant/pathology
- Pleural Effusion, Malignant/genetics
- Pleural Effusion, Malignant/metabolism
- Pleural Effusion, Malignant/diagnosis
- Adult
- Prognosis
- Aged, 80 and over
- Retrospective Studies
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Affiliation(s)
- Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus,
| | - Sojung Lim
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hyebin Lee
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
- Pharmonoid Co., Ltd., Seoul, Republic of Korea
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Su L, Li X, Song W, Zhang Y, Zhu J. Concurrent carcinocythemia, pleural and pericardial involvement in metastatic clear cell sarcoma. Int J Lab Hematol 2023; 45:628-629. [PMID: 37431595 DOI: 10.1111/ijlh.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Lei Su
- Department of Minimally Invasive Oncology, The District People's Hospital of Zhangqiu, Jinan, China
| | - Xuemei Li
- Department of Medical Ultrasound, The District People's Hospital of Zhangqiu, Jinan, China
| | - Wenwen Song
- Department of Clinical Laboratory, The District People's Hospital of Zhangqiu, Jinan, China
| | - Yun Zhang
- Department of Clinical Laboratory, The District People's Hospital of Zhangqiu, Jinan, China
| | - Jun Zhu
- Department of Clinical Laboratory, The Fifth People's Hospital of Jinan, China
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Sachan R, Gupta A, Awasthi PN, Singh P, Anand N, Chandra S, Gaur G, Husain N, Sachan KD. Application of international system for reporting serous fluid cytology (ISRSFC) in effusion samples-a prospective study in an oncology setting. J Am Soc Cytopathol 2023; 12:351-361. [PMID: 37244848 DOI: 10.1016/j.jasc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Serous fluid cytology is a cost-effective procedure that can help in the diagnosis, staging, and origin of the malignancy. Recently introduced International System for Reporting Serous Fluid Cytology (ISRSFC) standardizes the reporting of serous fluid cytology in the 5 categories: Category 1: Nondiagnostic (ND), Category 2: negative for malignancy (NFM), Category 3: atypia of undetermined significance (AUS), Category 4: suspicious for malignancy (SFM), and Category 5: malignant (MAL). Here, we present our experience adopting the ISRSFC. MATERIALS AND METHODS We implemented ISRSFC in December of 2019 at our institute and included a cohort of 555 prospective effusion samples. The pertinent surgical pathology, radiology, and clinical follow-up were also extracted to assess the risk of malignancy (ROM) and performance parameters. RESULTS The assessment of interobserver reliability indicated substantial concordance (κ = 0.717) between the 2 investigators for serous fluid categorization. A total of 555 effusion samples were classified as follows: ND, 14 (2.5%); NFM, 394 (71%); AUS, 12 (2.2%); SFM, 13 (2.3%); and MAL, 122 (22%). The ROM for the ND, NFM, AUS, SFM, and MAL categories was 57.1%, 9.9%, 66.7%, 66.7%, and 97.2%, respectively, in peritoneal effusions and 57.1%, 7.1%, 66.7%, 100%, 100%, respectively, in pleural effusions. The ROM for NFM and MAL was 0% and 100%, respectively, in pericardial effusion. CONCLUSIONS Application of the proposed ISRSFC can help in achieving uniformity and reproducibility in diagnoses and also help in risk stratification in cytology. ISRSFC was successfully adopted by our cytology laboratory and clinicians, with overall diagnostic performance similar to previous studies.
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Affiliation(s)
- Ruchita Sachan
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anurag Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Punit Namrata Awasthi
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradyumn Singh
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nidhi Anand
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subrat Chandra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gauri Gaur
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kumar Dheerendra Sachan
- Department of Radiation Oncology, Shrimant Rajmata Vijayaraje Scindia Medical College, Shivpuri, Madhya Pradesh, India
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Rakheja G, Singh M, Priyadarshnee B, Marimuthu B, Dhar L, Jain S, Khurana N, Rathore A. Categorisation of peritoneal serous effusions using the International System for Reporting Serous Fluid Cytopathology-A study on gynaecological samples. Cytopathology 2023; 34:138-145. [PMID: 36530023 DOI: 10.1111/cyt.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cytology of serous effusions is an indispensable diagnostic tool for the diagnosis of non-neoplastic as well as neoplastic effusions, aiding in the categorisation, staging, and prognostication of the patient. This study focuses on reclassifying cases of peritoneal fluid cytology following the International System for Reporting Serous Fluid Cytopathology (TIS), highlighting various challenges encountered and adding to the body of data regarding the risk of malignancy (ROM), focussing on peritoneal effusions due to gynaecological causes. METHODS Peritoneal effusion samples were retrieved from our department's archives and reclassified according to the TIS. The ROM for each category was calculated based on available surgical follow-up. RESULTS A total of 818 peritoneal effusions were studied. Following the definitions and guidelines of the TIS, the cases were reclassified with 125 (15.2%) in the category of non-diagnostic (ND), 595 (72.7%) as negative for malignancy (NFM), 26 (3.2%) as atypia of undetermined significance (AUS), 12 (1.5%) as suspicious for malignancy (SFM), and 60 (7.3%) as malignant (MAL). The respective ROM values for each category were 16.9%, 12.1%, 50%, 80%, and 100%, respectively. By considering the MAL and SFM groups as positive, and the ND, NFM, and AUS groups as negative, the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were determined as 85.2%, 36.7%, 99.1%, 91.7%, and 84.5%, respectively. CONCLUSIONS Peritoneal cytology categorisation following the proposed TIS offered a practical approach for categorisation of the fluids received. The ROMs reported in our study were mostly concordant with those published according to the TIS.
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Affiliation(s)
- Garima Rakheja
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | | | | | - Lity Dhar
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Asmita Rathore
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, India
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Batool S, Sadaf S, Chughtai AS, Qasim A, Zafar A, Jamil A. Diagnostic Accuracy of Cell Block and Immunohistochemistry in Effusion Cytology. Cureus 2023; 15:e34958. [PMID: 36938247 PMCID: PMC10018576 DOI: 10.7759/cureus.34958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Although the cytology of effusion fluids is considered a routine laboratory test, it has recently emerged as an essential tool in determining the primary site of origin of carcinoma of unknown primary. The sensitivity for diagnosing malignancy has enhanced with the inclusion of cytospin, cell block (CB), and immunohistochemistry (IHC) to effusion fluid cytology due to the improvement in morphological preservation and good cellular yield. The purpose of this study was to assess the diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value of IHC and CB in effusion cytology. Methodology An institution-based cross-sectional study was conducted over a period of six months on 150 cases of effusion fluids submitted for diagnostic purposes. After the preparation of cytospin, the residual amount of centrifuged deposit was mixed with CytoLyt solution, thrombin, and plasma, and CBs were prepared. IHC was applied to the CB. Calretinin was used for mesothelial cells, and BerEP4, TTF-1, ER, WT-1, and CD-X2 were used for the confirmation and origin of malignant cells. Results The mean age of the patients was 51.75 ± 16.63 years. The male-to-female ratio was 1:1.24. Out of 150 cases, 78 were pleural effusions, 68 were peritoneal effusions, and four were pericardial effusions. Out of 150 cases, based on cytological examination alone, 66 (44%) were classified as benign, 27 (18%) as malignant, and 57 (38%) were suspicious for malignancy. When cytology was combined with CB and IHC, the diagnostic yield was increased to benign 95 (63.33%), malignant 48 (32%), and suspicious for malignancy 7 (4.67%). The most common cause of malignant pleural effusion was breast carcinoma in females and lung carcinoma in males. The most common primary tumor in malignant peritoneal effusion was ovarian carcinoma in females and colonic adenocarcinoma in males. The sensitivity and specificity of combined cytology with cell block and IHC were 92.31% and 98.95%, respectively. This combination produced significantly better results (p-value = 0.001) for detecting malignancy and reduced suspicious cases from 38% to 4%. Conclusion CB, in combination with IHC, increases the diagnostic yield and aids in detecting malignancy at an unknown primary site in effusion fluids. Both of these techniques can thus enhance the sensitivity and specificity of the diagnosis of effusion cytology. Hence, CB and IHC have advanced utility over cytological smears in effusion fluid cytological diagnosis.
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Affiliation(s)
- Saima Batool
- Histopathology, Chughtai Institute of Pathology, Lahore, PAK
| | - Safana Sadaf
- Histopathology, Chughtai Institute of Pathology, Lahore, PAK
| | | | - Aafia Qasim
- Histopathology, Chughtai Institute of Pathology, Lahore, PAK
| | - Asma Zafar
- Histopathology, Chughtai Institute of Pathology, Lahore, PAK
| | - Anum Jamil
- Histopathology, Chughtai Institute of Pathology, Lahore, PAK
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12
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Sun T, Wang M, Wang H. Risk of malignancy assessment of the International System for Reporting Serous Fluid Cytopathology: Experience in a community hospital setting and comparison with other studies. Cancer Cytopathol 2022; 130:964-973. [PMID: 35994357 DOI: 10.1002/cncy.22638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The International System for Reporting Serous Fluid Cytopathology (ISRSFC) was published recently to provide standard reporting terminology for serous fluid. To date, several ISRSFC reclassification studies have reported a wide range of diagnostic category frequency and the associated risk of malignancy (ROM). Herein, the authors applied the ISRSFC to report pleural and peritoneal effusions retrospectively in a community hospital setting. METHODS With Internal Review Board approval, 446 peritoneal effusion specimens and 299 pleural fluid specimens from 576 patients in three community hospitals over a 12-month period were reviewed and reclassified according to the ISRSFC. RESULTS After reclassification, in pleural effusions, 18 (5.0%) were nondiagnostic (ND), 273 (76.0%) were negative for malignancy (NFM), 18 (5.0%) were atypia of undetermined significance (AUS), 6 (1.7%) were suspicious for malignancy (SFM), and 44 (12.3%) were malignant (MAL). In peritoneal effusions, after reclassification, 11 (5.5%) were ND, 168 (77.1%) were NFM, 9 (4.1%) were AUS, 2 (0.9%) were SFM, and 27 (12.4%) were MAL. The calculated ROM was 0.0% for ND, 1.8% for NFM, 37.5% for AUS, 83.3% for SFM, and 100.0% for MAL in peritoneal effusions; and the ROM was 8.3% for ND, 1.2% for NFM, 44.4% for AUS, and 100.0% for both SFM and MAL in pleural effusions. Further analysis demonstrated notable heterogeneity among published ISRSFC reclassification studies, although the overall ROMs did not differ significantly from the ISRSFC-determined ROMs (all p values were > .05 for mean ROM comparisons). CONCLUSIONS The findings suggested the necessity for each laboratory to perform its own ROM analysis based on its statistics for ISRSFC-tiered classification terminology.
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Affiliation(s)
- Tong Sun
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Minhua Wang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - He Wang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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13
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Shaker N, Wu D, Abid AM. Cytology of malignant pleural mesothelioma: Diagnostic criteria, WHO classification updates, and immunohistochemical staining markers diagnostic value. Diagn Cytopathol 2022; 50:532-537. [PMID: 36069384 PMCID: PMC9826471 DOI: 10.1002/dc.25053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a rare but aggressive malignancy with a poor prognosis. Because of this tumor rarity and overlapping histologic features with other malignancy types, the histopathological findings and diagnostic immunohistochemical workup are essential in establishing the final diagnosis of MPMs. We aimed to review the diagnostic criteria, WHO tumor classification updates, and immunohistochemical staining markers diagnostic value to achieve an appropriate clinical diagnosis.
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Affiliation(s)
- Nada Shaker
- Department of PathologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Douglas Wu
- Department of PathologyThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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14
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Penault-Llorca F, Kerr KM, Garrido P, Thunnissen E, Dequeker E, Normanno N, Patton SJ, Fairley J, Kapp J, de Ridder D, Ryška A, Moch H. Expert opinion on NSCLC small specimen biomarker testing - Part 1: Tissue collection and management. Virchows Arch 2022; 481:335-350. [PMID: 35857102 PMCID: PMC9485167 DOI: 10.1007/s00428-022-03343-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/11/2022]
Abstract
Biomarker testing is crucial for treatment selection in advanced non-small cell lung cancer (NSCLC). However, the quantity of available tissue often presents a key constraint for patients with advanced disease, where minimally invasive tissue biopsy typically returns small samples. In Part 1 of this two-part series, we summarise evidence-based recommendations relating to small sample processing for patients with NSCLC. Generally, tissue biopsy techniques that deliver the greatest quantity and quality of tissue with the least risk to the patient should be selected. Rapid on-site evaluation can help to ensure sufficient sample quality and quantity. Sample processing should be managed according to biomarker testing requirements, because tissue fixation methodology influences downstream nucleic acid, protein and morphological analyses. Accordingly, 10% neutral buffered formalin is recommended as an appropriate fixative, and the duration of fixation is recommended not to exceed 24-48 h. Tissue sparing techniques, including the 'one biopsy per block' approach and small sample cutting protocols, can help preserve tissue. Cytological material (formalin-fixed paraffin-embedded [FFPE] cytology blocks and non-FFPE samples such as smears and touch preparations) can be an excellent source of nucleic acid, providing either primary or supplementary patient material to complete morphological and molecular diagnoses. Considerations on biomarker testing, reporting and quality assessment are discussed in Part 2.
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Affiliation(s)
| | - Keith M Kerr
- Department of Pathology, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, UK
| | - Pilar Garrido
- Medical Oncology Department, Hospital Universitario Ramón Y Cajal, University of Alcalá, Madrid, Spain
| | - Erik Thunnissen
- Amsterdam University Medical Center, VU Medical Center, Amsterdam, the Netherlands
| | - Elisabeth Dequeker
- Department of Public Health, Biomedical Quality Assurance Research Unit, Campus Gasthuisberg, University Leuven, Leuven, Belgium
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Naples, Italy
| | | | | | | | | | - Aleš Ryška
- Department of Pathology, Charles University Medical Faculty Hospital, Hradec Králové, Czech Republic
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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15
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Koh J, Shin SA, Lee JA, Jeon YK. Lymphoproliferative disorder involving body fluid: diagnostic approaches and roles of ancillary studies. J Pathol Transl Med 2022; 56:173-186. [PMID: 35843627 PMCID: PMC9288893 DOI: 10.4132/jptm.2022.05.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Lymphocyte-rich effusions represent benign reactive process or neoplastic condition. Involvement of lymphoproliferative disease in body cavity is not uncommon, and it often causes diagnostic challenge. In this review, we suggest a practical diagnostic approach toward lymphocyte-rich effusions, share representative cases, and discuss the utility of ancillary tests. Cytomorphologic features favoring neoplastic condition include high cellularity, cellular atypia/pleomorphism, monomorphic cell population, and frequent apoptosis, whereas lack of atypia, polymorphic cell population, and predominance of small T cells usually represent benign reactive process. Involvement of non-hematolymphoid malignant cells in body fluid should be ruled out first, followed by categorization of the samples into either small/medium-sized cell dominant or large-sized cell dominant fluid. Small/medium-sized cell dominant effusions require ancillary tests when either cellular atypia or history/clinical suspicion of lymphoproliferative disease is present. Large-sized cell dominant effusions usually suggest neoplastic condition, however, in the settings of initial presentation or low overall cellularity, ancillary studies are helpful for more clarification. Ancillary tests including immunocytochemistry, in situ hybridization, clonality test, and next-generation sequencing can be performed using cytologic preparations. Throughout the diagnostic process, proper review of clinical history, cytomorphologic examination, and application of adequate ancillary tests are key elements for successful diagnosis.
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Affiliation(s)
- Jiwon Koh
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ah Shin
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Ji Ae Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Corresponding Author: Yoon Kyung Jeon, MD, PhD, Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8323, Fax: +82-2-743-5530, E-mail:
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16
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Zheng JL, Zhou YJ, Yan H. A case report-application of pericardial effusion cytology and next-generation sequencing technology: quick and secure diagnosis of primary effusion lymphoma. Eur Heart J Case Rep 2022; 6:ytac239. [PMID: 35821972 PMCID: PMC9269675 DOI: 10.1093/ehjcr/ytac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/19/2022] [Accepted: 06/11/2022] [Indexed: 11/14/2022]
Abstract
Background Primary effusion lymphoma (PEL) is an uncommon subtype of non-Hodgkin lymphoma (NHL) that usually involves the pleura, pericardium, and peritoneum without an obvious tumour mass, with multiple plasma effusions as its main clinical feature. We report a case of a massive pericardial effusion in an elderly male with a final diagnosis of PEL. Case summary A 70-year-old male patient was admitted to hospital with symptoms of chest tightness, shortness of breath, fatigue, loss of appetite, and cough with phlegm after a pericardial effusion had been found for 5 months. The next-generation sequencing of pericardial effusion found human herpesvirus type 8 (HHV-8) infection, and further cytomorphological and immunohistochemical examination were done. According to the patient's HHV-8 infection, the pathological features of heterogeneous B cells with plasmablastic differentiation and the immunohistochemical characteristics of PEL, the final diagnosis was made as human immunodeficiency virus-negative PEL. Discussion The diversity and non-specificity of PEL symptoms, as well as its rarity, make it difficult to diagnose. In this case, we used the next-generation sequencing technology to screen the pathogen of the patient's pericardial effusion and carried out morphological and immunohistochemical examination of the cells in the pericardial effusion, which provided a clinically operable diagnosis for an uncommon disease, enabling us to make a clear diagnosis faster and start treatment in time.
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Affiliation(s)
- Jin Lei Zheng
- Master of Medicine, Zhejiang University School of Medicine, Zhejiang, China
| | - Yi Jiang Zhou
- Doctor of Medicine, Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Hui Yan
- Doctor of Medicine, Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
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17
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Jhala N, Arriola A, Pantanowitz L. Serous cavity metastasis: Evaluation of unknown primary. Cytojournal 2022; 19:16. [PMID: 35510111 PMCID: PMC9063508 DOI: 10.25259/cmas_02_11_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 11/04/2022] Open
Abstract
Malignant effusions can occur in patients with neoplasia. Once a metastatic diagnosis is confirmed, the primary site of origin of malignancy needs to be ascertained. This task can be challenging without a prior history of malignancy. In some patients their effusion may be the initial presentation of an underlying malignancy. Metastases usually present with a dual population of mesothelial and malignant cells. Combining cytomorphologic examination with ancillary testing such as immunocytochemistry can help identify the origin of the foreign malignant cell population. Helpful architectural clues include a single cell pattern, solid cell ball pattern, single file arrangement, papillary formation, psammoma bodies and background mucin. Useful cellular features include the presence of signet ring cells, small cells, pleomorphic and multinucleated giant cells, squamous cells, spindle cells and pigmentation. Rarely, despite an extensive work-up the primary site of origin for a malignant effusion may remain unresolved. This review article will be incorporated finally as one of the chapters in CMAS (CytoJournal Monograph/Atlas Series) #2. It is modified slightly from the chapter by the initial authors in the first edition of Cytopathologic Diagnosis of Serous Fluids.
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Affiliation(s)
- Nirag Jhala
- Department of Pathology and Laboratory Medicine, Temple University Hospital and Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA,
| | - Aileen Arriola
- Department of Pathology and Laboratory Medicine, Temple University Hospital and Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA,
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18
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Straccia P, Chiappetta M, Magnini D, Cancellieri A. Application of the International System for Reporting Serous Fluid Cytopathology (TIS): A Retrospective Institutional Study. Cytopathology 2022; 33:305-311. [PMID: 35213747 DOI: 10.1111/cyt.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cytology of serous effusions is an important diagnostic tool for the diagnosis of cancer, staging and prognosis of the patient. Herein, we retrospectively applied the TIS on reporting serous cytopathology and provided the corresponding risk of malignancy (ROM). METHODS Pleural, pericardial and peritoneal effusion samples were retrieved from the archives of our department and reclassified according to the TIS. The ROM for each category was calculated based on available surgical follow-up. RESULTS A total 3790 effusions were available for the study. 1292 pleural samples were reclassified: 27 (2.1%) non-diagnostic (ND), 1014 (78.5 %) negative for malignancy (NFM), 86 (6.6 %) atypia of undetermined significance (AUS), 29 (2.3 %) suspicious of malignancy (SFM) and 136 (10.5%) malignant (M). 241 pericardial samples were reclassified: 4 (1.6 %) as ND, 173 (71.8 %) as NFM, 10 (4.1 %) as AUS, 7 (3 %) as SFM, and 47 (19.5%) as M. 2257 peritoneal cases were re-categorized as follows: 31 (1.4 %) as ND, 1897 (84 %) as NFM, 39 (1.7 %) as AUS, 53 (2.4 %) as SFM, and 237 (10.5 %) as M. The ROM was, respectively, for each of the aforementioned categories, 18.5%, 15%, 45.3%, 93%, 100% in pleural effusions, 25%, 13.2%, 35%, 100%, 100% in pericardial effusions and 19.3%, 10.4%, 43.5%, 100%, 100% in peritoneal effusions. CONCLUSIONS Pleural, pericardial, and peritoneal cytology show high specificity and moderate sensitivity in the evaluation of serous effusions. The ROM reported in our study was mostly concordant with ROM published by the TIS.
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Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, Largo Francesco Vito, 1-00168, Rome
| | - Marco Chiappetta
- Thoracic Surgery, Largo Francesco Vito, 1-00168, Rome.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Magnini
- Bronchoscopy and Pneumology Unit, Largo Francesco Vito, 1-00168, Rome
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19
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Dalvi SD, Chau K, Sajjan S, Chakraborty B, Karam P, Khutti S, Gimenez C, Das K. Adequacy of pleural fluid cytology for comprehensive molecular analysis of lung adenocarcinoma: Experience of a large health-care system. Cytojournal 2022; 19:7. [PMID: 35510120 PMCID: PMC9063584 DOI: 10.25259/cytojournal_18_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: Pleural fluid evaluation is an effective modality for identifying actionable genetic mutations to guide therapy in lung carcinoma. Clinicians requesting molecular studies often send large volumes of fluid to be processed that is not possible or cost effective and is hence not standard of practice in most cytopathology laboratories. We wanted to establish the characteristics of an adequate specimen that would yield reliable results with current molecular testing platforms. Material and Methods: A review of 500 malignant pleural effusions, from pulmonary and non-pulmonary sources, was undertaken over a 4-year period. Of these 44 cases (from 42 patients) that were positive for primary lung adenocarcinoma were included in the study. Molecular analysis was performed on 42 specimens. A complete next generation sequencing (NGS) panel was performed on 36 specimens. Individual testing for estimated glomerular filtration rate, KRAS, anaplastic lymphoma kinase, and ROS1 was performed on six specimens. The number of malignant cells and proportion of tumor to non-tumor nucleated cells (T: NT) on cell blocks was recorded as <20%, 20–50% and >50%. Results: The minimum volume on which a complete NGS panel could be performed was 20 ml with cell count of 1000 and T: NT proportion of 20–50%. The minimum number of tumor cells required for successful molecular analysis for T: NT proportion of <20%, 20–50%, and >50% was 300, 250, and 170 cells, respectively. Conclusion: We concluded that tumor cell proportion, rather than specimen volume, is of prime importance for determining the efficacy of pleural fluid for molecular studies. Evaluation of both absolute and relative numbers of tumor cells is critical for assessing the adequacy and predicting successful yield for molecular analysis.
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Affiliation(s)
- Siddhartha Dilip Dalvi
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
| | - Karen Chau
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
| | - Sujata Sajjan
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
| | - Baidarbhi Chakraborty
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
| | - Priyanka Karam
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
| | - Seema Khutti
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, United States,
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20
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Deep convolutional neural network-based classification of cancer cells on cytological pleural effusion images. Mod Pathol 2022; 35:609-614. [PMID: 35013527 PMCID: PMC9042694 DOI: 10.1038/s41379-021-00987-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022]
Abstract
Lung cancer is one of the leading causes of cancer-related death worldwide. Cytology plays an important role in the initial evaluation and diagnosis of patients with lung cancer. However, due to the subjectivity of cytopathologists and the region-dependent diagnostic levels, the low consistency of liquid-based cytological diagnosis results in certain proportions of misdiagnoses and missed diagnoses. In this study, we performed a weakly supervised deep learning method for the classification of benign and malignant cells in lung cytological images through a deep convolutional neural network (DCNN). A total of 404 cases of lung cancer cells in effusion cytology specimens from Shanghai Pulmonary Hospital were investigated, in which 266, 78, and 60 cases were used as the training, validation and test sets, respectively. The proposed method was evaluated on 60 whole-slide images (WSIs) of lung cancer pleural effusion specimens. This study showed that the method had an accuracy, sensitivity, and specificity respectively of 91.67%, 87.50% and 94.44% in classifying malignant and benign lesions (or normal). The area under the receiver operating characteristic (ROC) curve (AUC) was 0.9526 (95% confidence interval (CI): 0.9019-9.9909). In contrast, the average accuracies of senior and junior cytopathologists were 98.34% and 83.34%, respectively. The proposed deep learning method will be useful and may assist pathologists with different levels of experience in the diagnosis of cancer cells on cytological pleural effusion images in the future.
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21
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Claudin-18 Immunohistochemical Staining Facilitates the Identification of Metastatic Carcinoma of Gastric or Pancreatic Origin in Effusion Specimens. Appl Immunohistochem Mol Morphol 2022; 30:8-13. [PMID: 34879032 DOI: 10.1097/pai.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
Determining the primary origin of a malignant effusion remains a common challenge for cytopathologists. Although immunohistochemical (IHC) markers are available for most primary sites, ideal IHC markers for metastatic gastric adenocarcinoma and pancreatic ductal adenocarcinoma are lacking, and related interpretation is often hindered by mesothelial cells. We recently revealed that claudin-18 IHC staining is useful for identifying the stomach and pancreas as the primary sites of metastatic adenocarcinoma. Thus, we assessed the use of claudin-18 IHC staining in 111 cell blocks obtained from various metastatic cancers and specimens negative for malignancy. Positive membranous claudin-18 staining was noted in all 10 (100%) metastatic pancreatic ductal adenocarcinomas, 9 (90%) of 10 gastric adenocarcinomas, and 1 (9%) of 11 nonmucinous lung adenocarcinomas. The cases of metastatic mucinous carcinomas of lung origin (1 case) and ovarian origin (1 case) were also positive for claudin-18. The other remaining 89 cases showed variable cytoplasmic staining on some cells (73 cases) or complete absence of staining (16 cases). After normalization to the tumor frequency, the sensitivity and specificity for identifying the stomach or pancreas as primary tumor sites in ascites were 95% (confidence interval: 0.83-0.99) and 99% (confidence interval: 0.94-1), respectively. In conclusion, membranous claudin-18 staining is a useful marker for metastatic gastric adenocarcinoma and pancreatic ductal adenocarcinoma in effusion specimens.
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22
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OUP accepted manuscript. Am J Clin Pathol 2022; 158:416-425. [DOI: 10.1093/ajcp/aqac066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
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23
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Chebib I. Approach to malignant effusions in metastatic sarcoma. Cancer Cytopathol 2021; 129:774-775. [PMID: 34232565 DOI: 10.1002/cncy.22447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Ivan Chebib
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pathology, Harvard Medical School, Boston, Massachusetts
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24
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Kanber Y, Pusztaszeri M, Auger M. Immunocytochemistry for diagnostic cytopathology-A practical guide. Cytopathology 2021; 32:562-587. [PMID: 34033162 DOI: 10.1111/cyt.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Cytological specimens, which are obtained by minimally invasive methods, are an excellent source of diagnostic material. Sometimes they are the only material available for diagnosis as well as for prognostic/predictive markers. When cytomorphology is not straightforward, ancillary tests may be required for a definitive diagnosis to guide clinical management. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology is equivocal, to differentiate entities with overlapping morphological features, and to determine the cell lineage and the site of origin of a metastatic neoplasm. Numerous immunomarkers are available, and some are expressed in multiple neoplasms. To rule out entities within a differential diagnosis, the use of more than one marker, sometimes panels, is necessary. ICC panels for diagnostic purposes should be customised based on the clinical context and cytomorphology, and the markers should be used judiciously to preserve material for additional tests for targeted therapies in the appropriate setting. This review offers a practical guide for the use of ICC for diagnostic cytopathology, covering the most commonly encountered non-hematolymphoid diagnostic scenarios in various body sites.
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Affiliation(s)
- Yonca Kanber
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Manon Auger
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
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Xu Y, Hu AY, Wang SM, Wang Q, Pan YC, Zhang SH. A retrospective analysis of pleural effusion specimens based on the newly proposed International System for Reporting Serous Fluid Cytopathology. Diagn Cytopathol 2021; 49:997-1007. [PMID: 34019334 DOI: 10.1002/dc.24804] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, the International System for Reporting Serous Fluid Cytopathology (TIS) has been established, with an aim to standardize reporting and guide clinical decision making. METHODS The cytological and clinicopathological data of pleural effusions were retrieved from the pathology database and electronic medical records. All specimens were evaluated and reclassified in accordance with the TIS recommendations. Finally, the risk of malignancy (ROM) and performance parameters were measured. RESULTS A total of 2454 pleural effusion specimens were included, among which 30 (1.2%), 1670 (68.1%), 151 (6.2%), 54 (2.2%) and 549 (22.4%) patients were classified into non-diagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM) and malignancy (MAL) groups, respectively. The most commonly diagnosed malignancies were lung cancer (48.4%), ovary cancer (10.2%), breast cancer (7.5%), and 21.3% unknown primary site (UPS). Among the 36 UPS patients, the most common site of origin was lung (36.1%), followed by ovary (13.9%) and breast (11.1%) via immunocytochemistry of cell block. The calculated ROM values were 26.7%, 12%, 62.3%, 77.8% and 100% for ND, NFM, AUS, SFM and MAL groups, respectively. When considering MAL as the only positive group, the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were determined to be 95.2%, 81.9%, 100%, 100% and 93.6%, respectively. CONCLUSION The newly proposed TIS is an easy-to-master, user-friendly, and standardized classification system, especially when applying on pleural effusions. An adequate serous sample, application of immunocytochemistry, review of cytomorphological data and past medical history could enhance the accuracy of cytological diagnosis.
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Affiliation(s)
- Yi Xu
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Ai-Yan Hu
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Shou-Mei Wang
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Qian Wang
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Yun-Cui Pan
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Shu-Hui Zhang
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
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Kinoshita Y, Hamasaki M, Matsumoto S, Yoshimura M, Sato A, Tsujimura T, Kamei T, Kawahara K, Iwasaki A, Nabeshima K. Fluorescence in situ hybridization detection of chromosome 22 monosomy in pleural effusion cytology for the diagnosis of mesothelioma. Cancer Cytopathol 2021; 129:526-536. [PMID: 33493384 DOI: 10.1002/cncy.22409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is characterized by mutations in several genes, including cyclin-dependent kinase-inhibitor 2A/p16 in the 9p21 locus, BRCA1-associated protein 1 (BAP1), and neurofibromatosis type 2 (NF2) in the 22q12 locus. Recent studies indicate that fluorescence in situ hybridization (FISH) detects hemizygous loss of NF2 in tissue specimens of MPM. The authors investigated whether NF2 FISH, either alone or in combination with other diagnostic assays (9p21 FISH, methylthioadenosine phosphorylase [MTAP] immunohistochemistry [IHC], and BAP1 IHC), effectively distinguishes MPM cells from reactive mesothelial cells (RMCs) in cell blocks prepared from pleural effusions. METHODS FISH assays were used to examine the deletion status of NF2 and 9p21, and IHC was used to determine the expression of MTAP and BAP1 in cell blocks from 54 cases with MPM and 18 cases with RMCs. RESULTS Hemizygous NF2 loss (chromosome 22 monosomy or hemizygous deletion) showed 51.9% sensitivity (48.1% for chromosome 22 monosomy and 3.7% for hemizygous deletion) and 100% specificity in differentiating MPM cells from RMCs. Combinations of NF2 FISH, 9p21 FISH, and BAP1 IHC assays yielded greater sensitivity (98.1%) than any assay alone (9p21 FISH, 61.1%; MTAP IHC, 52.8%; or BAP1 IHC, 60.4%). The level of hemizygous NF2 loss in cell blocks positively correlated with that in corresponding tissues. Furthermore, to overcome cytologic specimen-specific challenges, FISH combined with cytokeratin AE1/AE3 immunofluorescence was necessary in 25.9% of MPM cases for FISH assessment of predominantly scattered MPM cells. CONCLUSIONS NF2 FISH alone or in combination with other diagnostic assays effectively differentiates MPM cells from RMCs in cell blocks prepared from pleural effusions.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan.,Department of Respiratory Medicine, Fukuoka University Chikushi Hospital and School of Medicine, Fukuoka, Japan
| | - Makoto Hamasaki
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Shinji Matsumoto
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Masayo Yoshimura
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Ayuko Sato
- Department of Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tohru Tsujimura
- Department of Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiaki Kamei
- Pathology and Cytology Center, BML Group PCL Japan, Inc, Fukuoka, Japan
| | | | - Akinori Iwasaki
- Department of Thoracic Surgery, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
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Davis RC, Broadwater G, Foo WC, Jones CK, Havrilesky LJ, Bean SM. Evaluation of pelvic washing specimens in patients with endometrial cancer: Cytomorphological features, diagnostic agreement, and pathologist experience. Cancer Cytopathol 2021; 129:517-525. [PMID: 33481348 DOI: 10.1002/cncy.22406] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pelvic washings for patients with endometrial cancer is recommended but not used for staging. The International System for Reporting Serous Fluid Cytology (TIS) has standardized diagnostic categories, but the criteria remain incomplete. The 3 primary goals of this study were to 1) investigate features that distinguish atypical/indeterminate from malignant specimens, 2) measure the level of agreement between chart and reviewer diagnoses, and 3) determine whether the number of years in practice had an effect on the diagnoses rendered. METHODS Pelvic washings and surgical pathology specimens for 52 patients with a chart diagnosis of atypical/indeterminate, suspicious, or malignant cytology and 52 age-matched controls with a negative chart diagnosis were included, reviewed blindly by 2 cytopathologists, and assigned a study diagnosis. Morphologic features were assessed. Agreement between original chart diagnoses and reviewer diagnoses were assessed as well as effect of years in practice. RESULTS The overall cellularity in cell block (CB) slides for the malignant category was significantly increased compared with the atypical/indeterminate category (P < .0001). In addition, the number of atypical groups in ThinPrep for malignant washings was significantly increased compared with the atypical category (P < .001) and the negative and suspicious categories (P < .0001) in the CB. Overall agreement between the original and adjudicated diagnoses was high (γ = 0.983). There was no significant difference between diagnoses rendered and years in practice. CONCLUSION The overall cellularity and number of atypical cells can be used to distinguish between malignant and atypical pelvic washing specimens. There is high reproducibility in the diagnostic categories and high agreement among pathologists, regardless of practice experience. These findings can help refine the criteria for TIS.
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Affiliation(s)
- Richard C Davis
- Department of Pathology, Duke University, Durham, North Carolina
| | - Gloria Broadwater
- Duke Cancer Institute Biostatistics, Duke University, Durham, North Carolina
| | - Wen-Chi Foo
- Department of Pathology, Duke University, Durham, North Carolina
| | - Claudia K Jones
- Department of Pathology, Duke University, Durham, North Carolina
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Sarah M Bean
- Department of Pathology, Duke University, Durham, North Carolina
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Grigoriadou GΙ, Esagian SM, Ryu HS, Nikas IP. Molecular Profiling of Malignant Pleural Effusions with Next Generation Sequencing (NGS): Evidence that Supports Its Role in Cancer Management. J Pers Med 2020; 10:jpm10040206. [PMID: 33139621 PMCID: PMC7712846 DOI: 10.3390/jpm10040206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Malignant pleural effusions (MPEs) often develop in advanced cancer patients and confer significant morbidity and mortality. In this review, we evaluated whether molecular profiling of MPEs with next generation sequencing (NGS) could have a role in cancer management, focusing on lung cancer. We reviewed and compared the diagnostic performance of pleural fluid liquid biopsy with other types of samples. When applied in MPEs, NGS may have comparable performance with corresponding tissue biopsies, yield higher DNA amount, and detect more genetic aberrations than blood-derived liquid biopsies. NGS in MPEs may also be preferable to plasma liquid biopsy in advanced cancer patients with a MPE and a paucicellular or it could be difficult to obtain tissue/fine-needle aspiration biopsy. Of interest, post-centrifuge supernatant NGS may exhibit superior results compared to cell pellet, cell block or other materials. NGS in MPEs can also guide clinicians in tailoring established therapies and identifying therapy resistance. Evidence is still premature regarding the role of NGS in MPEs from patients with cancers other than lung. We concluded that MPE processing could provide useful prognostic and theranostic information, besides its diagnostic role.
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Affiliation(s)
- Georgia Ι. Grigoriadou
- 1st Department of Medical Oncology, Theageneio Anticancer Hospital, 54007 Thessaloniki, Greece;
| | - Stepan M. Esagian
- Department of Medicine, School of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul 03080, Korea;
| | - Ilias P. Nikas
- School of Medicine, European University of Cyprus, 2404 Nicosia, Cyprus
- Correspondence:
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Diagnosis of Hodgkin Lymphoma from Cell Block: A Reliable and Helpful Tool in "Selected" Diagnostic Practice. Diagnostics (Basel) 2020; 10:diagnostics10100748. [PMID: 32992679 PMCID: PMC7601842 DOI: 10.3390/diagnostics10100748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 01/10/2023] Open
Abstract
Background: The diagnosis of lymphoma requires surgical specimens to perform morphological evaluation, immunohistochemical and molecular analyses. Ultrasound-guided fine needle aspiration may represent an appropriate first approach to obtain cytological samples in impalpable lesions and/or in patients unsuitable for surgical procedures. Although cytology has intrinsic limitations, the cell block method may increase the possibility of achieving an accurate diagnosis. Methods: We retrospectively selected a total of 47 ultrasound-guided fine needle aspiration and drainage samples taken from patients with effusion and deep-seated lesions which are clinically suspicious in terms of malignancy. Results: In 27 cases, both cell block and conventional cytology were performed: 21/27 cell blocks were adequate for the diagnosis of lymphoma and suitable for immunocytochemistry and molecular analyses vs. 12/20 samples to which only conventional cytology was applied. Moreover, in five patients we were able to make a diagnosis of Hodgkin lymphoma with the cell block (CB) technique. Conclusions: Contrary to conventional cytology, the cell block method may allow immunocytochemistry and molecular studies providing useful information for the diagnosis and subtypization of lymphoma in patients unsuitable for surgical procedure or with deep-seated lesions or extra-nodal diseases; additionally, it is a daily, simple and helpful approach. Moreover, we describe the usefulness of cell blocks in the diagnosis of Hodgkin lymphoma.
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Avondo S, Andreis A, Casula M, Imazio M. Update on diagnosis and management of neoplastic pericardial disease. Expert Rev Cardiovasc Ther 2020; 18:615-623. [PMID: 32797759 DOI: 10.1080/14779072.2020.1811087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pericardial neoplasms are uncommon, mostly due to secondary involvement of the pericardium by extracardiac tumors. Clinical presentation is nonspecific, frequently leading to a delayed diagnosis. Moreover, both benign and malignant pericardial tumors may be associated with myocardial infiltration and mechanical compression of cardiac chambers, possibly precipitating clinical conditions. Pericardial tumors are indeed a diagnostic and therapeutic clinical challenge. AREAS COVERED This review aims to provide an overview of the main clinical characteristics of pericardial tumors, along with their management in clinical practice. EXPERT COMMENTARY Multimodality imaging (echocardiography, chest X-ray, CT, CMR, and PET) enable full characterization of pericardial neoplasms. An individualized strategy should be developed by a multidisciplinary team including cardiologists, oncologists, radiologists, and cardiac surgeons.
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Affiliation(s)
- Stefano Avondo
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
| | - Alessandro Andreis
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
| | - Matteo Casula
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
| | - Massimo Imazio
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città Della Salute e Della Scienza Di Torino , Torino, Italy
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Díaz Del Arco C, Saiz-Pardo Sanz M, Ortega Medina L, Fernández Aceñero MJ. Ber-EP4 staining in effusion cytology: A potential source of false positives. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 54:114-122. [PMID: 33726887 DOI: 10.1016/j.patol.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/21/2020] [Accepted: 04/25/2020] [Indexed: 10/23/2022]
Abstract
The distinction between reactive mesothelium and carcinoma in serous effusions can be very difficult. Immunocytochemistry (ICC) is the most widely used tool to improve the diagnostic accuracy of body fluid cytology, with several ICC markers being proposed. Ber-EP4 antibody has shown high sensitivity and specificity rates for diagnosing metastatic carcinoma. In our department, we have detected Ber-EP4 positivity in mesothelium in some cytological specimens. We reviewed all articles on Ber-EP4 staining in effusion cytology, summarized current findings and analyzed the staining pattern of all cases expressing Ber-EP4. Some cases showing Ber-EP4 positivity in mesothelium have been reported, most of which showed only weak Ber-EP4 staining or staining of less than 50% of mesothelial cells. However, some cases may show strong positivity both in cytological and histological specimens. Clinicians and pathologists should be aware of this source of misdiagnosis, and ICC results in mesothelium should be always interpreted cautiously and correlated with clinical tests, other ICC markers and patient's previous history.
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Affiliation(s)
| | | | - Luis Ortega Medina
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
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Kinoshita Y, Hamasaki M, Matsumoto S, Yoshimura M, Sato A, Tsujimura T, Kamei T, Kawahara K, Nabeshima K. Genomic-based ancillary assays offer improved diagnostic yield of effusion cytology with potential challenges in malignant pleural mesothelioma. Pathol Int 2020; 70:671-679. [PMID: 32542810 DOI: 10.1111/pin.12973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022]
Abstract
BRCA1-associated protein 1 (BAP1) or methylthioadenosine phosphorylase (MTAP) immunohistochemistry (IHC) or 9p21 fluorescence in situ hybridization (FISH) are useful for the diagnosis of malignant pleural mesothelioma (MPM). However, the effect of these assays on the diagnostic yield of effusion cytology in MPM cases with suspicious cytomorphology or the diagnostic challenges in BAP1 or MTAP IHC have not been fully elucidated. Two cohorts of cytologic preparations obtained from pleural effusions were examined: MPM cases in cohort 1 were used to evaluate whether BAP1 or MTAP IHC or 9p21 FISH increase the diagnostic yield of effusion cytology; cohort 2 included cases suspicious for MPM, to which BAP1 or MTAP IHC was applied to clarify the challenges in the clinical assessment of these assays. In cohort 1 (n = 28), either assay elevated 62.5% of class II or III cases to class V. In cohort 2 (n = 139), 21.7% of BAP1 immunocytochemistry in smears and 10.6% of BAP1 IHC and 9.4% of MTAP IHC in cell blocks, were identified to be challenging. The application of genomic-based assays increased the diagnostic yield of effusion cytology in the diagnosis of MPM. However, diagnostic challenges limit the application of these assays in some cases.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan.,Department of Respiratory Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Makoto Hamasaki
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Shinji Matsumoto
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Masayo Yoshimura
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
| | - Ayuko Sato
- Department of Pathology, Hyogo College of Medicine, Hyōgo, Japan
| | - Tohru Tsujimura
- Department of Pathology, Hyogo College of Medicine, Hyōgo, Japan
| | - Toshiaki Kamei
- Pathology and Cytology Center, BML group PCL Japan, Inc., Fukuoka, Japan
| | | | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Fukuoka, Japan
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Lew M, Cantley R, Heider A, Jing X. Diagnosis and categorization of malignant effusions: A 6-year review from a single academic institution. Diagn Cytopathol 2020; 49:615-621. [PMID: 32275354 DOI: 10.1002/dc.24433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cytologic detection of malignant cells in pleural, peritoneal, or pericardial effusion most likely indicates advanced stage of malignant disease. There are a few studies updating the categorization of malignant effusions. METHODS The electronic pathology database was searched to identify consecutive cases of malignant effusion during a 6-year period. Patient age and gender, origins of known malignancy, and cytologic diagnoses were recorded and summarized. RESULTS A total of 1059 specimens included 561 (53%) pleural, 441 (41.6%) peritoneal, and 57 (5.4%) pericardial fluids. Most of the pleural (516, 92.0%), peritoneal (418, 94.8%), and pericardial (53, 93.0%) specimens were derived from patients with a single known malignancy. More common origins involving pleural fluid were lung (152, 27.1%) followed by breast (103, 18.4%) and gastrointestinal tract (76, 13.5%). The most common etiology for women and men was breast (102, 30.8%) and lung (67, 36.2%), respectively. More common origins involving peritoneal fluid were gastrointestinal (158, 35.8%) and gynecologic (156, 35.4%) tracts, and breast (46, 10.4%). The most common etiology for women and men was Mullerian (156, 55.5%) and gastrointestinal tract (94, 68.6%), respectively. Most common origins involving the pericardial fluid were breast (20, 37.7%) and lung (17, 29.8%). Breast and lung were the most common etiology for women (20, 57.1%) and men (8, 44.4%), respectively. CONCLUSIONS Breast and lung remain to be the most common origin of both malignant pleural and pericardial effusion for women and men, respectively. The most common origin involving peritoneal effusion is Mullerian for women and gastrointestinal tract for men.
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Affiliation(s)
- Madelyn Lew
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI, USA
| | - Richard Cantley
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI, USA
| | - Amer Heider
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI, USA
| | - Xin Jing
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI, USA
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Alshaikh S, Lapadat R, Atieh MK, Mehrotra S, Barkan GA, Wojcik EM, Pambuccian SE. The utilization and utility of immunostains in body fluid cytology. Cancer Cytopathol 2020; 128:384-391. [PMID: 32163239 DOI: 10.1002/cncy.22256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Body fluid cytology (BFC) is an important tool in the diagnosis and staging of malignancy and is aided by the judicious use of immunohistochemistry (IHC). The aim of this study was to determine the usage rates of IHC stains in BFC, their type and indications, and their diagnostic impact. We also attempted to estimate the optimal rate of IHC use in BFC by comparing the entire laboratory's and each individual cytopathologist's IHC use rates with their respective indeterminate and malignant diagnosis rates. METHODS We conducted a retrospective study of IHC stain use in BFC during a 5.5-year interval (2013-2018) and determined the laboratory's and each individual cytopathologist's IHC usage patterns according to the final diagnosis, site, and indications for their use. RESULTS A total of 477 out of 4144 (11.5%) BFC cases had 2128 individual immunostains performed, with an average of 4.5 immunostains per case. Individual cytopathologists used IHC stains on 6.7% to 22% of their BFC cases. Pathologists with higher rates of IHC stain use than the laboratory's mean were less experienced and had higher rates of indeterminate but not of malignant diagnoses. The most common indication for the use of IHC stains was differentiating mesothelial from malignant cells. MOC31, calretinin, Ber-EP4, CD68, and D2-40 were the most commonly used of the 67 different IHC stains used in BFC. CONCLUSIONS The laboratory's mean may represent the optimal IHC use rate, as higher IHC use rates did not lead to more diagnostic certainty or higher pickup rates of malignant cells.
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Affiliation(s)
| | - Razvan Lapadat
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Mohammed K Atieh
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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Hou Y, Bruehl FK, McHugh KE, Reynolds JP. Primary tumor types and origins in positive abdominopelvic washing cytology, a single institution experience. J Am Soc Cytopathol 2020; 9:89-94. [PMID: 31734259 DOI: 10.1016/j.jasc.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/16/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Abdominopelvic washing cytology is a common specimen evaluated for ovarian, fallopian tubal, and peritoneal cancer staging or other nongynecologic malignancies presented as metastases. We reviewed our experience in diagnosing abdominopelvic washing specimens and assessing the primary tumor types and origins of the positive abdominopelvic washings. MATERIALS AND METHODS A pathology archive database search was performed for abdominopelvic washing specimens from 2007 to 2018. The corresponding cytologic diagnoses, results of ancillary studies, clinical histories, and surgical follow-up were reviewed. The primary sites were determined based on the synoptic reports, when available. RESULTS A total of 5.8% (350 of 6023) of cases were positive for malignancy or neoplasm. Additionally, 1.3% (78 of 6023) were diagnosed as atypical cells. Of the 350 positive cases, 93.4% were müllerian tumors. The frequency of primary sites for müllerian tumors in descending order were: ovary, uterus, fallopian tube, peritoneum, and uncertain müllerian sites. The common ovarian tumors identified in pelvic washing in descending order were: high-grade serous carcinoma, serous borderline tumor, clear cell carcinoma, low-grade serous carcinoma, and endometrioid carcinoma. Gastrointestinal, breast, bladder, and lymphoma primaries were the 23 nongynecologic tumors identified in pelvic washings. CONCLUSIONS Positive findings in abdominopelvic washing cytology is rare. The majority of the positive cases were from müllerian origins, with ovary and uterus as the most common sites. Endometrial adenocarcinoma, endometrioid type and ovarian high-grade serous carcinoma were the most common tumor types. Knowing prior history of malignancy, morphologic comparison with concurrent surgical cases, and performing ancillary studies are keys to improve diagnostic accuracy of abdominopelvic washings.
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Affiliation(s)
- Yanjun Hou
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Frido K Bruehl
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kelsey E McHugh
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Patel A, Borczuk AC, Siddiqui MT. Utility of Claudin-4 versus BerEP4 and B72.3 in pleural fluids with metastatic lung adenocarcinoma. J Am Soc Cytopathol 2020; 9:146-151. [PMID: 32184064 DOI: 10.1016/j.jasc.2019.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/14/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Lung adenocarcinoma (LADC) is the most common occult primary in patients presenting with a malignant pleural effusion. Distinguishing metastatic LADC from reactive mesothelial cells (RMC) and malignant mesothelioma (MM) based on morphology alone has been a persistent diagnostic challenge in cytopathology. Claudin-4, a major functional constituent of tight junctions, has been shown to help distinguish LADC from RMC and MM in surgical specimens. Our goal was to further validate and assess the utility of Claudin-4 in comparison to BerEP4 and B72.3 in malignant effusions with a focus on metastatic LADC. MATERIALS AND METHODS We evaluated 58 pleural effusions (40 LADC, 10 RCM, and 8 MM). Immunohistochemistry was performed using Claudin-4, Ber-EP4, and B72.3 on cell blocks. Staining patterns, quantity of tumor cells, and intensity of staining (weak, moderate, or strong) were assessed. RESULTS All cases of LADC were positive for Claudin-4 with an overall sensitivity of 100% (40 of 40) and specificity of 100% (18 of 18). In addition, Claudin-4 showed the highest quantity and quality of staining with 3+ staining intensity in 73% (29 of 40) of cases, compared with 35% (14 of 40) of cases using BerEP4 and 52% (21 of 40) of cases using B72.3. The sensitivity and specificity for BerEP4 were 90% and 78%, respectively. The sensitivity and specificity for B72.3 were 87.5% and 100%, respectively. CONCLUSIONS In this study, Claudin-4 performed superiorly compared to BerEP4 and B72.3 in distinguishing lung adenocarcinoma from RMC or MM in pleural effusions. Our results show Claudin-4 is a useful marker for distinguishing RMC and MM from lung adenocarcinoma, with high sensitivity (100%) and specificity (100%), compatible with studies shown in the literature.
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Affiliation(s)
- Ami Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.
| | - Alain C Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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Diagnosis and characterization of malignant effusions through pleural fluid cytological examination. Curr Opin Pulm Med 2019; 25:362-368. [DOI: 10.1097/mcp.0000000000000593] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Pillappa R, Kraft AO. Immunohistochemical validation studies in effusion cytology: A cautionary tale. Cancer Cytopathol 2019; 127:680-683. [DOI: 10.1002/cncy.22149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Raghavendra Pillappa
- Department of Pathology Virginia Commonwealth University School of Medicine Richmond Virginia
| | - Adele O. Kraft
- Department of Pathology Virginia Commonwealth University School of Medicine Richmond Virginia
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Martínez-Girón R, Martínez-Torre S. Ascitic fluid cytology in a previously healthy woman. Cytopathology 2019; 31:63-64. [PMID: 31038821 DOI: 10.1111/cyt.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/05/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rafael Martínez-Girón
- Department of Health Anatomic Pathology and Cytodiagnosis, CFP San Juan de la Cruz, Madrid, , Spain
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Gulyas M, Fillinger J, Kaposi AD, Molnar M. Use of cholesterol and soluble tumour markers CEA and syndecan-2 in pleural effusions in cases of inconclusive cytology. J Clin Pathol 2019; 72:529-535. [PMID: 31028099 PMCID: PMC6678041 DOI: 10.1136/jclinpath-2018-205650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/05/2019] [Accepted: 04/06/2019] [Indexed: 11/08/2022]
Abstract
Aims In order to improve diagnostics in pleural effusions, additional value of effusion cholesterol, carcinoembryonic antigen (CEA) and syndecan-2 assays to cytology was studied. Methods Biomarkers were measured in effusion supernatants from 247 patients, of whom 126 had malignant pleural involvement, and their additional diagnostic efficacy to cytology was assessed. Results Syndecan-2 measurement, although gave detectable concentrations in all effusions with highest median value in mesotheliomas, was non-discriminative between different pathological conditions. CEA concentrations exceeding 5 ng/mL cut-off point indicated carcinomas, regardless of pleural involvement, which gave a sensitivity of 62% and specificity of 100% for carcinoma. Cholesterol concentration over 1.21 mmol/L cut-off value indicated neoplastic pleural involvement with 99% sensitivity and ‘merely’ 69% specificity, the latter mainly due to raised levels being associated also with benign inflammatory effusions. Combined CEA and cholesterol determinations increased the sensitivity for diagnosing carcinomatosis from 70% with cytology alone to 84% and established the correct diagnosis in 16 of 31 carcinomatosis cases with inconclusive cytology. Cholesterol measurement alone, with elevated level, in combination with absence of substantial number of inflammatory cells in effusion sediment proved to be a magnificent marker for neoplastic pleural involvement with 99% efficacy, and recognised all 36 such cases with inconclusive cytology. Conclusions Simultaneous measurement of CEA and cholesterol concentrations in effusion, or at least cholesterol alone, in combination with non-inflammatory fluid cytology, provides additional specific information about neoplastic pleural involvement, and can therefore be used as an adjunct to cytology, above all, in inconclusive cases.
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Affiliation(s)
- Miklos Gulyas
- Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Janos Fillinger
- Department of Pathology and Cytology, Korányi National Institute for Pulmonology, Budapest, Hungary
| | - Andras D Kaposi
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Miklos Molnar
- Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
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