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[Advances in Diagnosis and Treatment of Leptomeningeal Metastasis of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:517-523. [PMID: 35899451 PMCID: PMC9346159 DOI: 10.3779/j.issn.1009-3419.2022.102.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Leptomeningeal metastases (LM), a special type of metastasis in advanced lung cancer, is known for its severe clinical symptoms, rapid progression and poor prognosis. LM used to be featured with low clinical diagnosis rate, limited treatment options, poor treatment efficacy, and very short survival if treatment not given. Though cerebrospinal fluid (CSF) cytology remains to be the gold standard for the diagnosis of LM, the positive rate of the first CSF cytology even in patients with suggestive clinical symptoms and positive imaging generally does not exceed 50%, leading to a delay in the diagnosis and treatment of patients with LM. With the progress of targeted therapy for driver gene-positive lung cancer and immunotherapy for driver gene-negative lung cancer, the overall survival of patients with lung cancer has been prolonged, meanwhile incidence of LM has been increasing year by year. Current clinical research in this field center around how to improve diagnosis rate and to find effective treatment approaches. This paper reviews advances in diagnosis and treatment of LM of lung cancer..
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Goutas D, Savvidou K, Vrettou K, Meletis E, Levis P, Constantinides C, Lazaris AC, Mikou P. Comparison of conventional and liquid-based cytology using The Paris System for Reporting Urinary Cytology. Cytopathology 2021; 32:795-801. [PMID: 34289188 DOI: 10.1111/cyt.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 07/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This retrospective study was conducted to compare the conventional cytospin method and ThinPrep liquid-based urinary cytology in diagnosing bladder cancer using The Paris System (TPS) of classification. METHODS We retrieved files for 2020, at the Cytopathology Department of Laiko Hospital, of urinary cases diagnosed according to TPS. Cytospin and ThinPrep slides were separately reviewed and new diagnoses were rendered, then compared with the original diagnosis and histology when available. Risk of high-grade malignancy (ROHM) for each TPS category was assessed, along with accuracy parameters of each method and their combination. RESULTS The study material comprised 100 cases of void urinary cytology classified as 20 high-grade urothelial carcinoma (HGUC = TPS5) cases, 20 of suspicion for HGUC (SHGUC = TPS4), 25 of atypical urothelial cells (AUC = TPS3), and 35 of negative for HGUC (NHGUC = TPS2). A single inadequate (TPS1) case and 4 of low-grade urothelial neoplasm (TPS6) were excluded as small in number. The ROHM was 95% for HGUC, 55% for SHGUC, 28% for AUC and 5.7% for NHGUC. Agreement with the original diagnosis was 86% for cytospin and 82% for ThinPrep. No significant differences were observed among the two techniques or their combination regarding sensitivity and specificity, with a mild advantage for cytospin. Interobserver reproducibility and repeatability were high. CONCLUSION No significant differences were found concerning sensitivity and specificity between cytospin and ThinPrep when applying TPS criteria. TPS is a reliable classification scheme for either conventional/cytospin or liquid-based cytology, or their combination.
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Affiliation(s)
- Dimitris Goutas
- First Department of Pathology, School of Medicine, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Savvidou
- Department of Cytopathology, 401 General Military Hospital of Athens, Athens, Greece
| | - Klio Vrettou
- Department of Cytopathology, Laiko General Hospital of Athens, Athens, Greece
| | - Emmanouel Meletis
- Department of Cytopathology, Laiko General Hospital of Athens, Athens, Greece
| | - Panagiotis Levis
- First Urology Department, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Constantine Constantinides
- First Urology Department, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- First Department of Pathology, School of Medicine, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Mikou
- Department of Cytopathology, Laiko General Hospital of Athens, Athens, Greece
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Richardson CJ, Pambuccian SE, Barkan GA. Split‐sample comparison of urothelial cells in ThinPrep and cytospin preparations in urinary cytology: Do we need to adjust The Paris System for Reporting Urinary Cytology criteria? Cancer Cytopathol 2019; 128:119-125. [DOI: 10.1002/cncy.22218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/19/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Güliz A. Barkan
- Department of Pathology Loyola University Medical Center Maywood Illinois
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Straccia P, Fadda G, Pierconti F. Comparison between cytospin and liquid-based cytology in cerebrospinal fluid diagnosis of neoplastic diseases: A single institution experience. Cytopathology 2018; 30:236-240. [PMID: 30468697 DOI: 10.1111/cyt.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The current tools available for detecting malignant neoplasms in the cerebrospinal fluid (CSF) are neurological examination, followed by neuroimaging, cytology and molecular techniques. To highlight the role of cytology the diagnosis of metastatic tumours in CSF samples, we present our experience using cytospin and ThinPrep liquid-based cytology. METHODS A retrospective analysis was conducted using the pathological records of 8181 cytological specimens of CSF, which were diagnosed over a 17-year period. Between 2000 and 2014, a total of 6994 CSF samples were processed using cytospin method and 1187 specimens were examined using ThinPrep method in the period between 2015 and 2017. RESULTS The most frequent metastatic neoplasm of the first period was non-Hodgkin lymphoma; in the second period the commonest malignancy found was brain tumour (glioblastoma and medulloblastoma). The samples processed by cytospin revealed cytolysis and haemorrhage, while the cases processed by ThinPrep had a clear background. Ten false-positive cases belonging to the suspicious category were processed by cytospin, while there was only one false positive case in the group processed by ThinPrep. The positive predictive value was 95% in cytospin and 100% in Thin Prep with comparable sensitivity, specificity, diagnostic accuracy and negative predictive values. CONCLUSIONS CSF cytology is a reliable technique for identifying malignancy in CSF. ThinPrep technology can be applied with good results in terms of clear background, cell enrichment, better nuclear details and high cellularity per slide.
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Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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Brisuda A, Háček J, Čechová M, Škapa P, Babjuk M. Clinical and cytopathological factors affecting the cellularity of urinary cell blocks and the implication for diagnosis and follow-up of urinary bladder urothelial carcinoma. Cytopathology 2018; 29:537-544. [PMID: 29873845 DOI: 10.1111/cyt.12580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/13/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The methodology of cell blocks (CBs) has long been an integrated part of cytology. However, there are very few data on CBs derived from urine. Their main disadvantage is a lack of cellularity, which limits their broader clinical applicability. Factors affecting cellular adequacy in urine remain unclear. We assessed the impact of basic clinical and cytopathological factors on the adequacy of cellularity in urinary CBs. METHODS Freshly voided urine was collected from 401 consecutive individuals. Of these, 167 patients were diagnosed with urothelial carcinoma. The remaining 234 patients had various benign urological conditions. Papanicolaou classes were determined and CBs produced. Cellular adequacy was assigned to each CB (acellular, hypocellular, moderate cellularity, high cellularity), and moderately and highly cellular CBs were considered as adequate. Several factors were analysed to find any correlation with the adequacy of the cellularity. RESULTS In univariate analysis, seven factors significantly correlated with the adequacy of the CBs. In the multivariate model, positive sediment (OR = 3.7), female sex (OR = 2.7), positive urinary cytology (OR = 2.6) and positive leucocyturia (OR = 2.1) were independent predictors of adequate cellularity. Positive predictive value and negative predictive value of the model were 65.0% and 77.7%, respectively. CONCLUSIONS We determined four clinical and cytopathological factors which independently predict adequate cellularity in urinary CBs. Based on these results, several clinical situations have been proposed, in which the highest probability of adequate cellularity in urinary CBs can be achieved.
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Affiliation(s)
- Antonín Brisuda
- 2nd Faculty of Medicine, Department of Urology, Charles University, Prague, Czech Republic
| | - Jaromír Háček
- 2nd Faculty of Medicine, Department of Pathology and Molecular Medicine, Charles University, Prague, Czech Republic
| | - Marcela Čechová
- 2nd Faculty of Medicine, Department of Urology, Charles University, Prague, Czech Republic
| | - Petr Škapa
- 2nd Faculty of Medicine, Department of Pathology and Molecular Medicine, Charles University, Prague, Czech Republic
| | - Marek Babjuk
- 2nd Faculty of Medicine, Department of Urology, Charles University, Prague, Czech Republic
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Burn MB, Holtorf HL, Smith KM, Bernstein DT, Delgado DA, Prudhomme N, Deavers MT, McCulloch PC, Harris JD. Do Skin Lacerations Imply Tissue Transfer From Surgeon to Patient During Arthroscopic Knot Tying? Arthroscopy 2017; 33:2248-2254. [PMID: 29066268 DOI: 10.1016/j.arthro.2017.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To use simulated arthroscopic knot tying to assess (1) whether epithelial cells from the surgeon's hands were transmitted to the suture and (2) whether the number of knots tied or the presence of glove tears would correlate with the number of cells transmitted. METHODS Knots were tied in a simulated arthroscopic environment using a nonabsorbable No. 2 suture over a metal hook. The surgeon was double gloved for each knot tied. For each "anchor," a surgeon's knot was tied, followed by 3 reversed half-hitches on alternating posts. Multiple skin lacerations were sustained by the surgeon during each knot-tying session. Gloves were collected after tying 2, 4, or 6 anchors. Gloves were tested for perforation by (1) electroconductivity and (2) saline solution load testing. Cytopathologic ThinPrep analysis was applied and allowed for the number of epithelial cells found on each suture (within 10 high-powered fields) to be counted. Statistical analysis included analysis of variance and logistic regression. RESULTS There was no significant difference in the number of epithelial cells identified in any of the groups compared with the negative control groups (P > .05) or with each other (P > .05). Glove tears were present in 3.3% of gloves (50% in inner and 50% in outer gloves) and 1.7% of gloves (50% in inner and 50% in outer gloves) by electroconductivity and saline solution load testing, respectively. There was no significant association between glove tears and the number of epithelial cells found on the suture (P > .05). CONCLUSIONS Epithelial cells were transmitted to the suture during simulated arthroscopic knot tying. However, despite multiple skin lacerations produced during knot-tying sessions, the number of cells transmitted was not significantly different when compared with the negative controls. The number of cells transmitted did not correlate with the number of knots tied and/or the presence of glove tears. CLINICAL RELEVANCE Skin lacerations on the surgeon's fingers are often noted after arthroscopic knot tying. However, despite these skin lacerations, no skin tissue is transferred across the surgical gloves to the suture itself.
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Affiliation(s)
- Matthew B Burn
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Heidi L Holtorf
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Kevin M Smith
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Derek T Bernstein
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Domenica A Delgado
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Nickarr Prudhomme
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Michael T Deavers
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Joshua D Harris
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A..
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Toyonaga Y, Yamazaki K, Koyama Y, Yamada M, Ishida Y. A Modified Direct-Smear Processing Technique Employing Two-Step Centrifugation/Fixation Is Useful for Detecting High-Grade Urothelial Carcinoma. Acta Cytol 2017; 61:447-454. [PMID: 28954257 DOI: 10.1159/000480062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 08/08/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To demonstrate the usefulness of a direct-smear processing technique employing two-step centrifugation/fixation processing (TSCFP) in the cytoscreening of high-grade urothelial carcinoma (HGUC). STUDY DESIGN Using the T24 HGUC cell line, we compared the cell yield and the morphological preservation of preparations concurrently processed by direct-smear, SurePath, ThinPrep, and TSCFP techniques. A total of 287 urine cytology cases subjected to TSCFP over a period of 6 years were reviewed and reclassified according to the Paris System for Reporting Urinary Cytology (PSRUC) and correlated with histology results. RESULTS TSCFP of T24 cells demonstrated good cell yield with a recovery rate of about 70%. Diagnostic features of HGUC, such as a high nuclear/cytoplasmic ratio and irregular/hyperchromatic chromatin, were better discovered in TSCFP smears than in smears prepared with the other methods. Cytological evaluation of 287 voided urine specimens revealed that the rate of unsatisfactory preparations was quite low (0.30%) and the overall sensitivity, specificity, and positive and negative predictive values for urothelial carcinoma were 0.719, 0.923, 0.973, and 0.462, respectively. CONCLUSION TSCFP was able to provide adequate preparations for detecting HGUC in urine cytology and could be considered as a promising processing method according to the principal purpose of PSRUC.
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Affiliation(s)
- Yasuhiro Toyonaga
- Department of Surgical Pathology, Teikyo University, Chiba Medical Center, Ichihara, Japan
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Straccia P, Bizzarro T, Fadda G, Pierconti F. Comparison between cytospin and liquid-based cytology in urine specimens classified according to the Paris System for Reporting Urinary Cytology. Cancer Cytopathol 2016; 124:519-23. [DOI: 10.1002/cncy.21709] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/09/2016] [Accepted: 02/09/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University; Rome Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University; Rome Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University; Rome Italy
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Ainechi S, Pambuccian SE, Wojcik EM, Barkan GA. Cytomorphologic features and differential diagnosis of neoplasms with small cell features in liquid-based urinary tract cytologic specimens. J Am Soc Cytopathol 2015; 4:295-306. [PMID: 31051743 DOI: 10.1016/j.jasc.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Urinary tract cytology (UTCy) allows the accurate diagnosis of high grade urothelial carcinoma. Rare malignancies characterized by the presence of small cells may be more difficult to recognize, however. The aim of this study was to review our experience with liquid-based (ThinPrep) UTCy specimens showing small atypical cells and characterize their cytomorphology, potential differences from previously reported morphologic features, and discuss their differential diagnostic considerations. MATERIALS AND METHODS Among 18,859 UTCy specimens reviewed during a 13-year period (2001-2012), we identified 13 cases corresponding to surgical pathology specimens diagnosed as small cell carcinoma (6), melanoma (3), lymphoma (3), and leukemic involvement of the urinary tract (1). We recorded the original diagnoses made on these cases and 10 cytomorphologic features that could aid in their diagnosis. RESULTS We identified 13 cases in UTCy of 7 men and 6 women; 11 of which were diagnosed as positive or suspicious for malignancy. In 8 out of 13 cases (62%) the type of malignancy was correctly reported. Of the 10 recorded features, cellular clustering and nuclear molding were seen only in small cell carcinoma, whereas prominent nucleoli and an inflammatory background or diathesis were noted in lymphoma and melanoma cases. Intracellular pigment and multinucleation were recorded in melanoma cases. CONCLUSION The presence of small atypical cells in liquid-based UTCy should raise the suspicion of underlying malignancy involving the urinary tract. Cell clustering, nuclear molding, and hyperchromasia are helpful hints for the diagnosis of small cell carcinoma and the presence of small atypical cells with prominent nucleoli raises the possibility of lymphoma or melanoma.
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Affiliation(s)
- Sanaz Ainechi
- Department of Pathology and Laboratory Medicine, Albany Medical Center, MC-81, 47 New Scotland Ave., Albany, New York
| | - Stefan E Pambuccian
- Department of Pathology, Loyola University Healthcare System, 2160 South First Avenue, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology, Loyola University Healthcare System, 2160 South First Avenue, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology, Loyola University Healthcare System, 2160 South First Avenue, Maywood, Illinois.
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Cyto-3D-print to attach mitotic cells. Cytotechnology 2015; 68:1641-5. [PMID: 26464272 PMCID: PMC4960204 DOI: 10.1007/s10616-015-9917-2] [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: 05/16/2015] [Accepted: 09/15/2015] [Indexed: 10/31/2022] Open
Abstract
The Cyto-3D-print is an adapter that adds cytospin capability to a standard centrifuge. Like standard cytospinning, Cyto-3D-print increases the surface attachment of mitotic cells while giving a higher degree of adaptability to other slide chambers than available commercial devices. The use of Cyto-3D-print is cost effective, safe, and applicable to many slide designs. It is durable enough for repeated use and made of biodegradable materials for environment-friendly disposal.
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Luo Y, She DL, Xiong H, Yang L, Fu SJ. Diagnostic Value of Liquid-Based Cytology in Urothelial Carcinoma Diagnosis: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0134940. [PMID: 26241896 PMCID: PMC4524610 DOI: 10.1371/journal.pone.0134940] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/15/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the value of liquid-based cytology (LBC) in the diagnosis of urothelial carcinoma. METHOD Diagnostic studies were searched for the diagnostic value of LBC in urothelial carcinoma in PubMed, Embase, Cochrane Library, Web of Science, CBM and CNKI. The latest retrieval date was September 2014. The data were extracted and the quality of the included studies was independently assessed by 2 reviewers. Stata 13 software was used to perform the statistical analysis. The research was conducted in compliance with the PRISMA statement. RESULT Nineteen studies, which included 8293 patients, were evaluated. The results of the meta-analysis showed that the pooled sensitivity and specificity of LBC were 0.58 (0.51-0.65) and 0.96 (0.93-0.98), respectively. The diagnostic odds ratio (DOR) was 31 (18-56) and the area under the curve (AUC) of summary receiver operating characteristic (SROC) was 0.83 (0.80-0.86). The post-test probability was 80% when a positive diagnosis was made. Compared with high grade urothelial carcinoma (HGUC), the sensitivity of detecting low-grade urothelial carcinoma (LGUC) was significantly lower, risk ratio of sensitivity was 0.54 (0.43-0.66), P<0.001. However, no significant sensitivity improvement was observed with LBC when compared with traditional cytospin cytology, risk ratio was 1.03 (0.94-1.14), P = 0.524. CONCLUSION Despite LBC having a pooled 58% positive rate for urothelial carcinoma diagnosis in our meta-analysis, no significant improvement in sensitivity was observed based on the studies evaluated. Further research is needed to validate these findings.
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Affiliation(s)
- You Luo
- Gansu Nephro-Urological Clinical Center, Institute of Urology, Department of Urology, Key Laboratory of Urological Disease of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Dong-Li She
- Gansu Nephro-Urological Clinical Center, Institute of Urology, Department of Urology, Key Laboratory of Urological Disease of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Hu Xiong
- Gansu Nephro-Urological Clinical Center, Institute of Urology, Department of Urology, Key Laboratory of Urological Disease of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Li Yang
- Gansu Nephro-Urological Clinical Center, Institute of Urology, Department of Urology, Key Laboratory of Urological Disease of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Sheng-Jun Fu
- Gansu Nephro-Urological Clinical Center, Institute of Urology, Department of Urology, Key Laboratory of Urological Disease of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China
- * E-mail:
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Murro D, Slade JM, Lamzabi I, Gattuso P. Hematologic lesions in urine cytology. J Am Soc Cytopathol 2015; 4:107-112. [PMID: 31051690 DOI: 10.1016/j.jasc.2014.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/28/2014] [Accepted: 08/31/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Bladder infiltration by leukemia or lymphoma is rare and can mimic benign processes such as follicular cystitis (FC). MATERIALS AND METHODS Eight benign and malignant hematologic diseases encountered in urine cytology were retrospectively reviewed for clinical, radiographic, and cytologic findings. RESULTS There were 2 cases of acute myeloid leukemia, 2 cases of diffuse large B-cell lymphoma, and 4 cases of FC. The most common presenting symptom was hematuria. Imaging findings included echogenic debris within the bladder or an adjacent soft tissue mass in acute myeloid leukemia cases and bladder wall thickening in diffuse large B-cell lymphoma cases. No FC cases had any imaging abnormalities. Cytologic material of the leukemia cases showed numerous myeloid blasts with markedly increased nuclear-to-cytoplasmic ratios, centrally located nuclei, inconspicuous nucleoli, nuclear indentations, and some irregular nuclear membranes. The background showed sparse urothelial cells and histiocytes. Both lymphoma cases showed a discohesive population of atypical large lymphoid cells with irregular nuclear borders and prominent nucleoli. The FC cases had a background lymphoid cell population with a maturation spectrum from small lymphocytes to large lymphoid cells (immunoblasts) and histiocytes including tingible body macrophages. Additionally, there were many mature squamous cells and reactive urothelial cells. CONCLUSIONS Bladder leukemia, lymphoma, and FC are infrequently encountered on urine cytology. FC can be distinguished from a hematologic malignancy by the presence of a lymphocytic maturation spectrum and tingible body macrophages. Radiologic abnormalities are associated with malignant processes; however, discrete bladder masses are usually not identified.
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Affiliation(s)
- Diana Murro
- Rush University Medical Center, 1750 W Harrison Street, Chicago, Illinois.
| | | | - Ihab Lamzabi
- Rush University Medical Center, 1750 W Harrison Street, Chicago, Illinois
| | - Paolo Gattuso
- Rush University Medical Center, 1750 W Harrison Street, Chicago, Illinois
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Wronska DB, Krajewska M, Lygina N, Morrison JC, Juzumiene D, Culp WD, Nair SA, Darby M, Hofmann CM. Peptide-conjugated glass slides for selective capture and purification of diagnostic cells: Applications in urine cytology. Biotechniques 2014; 57:63-71. [PMID: 25109291 DOI: 10.2144/000114195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/25/2014] [Indexed: 11/23/2022] Open
Abstract
Obtaining a clear view of the cells of interest in diagnostic cytology can be challenging when specimens are contaminated with blood or other obscuring cells. In this study, we present a powerful technique for the selective capture of diagnostic epithelial cells directly on a microscope slide, highlighting its applications in urine cytology and immunocytochemistry (ICC). Using phage-display biopanning, we identified and synthesized a series of peptides that bind with high affinity to urothelial cells but not blood cells. We developed methods for conjugating the peptides to glass slides, and we used these slides to selectively capture both normal and cancerous epithelial cells from urine contaminated with blood cells. Unlike non-selective microscope slides, the peptide-conjugated slides selectively retained the cells of interest, recovering up to 75% of urothelial cells, while up to 98% of blood cells were washed away. The slides are compatible with Papanicolaou and hematoxylin and eosin (H&E) staining for cytology preparations, as well as ICC for detecting membrane-associated and nuclear cancer markers. We successfully detected the expression of carcinoembryonic antigen and survivin, two commonly measured bladder cancer markers. In addition to bladder cancer diagnostics, this technology has broad applications for increasing the quality of sample preparations in slide-based diagnostic testing.
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Birkhahn M, Mitra AP, Williams AJ, Barr NJ, Skinner EC, Stein JP, Skinner DG, Tai YC, Datar RH, Cote RJ. A novel precision-engineered microfiltration device for capture and characterisation of bladder cancer cells in urine. Eur J Cancer 2013; 49:3159-68. [PMID: 23849827 DOI: 10.1016/j.ejca.2013.04.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/22/2013] [Accepted: 04/03/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Sensitivity of standard urine cytology for detecting urothelial carcinoma of the bladder (UCB) is low, attributable largely to its inability to process entire samples, paucicellularity and presence of background cells. OBJECTIVE Evaluate performance and practical applicability of a novel portable microfiltration device for capture, enumeration and characterisation of exfoliated tumour cells in urine, and compare it with standard urine cytology for UCB detection. METHODS A total of 54 urine and bladder wash samples from patients undergoing surveillance for UCB were prospectively evaluated by standard and microfilter-based urine cytology. Head-to-head comparison of quality and performance metrics, and cost effectiveness was conducted for both methodologies. RESULTS Five samples were paucicellular by standard cytology; no samples processed by microfilter cytology were paucicellular. Standard cytology had 33.3% more samples with background cells that limited evaluation (p<0.001). Microfilter cytology was more concordant (κ=50.4%) than standard cytology (κ=33.5%) with true UCB diagnosis. Sensitivity, specificity and accuracy were higher for microfilter cytology compared to standard cytology (53.3%/100%/79.2% versus 40%/95.8%/69.9%, respectively). Microfilter-captured cells were amenable to downstream on-chip molecular analyses. A 40 ml sample was processed in under 4 min by microfilter cytology compared to 5.5 min by standard cytology. Median microfilter cytology processing and set-up costs were approximately 63% cheaper and 80 times lower than standard cytology, respectively. CONCLUSIONS The microfiltration device represents a novel non-invasive UCB detection system that is economical, rapid, versatile and has potentially better quality and performance metrics than routine urine cytology, the current standard-of-care.
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Affiliation(s)
- Marc Birkhahn
- Urologie am Ring, Kaiser Wilhelm Ring 36, Cologne, Germany
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Moatamed NA, Apple SK, Bennett CJ, Aronson WJ, Klisak I, Shirley BJ, Moatamed F. Exclusion of the uniform tetraploid cells significantly improves specificity of the urine FISH assay. Diagn Cytopathol 2011; 41:218-25. [PMID: 21987521 DOI: 10.1002/dc.21831] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 08/09/2011] [Indexed: 11/06/2022]
Abstract
The urine fluorescence in situ hybridization (FISH) assay (UroVysion™), with the current scoring criteria, has a higher sensitivity than routine cytopathology but a lower specificity. Among 215 urine FISH tests we performed, 45 had associated histopathology and clinical follow up. In this study, a cell with four signals for each probe was classified as a uniform tetraploid cell (UTC); a presumed reparative cell which is currently classified as an abnormal cell in the FDA approved assay. By using the existing criteria, the tests were scored as positive or negative before and after exclusion of the UTCs. Before the exclusion, 24 positive, 13 negative, seven false positive, and one false negative result were obtained with 96% sensitivity and 65% specificity. After the exclusion, the results changed to 22 positive, 19 negative, one false positive, and three false negatives resulting in a 88% sensitivity of 88% and a 95% specificity; a significant improvement in the specificity. We conclude that exclusion of the UTCs as abnormal cells would result in a more solid performance of the FISH assay.
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Affiliation(s)
- Neda A Moatamed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Thiryayi SA, Rana DN. Urine cytopathology: Challenges, pitfalls, and mimics. Diagn Cytopathol 2011; 40:1019-34. [DOI: 10.1002/dc.21769] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 05/31/2011] [Indexed: 12/12/2022]
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Ly TY, Barnes PJ, Macintosh RF. Fine-needle aspiration cytology of mammary fibroadenoma: a comparison of ThinPrep® and cytospin preparations. Diagn Cytopathol 2011; 39:181-7. [PMID: 21319319 DOI: 10.1002/dc.21358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mammary fibroadenoma (FA) is a lesion frequently sampled and diagnosed by fine-needle aspiration (FNA). Accurate cytologic diagnosis of this common benign lesion is important as this can lead to non-surgical, conservative management when breast imaging and clinical examination are concordant. In most instances, a confident diagnosis of FA is possible because of a characteristic cytologic appearance that includes hypercellularity, large epithelial cell groups, staghorn epithelial configurations, stromal fragments, and numerous background stripped nuclei. Nevertheless, FAs can be diagnostically challenging because of shared cytomorphologic features with other benign lesions and low-grade carcinoma. As such, FA is a well-recognized source of false results on FNA cytology. Furthermore, there are reports that newer thin layer cytopreparatory techniques, including the ThinPrep® (TP) system (Hologic Corp., Bedford, MA), alter the appearance of FA on FNA compared to conventional preparations and may compromise accurate cytologic diagnosis.
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Affiliation(s)
- Thai Yen Ly
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Choi J, Kim SH. Value of Additional Immunocytochemical Stain for Cytokeratin in the Diagnosis of Leptomeningeal Involvement of Metastatic Carcinoma. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.5.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Junjeong Choi
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Laucirica R, Bentz JS, Souers RJ, Wasserman PG, Crothers BA, Clayton AC, Henry MR, Chmara BA, Clary KM, Fraig MM, Moriarty AT. Do Liquid-Based Preparations of Urinary Cytology Perform Differently Than Classically Prepared Cases? Observations From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med 2010; 134:19-22. [DOI: 10.5858/2008-0673-cpr1.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—The cytomorphology of liquid-based preparations in urine cytology is different than classic slide preparations.
Objectives.—To compare the performance of liquid-based preparation specimens to classically prepared urine specimens with a malignant diagnosis in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology.
Design.—Participant responses between 2000 and 2007 for urine specimens with a reference diagnosis of high-grade urothelial carcinoma/carcinoma in situ/dysplasia (HGUCA), squamous cell carcinoma, or adenocarcinoma were evaluated. ThinPrep and SurePath challenges were compared with classic preparations (smears, cytospins) for discordant responses.
Results.—There were 18 288 pathologist, 11 957 cytotechnologist, and 8086 “laboratory” responses available. Classic preparations comprised 90% (n = 34 551) of urine challenges; 9% (n = 3295) were ThinPrep and 1% (n = 485) were SurePath. Concordance to the general category of “positive-malignant” was seen in 92% of classic preparations, 96.5% of ThinPrep, and 94.6% of SurePath challenges (P < .001). These results were statistically different for the exact reference interpretation of HGUCA (P < .001) but not for adenocarcinoma (P = .22). Cytotechnologists demonstrate statistically better performance for the general category of “positive-malignant” compared with pathologists for all urinary slide types and for the exact reference interpretation of HGUCA (94% versus 91.1%; P < .001) but not adenocarcinoma (96.3% versus 95.8%; P = .77) or squamous cell carcinoma (93.6% versus 87.7%; P = .07).
Conclusions.—Liquid-based preparations performed significantly better in urinary cytology challenges when evaluating malignant categories in the College of American Pathologists interlaboratory comparison program. The liquid-based preparation challenges also performed better for the exact reference interpretation of HGUCA, but no difference was observed for adenocarcinoma challenges. Cytotechnologists perform better than pathologists for all slide types, as well as those demonstrating HGUCA. These results suggest that liquid-based preparations facilitate a more accurate diagnosis than conventional preparations.
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Affiliation(s)
- Rodolfo Laucirica
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Joel S. Bentz
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Rhona J. Souers
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Patricia G. Wasserman
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Barbara A. Crothers
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Amy C. Clayton
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Michael R. Henry
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Beth Anne Chmara
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Karen M. Clary
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Mostafa M. Fraig
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
| | - Ann T. Moriarty
- From the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Utah, Salt Lake City (Dr Bentz); the Biostatistics Department (Ms Souers), and the Surveys Department (Mrs Chmara), College of American Pathologists, Northfield, Illinois; the Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, New York (Dr
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Lu DY, Nassar A, Siddiqui MT. High-grade urothelial carcinoma: comparison of SurePath liquid-based processing with cytospin processing. Diagn Cytopathol 2009; 37:16-20. [PMID: 18973118 DOI: 10.1002/dc.20957] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is limited literature available comparing SurePath (SP) with conventional cytospins (CS) for urine cytology specimens, especially urothelial carcinoma. In this study, urinary tract cytology cases of high-grade urothelial carcinoma were assessed on SP and CS slides. Also, the morphologic differences of high-grade urothelial carcinoma between SP and CS were evaluated on a total of 35 cases of high-grade urothelial carcinoma. SP showed that the tumor cells tend to present as three-dimensional groups and have a smaller cell size than CS. In terms of nuclear features, SP and CS were found to be comparable in morphologic assessment of the tumor cells, with CS providing a slightly better visualization.
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Affiliation(s)
- David Y Lu
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
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22
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Kim DY, Cho HJ, Oh HK, Shin IH, Jeon CH. [Comparison of the urine ThinPrep test and melanoma antigen gene RT-PCR for the detection of bladder cancer according to three urine collection methods]. Korean J Lab Med 2008; 27:50-5. [PMID: 18094551 DOI: 10.3343/kjlm.2007.27.1.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For the detection of transitional cell carcinoma (TCC) of the bladder, we compared the sensitivities and specificities between the ThinPrep test and Melanoma Antigen Gene (MAGE) test with voided urine (V), drained urine (D), and irrigated urine (I). METHODS We randomly selected 10 patients of a non-cancer group and 20 patients of a cancer group. V, D, and I were obtained preoperatively, and equally divided into two parts for the ThinPrep test and MAGE reverse transcriptase polymerase chain reaction (RT-PCR). The cystoscopic finding was used as the reference standard for detection of bladder cancer. The results of ThinPrep test and MAGE RT-PCR were compared according to cancer grade and stage. RESULTS The overall sensitivities of ThinPrep test were 45%, 85% and 85% for V, D, and I, respec-tively, while those of MAGE test were 50%, 85%, and 65%. Detection rate from drainage urine was considerably higher than that of voided urine in both methods (P<0.05). The specificities were 100% for all types of urine specimens with ThinPrep test and 100%, 90%, and 90% for V, D, and I, respectively, using MAGE test, without any statistically significant differences. CONCLUSIONS For the detection of bladder cancer, MAGE RT-PCR and ThinPrep test showed a comparable sensitivity and specificity, and drained urine revealed the best detection rate. MAGE RT-PCR might be utilized as another marker of bladder cancer using urine specimens.
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Affiliation(s)
- Duk-Yoon Kim
- Department of Urology, College of Medicine, Catholic University of Daegu, Daegu, Korea
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23
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Shin BK, Lee YS, Jeong H, Lee SH, Kim H, Kim A, Kim I, Kim HK. Detecting Malignant Urothelial Cells by Morphometric Analysis of ThinPrep® Liquid-based Urine Cytology Specimens. ACTA ACUST UNITED AC 2008. [DOI: 10.3338/kjc.2008.19.2.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Bong Kyung Shin
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
- Korea Lung Tissue Bank (KLTB), Seoul, Korea
| | - Young Suk Lee
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Hoiseon Jeong
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
- Korea Lung Tissue Bank (KLTB), Seoul, Korea
| | - Sang Ho Lee
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
- Korea Lung Tissue Bank (KLTB), Seoul, Korea
| | - Hyunchul Kim
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Aree Kim
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
- Korea Lung Tissue Bank (KLTB), Seoul, Korea
| | - Insun Kim
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Han Kyeom Kim
- Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea
- Korea Lung Tissue Bank (KLTB), Seoul, Korea
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Visvanathan K, Santor D, Ali SZ, Brewster A, Arnold A, Armstrong DK, Davidson NE, Helzlsouer KJ. The reliability of nipple aspirate and ductal lavage in women at increased risk for breast cancer--a potential tool for breast cancer risk assessment and biomarker evaluation. Cancer Epidemiol Biomarkers Prev 2007; 16:950-5. [PMID: 17507621 DOI: 10.1158/1055-9965.epi-06-0974] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Ductal lavage, a technique used to sample epithelial cells from breast ducts, has potential use in risk assessment and biomarker evaluation among women at increased risk for breast cancer. However, little is known about the reliability of the procedure. METHODS We evaluated the reliability of nipple aspirate (NAF) and ductal lavage at two time points 6 months apart in women at increased risk for breast cancer. Eligible women had a 5-year Gail risk >or=1.66% or lifetime risk of >20%, and/or a family history or personal history of breast cancer. All ducts that produced NAF were cannulated. The kappa statistic was used to evaluate reliability of NAF production, cellular yield, and cytologic diagnosis. RESULTS Sixty-nine women (mean age, 47 years) were enrolled over 35 months. Forty-seven returned for a second visit. At baseline, 65% of premenopausal and 41% of postmenopausal women produced NAF (P = 0.05), of which 72% underwent successful lavage of at least one duct. Samples of inadequate cellular material for diagnosis were significantly more likely in postmenopausal women than in premenopausal women (P = 0.04). Of the women who returned for a second visit, 18 of 24 who produced NAF had at least one duct successfully cannulated. Twenty-four ducts in 14 women were lavaged twice. Among these ducts, cellular yield for the two time points was inconsistent (kappa = 0.33 +/- 0.13), and only fair cytologic agreement was observed (kappa = 0.32 +/- 0.15). Ductal lavage was associated with moderate discomfort. CONCLUSION Currently, the use of ductal lavage is limited by technical challenges in duct cannulation, inconsistent NAF production, a high rate of inadequate cellular material for diagnosis, fair cytologic reproducibility, and low participant return rates.
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Affiliation(s)
- K Visvanathan
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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Hoda RS. Non-gynecologic cytology on liquid-based preparations: A morphologic review of facts and artifacts. Diagn Cytopathol 2007; 35:621-34. [PMID: 17854077 DOI: 10.1002/dc.20698] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Liquid-based preparations (LBP) are increasingly being used both for gynecologic (gyn) and non-gynecologic (non-gyn) cytology including fine needle aspirations (FNA). The two FDA-approved LBP currently in use include ThinPrep (TP), (Cytyc Corp, Marlborough, MA) and SurePath (SP), (TriPath Imaging Inc., Burlington, NC). TP was approved for cervico-vaginal (Pap test) cytology in 1996 and SP in 1999 and both have since also been used for non-gyn cytology. In the LBP, instead of being smeared, cells are rinsed into a liquid preservative collection medium and processed on automated devices. Even after a decade of use, the morphological interpretation of LBP remains a diagnostic challenge because of somewhat altered morphology and artifacts or facts resulting from the fixation and processing techniques. These changes include cleaner background with altered or reduced background and extracellular elements; architectural changes such as smaller cell clusters and sheets, breakage of papillae; altered cell distribution with more dyscohesion and changes in cellular morphology with enhanced nuclear features, smaller cell size and slightly more three-dimensional (3-D) clusters. Herein, we review the published literature on morphological aspects of LBP for non-gyn cytology.
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Affiliation(s)
- Rana S Hoda
- Department of Pathology, Cytopathology Unit, University of Rochester, Rochester, New York, USA.
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Kipp BR, Campion MB, Coffman E, Smith A, Tomisek JD, Browne GG, Panella JR, Desai R, Harwood AR, Halling KC. An evaluation of ThinPrep UroCyte filters for the preparation of slides for fluorescence in situ hybridization. Diagn Cytopathol 2006; 34:479-84. [PMID: 16783776 DOI: 10.1002/dc.20488] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to assess the performance of ThinPrep UroCyte filters, which were designed specifically for the preparation of slides for fluorescence in situ hybridization (FISH) analysis of urine specimens. One hundred urine specimens were evenly split, and one portion was utilized to prepare a slide with the UroCyte filter method and the other portion was used to prepare a slide with a manual dropping method. All 17 of the 100 specimens identified as positive by the manual method were also identified as positive with the UroCyte method. No significant differences were noted in the percentage of chromosomally abnormal cells (P = 0.227), cellularity (P = 0.857), signal quality (P = 0.816), and DAPI counterstain quality (P = 0.369) between the two methodologies. The average time taken to prepare a batch of 10 slides using the UroCyte method, and that using manual method was 103 min (10.3 min/case) and 194 min (19.4 min/case), respectively. This study suggests that the UroCyte filter method of preparing slides for FISH analysis reduces the time required to prepare these slides with overall results that are similar to the currently utilized manual dropping method.
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Affiliation(s)
- Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
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Elsheikh TM, Kirkpatrick JL, Wu HH. Comparison of ThinPrep and cytospin preparations in the evaluation of exfoliative cytology specimens. Cancer 2006; 108:144-9. [PMID: 16550571 DOI: 10.1002/cncr.21841] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There exists limited literature comparing ThinPrep (TP) with conventional cytospins (CS) in nongynecologic specimens. METHODS The differences between TP and CS were evaluated for a variety of parameters including cellularity, cytologic morphology, specimen preparation, screening time, laboratory cost effectiveness, cytologist preference, and impact on final diagnosis. Eighty-eight cases including 38 urine, 13 respiratory, and 37 body fluids were prepared simultaneously. RESULTS TP and CS demonstrated similar cellular yield in the majority of cases. Cytologists preferred TP in 63 (71.6%) and CS in 6 (6.8%) cases; whereas they indicated no preference in 19 (21.6%) cases. Of 14 abnormal cytologies, a more definitive diagnosis of malignancy was rendered by TP in 6 (42.9%) and by CS in 2 (14.3%) cases. TP demonstrated better nuclear chromatin morphology and more uniform distribution of cells. CS showed larger-sized clusters with better preservation of their architecture compared with smaller-sized clusters and significant shrinkage of cell size in TP. CONCLUSIONS TP was preferred over CS in the majority of cases by both cytotechnologists and pathologists. Cellularity, screening time, and specimen preparation were comparable, although the latter was easier to standardize in TP. In abnormal cases, TP was found to be 3 times more helpful than CS in rendering a definitive diagnosis of malignancy. TP, however, was associated with certain artifacts that cytologists must become familiar with when examining such preparations. Although TP was superior to CS in most cases, the application of both methods may be helpful in selected cases in which the TP diagnosis is not conclusive. Finally, TP was found to be more cost effective than CS.
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Affiliation(s)
- Tarik M Elsheikh
- Pathologists Associated, Ball Memorial Hospital, Muncie, Indiana 47303, USA.
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Piaton E, Faÿnel J, Hutin K, Ranchin MC, Cottier M. Conventional liquid-based techniques versus Cytyc Thinprep processing of urinary samples: a qualitative approach. BMC Clin Pathol 2005; 5:9. [PMID: 16207384 PMCID: PMC1260015 DOI: 10.1186/1472-6890-5-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 10/06/2005] [Indexed: 11/16/2022] Open
Abstract
Background The aim of our study was to objectively compare Cytyc Thinprep® and other methods of obtaining thin layer cytologic preparations (cytocentrifugation, direct smearing and Millipore® filtration) in urine cytopathology. Methods Thinprep slides were compared to direct smears in 79 cases. Cytocentrifugation carried out with the Thermo Shandon Cytospin® 4 was compared to Thinprep in 106 cases, and comparison with Millipore filtration followed by blotting was obtained in 22 cases. Quality was assessed by scoring cellularity, fixation, red blood cells, leukocytes and nuclear abnormalities. Results The data show that 1) smearing allows good overall results to be obtained, 2) Cytocentrifugation with reusable TPX® chambers should be avoided, 3) Cytocentrifugation using disposable chambers (Cytofunnels® or Megafunnel® chambers) gives excellent results equalling or surpassing Thinprep and 4) Millipore filtration should be avoided, owing to its poor global quality. Despite differences in quality, the techniques studied have no impact on the diagnostic accuracy as evaluated by the rate of abnormalities. Conclusion We conclude that conventional methods such as cytocentrifugation remain the most appropriate ones for current treatment of urinary samples. Cytyc Thinprep processing, owing to its cost, could be used essentially for cytology-based molecular studies.
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Affiliation(s)
- Eric Piaton
- INSERM U.407/Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud, 69495 Pierre Bénite Cedex, France
- Laboratoire de Cytopathologie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Jacqueline Faÿnel
- Laboratoire de Cytopathologie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Karine Hutin
- Laboratoire de Cytopathologie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Marie-Claude Ranchin
- Laboratoire de Cytopathologie, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - Michèle Cottier
- Laboratoire d'Histologie, CHRU de Saint-Etienne, Hôpital Nord, 42055 Saint-Etienne Cedex 2, France
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Abstract
BACKGROUND Voided urine cytology continues to play a paramount role in the surveillance of transitional cell neoplasms and as a screening modality in certain high-risk situations. Although a significant number of samples are diagnosed as atypical, there is little known about the outcome of these patients. In addition, the significance of transitional cell fragments in voided urine samples is uncertain. The objective of the current study was to evaluate retrospectively a large series of voided urine specimens that were reported as atypical. Standard cytomorphologic parameters were used with the aim of refining the atypical category. METHODS The authors studied 201 consecutive voided urine samples from 1995 that were evaluated by liquid-based cytology for the following features: specimen cellularity, the presence and number of cell clusters, and the architecture of the cell fragments. In addition, cells were examined for the following cytologic features: high nuclear-to-cytoplasmic ratios, nuclear membrane irregularities, hyperchromasia, India-ink nuclei, and chromatin pattern. Cytoplasmic features were evaluated but were limited significantly by poor preservation. Only specimens with a biopsy or cystoscopy and/or from patients who were followed for > 5 years were analyzed further. RESULTS In total, 23.4% of specimens showed transitional cell carcinoma (TCC) on biopsy, including 20 Grade 1 TCCs and 21 Grade 2 TCCs. Specimen cellularity, cluster numbers, nuclear membrane abnormalities, hyperchromasia, and India-ink nuclei were associated significantly with TCC. Twenty-six specimens (18.9%) were associated with renal calculi. CONCLUSIONS The atypical category contained a significant proportion of low-grade TCCs. Transitional cell clusters in voided urine are relevant clinically. The clinical picture, including the previous history of TCC and the presence of urinary calculi, provides valuable information when evaluating voided urine cytology. These features and careful attention to India-ink nuclei and nuclear membrane abnormalities could help make the "atypical" category a more meaningful group.
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Affiliation(s)
- Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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30
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Ciaccia M, Bertoloni R, Pinto F, Calpista A, Bassi P. Does Urine Cytology Still have a Role? Urologia 2005. [DOI: 10.1177/039156030507200301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Urine cytology is a reliable and well known tool in the diagnosis and follow-up of patients with transitional cell carcinoma even if it has high sensitivity only in high grade tumors and carcinoma in situ. In order to improve sensitivity of this test in patients with low grade tumors, new methods such as cytometry, microsatellite assays, Immunocyt®, fuorescence in-situ hybridization and Thin-Prep monolayer have been developed. These new assays will be able to increase the cytology detection rate and to predict the outcome of transitional cell carcinoma.
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Affiliation(s)
- M. Ciaccia
- Divisione Clinicizzata di Urologia, Policlinico G.B. Rossi, Università di Verona
| | - R. Bertoloni
- Divisione Clinicizzata di Urologia, Policlinico G.B. Rossi, Università di Verona
| | - F. Pinto
- Clinica Urologica, Ospedale Civile, Università di Padova
| | - A. Calpista
- Clinica Urologica, Ospedale Civile, Università di Padova
| | - P.F. Bassi
- Clinica Urologica, Ospedale Civile, Università di Padova
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31
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Piaton E, Hutin K, Faÿnel J, Ranchin MC, Cottier M. Cost efficiency analysis of modern cytocentrifugation methods versus liquid based (Cytyc Thinprep) processing of urinary samples. J Clin Pathol 2004; 57:1208-12. [PMID: 15509686 PMCID: PMC1770469 DOI: 10.1136/jcp.2004.018648] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Liquid based cytology (LBC) was developed as a replacement for cytocentrifugation in the treatment of cell suspensions. Because accurate data comparing the quality and total cost of modern cytocentrifugation methods versus LBC in non-gynaecological samples are not available, this study was designed to investigate these issues. METHODS The study comprised 224 urine samples treated with the Thermo Shandon Cytospin 4 using reusable TPX chambers, disposable Cytofunnels for samples up to 0.5 ml, and disposable Megafunnels for samples up to 6 ml. Each method was compared with the Cytyc Thinprep processing of a paired sample. Quality was assessed by scoring cellularity, fixation, red blood cells, leucocytes, abnormalities of urothelial cells, and suitability for molecular studies. Wage costs, investment, and consumables allowed a "total cost" to be calculated on the basis of 200 specimens/month. Total cost and quality combined were used to calculate an index of total quality (ITQ). RESULTS Cytocentrifugation with disposable chambers resulted in a global quality superior to that of Cytyc Thinprep LBC. Preparation and screening times were 2.25 and 1.33-2 times greater when using LBC compared with cytocentrifugation. The total cost each month reached 1960.23 $ to 2833.43 $ for cytocentrifugation methods and 5464.95 $ for Cytyc Thinprep LBC (92.8-178.8% increased cost). ITQ of cytocentrifugation with disposable chambers surpassed that of Cytyc Thinprep LBC (37.25/32.08 and 9.98, respectively). CONCLUSION Cytyc Thinprep LBC and cytocentrifugation are both appropriate methods for cytology based molecular studies, but cytocentrifugation remains the quality standard for current treatment of urinary samples because of its lower cost.
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Affiliation(s)
- E Piaton
- INSERM U.407, UCBL Lyon I, France.
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32
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Reich A, Polla E. Thin-Prep Urinary Cytology: New Method and Preliminary Results. Urologia 2004. [DOI: 10.1177/039156030407100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cytology of voided urine is a reliable and important tool in the diagnosis and follow-up of patients with epithelial tumors of the urinary bladder. In order to improve its sensitivity Thin-Prep monolayer technique has been used. This method seems to be suitable for the diagnosis of low grade papillary tumors too.
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Affiliation(s)
- A. Reich
- UO di Urologia Ospedale Santa Chiara, Trento
| | - E. Polla
- UO di Anatomia Patologica, Ospedale Santa Chiara, Trento
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