Image analysis and flow cytometric DNA studies of benign and malignant body cavity fluids: reappraisal of the role of current methods in the differential diagnosis of reactive versus malignant conditions

Utility of Flow Cytometry Analysis in the Detection of Nonhematologic Neoplasms: An Overview

Flow cytometry analysis has stood the test of time as a powerful tool in the assessment of hematologic neoplasms. The role of flow cytometry has expanded to evaluate various nonhematologic neoplasms encountered in body cavity malignant effusions, lymph nodes, and other body sites. This review explores the use of routine antibody panels as well as specially designed multicolor antibody panels that have been investigated by different groups and reported in the literature for evaluating nonhematologic neoplasms. In this context, the limitations, pitfalls, future directions, and promising applications of flow cytometry analysis are also discussed.

DNA aneuploidy combined with radial EBUS in the diagnosis of peripheral lung lesions

OBJECTIVE

To explore the diagnostic value of DNA aneuploidy analysis combined with radial endobronchial ultrasound (R-EBUS)-guided transbronchial biopsy in peripheral lung lesions.

METHOD

We performed a retrospective analysis of patients who underwent R-EBUS examination. DNA aneuploidy analysis of bronchial washing from the target bronchial segment were performed. The clinical information, R-EBUS data, pathological results and DNA image cytometry (DNA-ICM) results were collected. For patients who did not have a clear diagnosis after bronchoscopy, follow-up data was recorded.

RESULTS

A total of 42 cases were included. Thirty patients had confirmed malignant tumor of the lung, 19 of which were confirmed by pathology after bronchoscopy, and 11 cases were confirmed later by surgery or percutaneous lung puncture. Twelve patients were finally considered to have benign lesions. The sensitivity of R-EBUS is 63.3% and the specificity is 100%. DNA-ICM has a sensitivity of 76.7% and a specificity of 91.7%. When combined, they have a sensitivity of 90%, and specificity 91.7%. As for malignant lesions, we further analyzed smoking, the size and location of lesions on chest CT, the number of aneuploid cells and the maximum value of DNA content. The results indicated that increased number of aneuploid cells or increased max value of DNA content may predict higher probability of malignancy.

CONCLUSION

DNA-ICM combined with R-EBUS can improve the diagnostic sensitivity of malignant peripheral lung lesions. Increased number of aneuploid cells or increased max value of DNA content may indicate that the lesions are more likely to be malignant.

Value of automatic DNA image cytometry for diagnosing lung cancer

The present study aimed to investigate the diagnostic value of automatic DNA image cytometry (DNA-ICM) for diagnosing lung cancer. A total of three different types of samples from 465 cases were included: Bronchoalveolar lavage fluid (BALF), 386 samples; pleural effusion cases, 70 samples; and fine-needle aspiration procedures, 9 samples. Two methods, liquid-based cytology (LBC) and automatic DNA-ICM, were used to assess the samples, and the pathological results of 120/465 cases were reviewed. The results of DNA-ICM were compared with those of LBC and pathology. There were 57 cases of lung cancer without aneuploidy and 49 cases without evidence of malignant tumor, but with the presence of heteroploid cells. The positive diagnostic rate for BALF samples using LBC was significantly higher compared with that for DNA-ICM (P<0.05). No statistically significant difference was observed in the positive diagnostic rate between DNA-ICM and LBC in pleural effusion samples. For DNA-ICM in BALF, pleural effusion and all samples, no statistically significant differences were identified between the positive diagnostic rates of lung squamous carcinoma and lung adenocarcinoma. The positive diagnostic rate of LBC combined with DNA-ICM was not significantly improved. In non-small cell lung cancer (NSCLC) cases, the difference in the maximum value of DNA (DNAmax) was positively correlated with tumor stage (P<0.05), but no significant correlations were observed among DNA max, tumor type and tumor location. In small-cell lung cancer (SCLC) cases, no significant correlations were observed among DNAmax, tumor staging or tumor location. The differences in the DNAmax values of squamous cell carcinoma, adenocarcinoma, SCLC and NSCLC were not statistically significant. In the present study, the area under the receiver operating characteristic curve for LBC (0.936) was significantly greater compared with that for DNA-ICM (0.766) (P<0.05). DNA-ICM has medium diagnostic value in lung cancer, and the DNAmax was positively correlated with tumor stage in NSCLC. DNA-ICM may serve as a supplement to LBC, but it is not recommended as a sole procedure for lung cancer screening.

Image analysis tools for evaluation of microscopic views of immunohistochemically stained specimen in medical research-a review

The aim of this study is to review the methods being used for image analysis of microscopic views of immunohistochemically stained specimen in medical research. The solutions available range from general purpose software to commercial packages. Many studies have developed their own custom written programs based on some general purpose software available. Many groups have reported development of computer aided image analysis programs aiming at obtaining faster, simpler and cheaper solutions. Image analysis tools namely Aperio, Lucia, Metaview, Metamorph, ImageJ, Scion, Adobe Photoshop, Image Pro Plus are also used for evaluation of expressions using immunohistochemical staining. An overview of such methods used for image analysis is provided in this paper. This study concludes that there is good scope for development of freely available software for staining intensity quantification, which a medical researcher could easily use without requiring high level computer skills.

Image analysis tools for evaluation of microscopic views of immunohistochemically stained specimen in medical research-a review

The aim of this study is to review the methods being used for image analysis of microscopic views of immunohistochemically stained specimen in medical research. The solutions available range from general purpose software to commercial packages. Many studies have developed their own custom written programs based on some general purpose software available. Many groups have reported development of computer aided image analysis programs aiming at obtaining faster, simpler and cheaper solutions. Image analysis tools namely Aperio, Lucia, Metaview, Metamorph, ImageJ, Scion, Adobe Photoshop, Image Pro Plus are also used for evaluation of expressions using immunohistochemical staining. An overview of such methods used for image analysis is provided in this paper. This study concludes that there is good scope for development of freely available software for staining intensity quantification, which a medical researcher could easily use without requiring high level computer skills.

Significance of DNA ploidy analysis and carcinoembryonic antigen assay for differential diagnosis between benign and malignant ascites

AIM: To investigate the differential diagnostic significance of DNA ploidy analysis and serum, ascetic carcinoembryonic antigen (CEA), ascites/serum CEA ratios assay in malignant (PHC and non-PHC malignancy) and benign ascites.

METHODS: Flow cytometry (FCM) was used for DNA ploidy analysis and enzyme linked immunosorbent assay (ELISA) for CEA assay in 56 malignant (31 PHC and 25 non-PHC) ascites. As a control, 50 nonmalignant ascites were evaluated at the same time. If the serum or ascitic CEA value >5 μg/L, and the ascites/serum CEA ratios >1, then the CEA assay was defined as positive. If an aneuploidy was detected, the result of the DNA ploidy analysis was defined as positive.

RESULTS: The sensitivity and specificity of ascitic CEA, ascites/serum CEA ratios>1 and aneuploidy in differential diagnosis of PHC ascites and non-PHC with malignant ascites or with benign ascites were 35.48%, 84% and 72%, 84%; 35.48%, 98% and 72%, 98%; 70.97%, 86% and 71.43%, 86%, respectively. The sensitivity and specificity of the combination assay of aneuploidy and ascites/serum CEA ratios >1 in differential diagnosis of PHC ascites and non-PHC with malignant ascites or with benign ascites were 93.55%, 100%; 92%, 100%, respectively.

CONCLUSION: Our study confirmed the differential diagnostic value between benign and malignant ascites of the combination assay of ascites/serum CEA ratios assay and the DNA ploidy analysis.

Cytopathologic differential diagnosis of malignant mesothelioma, adenocarcinoma and reactive mesothelial cells: A logistic regression analysis

Distinguishing malignant mesothelioma, adenocarcinoma and reactive mesothelial proliferation in both cytologic and surgical pathologic specimens is often a diagnostic challenge. Conventional cytomorphologic assessment is an important step in the differential diagnosis of these entities.The pleural effusion cytologies from 40 cases of malignant mesothelioma, 40 cases of adenocarcinoma and 30 cases of reactive mesothelial proliferation diagnosed between 1997 and 2007 were reviewed. Twenty-seven cytologic features which are regarded as useful in the differential diagnosis of mesothelioma, adenocarcinoma and benign mesothelial proliferation were assessed. These cytologic features were subjected to a stepwise logistic regression analysis. Three features were selected to distinguish malignant mesothelioma from adenocarcinoma: giant atypical mesothelial cell (P = 0.0001), nuclear pleomorphism (P = 0.0001) and acinar structures (P = 0.0001), the latter two being characteristics of adenocarcinoma. The variables selected to differentiate malignant mesothelioma from reactive mesothelial cells were: cell ball formation (P = 0.0001), cell in cell engulfment (P = 0.0001) and monolayer cell groups (P = 0.0001), the latter being a feature of benign mesothelial proliferation. When these selected variables were subjected to a stepwise logistic regression analysis, the logistic model correctly predicted 90% of cases of benign mesothelial proliferation versus 97.5% of malignant mesothelioma and 92.5% of malignant mesothelioma versus 92.5% of adenocarcinoma.Conventional cytomorphologic assessment is the first step to establish an accurate diagnosis in pleural effusions. Several cytologic features have predictive value to separate malignant mesothelioma from adenocarcinoma and reactive mesothelial proliferation.