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Reyna Villasmil E, Mejia Montilla J, Reyna Villasmil N, Torres Cepeda D, Fernández Ramírez A. Factores que afectan la suficiencia e interpretación de la citología de cuello uterino. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: evaluar los factores que afectan la suficiencia e interpretación de la citología de cuello uterino. Materiales y métodos: estudio transversal y retrospectivo en el Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela con la revisión de las historias clínicas e informes de las citologías de cuello uterino de la consulta de ginecología y obstetricia de enero a diciembre 2019. Se analizan las características generales y la clasificación de los informes (satisfactorios para la evaluación, satisfactorios pero limitados por y no satisfactorios). Resultados: se seleccionaron 581 informes de los cuales 329 (56,6%) eran muestras satisfactorias, 233 (40,1%) satisfactorias pero limitadas y 19 (3,3%) insatisfactorios. El análisis univariante demostró que la muestra insatisfactoria, la presencia síntomas al momento de la toma y el tipo de método anticonceptivo fueron factores que se asociaron significativamente (p < 0,0001). Los que influyeron para un resultado anormal de la citología cervical fueron frotis satisfactorio (razón de probabilidad, 4,78; intervalo de confianza del 95%, 3,127-8,136) y presencia de síntomas (razón de probabilidad, 11,652; intervalo de confianza del 95%, 2,992-38,55). Esta asociación continuó siendo significativa luego de ajustarlos a los factores de edad, paridad, edad al momento de la toma de la primera citología y método de anticoncepción (p < 0,0001). Conclusión: la suficiencia de la muestra de citología es un factor importante para la detección de anomalías celulares de cuello uterino y evitar resultados falsos negativos, retrasando la detección del cáncer.
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McDermott SP, Pantanowitz L, Nikiforova M, Monaco SE. Quantitative assessment of cell block cellularity and correlation with molecular testing adequacy in lung cancer. J Am Soc Cytopathol 2016; 5:196-202. [PMID: 31042509 DOI: 10.1016/j.jasc.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/27/2015] [Accepted: 11/03/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Determination of fine-needle aspiration (FNA) material adequacy is essential prior to performing molecular testing (MT) in order to ensure good results and maximize resources. This study investigates several quantitative measures of cellularity in FNA samples of lung carcinoma, and correlates the results with MT adequacy. MATERIALS AND METHODS A blinded retrospective analysis of 20 non-small-cell lung carcinoma cases was conducted: 13 contained "sufficient" material for EGFR/KRAS sequencing and ALK FISH studies; and 7 contained "insufficient" material for these tests. Three 400x fields-of-view (FOVs) were analyzed from digitized cell block glass slides of these cases. Cellularity in these FOVs was quantified using three methods: (1) visual estimation by cytopathologist; (2) manually annotated contours (MACs); (3) software derived, manually adjusted contours (SDMACs) using a custom segmentation script with adjustable parameters. These methods were evaluated using the Mann-Whitney-Wilcoxon test, paired t test, and receiver operating characteristic/area under the curve (AUC) analysis. RESULTS There were significant differences between the insufficient/sufficient groups for each estimation method (visual P < 0.05, MAC P < 0.05, SDMAC P < 0.01). Variation of mean values was highest in the visual estimation method. AUC values were visual estimation = 0.903, MAC = 0.903, and SDMAC = 0.958. Mean variation of the 3 FOV values was found to be significantly higher for visual estimation compared with the other methods. CONCLUSION Quantitative analysis of cellularity in digitized cell block material is feasible using different methods. In this investigation, the SDMAC method provided the highest accuracy and lowest variability. This supports image analysis as an objective and quantitative tool to assess FNA sample adequacy for guiding supplemental MT.
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Affiliation(s)
- Sean P McDermott
- University of Pittsburgh Medical Center, Pittsburgh Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Sara E Monaco
- University of Pittsburgh Medical Center, Pittsburgh Pennsylvania.
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Prather J, Arville B, Chatt G, Pambuccian SE, Wojcik EM, Quek ML, Barkan GA. Evidence-based adequacy criteria for urinary bladder barbotage cytology. J Am Soc Cytopathol 2015; 4:57-62. [PMID: 31051710 DOI: 10.1016/j.jasc.2014.09.206] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Adequacy criteria are well established in some areas of cytopathology to prevent false negative diagnoses. To date, no such criteria have been proposed and validated for urinary tract specimens. Our aim was to determine a cellularity cutoff point that significantly affects the sensitivity of detecting high-grade or in situ urothelial carcinoma (HGUC or UCIS) in bladder barbotage/washing specimens. MATERIALS AND METHODS Bladder barbotage specimens collected in liquid-based media were selected. Specimens diagnosed as "positive for HGUC" (with histologic confirmation) composed the study group, with negative cases as control specimens. Samples were serially diluted and ThinPrep slides of decreasing cellularity were made and reviewed for diagnosis and cellularity. In a retrospective validation study, we identified cases with a "negative for malignancy" bladder barbotage/washing and a surgical pathology diagnosis of UCIS or HGUC (ie, false negative cytology). Cellularity was assessed. RESULTS A distinct difference in sensitivity was noted at a cutoff point of 2644 (20 per 10 high-power fields) urothelial cells. Sensitivities increased for atypical or higher (68.3% versus 100%) and HGUC (43.3% versus 88.0%) after application of this cutoff point with high statistical significance (P = 0.001 and 0.0001, respectively). For the retrospective review, cases below the cutoff point were reclassified as unsatisfactory, and sensitivity rose from 76.3% to 84.8% (P = 0.0027). CONCLUSIONS Our results indicate that, in the absence of atypical or malignant cells, an adequate bladder barbotage specimen should have a minimum of 2644 (20 per 10 high-power fields) well-visualized, well-preserved urothelial cells to increase the positive predictive value of this test.
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Affiliation(s)
- Jennifer Prather
- Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois
| | - Brent Arville
- Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois
| | - Grazina Chatt
- Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois; Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois; Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois.
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Quiroga-Garza G, Satrum LS, Trujillo CJ, Mody DR, Ge Y. Common causes for unsatisfactory Pap tests in a high-risk population: insights into a yet unresolved problem in gynecologic cytology. J Am Soc Cytopathol 2014; 3:256-260. [PMID: 31051679 DOI: 10.1016/j.jasc.2014.05.003] [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: 03/12/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Although the rates are generally low (0.2%-10%), unsatisfactory Papanicolaou (Pap) tests are associated with an increased risk of epithelial lesions on subsequent follow-up. Therefore, some studies have recommended extra laboratory processing, resampling of patients, and more recently, human papillomavirus testing. MATERIALS AND METHODS Consecutive cases signed out as unsatisfactory for evaluation (UE) were identified from January 1, 2008 to December 31, 2010 in the cytology laboratory at Houston Methodist Hospital. Patient's demographics, relevant prior clinical history, type of Pap test, reasons for UE diagnosis, and cytology or histology follow-up were obtained from the pathology database. RESULTS Among 56,563 total Pap tests, 276 were signed out as UE (0.47%). Nearly half of these patients were older than 50 years (15 to 88 years). The majority (85%) of patients over 50 years old had a history of prior gynecologic cancer. Low squamous cellularity was the most common cause of UE in all age groups. Follow-up abnormalities were identified in 21 of 73 patients (29%). CONCLUSIONS Low squamous cellularity was the most common cause of UE and was often seen in women older than 50 years of age. The significant risk associated with UE emphasizes the importance of appropriate follow-up on these patients.
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Affiliation(s)
- Gabriela Quiroga-Garza
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15221
| | - Laura S Satrum
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030
| | - Crystal J Trujillo
- Department of Pathology, Baylor College of Medicine, Houston, Texas, 77030
| | - Dina R Mody
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030
| | - Yimin Ge
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030.
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Jones HE, Mansukhani MM, Tong GX, Westhoff CL. Validity and reliability of using a self-lavaging device for cytology and HPV testing for cervical cancer screening: findings from a pilot study. PLoS One 2013; 8:e82115. [PMID: 24376516 PMCID: PMC3869665 DOI: 10.1371/journal.pone.0082115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/16/2013] [Indexed: 11/18/2022] Open
Abstract
Self-sampling could increase cervical cancer screening uptake. While methods have been identified for human papillomavirus (HPV) testing, to date, self-sampling has not provided adequate specimens for cytology. We piloted the validity and reliability of using a self-lavaging device for cervical cytology and HPV testing. We enrolled 198 women in New York City in 2008–2009 from three ambulatory clinics where they received cervical cancer screening. All were asked to use the Delphi Screener™ to self-lavage 1–3 months after clinician-collected index cytological smear (100 normal; 98 abnormal). Women with abnormal cytology results from either specimen underwent colposcopy; 10 women with normal results from both specimens also underwent colposcopy. We calculated sensitivity of self-collected cytology to detect histologically confirmed high grade lesions (cervical intraepithelial neoplasia, CIN, 2+); specificity for histology-negative (CIN 1 or lower), paired cytology negative, or a third cytology negative; and kappa for paired results. One hundred and ninety-seven (99.5%) women self-collected a lavage. Seventy-five percent had moderate to excellent cellularity, two specimens were unsatisfactory for cytology. Seven of 167 (4%) women with definitive results had CIN2+; one had normal and six abnormal cytology results with the self-lavage (sensitivity = 86%, 95% Confidence Interval, CI: 42, 100). The kappa for paired cytology was low (0.36; 95% CI: 0.25, 0.47) primarily due to clinician specimens with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) coded as normal using Screener specimens. However, three cases of HSIL were coded as ASC-US and one as normal using Screener specimens. Seventy-three women had paired high-risk HPV tests with a kappa of 0.66 (95% CI: 0.49, 0.84). Based on these preliminary findings, a larger study to estimate the performance of the Screener for co-testing cytology and HPV or for HPV testing with cytology triage is warranted. Trial Registration ClinicalTrials.gov NCT00702208
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Affiliation(s)
- Heidi E. Jones
- Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, New York, United States of America
- Epidemiology & Biostatistics Program, City University of New York School of Public Health and Hunter College, New York, New York, United States of America
- * E-mail:
| | - Mahesh M. Mansukhani
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States of America
| | - Guo-Xia Tong
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States of America
| | - Carolyn L. Westhoff
- Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, New York, United States of America
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Manrique EJC, Souza NLA, Tavares SBN, Albuquerque ZBP, Zeferino LC, Amaral RG. Analysis of the performance of 100% rapid review using an average time of 1 and 2 minutes according to the quality of cervical cytology specimens. Cytopathology 2010; 22:195-201. [DOI: 10.1111/j.1365-2303.2010.00776.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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