Clinical application of the liquid-based cytological test in cytological screening of sputum for the diagnosis of lung cancer

Prospects, advances and biological applications of MOF-based platform for the treatment of lung cancer

Nowadays in our society, lung cancer is exhibiting a high mortality rate and threat to human health. Conventional diagnostic techniques used in the field of lung cancer often necessitate the use of extensive instrumentation, exhibit a tendency for false positives, and are not suitable for widespread early screening purposes. Conventional approaches to treat lung cancer primarily involve surgery, chemotherapy, and radiotherapy. However, these broad-spectrum treatments suffer from drawbacks such as imprecise targeting and significant side effects, which restrict their widespread use. Metal-organic frameworks (MOFs) have attracted significant attention in the diagnosis and treatment of lung cancer owing to their tunable electronic properties and structures and potential applications. These porous nanomaterials are formed through the intricate assembly of metal centers and organic ligands, resulting in highly versatile frameworks. Compared to traditional diagnostic and therapeutic modalities, MOFs can improve the sensitivity of lung cancer biomarker detection in the diagnosis of lung cancer. In terms of treatment, they can significantly reduce side effects and improve therapeutic efficacy. Hence, this perspective provides an overview concerning the advancements made in the field of MOFs as potent biosensors for lung cancer biomarkers. It also delves into the latest research dealing with the use of MOFs as carriers for drug delivery. Additionally, it explores the applications of MOFs in various therapeutic approaches, including chemodynamic therapy, photodynamic therapy, photothermal therapy, and immunotherapy. Furthermore, this review comprehensively analyses potential applications of MOFs as biosensors in the field of lung cancer diagnosis and combines different therapeutic approaches aiming for enhanced therapeutic efficacy. It also presents a concise overview of the existing obstacles, aiming to pave the way for future advancements in lung cancer diagnosis and treatment.

Special Staining of the Liquid-Based Cytopathology Test in Bronchoalveolar Lavage Fluid for Diagnosis of Invasive Pulmonary Aspergillosis with Nonneutropenic Patients

In recent years, various biomarkers have been gradually applied on bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive pulmonary aspergillosis (IPA). The objective of this study is to assess the value of the liquid-based cytopathology test (LCT) for improving the identification of IPA in BAL fluid from possible IPA patients, following special staining with periodic acid-Schiff staining (PAS) or Grocott's methenamine silver (GMS). A total of 47 consecutive possible IPA patients who underwent bronchoscopy with BAL fluid from January 2017 to December 2018 were included. 45 people had a pair of BAL fluid specimens and 2 patients had two BAL fluid specimens. The 49 pairs of BAL fluid specimens were processed for culture, tuberculosis acid fast staining smear, direct microbial smear, and LCT with special staining (PAS and GMS), respectively. Then, we compared the sensitivity and specificity of PAS and GMS in BAL fluid in high-risk patients. Among 47 possible IPA patients, 25 patients had proven/probable IPA, and 11 patients had other invasive fungal diseases. The sensitivity of GMS was higher than that of PAS (92.11% versus 81.58%; P = 0.175). The specificity of GMS was 81.82%, which was higher than that of PAS (81.82% versus 72.73%; P = 0.611). The negative predictive value (NPV) for PAS and GMS were 53.33% and 75.00%, respectively. The positive predictive value (PPV) for PAS and GMS were 91.18% and 94.59%, respectively. This study showed that special staining of LCT in BAL fluid may be a novel method for the diagnosis of IPA, and the GMS of LCT had higher sensitivity and specificity, which was superior to PAS.

Liquid-Based Cytopathology Test: A Novel Method for Diagnosing Pulmonary Mucormycosis in Bronchial Brushing Samples

Background: Pulmonary mucormycosis, a relatively rare but severe pulmonary fungal disease with a high mortality rate, is difficult to diagnose in immunocompromised patients. Conventional cytopathology (CCP) examination of respiratory samples can help detect Mucorales, but its diagnostic sensitivity is poor. The aim of this study was to assess the first application of liquid-based cytopathology test (LCT) to detect Mucorales.

Methods: A total of 33 pairs of bronchial brushing samples from 27 patients diagnosed as pulmonary mucormycosis by fiberoptic bronchoscopy biopsy were prepared as slides using both CCP and LCT. LCT and CCP used the same cytology brush to obtain samples at the same site during the same time as the fiberoptic bronchoscopy biopsy. All samples were stained with Papanicolaou, GMS and PAS. CCP and LCT slides were evaluated from the rate of positive detection, 8 cytomorphological features and 7 background features.

Results: LCT-prepared slides showed a higher positive rate of Mucorales detection than CCP-prepared slides for Papanicolaou’s staining [28/33 (84.85%) vs. 15/33 (45.45%), p = 0.001] and for “special staining” with GMS and PAS [29/33 (87.88%) vs. 18/33 (54.55%), p = 0.003]. Clearer smear background and more distinct stereoscopic cytopathological features were observed in LCT. Messy yarn-like necrosis observed in conventionally prepared 75.76% (25/33) samples was cytomorphological suggestive for the diagnosis of mucormycosis.

Conclusion: This retrospective study suggests that LCT may be better than CCP to detect Mucorales in bronchial brushing samples from patients with pulmonary mucormycosis.

Committee II: Guidelines for cytologic sampling techniques of lung and mediastinal lymph nodes

The Papanicolaou Society of Cytopathology has developed a set of guidelines for pulmonary cytology including indications for bronchial brushings, washings, and endobronchial ultrasound guided transbronchial fine-needle aspiration (EBUS-TBNA), technical recommendations for cytological sampling, recommended terminology and classification schemes, recommendations for ancillary testing and recommendations for post-cytological management and follow-up. All recommendations are based on the expertise of the authors, an extensive literature review and feedback from presentations at national and international conferences. This document selectively presents the results of these discussions. The present document summarizes recommendations regarding techniques used to obtain cytological and small histologic specimens from the lung and mediastinal lymph nodes including rapid on-site evaluation (ROSE), and the triage of specimens for immunocytochemical and molecular studies.

Liquid-based cytopathology test as a novel method to identify Aspergillus in patients with pulmonary aspergillosis

Conventional cytopathology examination of respiratory samples can aid in identifying Aspergillus but with poor sensitivity, so this study aimed to assess the potential of the liquid-based cytopathology test (LCT) for improving the identification of Aspergillus in respiratory samples following Papanicolaou's or Special staining with Grocott's methenamine silver or periodic acid-Schiff staining. Paired bronchial brushing samples (n = 54) and sputum samples (n = 117) from 171 patients with pulmonary aspergillosis were prepared as slides using either conventional cytopathology or SurePath LCT. LCT slides were generally superior to conventional slides, showing smaller cell monolayer surface area, clearer background and more distinct stereoscopic cytological features. For Papanicolaou's staining, LCT-prepared slides allowed a higher positive rate of Aspergillus identification than conventional slides for bronchial brushing samples (59.25% vs. 20.37%, P < 0.05) and sputum samples (29.05% vs. 8.55%, P < 0.05). Similarly, Special staining of LCT-prepared slides showed a higher positive rate of Aspergillus identification for bronchial brushing samples (83.33% vs. 57.41%, P < 0.05) and sputum samples (43.59% vs. 19.66%, P < 0.05). This preliminary study suggests that LCT may be better than conventional slide preparation for identifying Aspergillus in respiratory samples from patients with pulmonary aspergillosis.

Lung cancer samples preserved in liquid medium: One step beyond cytology

Lung cancer is one of the most common cancer types in men and women worldwide with a high mortality rate. World Health Organization (WHO) classification has accepted biopsy as the primary sample for lung cancer diagnosis, pathological classification and molecular testing for management of patients, yet, the use of alternative sampling procedures is highly encouraged. Bronchial cytological samples require a less invasive collection technique and may be suitable for pathological and molecular analysis and storage in liquid medium. Furthermore, the molecular analysis of bronchial cytological samples allows the detection of molecular biomarkers, which may be useful for the selection of molecular targeted therapies. Thus, the purpose of this review is to describe the usefulness of bronchial cytological samples preserved in liquid medium from lung cancer patients for pathological diagnosis and molecular investigation.

Comparative analysis of cell morphology in sputum samples homogenized with dithiothreitol, N-acetyl-L cysteine, Cytorich(®) red preservative and in cellblock preparations to enhance the sensitivity of sputum cytology for the diagnosis of lung cancer

BACKGROUND

Lung cancer claims highest rate of cancer related mortality worldwide, mainly due to late diagnosis and distant metastasis. Sputum cytology is the simplest, non-invasive and cost effective technique but it has low sensitivity due to lack of robust processing methods to retrieve all the diagnostic materials clogged in mucus, inflammatory exudates and blood.

METHODS

This study have compared conventional pick and smear method of sputum processing with samples prepared by homogenization methods using N-acetyl-l-cysteine, Dithiothreitol (DTT), CytoRich red solution and cell blocks (CBs) with respect to screening time, quality of staining, cellularity, smear background, nuclear and cytoplasmic morphology preservation, and diagnostic efficacy. The significance of CB prepared from homogenised samples for immunocytochemistry, protein extraction, Genomic DNA and RNA extraction were also evaluated on a cohort 3,185 samples. The significance of the morphological features in each of the techniques was statistically analysed using SPSS 11 software.

RESULTS

The smear background clarity, staining quality and diagnostic efficacy of samples processed in red solution was found to be superior to the conventional method (P < 0.0001), where as samples homogenized in DTT showed a better cellularity (P < 0.0001). CBs prepared from samples homogenized in red solution were found to be very significant (P < 0.0001) in increasing the diagnostic efficacy compared to other two methods. Immunocytochemistry and DNA extraction were found possible in CBs as well as from the cell suspension. A combined analysis of smears and CBs found to improve the sensitivity of sputum cytology.

CONCLUSION

The study suggests homogenization of sputum in CytoRich ® red solution and cellblock preparations routinely for all samples to improve the sensitivity of sputum cytology. IHC and DNA extraction can be performed in sputum samples suggesting the role of sputum samples for ancillary techniques.

The implementation of liquid-based cytology for lung and pleural-based diseases

OBJECTIVE

First introduced for the processing of cervico-vaginal samples, liquid-based cytology (LBC) soon found application in nongynecological specimens, including bronchoscopic brushings, washings and transcutaneous and transbronchial aspiration biopsy of the lung as well as pleural effusions. This article reviews the existing literature related to these specimens along with the authors' own experience.

STUDY DESIGN

A literature review was conducted through Ovid MEDLINE and PubMed search engines using several key words.

RESULTS

Most of the literature is based on data collected through the use of split samples. The data confirms that the use of LBC is an acceptable, and sometimes superior, alternative to the conventional preparations (CP). LBC offers several advantages, including the ability to transport in a stable collecting media, elimination of obscuring elements, ease of screening, excellent preservation, random representative sample, and application of ancillary techniques on additional preparations. Some diagnostic pitfalls related to the introduced artifacts were reported.

CONCLUSION

The utilization of LBC offers many advantages over CP and has a diagnostic accuracy that is equal to or surpasses that of CP. LBC affords a bridge to the future application of molecular and other ancillary techniques to cytology. Knowledge of the morphological artifacts is useful at the early stages of implementation.

Correlation between morphology and human telomerase gene amplification in bronchial brushing cells for the diagnosis of lung cancer

The aim of this study was to investigate the frequency of amplification of the human telomerase gene (TERC), as measured by fluorescence in situ hybridization (FISH), in routine liquid-based cytological preparations from bronchial brushing specimens, and to assess the associations between TERC amplification, cytological diagnosis, and cytological morphology, in order to obtain further insight into these associations. Bronchial brushings from 102 patients with lung carcinoma (52 squamous-cell carcinomas, 22 adenocarcinomas, 28 small cell lung carcinomas) and 40 patients with nonmalignant disease were used. Amplification of TERC was performed using a commercially available two-color FISH probe, and slides were prepared for the SurePath liquid-based Pap test (LPT) using the same samples. Amplification of TERC was significantly associated with histological diagnoses (P < 0.05). Patients with lung cancer, and especially those with nonsmall cell lung cancer, had significantly higher percentages of cells with amplification of TERC than did patients with nonmalignant disease (P < 0.05). Comparing the FISH and LPT results, there was no significant difference in diagnostic sensitivity between the two methods (P > 0.05). However the difference in diagnostic sensitivity of the two methods for squamous-cell carcinoma was significant (P < 0.01). FISH can be performed on bronchial brushing specimens to detect amplification of TERC. This test may be an adjunct to cytology screening, especially in squamous-cell carcinoma, and may provide an indication of the potential of individual lesions to progress.

Clinical application of the SurePath liquid-based Pap test in cytological screening of bronchial brushing for the diagnosis of lung cancer

The SurePath liquid-based Pap test (LPT) is successfully and widely used to assess sputum cytology. This study aimed to compare the cytological findings and diagnostic sensitivity of LPT with those of the conventional Pap smear (CPS) method for diagnosing lung cancer. Bronchial brushing specimens from 204 patients diagnosed with lung cancer were studied. LPT slides showed decreased areas of cell monolayers, a clearer background and distinct, stereoscopic cytological features. The LPT had a significantly higher diagnostic sensitivity for lung cancer (71.6%) than the CPS method (57.8%, p < 0.05), particularly for small cell lung carcinoma and >2 cm lesions (p < 0.05). Combination of the LPT with the CPS method showed obviously higher diagnostic sensitivity for the detection of adenocarcinoma (63.6%), central lesions (85.0%) and >2 cm lesions (81.4%) compared with the CPS method alone (p < 0.05, p < 0.01). Thus, LPT is a useful and easily performed technique that can be widely applied, and is suitable for the early diagnosis of lung cancer.