Semiautomated monolayer preparation of bronchial secretions using AutoCyte PREP

Detection and minimally invasive treatment of early squamous lung cancer

Non-small cell lung cancer (NSCLC) is the most common cause of cancer deaths worldwide. The majority of patents presenting with NSCLC have advanced disease, which precludes curative treatment. Early detection and treatment might result in the identification of more patients with early central lung cancer and improve survival. In addition, the study of early lung cancer improves understanding of lung carcinogenesis and might also reveal new treatment targets for advanced lung cancer. Bronchoscopic investigation of the central airways can reveal both early central lung cancer in situ (stage 0) and other preinvasive lesions such as dysplasia. In the current review we discuss the detection of early squamous lung cancer, the natural history of preinvasive lesions and whether biomarkers can be used to predict progression to cancer. Finally we will review the staging and management of preinvasive lung cancer lesions and the different therapeutic modalities that are available.

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.

Effectiveness of sputum cytology using ThinPrep method for evaluation of lung cancer

Sputum cytology is a non-invasive test for evaluating lung cancer. But, its sensitivity is yet lower than other tests. ThinPrep (TP) is an automated cytopreparatory method that has mucolytic and hemolysing effects. We compared 955 sputum specimens that were prepared by both TP and conventional preparation (CP). The nuclear details were more preserved on the TP slides, while the obscuring materials were more eliminated on the TP slides as compared with the CP. The cytologic rates of TP were 2.7% unsatisfactory, 4.7% normal, 81.0% benign, 2.4% suspicious, and 9.1% malignancy. The rates of CP were 7.9% unsatisfactory, 1.6% normal, 84.8% benign, 1.8% suspicious, and 4.0% malignancy. The false negative rates, relative to the histologic data for 352 cases which the tissue diagnosis was available, were 49.6% (TP) and 69.4% (CP). Sputum cytology using the TP method improves the diagnostic accuracy for evaluating lung cancer by reducing the unsatisfactory and false-negative rates.

Non-gynecologic cytology on liquid-based preparations: A morphologic review of facts and artifacts

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.

Comparison of ThinPrep and TriPath PREP liquid-based preparations in nongynecologic specimens: a pilot study

ThinPrep (TP) and TriPath PREP (TriP) are two liquid-based cytologic preparations that produce a thin layer of cells. This study compares the diagnostic accuracy and different cytomorphologic alterations produced by these preparations in nongynecologic specimens. Samples from 10 urines (3 urothelial carcinomas and 7 negative), 4 positive serous fluids, and 7 fine-needle aspirates (FNAs) were prepared by both techniques. FNAs represented one each of: Hashimoto's thyroiditis (HT), hyperplastic colloid nodule (HCN), Hodgkin's lymphoma, liposarcoma, chondrosarcoma, squamous-cell carcinoma (SCC) metastatic to the lymph node, and carcinoid tumor. All 5 participants, none of whom had prior knowledge of the clinical history or histologic diagnosis, reviewed and interpreted the slides. Both techniques produced a clean background and were equally accurate in urines, serous fluids, and three FNAs. TriP was slightly more accurate in four FNAs: HCN and HT where colloid and lymphocytes were better represented, SCC where keratin and malignant cells were more readily identified among lymphocytes, and carcinoid which was easier to evaluate on TriP due to less cellular shrinkage and more dispersion of cells between aggregates. TP preparations had more cell shrinkage, and the chromatin was harder to evaluate. Both techniques produced artificial aggregations of lymphocytes, but TriP had a more evenly dispersed single-cell population between aggregates, rendering them easier to evaluate for atypia. TP produced fragmentation of large sheets that were flattened, while TriP contained larger branching sheets in a three-dimensional (3-D) configuration. TP produced a true monolayer of cells that were all spread at the same plane, while in TriP the cells were spread at slightly different planes, requiring frequent focusing of the viewed plane. While both techniques are acceptable for diagnostic purposes, they both introduce new cytomorphologic alterations that pathologists need to recognize. TriP seems superior to TP in FNAs specimens where preservation of architecture and cellular integrity are important considerations.