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Thorat J, Bhat S, Sengar M, Baheti A, Bothra S, Bhaskar M, Tandon SP, Biswas SK, Salunke GV, Karimundackal G, Tiwari VK, Pramesh C, Sharma N, Kapu V, Eipe T, Bagal BP, Nayak L, Bonda A, Janu A, Shetty A, Jain H. Clinical Utility of Stepwise Bronchoalveolar Lavage Fluid Analysis in Diagnosing and Managing Lung Infiltrates in Leukemia/Lymphoma Patients With Febrile Neutropenia. JCO Glob Oncol 2024; 10:e2300292. [PMID: 38301183 PMCID: PMC10846792 DOI: 10.1200/go.23.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/28/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE Febrile neutropenia (FN) is a serious complication in hematologic malignancies, and lung infiltrates (LIs) remain a significant concern. An accurate microbiological diagnosis is crucial but difficult to establish. To address this, we analyzed the utility of a standardized method for performing bronchoalveolar lavage (BAL) along with a two-step strategy for the analysis of BAL fluid. PATIENTS AND METHODS This prospective observational study was conducted at a tertiary cancer center from November 2018 to June 2020. Patients age 15 years and older with confirmed leukemia or lymphomas undergoing chemotherapy, with presence of FN, and LIs observed on imaging were enrolled. RESULTS Among the 122 enrolled patients, successful BAL was performed in 83.6% of cases. The study used a two-step analysis of BAL fluid, resulting in a diagnostic yield of 74.5%. Furthermore, antimicrobial therapy was modified in 63.9% of patients on the basis of BAL reports, and this population demonstrated a higher response rate (63% v 45%; P = .063). CONCLUSION Our study demonstrates that a two-step BAL fluid analysis is safe and clinically beneficial to establish an accurate microbiological diagnosis. Given the crucial impact of diagnostic delays on mortality in hematologic malignancy patients with FN, early BAL studies should be performed to enable prompt and specific diagnosis, allowing for appropriate treatment modifications.
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Affiliation(s)
- Jayashree Thorat
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Surabhi Bhat
- Hematological Cancer Consortium, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Akshay Baheti
- Department of Radio-diagnosis, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Sweta Bothra
- Department of Radio-diagnosis, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Maheema Bhaskar
- Department of Pulmonary Medicine, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Sandeep Prakashnarain Tandon
- Department of Pulmonary Medicine, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Sanjay K. Biswas
- Department of Microbiology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Gaurav V. Salunke
- Department of Microbiology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | | | - Virendra Kumar Tiwari
- Department of Thoracic Surgical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - C.S. Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Neha Sharma
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Venkatesh Kapu
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Thomas Eipe
- Department of Clinical Pharmacology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Bhausaheb Pandurang Bagal
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Lingaraj Nayak
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Avinash Bonda
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Amit Janu
- Department of Radio-diagnosis, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Alok Shetty
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Centre, Affiliated with Homi Bhabha National University, Mumbai, India
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Misra V, Gupta SC, Tandon SP, Gupta AK, Sircar S. Cytohistological study of urinary bladder neoplasms. INDIAN J PATHOL MICR 2000; 43:303-9. [PMID: 11218677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Eighty patients presenting with painless hematuria and 24 patients of transitional cell carcinoma bladder coming for follow up were included in this study to assess the role of exfoliative (voided urine) and lavage (saline lavage) cytology in initial diagnosis and follow up of the patient with carcinoma bladder. Freshly voided urine samples and saline lavage bladder washing samples were collected. A thorough cystoscopic examination was done and biopsy was taken from any apparent growth. Cytological smears were stained with hematoxylene and eosin and PAP's stain, histology sections were stained with hematoxylene and eosin. A statistically significant correlation (p < 0.001) was observed between the increasing grade of malignancy and cytopositivity. A good association was observed between histology and two methods of cytology (p < 0.01). The sensitivity, specificity and overall diagnostic accuracy of lavage cytology was more as compared to exfoliative cytology (71.05%, 56.0%, 78.85% Vs 47.37%, 41.18% and 61.54%). Cystopositivity was more with single large sessile tumour as compared to multiple small pedunculated tumours. Cytohistological discrepancy was observed in patients of transitional cell carcinoma with recurrence. It is concluded that cytology may act as a good adjuvant to histology in picking up early flat lesions and/or follow up of patients with transitional cell carcinoma.
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Affiliation(s)
- V Misra
- Department of Pathology, MLN Medical College, Allahabad
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Mukherjee J, Misra V, Gupta SC, Gupta AK, Tandon SP. Argyrophilic nucleolar organizer regions in atypical adenomatous hyperplasias, prostatic intraepithelial neoplasias and prostatic neoplasms. Urol Int 1997; 58:75-9. [PMID: 9096266 DOI: 10.1159/000282954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Sections from 104 cases of benign, preneoplastic and neoplastic lesions of the prostate were studied for argyrophilic nucleolar organizer regions (AgNORs). The mean NOR counts in normal controls (2.87) and benign prostatic hyperplasia with or without chronic prostatitis (4.90 and 3.84 NORs/nucleus, respectively) were found to be significantly less (p < 0.001) than that in prostatic intraepithelial neoplasia (PIN) and adenocarcinoma of the prostate (5.65 and 5.78 NORs/nucleus, respectively). The mean AgNOR count of a section with atypical adenomatous hyperplasia was significantly lower than that in PIN. No statistically significant difference was observed between AgNOR counts of high-grade PIN and well-differentiated adenocarcinoma (WDAC; 5.67 vs. 5.78 NORs/nucleus, respectively), however the difference between low-grade PIN and WDAC was statistically significant (5.46 vs. 5.78 NORs/nucleus, p < 0.005). The increase in NOR counts occurred concomitantly with the decrease in the degree of differentiation of adenocarcinoma. Thus, NOR was found to be a good adjuvant to the existing diagnostic parameters to pick up more cases at the stage of PIN when prognosis is better.
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Affiliation(s)
- J Mukherjee
- Department of Pathology, MLN Medical College, Allahabad, India
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