Biliary hCGβ Is a Potential Novel Marker for Prediction of Biliary Neoplasia in Primary Sclerosing Cholangitis Patients

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease, which is associated with an increased risk of cholangiocarcinoma (CCA). Novel markers, to complement or replace CA19-9, are urgently needed for the screening of PSC-associated biliary neoplasia. Previous studies have suggested that serum trypsinogen-2 and human chorionic gonadotropin β-subunit (hCGβ) may serve as such markers. Using highly specific in-house immunoassays, we studied trypsin(ogen)-2 and -3, SPINK1 and hCGβ in bile samples of 214 patients, referred for endoscopic retrograde cholangiography. We found that biliary trypsinogen-2 was decreased (p = 0.027) and hCGβ was elevated (p < 0.001) in PSC patients who were diagnosed 1.6 years (median, range 0.1–8.8 years) later with CCA or in whom biliary dysplasia was observed at least twice in brush cytology (n = 11) as compared to PSC patients without CCA or repeated dysplasia (n = 171). The other studied markers did not show significant differences between these groups. Our results warrant further evaluation of hCGβ as a predictive marker for PSC-associated biliary neoplasia.

Bronchial brush cytology, endobronchial biopsy, and SALSA immunohistochemistry in severe equine asthma

Horses with severe equine asthma (SEA), also known as heaves and recurrent airway obstruction, have persistent neutrophilic inflammation of the lower airways. Cytologic evaluation of bronchoalveolar lavage (BAL) fluid is commonly used to confirm the clinical diagnosis of SEA. However, the utility of microscopic assessment of bronchial brushings, endobronchial biopsies, and immunohistochemical detection of disease-associated biomarkers for the diagnosis of SEA remain poorly characterized. Salivary scavenger and agglutinin (SALSA) has anti-inflammatory properties and downregulated gene expression in SEA; therefore, it was investigated as a tissue biomarker for airway and systemic inflammation. Six asthmatic and 6 non-asthmatic horses were exposed to an inhaled challenge. Before and after challenge, samples of BAL fluid, bronchial brushing, and endobronchial biopsy were collected. Location of SALSA in biopsies was determined, and immunohistochemical label intensity was computed using image analysis software. Serum amyloid A (SAA) was measured to assess systemic inflammation. After challenge, neutrophil proportions were significantly higher in asthmatic versus non-asthmatic horses in BAL fluid (least squares means, 95% confidence interval: 80.9%, 57.2% to 93.1%, vs 3.6%, 1.1% to 10.7%) and in brush cytology slides (39.5%, 7.7% to 83.6%, vs 0.2%, 0% to 2.3%), illustrating the potential of brush cytology as an alternate modality to BAL for assessing intraluminal inflammation. Bronchial histopathologic findings and intensity of SALSA immunolabeling in surface and glandular epithelium were similar in asthmatic and non-asthmatic horses, indicating limited changes in bronchial tissue from the inhaled challenge. Increases in SAA indicated systemic inflammation, but SALSA immunolabeling did not change significantly.

Accuracy of liquid-based brush cytology and HPV detection for the diagnosis and management of patients with oropharyngeal and oral cancer

Objectives This study aims to evaluate the usefulness of liquid-based brush cytology for malignancy diagnosis and HPV detection in patients with suspected oropharyngeal and oral carcinomas, as well as for the diagnosis of tumoral persistence after treatment. Material and methods Seventy-five patients with suspicion of squamous cell carcinoma of the oropharynx or oral cavity were included. Two different study groups were analyzed according to the date of the sample collection: (1) during the first endoscopy exploration and (2) in the first control endoscopy after treatment for squamous cell carcinoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy diagnosis as well as for HPV-DNA detection on brush cytologies were assessed. Results Before treatment, the brush cytology showed a sensitivity of 88%, specificity of 100%, and accuracy of 88%. After treatment, it showed a sensitivity of 71%, specificity of 77%, and accuracy of 75%. HPV-DNA detection in cytology samples showed a sensitivity of 85%, specificity of 100%, and accuracy of 91% before treatment and an accuracy of 100% after treatment. Conclusions Liquid-based brush cytology showed good accuracy for diagnosis of oropharyngeal and oral squamous cell carcinoma before treatment, but its value decreases after treatment. Nevertheless, it is useful for HPV-DNA detection, as well as to monitor the patients after treatment. Clinical relevance Brush cytology samples are reliable for the detection of HPV-DNA before and after treatment and may be a useful method to incorporate in the HPV testing guidelines.

CYTO-HISTOLOGICAL CORRELATION OF BRONCHIAL BRUSH AND BRONCHIAL BIOPSY IN LUNG MALIGNANCIES

BACKGROUND:Lung cancer is one of the most common cancer and cause of cancer related deaths in about 29% of males and 26% of females all over the world. Fiberoptic bronchoscopy has an excellent result in diagnosis of lung cancer when combined with brushing cytology and biopsy. The Aim of the study is to correlate AIM: cytological and histological ndings in diagnosing lung carcinomas. This study was done in Department of Pathology, Government General MATERIALS AND METHODS: and Chest Hospital, Erragada, Hyderabad, Telangana from June 2018 to May 2020. 240 clinically suspected cases of lung malignancies underwent both bronchial brush and bronchial biopsy and were included in this study.RESULTS: Out of 240 cases, malignancy was conrmed in 194 cases by histopathology of bronchial biopsy, in which 152 cases were well correlated with brush cytology. Bronchial brush cytology showed sensitivity of 78.35% , specicity of 100% and accuracy of 82.5%. Bronchial biopsy has better detection rate t CONCLUSION han bronchial brush cytology in this study. However combination of brush cytology and biopsy can be considered as the best procedures for the diagnosis of lung malignancies.

Diagnostic Efficacy of Bronchoalveolar Lavage in a Rural Industrial Hospital in Madhya Pradesh, India

BACKGROUND The incidence of lung carcinomas is on rise and it is the second most common cause of death due to carcinomas in the West. Due to rise in air pollutants other lung diseases are also on rise. The use of cytological methods in the diagnosis of pathological lesions of respiratory tract has been generally acclaimed as one of its most successful application. Flexible fibre optic bronchoscope revolutionised respiratory cytology because techniques like broncho alveolar lavage, brush cytology, bronchial biopsy, and fine needle aspiration cytology (FNAC) have become easier and more acceptable, shifting the emphasis from advanced inoperable malignancy to use of cytology as first line diagnostic and management tool. Broncho alveolar lavage (BAL) which was originally developed as a therapeutic tool for pulmonary alveolar proteinosis, cystic fibrosis and intractable asthma also has gained acceptance and steady popularity as a tool for diagnosis of lung pathology. We wanted to analyse BAL examined in the Department of Pathology, Nehru Shatabdi Chikitsalaya (NSC), NCL and establish its utility as a diagnostic tool in our setup and reduce referral to higher centres. METHODS 36 BAL samples were examined from August 2006 to December 2007. Bronchoscopy was performed by ENT specialists among all patients who were not relieved by the medical treatment and their X-ray lung showed some findings, as an outdoor procedure. Patients were asked to come in an empty stomach, and X-ray chest was done before bronchoscopy. All bronchoscopies were performed under local anaesthesia (LA) except for a 2 yrs. old child. BAL fluid was subjected to cytological studies and Ziehl-Neelsen staining wherever required. RESULTS Out of 36 cases, nonspecific inflammation was seen in 13 cases, tuberculosis in 8 cases, where in three samples of sputum were negative for acid-fast bacillus (AFB) and BAL showed bacteria in many fields. Two cases were found to have aspergillosis, to rule out contamination, serum antibodies against aspergillosis were estimated which was very high ruling out contamination. Out of 8 cases of malignancy one was metastasis from mature teratoma testis. Two cases of adenocarcinoma (both females) and two cases of squamous cell carcinoma were found, in one case of adenocarcinoma and two cases of squamous cell carcinoma (SCC), BAL was found negative. No history was available regarding tobacco smoking in females with adenocarcinoma. CONCLUSIONS Study of BAL obtained by simple non-invasive technique has improved the diagnostic accuracy of lung diseases. Carcinomas can be diagnosed at an early operable stage. The combination of BAL with brush cytology increases the accuracy. To conclude, in all bronchoscopic examination BAL should be performed and should be subjected to microscopic examination irrespective of the age of patient. KEY WORDS Fiberoptic Bronchoscope, Lung, BAL, Tuberculosis, Adenocarcinoma Lung, SCC Lung

EVALUATION OF CELL BLOCK TECHNIQUE VERSUS CONVENTIONAL CYTOLOGY ON BRONCHOSCOPY GUIDED NEEDLE ASPIRATION/ BRUSH CYTOLOGY FOR DIAGNOSIS OF LUNG CANCER

INTRODUCTION: Bronchoscopy is a safe and effective method for diagnosing lung carcinomas with a variation in the diagnostic yield with different bronchoscopy guided procedures. Cell block technique has shown an addition cases positivity in diagnosing carcinomas as compared to the conventional method. AIM: The present study was aimed to evaluate the diagnostic utility of cell block technique on Bronchoscopy guided needle aspiration/ Brush and also to compare cytological preparation with cell block. MATERIAL AND METHODS: A total of 50 cases were included in the study that was suspected to be having lung carcinoma. These patients went under bronchoscope guided aspirations (TBNA, EBNA, and Brush). Smears were immediately made for conventional cytology study and well as in another aliquot samples were collected to prepare cell blocks following which H&E staining was done. RESULTS: Out of 50 cases, 8 cases came out to be negative on conventional smears and when compared with cell block technique 4 additional cases came out to be positive who were negative on conventional smears. The diagnosis were compared with histopathology biopsies keeping it as a gold standard and results on cell block techniques were conrmed to be true. CONCLUSION: Out of 50 cases, an additional 4 more cases were diagnosed malignant by using the cell blocks technique but there were few drawbacks with cell block technique. In few of the cases on cell block, cellularity was very less, cells morphology was also not very clear and some showed cells entrapped in a clusters. The conclusion made out of this study is that cell block technique is more accurate than the cytological smears and when used in combination diagnostic efcacy will be improved.

Diagnostic Three Slides Pap Test Compared to Punch Biopsy and Endocervical Curettage in Confirmed HSIL+ Diagnosis

Objective: The aim of the study was to evaluate the accuracy of the diagnostic Pap test (DPT) on three slides and punch biopsy and endocervical curettage (PB/ECC) compared with the final biopsy material in the detection of high-grade squamous intraepithelial lesion (HSIL). Materials and methods: Patients treated with conization after previous DPT and PB/ECC were analyzed. The findings of the DPT and PB/ECC as well as of the endocervical brush cytology and ECC were compared with the final conus histology. Results: 150 patients were analyzed, and final histology verified 145 cases of HSIL and 3 cancers. The percentage of confirmed HSIL cytology was 97%, while for PB/ECC it was 79% with 30/145 false negative results. The correlation between Pap test and PB/ECC showed that the diagnostic accuracy of DPT is significantly higher (p < 0.0001). Endocervical brush cytology confirmed HSIL+ in the endocervical canal in 83% and ECC in 35% of cases (p < 0.0001). Conclusion: The DPT on three slides enables better detection of HSIL compared to PB/ECC, particularly for lesions localized in the endocervical canal sampled with a cytobrush. A high quality DPT could represent a surrogate for PB/ECC and open the possibility of direct access to therapeutic procedure.