Colposcopic and cytological parallels in pregnant women with a history of infertility of various genesis

The state of the cervix was studied in pregnant women with a history of infertility of various genesis by colposcopic and cytological research methods. The data obtained indicate an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility, compared with pregnant women who had endocrine infertility. Purpose — to determine the relationship between the nature and severity of colpocoscopic and cytological changes in the cervix in pregnant women who had a history of infertility. Materials and methods. 101 women were examined: 14 pregnant women with a history of endocrine infertility, group 1; 27 pregnant women with a history of tuboperitoneal infertility — group 2; 40 pregnant women, had combined infertility — group 3, 20 healthy pregnant women with no history of infertility — group 4. Methods for assessing the state of the cervix in pregnant women — video colposcopic and cytological (on glass). Results. Normal cytological changes (NILM) were found: in group 1–8 (57.2%), in group 2 — in 15 (55.6%), in group 3 — in 23 (57.5%), in group 4, 14 (70.0%) pregnant women. Benign cytological and ASCUS signs were: in group 1 — in 5 (35.7%), in group 2 — in 6 (22.2%), in group 3 — in 10 (25.0%), in group 4 — in 5 (25%) patients. Precancer (LSIL+HSIL): in group 1 — in 1 (7.1%), in group 2 — in 6 (22.2%), in group III — in 9 (22.5%) women, and in group 4, no precancers were found cytologically. Normal colposcopic signs (stratified squamous epithelium) were found: in group 3 — in 11 (27.5%), in group 2 — in 8 (29.6%), and in group 1 — in 7 (50.0%) pregnant women. And benign colposcopic changes (ectopia, open glands, Nabotovi cysts, deciduosis): in group 3 — in 19 (47.5%), in group 2 — in 16 (59.3%), in group 1 — in 6 (42.9%), in group 4 — in 5 (35.7%) patients. Our data indicate that precancers during colposcopy occurred: in group 3 — in 9 (22.5%), in group 2 — in 3 (11.1%), in group 1 — in 1 (7.1%), in group 4 — in 1 (5.0%) women. No colposcopic signs of invasive growth were found in any of the groups. Conclusions. The study revealed an increased level of precancerous pathology of the cervix in pregnant women with a history of tubo-peritoneal and concomitant infertility. A fairly high percentage of precancerous conditions of the cervix in group 2 — in 6 (22.2%) and in group 3 — in 9 (22.5%) women indicates that in the presence of Human papillomavirus (HPV) and other genital infections and with increasing age, the probability self-elimination of the papilloma virus is reduced. After long-term infertility treatment, all pregnant women must undergo a colposcopic examination at the first visit to the antenatal clinic, in addition to taking a cytological smear. If LSIL and HSIL are found in this category of women, colposcopic and cytological control once every 3 months during pregnancy with mandatory HPV PCR HCR. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: pathology of the cervix, pregnancy after infertility, video colposcopy, cytology.

Detection of Escherichia coli in Postpartum Clinical Endometritis of Dairy Cattle by PCR

Background: Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Trueperella pyogenes (T. pyogenes), Klebsiella pneumoniae (K. pneumoniae), Bacillus spp. and Fusobacterium necrophorum (F. necrophorum) are the common bacterial agents isolated from postpartum endometritis in dairy cattle. The objective of the present study was to determine the association of E. coli with postpartum endometritis by polymerase chain reaction (PCR).Methods: The present study was conducted from September 2019 to January 2020 at Teaching Veterinary Clinical Complex, College of Veterinary and Animal Sciences, Pookode, Kerala and organised dairy farms in Wayanad district, Kerala. Endometrial cytobrush samples (n = 36) were collected by cytobrush technique at 28 to 35 days postpartum (dpp). 16S rRNA gene was employed for the identification of E. coli by PCR.Result: Upon evaluating endometrial cytological smear, 26 animals were positive for endometritis with more than 5% polymorphonuclear (PMN) cells. The prevalence of endometritis was 72.22 per cent (26/36). E. coli was detected in 12 samples by PCR. The study suggested PCR as a highly sensitive method for the identification of E. coli associated with endometritis in postpartum dairy cows.

Rapid Cell Transfer by Means of Nylon Mesh to Improve Cellular Diagnosis: The Role of Immunocytochemistry

Immunocytochemistry (ICC) is an important ancillary technique in clinical cytology for not only identifying and characterizing tumor cells but also gaining prognostic or therapeutic information. Although cell blocks are often prepared for immunocytochemical evaluation of body cavity fluid and fine-needle aspiration specimens, they are not suitable for hypocellular samples. Liquid-based cytology can help prepare additional smears from residual cytological specimens. However, since conventional methods are used for nongynecological specimens in most laboratories, ICC is often limited by the number of cytological smears. Cell transfer methods permit to evaluate several immunocytochemical markers in a single cytological smear. Yet, these methods have some limitations; for example, they are time-consuming (about 3–40 h) and medium membranes with their attached cells are occasionally stretched or torn when peeled off the slides. Therefore, in an attempt to solve these problems, we developed a rapid and reliable cell transfer method using a nylon mesh. Our method requires no special equipment or reagent and can significantly reduce the turnaround time, as compared to previous methods.

Analysis of diagnostic value of cytological smear method versus cell block method in body fluids with clinical and biochemical correlation: study of 150 cases

Background: Aspiration of serous cavities is a simple and relatively non-invasive technique toachieve diagnosis. Cytological evaluation of body cavity fluid is diagnostically challenging. Especiallyin malignant effusions, helps in staging, prognosis and management of the patients. Aims: Toassess the utility and sensitivity of cell block method over conventional smear technique incytodiagnosis of the serous effusions. And to assess the utility and sensitivity of cytologicalevaluation of body fluids with biochemical and clinical correlation. Methods: A total of 150 fluidspecimens were examined for conventional cytological smear (CS) and cell block method (CB). Outof 150 fluids, 96 were pleural fluid, 48 were ascitic fluid, 04 fluid from pouch of Douglas and 01 wasfrom synovial fluid. Results: In this study, the utility of the CB method in the cytodiagnosis ofmalignant effusions was found to be highly significant as compared to the CS method. The additionalyield of malignancy was 12% more as was obtained by the CB method. Conclusion: For the finalcytodiagnosis of body fluid, there is statistically significant difference between the two techniques. Inother words, CB is superior to CS method. It gives more information about the architecturalarrangement and the likely source of primary. More important is that diagnostic material in cellblocks is available for special studies for Immunohistochemistry which can further supplement ourknowledge about the primary source of metastasis.

Prediction of Calving to Conception Interval Length Using Algorithmic Analysis of Endometrial mRNA Expression in Bovine

After parturition, the uterus undergoes significant reconstruction, allows the endometrium to create an environment for subsequent embryo development. Here, we used an unsupervised algorithmic approach to select characteristic endometrial mRNA expression patterns of proposed markers and investigate each marker’s role as an individual indicator of reproductive success. Clinically healthy cows at a sixth week postpartum were examined, the percentage of neutrophils (PMNs%) in the cytological smear was calculated, and an endometrial biopsy was taken for qPCR. Based on pregnancy examination, cows were divided into three groups: Pregnant before 100 days postpartum (P100, n = 11), pregnant between 100–200-day (P200, n = 14), and culled (C, n = 10). Animals were also classified based on two PMNs% thresholds > 5% PMNs and > 10% PMNs. The expression of IL1B, IL6, CXCL8, and IL17A was higher in >10%PMNs. The expression of PTGS1 was higher in the P200 compared to P100. Upregulation of inhibin A subunit (INHA) and downregulation of inhibin β A subunit (INHBA) were observed in the P100. INHBA/INHA ratio was the most accurate linear predictor of the calving-to-conception interval. The application of the k-means algorithm allowed the identification of five unique expression patterns. The sensitivity and specificity of predicting allocation to P100 were 81% and 79%. We also documented the low efficiency of genes associated with subclinical endometritis and PMNs% in determining reproductive capability. These results suggested the presence of distinctive expression patterns in 6 weeks postpartum, correlated with cows’ reproductive capacity. Furthermore, we proposed the INHBA/INHA ratio as an indicator of calving-to-conception interval length.

Colposcopic assessment of the normal cervix in pregnant women

Background. Colposcopy in a pregnant woman is carried out to rule out the presence of invasive cervical cancer and to determine the need for targeted biopsy. Indications for colposcopy include pathological cytological smear, abnormal appearance of cervix, or bleeding of unknown origin. Objective. To describe the features of colposcopic examination in pregnant women. Materials and methods. Analysis of own experience and literature sources on this topic. Results and discussion. Literature data indicate the reliability and safety of colposcopic examination of pregnant women. It should be noted that the examination of pregnant women requires a higher qualification from the colposcopist than the examination of non-pregnant women, although the assessment is based on the same principles. Simple colposcopy allows to assess the vascular pattern and color of the epithelium. For a more thorough assessment acetic acid and aqueous Lugol solution probes are carried out. The tasks of colposcopy are to identify the causes of deviations from the norm of cytological examination, to determine the location and boundaries of the pathological area, to choose the location of the targeted biopsy, to carry out medical manipulations within healthy tissues, and to monitor treatment results. To improve the planning of the necessary treatment options for excisions, a Nomenclature of colposcopic terms for cervix was created. Features of the cervix in pregnant women include the increased cervix vascularization, edema and hypertrophy of the papillae of the cervical canal, increased secretory activity of the cervical canal, eversion of the cervical mucosa, dehiscence of the cervical canal, increased metaplasia, deciduosis, prolapse of the vaginal walls. These physiological changes may cause overdiagnosis of pathological conditions. Thus, hypervascularization can mimic atypical vessels, and deciduosis – malignant tumors. Conversely, hypervascularization and bleeding, increased mucus production and prolapse of the vaginal walls can mask the manifestations of the disease, being the causes of underdiagnosis. The progression of eversion during pregnancy allows to visualize the lesion, which was previously localized in the cervical canal, better and better. Deciduosis in pregnant women is divided into decidual ectopia and decidual polyps of the cervical canal. The tumor-like form of deciduosis visually and colposcopically mimics exophytic tumors. The ulcer form is characterized by dense whitening when applying acetic acid, but is not stained with Lugol solution. Manifestations of the papillary form become the most pronounced after the acetic acid test. The vesicular form is the most common and most easily diagnosed by colposcopists. Decidual polyps become densely whitened during the acetic acid test, but unlike cervical cancer, blood vessels do not disappear. These polyps are not stained with iodine. Decidual polyps are usually localized in the areas of the original epithelium; they are multifocal and small in size. Instead, malignant tumors are localized within the atypical zone of transformation; they are single and have a bumpy uneven surface. Polymorphism and variety of lesions, young age, pregnancy, normal results of cytological examination are more typical for deciduosis. If the colposcopist is unsure of the benign nature of the process, a targeted biopsy should always be performed. Conclusions. 1. The purpose of colposcopy in a pregnant woman is to rule out the presence of invasive cervical cancer and to determine the need for targeted biopsy. 2. Indications for colposcopy include pathological cytological smear, abnormal cervix appearance, or bleeding of unknown origin. 3. Physiological changes during pregnancy can be the cause of hyper- and hypodiagnosis of pathological conditions. 4. If the colposcopist is unsure of the benign nature of the process, a targeted biopsy should always be performed.

Real-world, Prospective, and Multicenter Validation of a microRNA-based Thyroid Molecular Classifier

ABSTRACTBackgroundThe diagnosis of cancer in thyroid nodules with indeterminate cytology (Bethesda III/IV) is challenging as fine-needle aspiration (FNA), the gold standard method, has limitations, and these cases usually require diagnostic surgery. As approximately 77% of these nodules are not malignant, a diagnostic test accurately identifying benign thyroid nodules can reduce surgery rates. We have previously reported the development and validation of a microRNA-based thyroid molecular classifier for precision endocrinology (mir-THYpe) with high sensitivity and specificity, which could be performed directly from readily available cytological smear slides without the need for a new dedicated FNA. We sought to evaluate whether the use of this test in real-world clinical routine can reduce the rates of surgeries for Bethesda III/IV thyroid nodules and analyze the test performance.MethodsWe designed a real-world, prospective, multicenter cohort study. Molecular tests were performed in a real-world clinical routine with samples (FNA smear slides) prepared at 128 cytopathology laboratories. Patients were followed-up from March 2018 until surgery or until March 2020 (for those patients not recommended for surgery). The final diagnosis of thyroid tissue samples was retrieved from postsurgical anatomopathological reports.ResultsAfter applying the exclusion criteria, 435 patients (440 nodules) classified as Bethesda III/IV were followed-up. The rate of avoided surgeries was 52.5% for all surgeries and 74.6% for “potentially unnecessary” surgeries. After the statistical treatment of non-resected test-negative samples, the test achieved 89.3% sensitivity (95% CI 82–94.3), 81.65% specificity (95% CI 76.6–86), 66.2% positive predictive value (95% CI 60.3–71.7), and 95% negative predictive value (95% CI 91.7–97) at 28.7% (95% CI 24.3–33.5) cancer prevalence. The test influenced 92.3% of clinical decisions.ConclusionsThe reported data demonstrate that the use of the microRNA-based classifier in the real-world can reduce the rate of thyroid surgery with robust performance and significantly influence clinical decision-making.

Effect of tobacco in human oral leukoplakia: a cytomorphometric analysis

Objectives. Tobacco use is one of the most critical risk factors for different oral diseases. The aim of this study is to demonstrate the effect of tobacco on oral mucosa by cytomorphometric analysis of cells with the help of exfoliative cytology and to find out the improvement in diagnostic sensitivity of exfoliative cytology in the detection of dysplastic changes and early oral malignancy. Methods. The nuclear area (NA) and cytoplasmic area (CA) of cells were measured within cytological smear obtained from leukoplakia lesions of buccal mucosa of 90 tobacco users, 30 smokers (TS), 30 chewers (TC) and 30 with combined habit of smoking and chewing (TSC)] and from normal buccal mucosa of 30 non users (NU) of tobacco. Each habit group consisted of 30 tobacco users with oral leukoplakia lesion with mild epithelial dysplasia only. The 30 non-users of tobacco served as controls. The mean values of the CA and NA were obtained for each case, and the nuclear/cytoplasmic area (NA/CA) ratio was calculated. Results. The results showed a statistically significant increase (P<0.001) in mean NA and a statistically significant decrease (P<0.001) in mean CA values of tobacco users with leukoplakia as compared to non-users, hence NA/CA ratio value was significantly higher in tobacco users with the lesion. Conclusion. The changes in cellular morphology caused by tobacco use can be visualized by use of exfoliative cytology with the help of cytomorphometric analysis. The evaluation of parameters (NA, CA and NA/CA ratio) may increase the sensitivity of exfoliative cytology for the early diagnosis of oral premalignant and malignant lesions.