High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire a cytological specimen, despite a sensitivity around 45 %. Rapid on-site evaluation (ROSE) is widely used for endoscopic ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity. Nevertheless, no study has evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. Patients and methods This was a retrospective single-center study that included patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false-negative or true-positive results was performed. Results Two hundred six patients were included, 57.3 % males, median age 72 years, 77.2 % having extrahepatic biliary strictures. Of the patients, 99 % had an adequate sample at ROSE after a mean of 2.6 passages. The diagnostic yield was accuracy 83 %, sensitivity 74.6 %, and specificity 98 %, positive and negative predictive values 98 % and 71 % respectively, with an area under the curve of 0.86. A diagnosis of cholangiocarcinoma was significantly more frequent among true-positive cases (68 % vs 46.8 %; P = 0.04). Conclusions This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone and at least comparable to those of more expensive and invasive techniques.

Role of Immunocytochemistry in the Cytological Diagnosis of Pulmonary Tumors

Pulmonary cytology is a challenging diagnostic tool, and it is usually evaluated considering medical history and radiological findings in order to reach an accurate diagnosis. Since the majority of lung cancer patients have an advanced stage at diagnosis, a cytological specimen is frequently the only material available for diagnosis and further prognostic/predictive marker determination. Several types of specimens can be obtained from the respiratory system (including sputum, bronchoalveolar lavage, bronchial brushing, fine needle aspiration, and pleural fluid) with different technical preclinical management protocols and different diagnostic yields. Immunocytochemistry (ICC) has a pivotal role in the determination of diagnostic, prognostic, and predictive markers. Therefore, limited cytology samples are to be used with a cell-sparing approach, to allow both diagnostic ICC evaluation as well as predictive marker assessment by ICC or specific molecular assays. In this review, we describe the most common ICC markers used for the diagnosis and prognostic/predictive characterization of thoracic tumors in different cytological specimens.

Assessment of the diagnostic value of immunocytochemitsry and in situ hybridization in cytological specimen of childhood leprosy

Background: Hardly any studies have been done to study diagnostic value of immunocytochemistry and in situ hybridization in cytological specimens for the diagnosis of leprosy in children. The objective of this study is to assess the diagnostic value of immunocytochemistry and in situ hybridization in cytological specimens of leprosy patients. To compare these techniques with Z.N. staining.Methods: This prospective study was carried out in 24 patients (≤18 years of age) of leprosy. Clinical examination of each patient was done and categorized according to IAL. After taking consent, three skin smears was taken, one for Z.N. staining and remaining two for immunocytochemistry and in situ hybridization respectively.Results: Routine skin smear examination by ZN staining method confirmed the diagnosis in 2/24 (8.3%) cases and they belonged to BL category. Immunocytochemistry showed positivity in 4/7 (57.1%) in early leprosy (BT) and 82.3% (BB/BL) in late leprosy. Immunocytochemistry improved the diagnosis by 66.7%, and the results were statistically significant (p<0.01). In situ hybridization showed the positive results in 66.6% cases of early leprosy and 86.6% cases of late leprosy (BB/BL). In situ hybridization improved the diagnosis 72.6% in comparison to ZN staining and the results were statistically significant (p<0.01).Conclusions: Immunocytochemistry and in situ hybridization enhance the diagnosis of leprosy when compared to routine skin smears stained by ZN staining. They are important diagnostic tools for definitive diagnosis in early as well as established cases of leprosy.

Cytological specimen as a source of genetic individualized information in forensic medicine

A possibility of using a cytological specimen’s as an object of a forensic identity research, using moleculargenetic methods and a minimal number of nucleus containing cells in the specimens, necessary for a “positive” person’s identification, have been studied in this paper.