Paris System Has A Higher Cytohistologic Correlation And Reproducibility Than Traditional Urine Cytology Method

Introduction/Objective The major limitation of urine cytology is the lack of consensus regarding the terminology and diagnostic criteria that should be used for urothelial atypia. The main goal of the newly proposed Paris System for Reporting Urine Cytology is to concentrate primarily on the detection of high grade urothelial carcinoma while minimizing the detection of low grade lesions. This study aimed to apply the criteria and categories of the Paris system in retrospectively collected urine cytology specimens and assess histologic correlation and reproducibility. Methods Two senior pathologists independently reviewed retrospectively collected urine cytology specimens strictly following the Paris system criteria for categorization. Cytologic diagnosis were compared with previous cytology result and histologic diagnosis. Results A total of 67 patients were included in the study. The mean age is 65.8 years (36-89 years), majority were males (73.1%) and African American (89.6%). Urine cytology using traditional method showed mostly atypical results (58.2%), followed by reactive (26.9%), high-grade urothelial carcinoma (11.9%) and suspicious (3.0%). On the other hand, the Paris system had more negative results (62.7%), followed by atypical (19.4%), high-grade urothelial carcinoma (11.9%) and lastly suspicious (6.0%). All of negative cases (18 out of 18) and majority of HGUC cases (7 out of 8) were concordant between the two cytology methods. Traditional urine cytology method only yielded 71.4% histologic concordance, while 100% Paris system results were concordant with bladder histology. Majority of the atypical cases using traditional method were converted to negative, and a few atypical cases were converted to suspicious and high-grade. All results using Paris system were concordant between two general pathologists. Conclusion Using the Paris system in analyzing urine cytology resulted to higher cytohistologic concordance than traditional method. Majority of atypical cases from traditional method were converted to more definitive categories. The cytopathologic analyses from two general pathologists applying the criteria of Paris system had superior reproducibility. Applying the Paris system, therefore, can significantly improve the performance of urine cytopathology.

Cytological Follow-Up of Cervical Intraepithelial Neoplasia 1 after Initial Management During 2-Year Period: Bhumibol Adulyadej Hospital Experience

Objective: To evaluate the frequency of cervical cytological results in patients diagnosed as low-grade squamous intraepithelial lesion (LSIL) in cytology report between women younger than 30 and woman 30 or older after initial management and the completed 2-year follow-up to suggest the proper management for Thai women. Materials and Methods: The present study was retrospectively conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand between January 2011 and December 2016. The medical records of 279 patients whose cervical cytology reported LSIL were reviewed. The prevalence of silent high grade cervical intraepithelial neoplasia (CIN 2/3) in LSIL cytology result was determined. The results of the cervical cytology after the patients completed the 2-year follow-up were evaluated. Results: During the present study period, 279 cases of LSIL in cytology result were enrolled. In women with LSIL in the cytology report, two-third were in pre-menopausal status. The prevalence of CIN 2/3 in LSIL cytology in women younger than 30 and 30 or older were 11.9% and 11.2%, respectively. At 2-year follow-up, around 97% of the patients who completed the follow-up had a spontaneous regression of the disease in both aged groups. Three percent of cases (3/85) had persistent disease in women 30 or older only. There was no progressive disease in the present study. Conclusion: Silent CIN 2/3 in LSIL cytology in the present study were high. Colposcopy should be recommended for diagnosis and follow-up in this setting. Abnormal Pap at 2-year follow-up was around three percent, therefore, abnormal cytology was still a problem. Continuous close cytology follow-up is still recommended. Keywords: Low-grade squamous intraepithelial lesion, LSIL, Cervical intraepithelial neoplasia, CIN, Cytology

Incidence of Positive HPV High Risk in Negative Cytology Result

Objective: This research aim is to report the incidence of positive HPV high risk in negative cytology result. Method: We collected 83 women underwent liquid-based cytology (LBC) and HPV DNA examination at the same time. We were using DiagCor GenoFlow Human Papillomavirus Array Test (GenoFlow), a novel HPV test based on PCR and "Flow-through" hybridization that can identify 33 HPV subtypes: 18 types of High risk HPV such as 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 81 and 82 Result: We grouped the subjects based on age below or equal to 30 years old (n=6) and above 30 years old (n=77). We found a significant difference in HPV DNA result within this group (P = 0.034), with 19.3% had HPV DNA type 16 and 18 in a group of age above 30 years old. Our study showed that 27 women (32.5%) underwent screening for cervical cancer having negative LBC result but showed positive HPV DNA positive. Conclusion: We found a significant difference in HPV DNA test result among women above 30 years old. Co-testing of Pap and HPV DNA is needed, especially if HPV DNA type 16 and 18 were found among negative Pap results. Keywords: Cervical cancer, HPV DNA, incidence, LBC, screening Abstrak Tujuan: Penelitian ini bertujuan melaporkan insidensi dari HPV risiko tinggi yang positif pada hasil sitologi negatif. Metode: Kami mengumpulkan 83 wanita yang menjalani liquid based cytology (LBV) dan pemeriksaan HPV DNA pada waktu yang bersamaan. Dengan menggunakan DiagCor GenoFlow Human Papilloma Virus Array Test (GenoFlow), yaitu sebuah uji HPV terbaru yang berbasis PCR dan “Flow-throug” hybridization dapat mengidentifikasi 33 subtipe HPV: 18 tipe HPV risiko tinggi seperti 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 81 dan 82. Hasil: Kami mengelompokkan subjek berdasarkan usia dibawah atau setara 30 tahun dan diatas 30 tahun (n=77). Kami menemukan perbedaansignifikan dari hasil HPV DNA dalam kelompok ini (P=0.034), dengan 19.3% memiliki HPV DNA tipe 16 dan 18 dalam kelompok usia diatas 30 tahun. Penelitian ini menunjukkan 27 perempuan (32.5%) menjalani skrining kanker serviks memiliki hasil LBC yang negatif namun menunjukkan HPV DNA positif. Kesimpulan: Terdapat perbedaan signifikan dari uji HPV DNA pada wanita usia diatas 30 tahun. Pemeriksaan bersamaan antara Pap dan HPV DNA dibutuhkan terutama ketika HPV DNA tipe 16 dan 18 ditemuka pada hasil Pap negatif. Kata kunci: HPV DNA, insidensi, kanker serviks, LBC, skrining

Silent High Grade Cervical Intraepithelial Neoplasia Diagnosis of Atypical Smear between Conventional and Liquid Based Papanicolaou Smear in Suburban Area of Thailand

Objectives: To evaluate the prevalence of silent high grade cervical intraepithelial neoplasia diagnose in atypical squamous cells of undetermined significance (ASC-US) in cytology result between conventional (CPP) and liquid-based cervical cytology (LBP) methods to suggest the proper management for Thai women.Methods: This retrospective study was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand between January 2011 and December 2016. Medical records of 28,564 patients who attended for cervical cancer screening were reviewed. Prevalence of silent high grade cervical intraepithelial neoplasia (CIN) in atypical squamous cells of undetermined significance (ASC-US) cytology result was determinedResults: During the study period, 28,564 cases were enrolled. There were 22,552 and 6,012 of CPP and LBP cases, respectively. A total of 644 cases of ASC-US cytology were enrolled. In women with ASC-US in cytology, the mean age was younger than women with negative screening cytology group and approximately 70% were in pre-menopausal status. Prevalence of high grade cervical intraepithelial neoplasia in ASC-US cytology from CPP and LBP were 9.5 and 11.9%, respectively. Ten percent (23/248) of atypical glandular cytology pattern was cancer. One-quarter of them was endometrial cancer.Conclusion: Silent high grade cervical intraepithelial neoplasia in ASC-US cytology and the rate of cancer in atypical glandular cytology pattern were high. We recommended colposcopy for women who had the cervical cytological report as atypical squamous and glandular cytology pattern.

HAEMATURIA;

Introduction: Urine analysis was the first laboratory test performed in medicineand has been used for several thousand years. Today it continues to be a powerful tool inobtaining crucial information for diagnostic purposes in medicine.1 Aims and Objectives:To estimate the source of bleeding by erythrocyte morphology on PCM, in patients withhaematuria. Study Design: Descriptive. Setting: The Nephrology and Urology out Patients.Period: 2014 to 2015. Methods: Urinary samples were collected from 100 random patientswho presented with haematuria. Samples were examined by face contrast microscope.UrineRBCs were identified as isomorphic and dysmorphic, proportion was taken, >20% of eithercells were used for localizing the source of bleeding. Later on, finding was furtherconfirmed byultra sound or other investigations like renal Biopsies and cell cytology. Result: In our studywe found that not only the correct bleeding site can be located with a high specificity, but alsoadditional findings can be looked for with a little background knowledge of patient’s medicalhistory. Conclusion: Phase contrast microscopy should be used by the clinicians for gatheringthe primitive information in the patients with haematuria.

Punção Aspirativa de Nódulos da Tiroide: Vale a Pena Repetir?

Introduction: The fine-needle aspiration has a significant role in assessing the malignancy risk of thyroid nodules. There is uncertainty regarding the value of repeat fine-needle aspiration in benign nodules. This study aims to evaluate the concordance of results in consecutive fine-needle aspiration and to study the relevance of repetition in benign results.Material and Methods: Retrospective study of the 4800 thyroid nodules fine-needle aspiration held in Instituto de Patologia e Imunologia Molecular da Universidade do Porto between January 1, 2014 and May 2, 2016. Of the initial sample, we selected the repeated fine-needle aspiration on the same nodule.Results: The first fine-needle aspiration result of the 309 nodules underwent revaluation was non-diagnostic in 103 (33.3%), benign in 120 (38.8%) and atypia/follicular lesion of undetermined significance in 86 (27.8%). The agreement between the first and second fine-needle aspiration was significantly higher in cases with an initial benign result (benign: 85.8%, non-diagnostic: 27.2% and atypia/ follicular lesion of undetermined significance: 17.4%, p < 0.005). The fine-needle aspiration repeating motifs in initially benign nodules (n = 78) were repetition suggestion in 58, nodule growth in 17 and suspicious ultrasonographic features in 3.Discussion: The fine-needle aspiration repetition in nodules with initial non-diagnostic and atypia/follicular lesion of undetermined significance result changed the initial diagnosis in a significant proportion of patients, modifying their therapeutic approach. The high concordance of results in initially benign nodules makes fine-needle aspiration repetition not cost-effective in most cases.Conclusion: The fine-needle aspiration should be repeated when the initial cytology result is non-diagnostic or atypia/follicular lesion of undetermined significance.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features

Recently, it was proposed that some papillary thyroid carcinomas (PTC) will no longer be termed ‘cancer’ and are christened as ‘noninvasive follicular thyroid neoplasm with papillary-like nuclear features’ (NIFTP). As this is a recent definition, little information is available about NIFTP. The objective of this study was to report the frequency, ultrasonographic appearance, cytology result and long-term evolution of cases of NIFTP seen at our institution. We excluded tumours ≤1 cm. The sample consisted of 129 patients. Sixty-four patients were submitted to total thyroidectomy and 65 to lobectomy. These patients with NIFTP did not receive radioiodine. NIFTP corresponded to 15% of cases diagnosed as PTC >1 cm. An ultrasonographic appearance considered to be of low suspicion for malignancy was common in NIFTP (32.5%), whereas a highly suspicious appearance was uncommon (5%). NIFTP frequently exhibited indeterminate cytology (62%), while malignant cytology was uncommon (4%). The patients were followed up for 12–146 months (median 72 months) after surgery. None of the patients developed structural disease during follow-up. Comparing the concentrations of thyroglobulin (Tg) and anti-Tg antibodies (TgAb) obtained 6–12 months after surgery and in the last assessment, none of the patients exhibited an increase in these markers.