Non-gynecological cytology on liquid-based preparations pdf

non-gynecological cytology on liquid-based preparations professor rana hoda director: cytology medical university of south carolina charleston sc non-gynecologic cytology on nonliquid-based preparations liquid- cancer is #1 cause of death in hong kong >12,000 deaths non-gyn liquid-based cytology nonliquidliquid-based preparation liquidadvantages general artifacts whistler’s mother whistler’ conventional preparation direct smear cytospin direct smears advantages fast inexpensive retains background routine processing disadvantages handling of needle multiple slides obscuring background air drying air-drying airartifacts adequacy, presence of abnormal cells, number and distribution of abnormal cells, relationship between cells, cell size, shape, nuclear size, shape, n:c ratio, nuclear changes, nucleoli, cytoplasmic features, background or diathesis, abnormality in size and shape of cells, variation in cell size and shape, increase in nuclear size, nuclear membrane irregularity, hyperchromasia, prominence of nucleoli, irregularity in shape thereof, thickening of nuclear membrane, increase in n:c ratio, cytoplasm, mitosis, increased number and abnormal forms thereof, non-cohesiveness etc liquid-based preparations liquid- ThinPrep®, TP cytyc, boxborough, ma fda-approved for hpv-dna test SurePath®, SP triPath, burlington, nc conventional smear liquid-based liquidpreps _ cellularity high architecture preserved cell size preserved background distracting diathesis diffuse nuclei preserved ancillary tests +/+/conventional lower < preserved smaller cleaner clinging, clumped preserved + liquid-based liquid- advantages of liquid-based preps easier collection & transport standardized prep slide screening area air-drying artifact obscuring elements morphology=conventional prep problems of liquid-based preps background material: & altered necrosis, blood, inflammation extracellular elements: & altered colloid, mucin, stroma architectural integrity: disrupted fragmentation of papillae cellular morphology: altered shrunken ThinPrep sample collection lab cytolyt® conventional liquid-based ThinPrep 2000 processor ThinPrep processing fluid, including urine, specimens centrifuge sample, add CytoLyt mucoid specimens add 30ml of CytoLyt superficial specimens brushings collected directly in PreservCyt SurePath specimen collection ThinPrep process dispersion cell collection cell transfer SurePath density gradient: cell enrichment ThinPrep SurePath 20 mm methanol 13 mm ethanol morphologic differences technical differences ThinPrep ThinPrep expensive lab space technical expertise prep time: 30 pre-made slides screen time: SurePath expensive lab space technical expertise prep time: 60 slides prepared daily screen time: >2 SurePath monolayer flattened clusters different planes of focus 3-dimensional clusters pattern recognition is key to interpretation cytologists should learn differences in cytological appearances between conventional and liquid-based preps liquid- hopper hopper hopper hopper hodgkin’s lymphoma sp breast cytology diagnosis: invasive lobular ca lobular carcinoma shows similar features on conventional smear & thinprep ustiin et al diagn cytopathol 2002;27:22 dq cs, pap ductal ca fibroadenoma tp apocrine metaplasia myers archiv pathol 2000;124:1667 dq tp cs ali acta cytol 2004;48:481 papillary neoplasm ali acta cytol 2004;48:481 metastatic breast ca ‘morula’ cytological diagnosis of breast diseases sensitivity ppv specificity npv CS 84 96 98 91 vs vs vs vs LBP 86% 95% 96% 88% bedard ajcp 1999;111:523 breast cytology problems fibroadenoma fewer myoepithelial cells less epithelial stromal relationship colloid carcinoma scanty mucin papillary neoplasm fragmentation of papillae thyroid cytology sp diagnosis of papillary carcinoma: nuclear features sp michael diagn cytopathol 2000;23:63 nodular hyperplasia colloid of nodular hyperplasia tulecke, diagn cytopathol 2004, 30:7 hashimoto’s thyroiditis hashimoto’s thyroiditis sp follicular neoplasm thyroid on liquid-based cytology colloid: dense, hard, fragmented, droplets sensitivity 97% specificity 93% + predictive value 93% lbp: ? technique of choice for thyroid malle acta cytol 2006;50:23 ford otolaryngol head neck surg 2002, 126:554 afify cancer cytopathol 2001;93:179 thyroid on liquid-based preparations problems undifferentiated “anaplastic” carcinoma aggressive tumors mortality rate ~100% colloid: changes features papillary ca: fragmented hashimoto’s thyroiditis: low sensitivity ? fna of thyroid mass tulecke diagn cytopathol 2004, 30:7-13 tp pap anaplastic carcinoma dq pleomorphic adenoma head & neck cytology pleomorphic adenoma: matrix not obvious dq cs warthin’s tumor sp 10 adenoid cystic ca sarcoidosis sp dq squamous carcinoma squamous carcinoma tp small cell ca non-small cell lung carcinoma cs dq h&e delgado cancer 2000;90:279 11 carcinoid tumor neuroendocrine metastatic melanoma in lymph node tumor tp aron diagn cytopathol, 2004;30:62 barkan diagn cytopathol 2002;26:334 morrison ajcp, 2002;118:435-441 colon adenoca, mucinous colonic adenoca cs sp diffuse large b-cell lymphoma anaplastic large cell lymphoma tp mcevoy, cady & hoda diagn cytopathol 2006;34:112 12 necrosis pancreatic adenoca cs minamiguchi & hoda diagn cytopathol 2004;30:292 pancreatic ca better preserved on liquid-based preps liquidsensitivity specificity tp:cs tp:cs metastatic 091%:058% 100%:100% mnf116 “lbp new frontier in the cytologic assessment of pancreatic lesions” lesions” giri & hoda acta cytol 2000;44:232 siddiqui et al diagn cytopathol 2005;32:75 granular cell tumor of bile duct hoda acta cytol 2005;49:199 13 aspergillus aspergillus fruiting body crapanzano, cancer 2001;93:364 hoda diagn cytopathol 2005;33:244 cytomegalovirus hsv tp sp blastomyces cryptococcus tp 14 strongyloides stercoralis pneumocystis jiroveci linssen acta cytol 2004;48:497 reactive pneumocytes bronchial washing on liquid-based preps diagnostic accuracy liquid-based ~ 2-4 conventional superior overall quality excess mucus may be a problem koivurinne acta cytol 2003;47:637 motherby acta cytol 1999;43:47 linssen, acta cytol 2004;48:497 urine: polyomavirus in renal transplant cases low-grade papillary ca key cytospin criteria applicable to thinprep high nuclear:cytoplasmic ratio irregular nuclear borders homogeneous cytoplasm koss lg acta cytol 2005, 49:233 boldorini et al acta cytol 2005, 49:235 xin et al diagn cytopathol 2003;29:125 15 high-grade urothelial carcinoma low-grade papillary ca sp thinprep~4 cytospins lbp in urine: reliable tp zardawi acta cytol 2003;47:1038 xin diagn cytopathol 2003;29:125 diagnostic sensitivity of urine cytology on… …conventional cytology low-grade intensity on lbp distribution of proper staining on lbp cleaner background & easier to interpret dabbs et al diagn cytopathol 1997;17:388 hoda et al diagn cytopathol 2005;33:450 sp liquid-based cytology liquidadvantages in cytomorphology high diagnostic accuracy lesser unsatisfactory rate preserved cell features lesser fixation artifact cleaner background based on review of literature to date 17 ...non-gynecologic cytology on nonliquid-based preparations liquid- cancer is #1 cause of death in hong kong >12,000 deaths non-gyn liquid-based cytology nonliquidliquid-based preparation liquidadvantages... thereof, non-cohesiveness etc liquid-based preparations liquid- ThinPrep®, TP cytyc, boxborough, ma fda-approved for hpv-dna test SurePath®, SP triPath, burlington, nc conventional smear liquid-based. .. strongyloides stercoralis pneumocystis jiroveci linssen acta cytol 2004;48:497 reactive pneumocytes bronchial washing on liquid-based preps diagnostic accuracy liquid-based ~ 2-4 conventional