The diagnostic reliability of cytologic typing in primary lung cancer with a review of the literature

To evaluate the growing tendency in recent years to attribute more diagnostic reliability to cytologic methods, we investigated the accuracy of cytologic typing in specimens obtained from bronchopulmonary material by five different clinical sampling methods, comparing the cytologic diagnoses with the known histologic diagnoses. The study consisted of 232 cytologic specimens from 157 cases of primary lung cancer. Of the 232 specimens, 173 (75%) were correctly typed and 59 (25%) incorrectly typed with respect to the appropriate histologic diagnoses. When all sampling methods were considered together, the study demonstrated that well-differentiated epidermoid carcinoma and "oat cell" and spindle-polygonal anaplastic carcinomas yielded high cytologic typing accuracies. In poorly differentiated tumors, bronchioloalveolar cell carcinoma and bronchogenic adenocarcinoma, the correct cytologic typing was much lower. The different tumor types and their degrees of differentiation seem to be the decisive factors in cytologic typing accuracy. The findings of this study were compared with those of others and were found to be consistent with the results of even larger series of cases. For some types the typing accuracy was higher than that reported in other series, whereas for other types, e.g., adenocarcinomas, it was lower.     

Chylothorax as a possible diagnostic pitfall: a report of 2 cases with cytologic findings

BACKGROUND: Chyothorax is an uncommon medical condition. To the best of our knowledge, there have been no detailed English-language report dealing with its cytopathologic findings and diagnostic pitfalls CASES: A 12-year-old boy, hemodialysis dependent, with congenital nephrotic syndrome due to focal segmental glomerular sclerosis and a failed renal transplant, developed shortness of breath. Physical and radiologic examinations revealed a left pleural effusion. A 7-year-old boy developed shortness of breath, with a subsequent finding of a left pleural effusion. Multiple osteolytic skeletal lesions were found in this patient. Both patients underwent thoracocentesis. Cytologically, both fluids contained many relatively uniform, large lymphoid cells with high nuclear/cytoplasmic (N/C) ratio, condensed chromatin and occasional nucleoli, resembling blasts. Some nuclei were convoluted. Mitotic figures were present. Foamy macrophages were present in both cases. The differential diagnosis of these populations of cells included a lymphoproliferative disorder. However, the mature T-lymphocytic nature of the cells was confirmed by immunohistochemistry performed on cell block preparations, confirming the clinical impression of chylothorax in both cases. The first patient had chylothorax as a result of trauma due to therapeutic interventions (subclavian vein cannulation), in the second patient the chylothorax was a part of Gorham-Stout syndrome. CONCLUSION: The large T-lymphocytes that are the major cellular component of chylothorax may arouse suspicion of a lymphoproliferative disorder. Attention to the clinical history and immunophenotyping confirm the benign nature of the pleural space fluid. Also, abundant foamy macrophages can be considered a low-power clue to this diagnosis.     

Scrape cytology of meningioangiomatosis: a report of two cases with diagnostic cytologic features.

BACKGROUND: Meningioangiomatosis is a rare, probably hamartomatous condition characterized by nonneoplastic intracortical proliferation of meningothelial cells, capillaries and fibroblasts. The lesion may mimic a tumor both clinically and radiologically. We present two cases of the entity, including its cytologic features. CASES: A 71-year-old man presented with an eight-month history of headache, change in vision, loss of depth perception and unsteady gait. Magnetic resonance imaging (MRI) revealed an infiltrative lesion of the left occipital lobe, diffuse in nature. Cytologic smears prepared at the time of intraoperative consultation showed numerous thin-walled capillaries together with bland spindle cells. Occasional large cells with prominent nucleoli were also present. Frozen section confirmed the presence of linear, small capillaries surrounded by fibroblasts and meningothelial cells, consistent with meningioangiomatosis. The second case was a 3-year-old girl who presented with a one-day history of seizure, vomiting, fever and perioral cyanosis. MRI revealed an enhancing lesion in a temporal lobe of the cerebrum. The patient underwent excision of the lesion. Intraoperative cytology showed numerous meningothelial whorls together with neurons and occasional capillaries. Both patients were well, one after three months and the other after six. CONCLUSION: Meningioangiomatosis is a lesion characterized by linear capillaries, meningothelial cells and neurons, some exhibiting nuclear atypia. The combination can lead to an erroneous diagnosis of more common conditions, such as meningioma (with intracortical extension) and anaplastic astrocytoma. Contrary to these more sinister diagnoses, meningioangiomatosis is a completely benign, presumably hamartomatous entity.     

Intraoperative cytologic crush preparation findings in craniopharyngioma: a study of 72 cases

OBJECTIVE: To describe the intraoperative crush preparation and the cytologic features of craniopharyngioma and the differential diagnosis. STUDY DESIGN: Twelve cases of craniopharyngioma were diagnosed by crush preparation cytology in the Department of Pathology, Shiraz Medical School, and formed the basis of this study. The patients' ages ranged from 7 to 43 years; 3 were female and 9 male. The cytologic findings together with the histologic findings were studied. RESULTS: All cases had a high yield of cells, consisting of honeycomb sheets of epithelial cells with and without palisading rows of cells, papillary clusters, squamous cell clusters, anucleated squames, calcification, multinucleated giant cells, cholesterol crystals, glandular or rosettelike structures, ciliated columnar cells and spindle cells. The smears were diagnosed as suggestive of craniopharyngioma. Histologic sections confirmed the cytologic diagnoses. CONCLUSION: Intraoperative cytologic crush preparation findings are helpful in the diagnosis of craniopharyngioma, when combined with clinical information. Crush preparation cytology is important in the diagnosis of central nervous system tumors.     

Increasing diagnostic accuracy with a cell block preparation from thin-layer endometrial cytology: a feasibility study

OBJECTIVE: To investigate (1) the feasibility of preparing cell blocks by inverted filter sedimentation (IFS-CB) from endometrial samplings processed by the ThinPrep (TP) technique (Cytyc Corp., Boxborough, Massachusetts, U.S.A.), and (2) the possibility of increasing the diagnostic accuracy of TP endometrial cytology by examining the tissue architecture as an adjunctive method of detecting endometrial lesions. STUDY DESIGN: Three hundred one endometrial samplings were obtained, using the Endogyn endometrial device (Biogyn S. n.c., Italy), from perimenopausal and postmenopausal women. The endometrial samplings were collected in a vial with liquid fixative for the TP processing. One TP slide was prepared from each case. If adequate material remained in the vial after the TP slide preparation, it was processed for IFS-CB preparation. RESULTS: IFS-CB preparation was processed in 263 cases (87%) with adequate material. Diagnoses on IFS-CB preparations obtained by endometrial sampling matched those of the hysterectomy specimens. The addition of IFS-CB histology to the cytologic diagnosis by TP increased the diagnostic accuracy of endometrial cytology to 96.3% and 100% for benign/atrophic endometrium and adenocarcinoma, respectively (p = 0.39 and 0.46). In hyperplasia without atypia and hyperplasia with atypia, the diagnostic accuracy increased significantly, to 96% and 95.3%, respectively (p = 0.037 and < 0.001). CONCLUSION: This study illustrates the merit of linking TP cytology with direct endometrial sampling, including small tissue fragments and material adequate for IFS-CB preparation. TP cytology provides an accurate cytologic diagnosis and the possibility of IFS-CB preparation, which could be a valuable diagnostic adjunct to TP cytology.     

Anatomo-clinical study of 102 cases of primary lung cancer

The authors do a clinical anatomic study showing 102 cases of lung primitives cancers to be diagnose in 60% cases on biopsy and 40% on operation'piece. The matter in boundless majority of cases is carcinoma 92%, themselves overlooked by squamous cells carcinoma 55%, forwarded by adenocarcinoma 20%, small cells carcinoma represent 11% of cases and large cells carcinoma 7%. The mean age of occur is 55 years and any cases of carcinoma is observed at persons under 30 years of age. 94% of person are masculine. The majority of tumors 58% cases present themselves as bulky masses exceeding 6 cm of diameter. The authors insist in this study on necessity of early diagnosis when the therapeutic will be curative.     

Diagnostic accuracy of MALDI-TOF mass spectrometry for non-small cell lung cancer: a meta-analysis

Objective: To assess the overall accuracy of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in identifying non-small cell lung cancer (NSCLC).

Methods: A comprehensive search of PubMed, EMBASE and CNKI databases as well as the reference lists from relevant articles was performed prior to July 2017. Two authors independently screened articles based on inclusion and exclusion criteria and assessed the quality of each study using the Quality Assessment of Diagnostic Accuracy Studies 2 (QADAS-2) tool. Meta-disc 1.4 and Stata12.0 software programs were used for the statistical analysis.

Results: Eleven eligible articles comprising 16 studies and representing 935 subjects were included in this meta-analysis. The pooled sensitivity and specificity were 0.84 (95% CI: 0.80–0.87) and 0.77 (95% CI: 0.74–0.80), respectively. The overall diagnostic performance as measured by the area under the curve (AUC) for the summary receiver-operating characteristic (SROC) curve was 0.9380.

Conclusions: MALDI-TOF MS has a high diagnostic accuracy for NSCLC.     

Comparison of several techniques for sampling macroinvertebrates in different habitats of a North Iberian pond

Several habitats of a Mediterranean pond were sampled for macroinvertebrates using different techniques: quantitative methods, semiquantitative hand-net sweep sampling and a qualitative protocol based on hand-net sweeps with fixed counts of individuals. The taxonomic composition was analyzed by DCA and several indices based on taxon composition or percentage of individuals were calculated. The aim of the study was to compare the results provided by these techniques and, in particular, to check if the qualitative approach could be an appropriate low-cost methodology for use in biomonitoring. The results provided by the three sampling methods in relation to submerged macrophytes were very similar. In soft sediment, certain differences were found between the quantitative and semiquantitative techniques. The qualitative protocol applied to single habitats collected fewer taxa than the corresponding quantitative or semiquantitative techniques. However, the overall protocol, consisting of samples from three habitats, provided higher richness values than all the quantitative and semiquantitative methods together, with 59 taxa out of the 70 collected during the study. It is concluded that this qualitative methodology performed reasonably well since it offers a reliable view of the community and it misses few taxa. Moreover, it is not so time consuming as other techniques and can be applied in a variety of habitats. It, therefore, seems to be an efficient method for bioassessment of the macroinvertebrate communities of ponds or the littoral zone of lakes.     

Fibromatosis colli in infants. A cytologic study of eight cases

OBJECTIVE: To review eight cases of fibromatosis colli and assess their cytomorphologic features. STUDY DESIGN: Cytologic smears from eight patients diagnosed as having fibromatosis colli on fine needle aspiration cytology were reviewed. RESULTS: Cytologic features of fibromatosis colli are bland-appearing fibroblasts and degenerative atrophic skeletal muscle in a clean background. Besides these, we found a large number of muscle giant cells; numerous bland, bare nuclei; and parallel clusters of fibroblasts. Collagen was seen in all cases. CONCLUSION: A confirmatory, noninvasive diagnosis of fibromatosis colli can be made by fine needle aspiration cytology alone; invasive diagnostic and therapeutic measures are best avoided. Excision biopsy may not be necessary and should be reserved for cases with a strong clinicopathologic suspicion of malignancy.     

Hodgkin's disease: diagnostic accuracy of fine needle aspiration; a report based on 62 consecutive cases

We report on our series of 62 cases occurring between January 1977 and December 1990, which were diagnosed as Hodgkin's disease by fine needle aspiration (FNA) samples. the overall accuracy of the cytological diagnosis was high, with only four incorrect diagnoses and a positive predictive value of 93.5%. the value of FNA as a first level diagnostic technique in the screening of lymphadenopathies is discussed, as well as the limitations and pitfalls of the cytological diagnosis.     

RNASEL Asp541Glu and Arg462Gln polymorphisms in prostate cancer risk: evidences from a meta-analysis

Epidemiological studies have evaluated the association between RNASEL Asp541Glu and Arg462Gln polymorphisms and prostate cancer (PCa) risk. However, the results remain inconclusive. To derive a more precise estimation of the association between RNASEL polymorphisms and PCa risk, we performed a meta-analysis based on nineteen case?Ccontrol studies. We used odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of the association. Overall, we found that both Asp541Glu and Arg462Gln polymorphisms were not associated with PCa risk (for Asp541Glu polymorphism: Glu/Glu vs. Asp/Asp: OR 1.17, 95% CI: 0.95?C1.45, P?=?0.13; Glu/Asp vs. Asp/Asp: OR 1.02, 95% CI: 0.92?C1.14, P?=?0.70; for Arg462Gln polymorphism: Gln/Gln vs. Arg/Arg: OR 0.98, 95% CI: 0.88?C1.08, P?=?0.62; Gln/Arg vs. Arg/Arg: OR 0.97, 95% CI: 0.91?C1.04, P?=?0.53). The insignificant association was maintained in the dominant and the recessive genetic models. In subgroup analyses, the significant association was not detected in Caucasian populations. However, we found the significant association of RNASEL Asp541Glu polymorphism with sporadic PCa (Glu/Glu vs. Asp/Asp: OR 1.29, 95% CI: 1.04?C1.59, P?=?0.02; Glu/Asp vs. Asp/Asp: OR 1.24, 95% CI: 1.03?C1.50, P?=?0.03). In conclusion, we found that these RNASEL polymorphisms were not related to overall PCa risk, especially in Caucasians. However, in subgroup analyses we found a suggestion that RNASEL 541Gln allele might be a low-penetrent risk factor for sporadic PCa.     

The accuracy of methods for coding and sampling higher-level taxa for phylogenetic analysis: a simulation study

Many phylogenetic analyses, particularly morphological studies, use higher taxa (e.g., genera, families) rather than species as terminal taxa. This general approach requires dealing with interspecific variation among the species that make up the higher taxon. In this paper, I review different parsimony methods for coding and sampling higher taxa and compare their relative accuracies using computer simulations. Despite their widespread use, methods that involve coding higher taxa as terminals perform poorly in simulations, relative to splitting up the higher taxa and using species as terminals. Among the methods that use higher taxa as terminals, coding a taxon based on the most common condition among the included species (majority or modal coding) is generally more accurate than other coding methods, such as coding taxa as missing or polymorphic. The success of the majority method, and results of further simulations, suggest that in many cases "common equals primitive" within variable taxa, at least for low and intermediate rates of character change. The fixed-only method (excluding variable characters) performs very poorly, a result that is indirectly supported by analyses of published data for squamate reptiles. Sampling only a single species per higher taxon also yields low accuracy under many conditions. Along with recent studies of intraspecific polymorphism, the results of this study show the general importance of (1) including characters despite variation within taxa and (2) using methods that incorporate detailed information on the distribution of states within variable taxa.     

Histologic and cytologic patterns of lung cancer in 2,580 men and women over a 15-year period

This paper describes the relative frequencies and changes in the morphologic patterns of lung cancer, as documented in the histologic and cytologic specimens from 2,580 patients diagnosed and treated at Duke University Medical Center over a period of 15 consecutive years. During the first five years, the relative frequencies of the various types of lung cancers were, in descending order, squamous cell carcinoma (43.1%), large cell undifferentiated carcinoma (22.5%), adenocarcinoma of the acinar type (18.6%), small cell undifferentiated carcinoma (11.6%), bronchioloalveolar carcinoma (3.5%) and adenosquamous carcinoma (0.7%). During the second and third five-year periods, squamous cell carcinoma remained the most common neoplasm, but declined to 35.7%, while adenocarcinoma of the acinar type became the second most common lung cancer at 22.0%. The absolute and relative incidences of lung cancer in women showed a striking increase from 21.8% to 29.9%. During this same period, adenocarcinoma of the acinar type replaced squamous cell carcinoma as the most common primary lung cancer in women.     

Cytofluorimetric evaluation of DNA ploidy in lung cancer: a bronchoscopic study

The study of the biological characteristics of lung cancer is gaining more and more interest both because of their potential role as prognostic indicators and for therapeutic reasons. The DNA content estimated by flow cytometry in surgical samples of non-small cell lung cancer (NSCLC) has already been demonstrated to be correlated with survival in these patients. From July 1990 to February 1992 we analyzed the DNA distribution of bronchoscopic biopsies from 88 patients with lung cancer (18 small cell lung cancer, SCLC, and 68 NSCLC, two unspecified histology). Twenty-eight tumors (34.6%) had a diploid DNA distribution, while 53 were aneuploid (65.4%). A correlation was found between DNA ploidy and survival. Evaluation of the DNA content in bronchoscopic samples in a large series of patients could determine the role of this analysis prior to surgery in NSCLC and its value as a marker with respect to prognosis and response to therapy in SCLC.     

Exfoliative cytologic findings of primary pulmonary adenoid cystic carcinom: a report of 2 cases with a review of the cytologic features

BACKGROUND: Adenoid cystic carcinoma is a very rare primary pulmonary neoplasm. Cytologic findings of pulmonary washing and brushing in 2 cases of primary bronchial adenoid cystic carcinoma with special histologic features are described, with an emphasis on some points that have not been reported previously, together with the diagnostic pitfalls. CASES: Two cases of primary adenoid cystic carcinoma of the lung were diagnosed on exfoliative cytology. The patients' ages were 55 and 65 years old. Cytologic findings included large and small clusters of small cells in both 2 and 3 dimensions with occasional cystlike spaces containing mucoid material. The cells were arranged in spherical, cylindrical, basaloid and rosettelike arrangements. There were also abundant small and large mucoid globules, cylinders of homogeneous, acellular, mucous material and cannon balls. Cytoplasmic and intranuclear round inclusions were noted in case 1. Rare findings of nuclear molding were noted. In case 2, chondromyxoid material and a bimorphic population of tumor cells caused diagnostic confusion with other salivary gland-type tumors of the lung. CONCLUSION: These cases showed characteristic cytologic findings of adenoid cystic carcinoma together with rare findings of intracellular and extracellular inclusionlike bodies, myxochondroid material, bimorphic populations and nuclear molding, which can cause diagnostic confusion with other lung tumors.     

Analysis of microsatellite mutations in buccal cells from a case-control study for lung cancer

Exposure to tobacco carcinogens is the major cause of human lung cancer, but even heavy smokers have only about a 10% life-time risk of developing lung cancer. Currently used screening processes, based largely on age and exposure status, have proven to be of limited clinical utility in predicting cancer risk. More precise methods of assessing an individual's risk of developing lung cancer are needed. Because of their sensitivity to DNA damage, microsatellites are potentially useful for the assessment of somatic mutational load in normal cells. We assessed mutational load using hypermutable microsatellites in buccal cells obtained from lung carcinoma cases and controls to test if such a measure could be used to estimate lung cancer risk. There was no significant association between smoking status and mutation frequency with any of the markers tested. No significant association between case status and mutation frequency was observed. Age was significantly related to mutation frequency in the microsatellite marker D7S1482. These observations indicate that somatic mutational load, as measured using mutation frequency of microsatellites in buccal cells, increases with increasing age but that subjects who develop lung cancer have a similar mutational load as those who remain cancer free. This finding suggests that mutation frequency of microsatellite mutations in buccal cells may not be a promising biomarker for lung cancer risk.     

Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan.

In a study in 29 health centre districts in Japan 91 540 non-smoking wives aged 40 and above were followed up for 14 years (1966-79), and standardised mortality rates for lung cancer were assessed according to the smoking habits of their husbands. Wives of heavy smokers were found to have a higher risk of developing lung cancer and a dose-response relation was observed. The relation between the husband''s smoking and the wife''s risk of developing lung cancer showed a similar pattern when analysed by age and occupation of the husband. The risk was particularly great in agricultural families when the husbands were aged 40-59 at enrolment. The husbands'' smoking habit did not affect their wives'' risk of dying from other disease such as stomach cancer, cervical cancer, and ischaemic heart disease. The risk of developing emphysema and asthma seemed to be higher in non-smoking wives of heavy smokers but the effect was not statistically significant. The husband''s drinking habit seemed to have no effect on any causes of death in their wives, including lung cancer. These results indicate the possible importance of passive or indirect smoking as one of the causal factors of lung cancer. They also appear to explain the long-standing riddle of why many women develop lung cancer although they themselves are non-smokers. These results also cast doubt on the practice of assessing the relative risk of developing lung cancer in smokers by comparing them with non-smokers.     

The diagnostic process: a comparison of scanning techniques.

In choosing between various scanning techniques the factors to be considered include availability, cost, the type of equipment, the expertise of the medical and technical staff, and the inherent capabilities of the system. Although it is difficult to state dogmatically which scanning technique is best for each patient and condition, one or other technique is clearly preferable in some areas of medicine. Ultrasound, for example, should be used in obstetrics, while computerized tomography has revolutionised neuroradiological diagnosis. Nevertheless, there is still no substitute for good history taking and a thorough physical examination. The most important factor determining the choice of technique is the system''s ability to answer the specific question required for the management of the patient.