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Five-Year Survivors of Non-Small Cell Lung Cancer Patients with Positive Pleural Lavage Cytology  [PDF]
Masaki Tomita, Takanori Ayabe, Eiichi Chosa, Kunihide Nakamura
Advances in Lung Cancer (ALC) , 2014, DOI: 10.4236/alc.2014.31003

Background: The pleural lavage cytology (PLC) for non-small cell lung cancer (NSCLC) patients has been reported as a significant prognostic factor. The aim of this study is to clarify the clinicopathological characteristics of 5-year survivors of patients with positive PLC. Methods: Among 401 resected NSCLC patients, 30 (7.48%) patients with positive PLC were reviewed retrospectively. Results: Only 7 of 30 patients (23.3%) survived more than 5-year. There were no differences in age, gender, histology, pT status and pN status between 5-year survivors and non-survivors. On the other hand, the serum carcinoembryonic antigen (CEA) level was significantly higher in non-survivors. Among these 5-year survivors, 4 of 7 patients died of NSCLC recurrences more than 5 years after surgery. Remaining 3 patients survived without cancer recurrences. Interestingly these 3 survivors had not received any adjuvant therapies after surgery. Conclusion: None of the 5-year survivor with positive PLC had high serum CEA level. Furthermore 5-year survival did not equal to cure in NSCLC patients with positive PLC.

Role of scrape cytology in the intraoperative diagnosis of tumor  [cached]
Kolte Sachin,Satarkar Rahul
Journal of Cytology , 2010,
Abstract: Background : Rapid diagnosis of surgically removed specimens has created many controversies and a single completely reliable method has not yet been developed. Histopathology of a paraffin section remains the ultimate gold standard in tissue diagnosis. Frozen section is routinely used by the surgical pathology laboratories for intraoperative diagnosis. The use of either frozen section or cytological examination alone has an acceptable rate (93-97%) of correct diagnosis, with regard to interpretation of benign versus malignant. Aim : To evaluate the utility of scrape cytology for the rapid diagnosis of surgically removed tumors and its utilisation for learning cytopathology. Materials and Methods : 75 surgically removed specimens from various organs and systems were studied. Scrapings were taken from each specimen before formalin fixation and stained by modified rapid Papanicolaou staining. Results : Of the 75 cases studied, 73 could be correctly differentiated into benign and malignant tumors, with an accuracy rate of 97.3%. Conclusions : Intraoperative scrape cytology is useful for intraoperative diagnosis of tumor, where facilities for frozen section are not available. The skill and expertise developed by routinely practicing intraoperative cytology can be applied to the interpretation of fine needle aspirate smears. Thus, apart from its diagnostic role, intraoperative cytology can become a very useful learning tool in the field of cytopathology.
Intraoperative consultation and smear cytology in the diagnosis of brain tumours  [PDF]
JR Kini,V Jeyraj,CS Jayaprakash,S Indira,CNR Naik
Kathmandu University Medical Journal , 2008, DOI: 10.3126/kumj.v6i4.1734
Abstract: Background: Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. Objectives : 1) To assess the utility of intraoperative smear cytology and correlate with the final histopathological diagnosis. 2) To describe the cytomorphological features of common brain tumours in smear preparation. Materials and methods : The material for this study was obtained from 100 consecutive biopsies of central nervous system neoplasms sent for intraoperative consultation. Smears were prepared from the biopsy samples sent in isotonic saline for immediate processing. The smears were stained by the rapid Haematoxylin and Eosin method. The cytomorphological features were noted and correlated with paraffin section findings. Results : Of the total 100 cases, 86 showed accuracy when compared with histopathological diagnosis. This was comparable with other studies. Of the remaining, two cases were frank errors, 12 cases showed partial correlation, with five cases showed incomplete typing of the cell type and seven, discrepancy in grading of tumours. The error percentage was 14%. Correlation with clinical details and radiological findings were helpful in improving the accuracy rate. Conclusions : Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible and cost effective tool to diagnose brain tumours. Smear cytology is of great value in intraoperative consultation of central nervous system pathology. Key words: Intraoperative consultation, smear cytology, central nervous system neoplasms ? doi: 10.3126/kumj.v6i4.1734 ? Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 453-457
Comparison of the cytology technique and the frozen section results in intraoperative consultation of the breast lesions
"Haeri H,Djamali M,Ahmadinejad M "
Acta Medica Iranica , 2002,
Abstract: The cytology study is effective and reliable technique in intraoperative consultation. This study was performed to evaluate the accuracy of the cytology study in intraoperative consultation of the breast lesions. 125 specimens of the breast lesions were examined and studied in Imam Khomeini Hospital during the years 1998-99. The sensitivity, specificity and accuracy for cytological method were 87.5% , 95%, 90.5% and for the frozen section 92.4%, 100% and 95.4% respectively. The false positive reports were 2% in the cytology technique and the most important source of error and false postivie reports was fibroadenoma in this method. By reviewing the results. It could be concluded that combination of these two techniques is beneficial and more reliable in intraoperative consultation resports of the breast lesions
Role of Fine Needle Aspiration Cytology and Intraoperative Diagnosis in the Diagnosis of Thyroid Nodules  [cached]
Deniz NART,Ye?im ERTAN,Asuman ARGON,Murat SEZAK
Türk Patoloji Dergisi , 2010,
Abstract: Objective: The utilization of fine needle aspiration cytology-FNAC is an accurate, cost-effective and specific first method in the diagnosis of thyroid nodules. However, cases diagnosed as “inadequate for interpretation” or “suspicious cytology” remain a dilemma. Intraoperative diagnosis (frozen section) is usually performed to avoid unnecessary surgical treatment. The aim of this study was to assess the sensitivity, specificity, and accuracy of FNAC and intraoperative section for the diagnosis of thyroid nodules.Material and Method: The present study included 291 consecutive patients who underwent FNAC, intraoperative section and subsequently surgery.Results: Of 291 FNAC specimens, 213 were benign and 31 were suspicious, 25 were positive for malignancy, and 22 were nondiagnostic. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of FNAC in the diagnosis of malignancy were 43%, 68%, 80%, 72%, and 73%, respectively. No false positive results were noted. Of 291 patients analyzed by intraoperative section, the diagnosis was benign in 186 and positive for malignancy in 67 patients. Thirty-eight patients were diagnosed using permanent sections. Of these 38 patients, 21 had malignant tumors confirmed by the permanent sections. Falsepositive results were noted in only one case. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of intraoperative diagnosis were 76%, 82%, 82.8%, 85%, and 84.5%, respectively.Conclusion: FNAC is a sensitive first diagnostic method in selecting patients who require surgery. Routine use of intraoperative section is specific and complementary in determining the extent of surgery in patients with suspicious or malignant cytology.
Does pleural fluid appearance really matter? The relationship between fluid appearance and cytology, cell counts, and chemical laboratory measurements in pleural effusions of patients with cancer
Bulent Ozcakar, Carlos H Martinez, Rodolfo C Morice, Georgie A Eapen, David Ost, Mona G Sarkiss, Hsienchang T Chiu, Carlos A Jimenez
Journal of Cardiothoracic Surgery , 2010, DOI: 10.1186/1749-8090-5-63
Abstract: Medical records were reviewed from all 390 patients who were diagnosed with cancer, who underwent thoracentesis before placement of an intrapleural catheter (IPC) between April 2000 and January 2006. Adequate information for data analysis was available in 365 patients. The appearance of their pleural fluid was obtained from procedure notes dictated by the pulmonologists who had performed the thoracenteses. The patients were separated into 2 groups based on fluid appearance: non-bloody and bloody. Group differences in cytology interpretation were compared by using the chi square test. Cellular counts, chemical laboratory results, and survival after index procedure were compared by using the student's t test.Pleural fluid cytology was positive on 82.5% of the non-bloody effusions and on 82.4% of the bloody ones. The number of red blood cells (220.5 × 103/μL vs. 12.3 × 103/μL) and LDH values (1914 IU/dl vs. 863 IU/dl) were statistically higher in bloody pleural effusions.The presence or absence of blood in pleural effusions cannot predict their etiology in patients with cancer and recurrent symptomatic pleural effusions.Pleural effusions are a common problem in cancer patients. In a postmortem series published by Rodriguez-Panadero and colleagues[1], there was evidence of malignant pleural involvement in 28% of patients with one or more malignant tumors, of whom approximately one-half presented with a pleural effusion. The incidence of malignant pleural effusions in the United States approaches 150,000 cases annually[2].For patients presenting with clinical signs of a pleural effusion, the primary diagnostic tools include roentgenographic studies of the chest and a thoracentesis. Initial information about the pleural effusion comes from the color and appearance of the fluid obtained during thoracentesis. Additional information concerning the inflammatory characteristics of the fluid is obtained later, using indicators such as white and red blood cell counts, and chemic
Fluorescence in situ hybridization as adjunct to cytology improves the diagnosis and directs estimation of prognosis of malignant pleural effusions  [cached]
Han Jingquan,Cao Shouqiang,Zhang Kai,Zhao Guibin
Journal of Cardiothoracic Surgery , 2012, DOI: 10.1186/1749-8090-7-121
Abstract: Background The identification of malignant cells in effusions by conventional cytology is hampered by its limited sensitivity and specificity. The aim of this study was to investigate the value of fluorescence in situ hybridization (FISH) as adjuncts to conventional cytologic examination in patients with malignant pleural effusions. Methods We conducted a retrospective cohort study of 93 inpatients with pleural effusions (72 malignant pleural effusions metastatic from 11 different organs and 21 benign) over 23 months. All the patients came from Chinese northeast areas. Aspirated pleural fluid underwent cytologic examination and fluorescence in situ hybridization (FISH) for aneuploidy. We used FISH in single-colour or if appropriate in dual-colour evaluation to detect chromosomal aberrations (chromosomes 7, 11, and 17) in effusion cells as markers of malignancy, to raise the diagnostic yield and identified the efficiency by diagnostic biopsy. Predominant cytogenetic anomalies and patterns of intratumor cytogenetic heterogeneity were brought in relation to overall survival rate. Results Cytology alone confirmed malignant pleural effusions in 45 of 72 patients (sensitivity 63%), whereas FISH alone positively identified 48 of 72 patients (sensitivity 67%). Both tests had high specificity in predicting benign effusions. If cytology and FISH were considered together, they exhibited 88% sensitivity and 94.5% specificity in discriminating benign and malignant effusions. Combined, the two assays were more sensitive than either test alone. Although the positive predictive value of each test was 94.5%, the negative predictive value of cytology and FISH combined was 78%, better than 47% and 44% for FISH and cytology alone, respectively. There was a significantly prolonged survival rate for patients with aneuploidy for chromosome 17. Conclusions FISH in combination with conventional cytology is a highly sensitive and specific diagnostic tool for detecting malignant cells in pleural effusions . The high sensitivity and specificity may be associated with geographic area and race. Simple numeric FISH anomalies may be prognostic.
Comparative Study between Intraoperative Frozen Section and Scrape Smear Cytology in the Diagnosis of Ovarian Neoplasm  [PDF]
Amany M. Abdelghany, Essa M. Arafa, Nadia M. Madkour, Wael S. Nossair, Ekramy A. Mohamed, Walid A. Abdelsalam, Amira A. Salem
Open Journal of Obstetrics and Gynecology (OJOG) , 2015, DOI: 10.4236/ojog.2015.51005

Objective: The aim of this work is to compare between intraoperative frozen section and scrape smear cytology in the diagnosis of ovarian neoplasm. Method: This study was performed between March 2011 and March 2012, on 50 patients presented with ovarian mass. Gross examination of the tumor removed was done by inspection and palpation. The specimen was then cut with a sharp knife into two halves. The area was scraped with a sharp scalpel or the end of a glass slide, depending upon the type of tissue. A semifluid drop thus obtained was spread over a glass slide. One to four slides per case were taken from different representative areas. The slides were labelled and immediately put into 95% ethyl alcohol and stained with hematoxylin-eosin. The specimens were then fixed in formalin. Paraffin blocks of the sections were processed in the routine way and sections were stained with hematoxylin and eosin (H and E). Assessment of the overall accuracy of the intraoperative diagnosis was classified as concordant or discordant. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of benign ovarian masses were 100%, 95.2%, 96.7%, 100% and 98% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of border line ovarian masses were 100%, 93.4%, 25%, 100% and 94% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of scraping technique in the diagnosis of malignant ovarian masses were 80%, 100%, 100%, 88.2% and 92% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of benign ovarian masses were 100%, 100%, 100%, 100% and 100% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of borderline ovarian masses were 100%, 95.9%, 33.3%, 100% and 96% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of frozen section in the diagnosis of malignant ovarian masses were 90%, 100%, 100%, 93.8% and 96% respectively. Conclusion: Frozen section is more accurate than smear preparations in the intraoperative assessment of ovarian tumors in this study. However, the cytology preparations were helpful in

Pancreatectomy Using the No-Touch Isolation Technique Followed by Extensive Intraoperative Peritoneal Lavage to Prevent Cancer Cell Dissemination: A Pilot Study
Hirota M,Shimada S,Yamamoto K,Tanaka E
JOP Journal of the Pancreas , 2005,
Abstract: CONTEXT: In pancreatic cancer, even for patients who have undergone curative resection (R0), survival analysis has revealed a poor survival rate due to cancer recurrence. Because the operation itself might have caused the dissemination of these cancer cells, the no-touch isolation technique and extensive intraoperative peritoneal lavage may be a potential operative procedure for improving the outcome. PATIENTS: Eight patients treated by the no-touch isolation technique were compared with 10 patients treated using conventional techniques. MAIN OUTCOME MEASURES: Cancer cell detection rates in the portal venous blood, frequency of recurrence, and survival rate. We also analyzed the lymphatic fluid squeezed from the resected cancerous pancreatic tissue. RESULTS: In 5 out of 10 cases (50%) in the conventional procedure group, CEA mRNA was identified in the portal blood after tumor manipulation, while only 1 out of 8 cases (13%) in the no-touch isolation technique group was positive for portal CEA mRNA. All lymphatic fluid samples squeezed from the resected cancerous pancreatic tissue were positive (8/8) for CEA mRNA. The recurrence rate was 90% (9/10) in the conventional procedure group, and 38% (3/8) in the no-touch isolation technique group (P=0.043). In the conventional procedure group, hepatic metastasis, local recurrence, peritoneal dissemination, and extraabdominal recurrence were identified in 6 (60%), 4 (40%), 4 (40%), and 2 patients (20%), respectively. On the other hand, among the no-touch isolation technique group, recurrence was identified in 1 (13%), 1 (13%), 0 (0%), and 1 patient (13%), respectively. There was no peritoneal dissemination along with the decreased hepatic recurrence rate. Mean (+/-SEM) survival time was 21.2+/-5.8 months for the conventional procedure group and 41.5+/-5.6 months for the no-touch isolation technique group (P=0.018). The 3-year survival rate was 12.5+/-11.5% for the conventional procedure group and 75.0+/-21.7% for the no-touch isolation technique group. CONCLUSION: This study presented the potential of cancer dissemination during the intraoperative manipulation of tumors and its contribution to cancer recurrence, as well as the significance of the no-touch isolation technique and extensive intraoperative peritoneal lavage for pancreatic cancer surgery.
Diagnostic and Prognostic Value of SHOX2 and SEPT9 DNA Methylation and Cytology in Benign, Paramalignant and Malignant Pleural Effusions  [PDF]
Dimo Dietrich, Maria Jung, Svenja Puetzer, Annette Leisse, Emily Eva Holmes, Sebastian Meller, Barbara Uhl, Philipp Schatz, Claudia Ivascu, Glen Kristiansen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0084225
Abstract: Pleural effusions (PE) are a common clinical problem. The discrimination between benign (BPE), malignant (MPE) and paramalignant (PPE) pleural effusions is highly important to ensure appropriate patient treatment. Today, cytology is the gold standard for diagnosing malignant pleural effusions. However, its sensitivity is limited due to the sometimes low abundance of tumor cells and the challenging assessment of cell morphology in cytological samples. This study aimed to develop and validate a diagnostic test, which allows for the highly specific detection of malignant cells in pleural effusions based on the DNA methylation biomarkers SHOX2 and SEPT9. A quantitative real-time PCR assay was developed which enabled the accurate and sensitive detection of SHOX2 and SEPT9 in PEs. Cytological and DNA methylation analyses were conducted in a case control study comprised of PEs from 114 patients (58 cases, 56 controls). Cytological analysis as well as SHOX2 and SEPT9 methylation resulted in 100% specificity. 21% of the cases were cytologically positive and 26% were SHOX2 or SEPT9 methylation positive. The combined analysis of cytology and DNA methylation resulted in an increase of 71% positively classified PEs from cancer patients as compared to cytological analysis alone. The absolute sensitivity of cytology and DNA methylation was not determinable due to the lack of an appropriate gold standard diagnostic for distinguishing between MPEs and PPEs. Therefore, it was unclear which PEs from cancer patients were malignant (containing tumor cells) and which PEs were paramalignant and resulted from benign conditions in cancer patients, respectively. Furthermore, DNA methylation analysis in PEs allowed the prognosis of the overall survival in cancer patients (Kaplan-Meier analysis, log rank test, p = 0.02 (SHOX2), p = 0.02 (SEPT9)). The developed test may be used as a diagnostic and prognostic adjunct to existing clinical and cytopathological investigations in patients with PEs of unclear etiology.
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