Diagnostic value of liquid-based cytology and smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration: A meta-analysis

BACKGROUND Smear cytology(SC)using endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is the established and traditional choice for diagnosing pancreatic lesions.Liquid-based cytology(LBC)is a novel alternative cytological method,however,the comparative diagnostic efficacy of LBC remains inconclusive.AIM To examine the diagnostic efficacy of LBC and SC for pancreatic specimens obtained through EUS-FNA via a systematic review and meta-analysis.METHODS A systematic literature search was performed using PubMed,EMBASE,the Cochrane Library,and Web of Science.The numbers of true positives,false positives,true negatives,and false negatives for each cytological test(LBC and CS)were extracted from the included studies.The pooled sensitivity and specificity and the area under the summary receiver operating characteristic curve(AUC)were calculated,and the AUC was compared by Tukey's multiple comparisons test.The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies II tool.RESULTS A total of 1656 patients in eight studies were included.The pooled sensitivity and specificity and the AUC for LBC were 0.76(95%CI:0.72-0.79),1.00(95%CI:0.98-1.00),and 0.9174,respectively,for diagnosing pancreatic lesions.The pooled estimates for SC were as follows:Sensitivity,0.68(95%CI:0.64-0.71);specificity,0.99(95%CI:0.96-100.00);and AUC,0.9714.Similarly,the corresponding values for LBC combined with SC were 0.87(95%CI:0.84-0.90),0.99(95%CI:0.96-1.00),and 0.9894.Tukey’s multiple comparisons test was used to compare the sensitivities and AUCs of the three diagnostic methods;statistically significant differences were found between the three methods,and LBC combined with SC was superior to both LBC(P<0.05)and SC(P<0.05).The pooled sensitivity and AUC did not change significantly in the sensitivity analysis.CONCLUSION LBC may be sensitive than SC in the cytological diagnosis of pancreatic lesions,however,the superior diagnostic performance of their combination emphasizes their integrated usage in the clinical evaluation of pancreatic lesions.

Comparison of smear cytology with liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)is a safe and accurate technique to confirm the diagnosis of pancreatic cancers.Recently,numerous studies comparing the diagnostic efficacy of smear cytology(SC)and liquid-based cytology(LBC)for pancreatic lesions yielded mixed results.AIM To compare and identify the better cytology method for EUS-FNA in pancreatic lesions.METHODS A comprehensive search of PubMed,Embase,and Cochrane was undertaken through July 18,2020.The primary endpoint was diagnostic accuracy(sensitivity and specificity).Secondary outcomes included sample adequacy and post procedure complications.In addition,factors affecting diagnostic efficacy were discussed.RESULTS Data on a total of 1121 comparisons from 10 studies met the inclusion criteria.Pooled rates of sensitivity for SC and LBC were 78%(67%-87%)vs 75%(67%-81%),respectively.In any case,both SC and LBC exhibited a high specificity close to 100%.Inadequate samples more often appeared in LBC compared with SC.However,the LBC samples exhibited a better visual field than SC.Very few post procedure complications were observed.CONCLUSION Our data suggested that for EUS-FNA in pancreatic lesions(particularly solid lesions),SC with Rapid On-Site Evaluation represents a superior diagnostic technique.If Rapid On-Site Evaluation is unavailable,LBC may replace smears.The diagnostic accuracy of LBC depends on different LBC techniques.

Comparative Study of Cell Findings by Conventional Smear and Liquid-Based Cytology for Oral Exfoliative Cytology

Background: Liquid-based cytology (LBC) is a method of manufacturing cyto-diagnostic specimens. Improved accuracy is expected from standardizing specimen production and use of this method is rapidly spreading in oral cytology. On the other hand, LBC reportedly requires training to show peculiar cell findings compared to those of conventional smear cytology (CVC). Few studies have compared detailed cell findings for oral CVC and LBC. Objectives: The aim of this study was to compare cytological findings between CVC and LBC using cytomorphological image analysis. Materials and Methods: Cytological specimens were collected from 20 patients (negative for squamous neoplasia in 10, dysplasia in 5, squamous cell carcinoma in 5) and 5 controls of the tongue between January 2017 and December 2018. Two different preparation techniques were investigated cytomorphologically for CVC and LBC (BD CytorichTM). Results: LBC showed significantly higher cell numbers than CVC for all lesions. LBC-to-CVC ratio ranged from 9.52 (hyperkeratosis) to 1.87 (deep cells in oral squamous cell carcinoma (OSCC)). Nuclear area of normal, hyperkeratosis, and inflammation were significantly higher in LBC than those of CVC. Hyperchromasia was significantly more frequent with CVC than with LBC for hyperkeratosis, inflammation, dysplasia and OSCC. There was no significant difference in circularity between CVC and LBC among all lesions. Conclusion: Only one cytomorphological disadvantage was seen with LBC, in the form of decreased hyperchromasia. Further clarification of the advantages and disadvantages of LBC is needed, including management of precision and screening practices.

Vaginal Intraepithelial Neoplasia Detected with Cervical Liquid-Based Cytology: Old Concerns or New Facilities?

Background: The detection of vaginal intraepithelial neoplasia (VAIN) in cervical samples is not a common finding. Therefore, we aimed to report VAINs detected in liquid-based cytology (LBC) from women examined at Hospital das Clínicas of Faculty of Medicine, Sao Paulo State University. Materials and Methods: We evaluated LBC samples from women referred to gynecology examination for different reasons (previous abnormal PapTest, follow up of treated cervical lesion, ecc) and women examined for regular screening proposals, and compared with biopsy diagnoses, including the controversial diagnoses of vaginal intraepithelial neoplasia (VAIN). Results: From 1866 patients, 1423 (76.3%) cases were negative and 443 (23.7%) were positive for any cellular alteration. Age of patients ranged from 12 to 86 years. We detected 25 histologically confirmed VAIN (1.3% p = 0.0002 by Fisher’s exact test IC 95% 0.0090 - 0.0198) and 1.1% VAIN (p = 0.0031 by Fisher’s exact test IC 95% 0.0077 - 0.0179). Conclusion: The identification of VAIN in routine is feasible;the professionals involved with cytological examination should be aware of these lesions in Pap test samples.

Research of cervical cytology screening in diagnosis of 370,000 cases with cervical lesion in Guangdong

Objective： Analysis of the results of 37 million cases by using cervical liquid-based cytology screening, discussion the situation of cervical cancer and precancerous lesions in Guangdong province. Methods： From 2002 to 2006, using liquid-based thin-layer cytology （TCT） method screening cervical lesions within 371,929 women in Guangdong. Cytological diagnosis adopt TBS （the Bethesda system） Standard （TBS improved 2001 version of the diagnostic criteria）, statistic positive rate by age and region respectively. Results： 371,929 cases of gynecology cervical samples in Guangdong, 331,251 cases were negative, accounted for 91.23%; cytology positive cases： 32,548 cases were squamous intraepithelial lesions （8.96%）, 486 cases were glandular epithelial lesions （0.13%）; grouped according to age： 30 to 40-year-old positive rate was 9.13%, 40 to 50-year-old positive rate was 9.60%, the latter had higher cytology positive rate; grouped according to region： the total samples in PRD areas were 304.951 cases, accounted for 81.99%, in which 24301 cases were positive （8.14%）, in 66978 cases （18.01%） of NON-PRD regions, 7645 cases were positive （11.87%）, there were 1858 cases had biopsy/follow-up results from 2004 to 2005, and the rate was 2.88%. Conclusion： The cytological positive rate of cervical cancer and its precancerous lesions was 9.09% in Guangdong （of which the rate of cytological diagnosis as precancerous lesions was 3.40%）, 30 to 50 age group had the high incidence of cervical cancer and its precursor lesions, and also the main stage of prevention for cervical cancer. Cytology positive rate was 11.87% in economic underdevelopment Non-Pearl River Delta regions, much higher than the Pearl River Delta region.

华为云ModelArts平台驱动的AI辅助诊断系统在宫颈液基细胞学非典型病变检出中的应用研究

目的探索并验证基于华为云ModelArts平台构建的深度学习模型在宫颈液基细胞学(liquid-based cytology,LBC)非典型细胞诊断中的应用价值,并评估其对不同诊断经验医师的辅助效果。方法回顾性分析2020年东莞市人民医院1044例宫颈脱落细胞学标本,采用华为云ModelArts平台开发的人工智能(artifical intelligence,AI)辅助诊断系统与初级、中级、高级医师进行诊断比对,计算灵敏度、特异度、精确率、符合率、曲线下面积(area under the curve,AUC)等指标,评估AI系统的诊断效能及其对不同年资医师的辅助诊断效果。采用McNemar检验比较AI系统与人工诊断的差异。结果在1044例宫颈脱落细胞学标本中,AI系统在非典型细胞检出的灵敏度和特异度分别为98.96%和89.15%,均高于初级医师(81.95%和91.81%)。AI系统的总体诊断精确率为93.68%,显著高于初级医师(87.26%,P<0.001)。AI辅助可显著提高初级医师的诊断性能,灵敏度从80.1%提升至96.5%,特异度从85.6%提升至92.3%。结论本研究构建的AI辅助宫颈细胞学诊断系统性能优越,尤其能显著提高初级医师的诊断水平,具有良好的临床应用前景。

LBC和HR-HPV DNA检查对宫颈高度鳞状上皮内病变LEEP术后切缘累及患者随访中的价值

目的探讨宫颈液基细胞学检查(LBC)和高危型人乳头瘤病毒DNA检查(HR-HPV DNA)对宫颈高度鳞状上皮内病变子宫环形电切除术(LEEP)后切缘累及患者随访中的价值。方法选取2013年1月-2015年6月在湖南省妇幼保健院治疗的宫颈上皮高度鳞状上皮内病变,且切缘有病灶累及患者124例,随访术后12个月情况,并分别在术后3个月、6个月和12个月采用LBC和HR-HPV DNA进行检查。结果术后1年内有52.42%的患者LBC和HR-HPV DNA均阴性,47.58%的患者出现LBC异常和(或)HR-HPV DNA阳性;LBC异常和(或)HR-HPV DNA阳性者出现残留/复发比例为20.34%,明显高于LBC和HR-HPV DNA阴性者(6.15%),比较差异有统计学意义(χ2=5.537,P<0.05);LBC异常和(或)HR-HPV DNA阳性,提示病灶有残留或复发的灵敏度为75.00%,特异度为56.48%,阳性预测值为20.34%,阴性预测值为93.85%。结论宫颈高度鳞状上皮内病变且LEEP术后切缘累及患者,随访复查LBC和HR-HPV DNA检查,对评估病变残留/复发有一定作用。

Effectiveness of Co-Testing in Cervical Cancer Screening Program in Macao SAR

Background: Cervical cancer remains a significant public health concern in Macao SAR despite the implementation of a cervical cancer screening program and HPV vaccination. To improve early detection, Macao SAR introduced HPV DNA testing alongside cytology (co-testing) as the primary screening method in 2019. This study evaluates the effectiveness of co-testing in identifying cervical precancerous lesions (CIN2+) compared to cytology alone. Methods: We conducted a retrospective analysis of women aged 30 - 65 years who participated in the routine cervical cancer screening program in Macao SAR Primary Healthcare Centers from 2019 to 2022. Data from over 70,000 women were analyzed, comparing the detection rates of CIN2+ through co-testing and cytology alone. Women with abnormal cytology or positive HPV results were referred for colposcopy. Results: The introduction of co-testing led to a significant increase in the detection of CIN2+, particularly in women with atypical squamous cells of undetermined significance (ASCUS) or negative for intraepithelial lesion or malignancy (NILM) cytology results. Between 2019 and 2022, the percentage of women with ASCUS/NILM and any high-risk HPV (hrHPV) positive who were diagnosed with CIN2+ after colposcopy were 24%, 13%, 10% and 7.5% respectively. This highlights the ability of co-testing to identify high-risk individuals who would have been missed by cytology alone. Discussion: Our findings demonstrate the effectiveness of co-testing in improving the sensitivity of cervical cancer screening in Macao SAR. The inclusion of HPV DNA testing allows for better risk stratification of women with ASCUS/NILM cytology, leading to more targeted referrals for colposcopy and timely detection of precancerous lesions. The initial high positive rate in 2019 (24%) might be attributed to the small sample size and potentially reflects a backlog of undiagnosed cases prior to co-testing implementation. Conclusion: The implementation of co-testing in Macao SAR’s cervical cancer screening program significantly improves the early detection of precancerous lesions, particularly in women with ambiguous cytology results. This proactive approach contributes to reducing cervical cancer morbidity and mortality and improving women’s health outcomes in Macao SAR.

Study on the Correlation between Human Papillomavirus and Mycoplasma genitalium Combined with TCT Detection

Objective: This study aims to explore the correlation between human papillomavirus (HPV) and Mycoplasma genitalium (CT) combined with TCT detection in cervical cancer screening. Method: A cross-sectional study design was adopted, and a total of 609 women who came to seek medical treatment were recruited as the study subjects. Combination testing was evaluated on cervical cancer screening by testing the women for HPV, CT with TCT detection and analyzing the relationship of cervical lesions with HPV and CT infection. Results: The study results showed that 21.57% of the subjects were infected with both HPV and CT, and 48.42% of the cases had abnormal TCT results at the same time. Further data analysis showed that HPV infection was significantly associated with abnormal TCT outcomes (p < 0.05), suggesting a possible synergistic effect of the two infections in cervical lesions. The combined sensitivity and specificity of HPV, CT and TCT detection were 21.57% and 48.42%, respectively, which were significantly higher than that of single detection. Conclusion: In summary, the results of this study support the importance of combined HPV, CT, and TCT testing in cervical cancer screening, and propose the hypothesis that combined testing may improve screening effectiveness. However, further large sample studies are needed to confirm this conclusion and explore the prospects of combined testing in clinical practice.

Case Report:Liquid-based cytology aids in primary fallopian tube cancer diagnosis

Primary fallopian tube carcinoma(PFTC) is a rare malignant carcinoma among all genital tract malignancies.It occurs most commonly in postmenopausal women and is similar to ovarian malignancy historically and clinically.Because of its insidious onset and silent course,the diagnosis is made usually postoperatively.Liquid-based cytology(LBC) is a type of method for cervical cancer screening,but sometimes it may aid in making PFTC diagnosis.We report a 47-year-old woman with PFTC,whose diagnosis was made with the aid of LBC.

HPV E6/E7 mRNA联合TCT检测在宫颈癌筛查的临床应用价值

目的分析HPV E6/E7 mRNA联合液基薄层细胞学检测(TCT)在宫颈癌筛查中的临床应用价值。方法选取2017年1月至2018年12月在上海中医药大学附属第七人民医院妇科门诊行宫颈癌联合筛查的女性1 925例,其中接受HPV DNA分型+TCT检测者纳入对照组(n=1 050),接受高危型HPV E6/E7 mRNA+TCT检测者纳入观察组(n=875),以组织病理学结果为金标准,比较两组不同Bethesda分类、不同病理分型中HPV DNA及HPV E6/E7 mRNA阳性率、阴道镜转诊率和患者满意度,分析HPV DNA及HPV E6/E7 mRNA分别联合TCT的筛查价值。结果观察组HPV E6/E7 mRNA初筛阳性率为31.09%(272/875),低于对照组HPV DNA初筛阳性率39.14%(411/1 050),χ^2=13.535,P<0.01;Bethesda分类中,未见上皮内病变细胞或恶性细胞(NILM)、鳞状上皮内低度病变(LSIL)、鳞状上皮内高度病变(HSIL)患者的HPV DNA阳性率高于HPV E6/E7 mRNA阳性率(χ^2值分别为20.541、7.446、9.220,均P<0.01),且总体HPV DNA阳性率高于HPV E6/E7 mRNA阳性率(χ^2=34.389,P<0.01);随着病理分级增加,HPV E6/E7 mRNA阳性率、HPV DNA阳性率及mRNA拷贝数上升(χ^2/F值分别为77.613、119.863、5 175.005,P<0.01),而DNA拷贝数比较差异无统计学意义(P>0.05),宫颈上皮内瘤变(CIN)1级、CIN2级、CIN3级患者中HPV DNA、HPV E6/E7 mRNA阳性率比较差异无统计学意义(均P>0.05);观察组阴道镜转诊率低于对照组,患者满意度高于对照组(χ^2值分别为50.661、77.647,均P<0.01);HPV E6/E7 mRNA联合TCT筛查评估高级别宫颈上皮内瘤变(CIN分级2~3级)及宫颈癌的灵敏度、特异度、准确度高于HPV DNA联合TCT筛查(χ^2值分别为39.894、138.474、106.147,均P<0.05)。结论与HPV DNA联合TCT筛查相比,HPV E6/E7 mRNA联合TCT筛查应用在宫颈癌筛查中,灵敏度、特异度更高,并能有效降低阴道镜转诊率,提高患者满意度,值得在临床推广实践。

宫颈非典型腺细胞液基细胞学诊断的临床意义探讨

目的探讨细胞病理学宫颈非典型腺细胞(AGC)诊断的临床意义。方法对细胞学诊断141例AGC进行随访,与有组织病理学诊断的117例进行对照总结。结果宫颈细胞学诊断26345例中,细胞学异常诊断2966例(11.3%),其中腺细胞异常诊断335例(1.27%),AGC诊断141例(0.54%)。141例AGC中117例有随访病理结果,10例病理诊断良性,8例为鳞状上皮病变,97例腺上皮病变(3例宫内膜非典型增生、94例为宫内膜/卵巢/宫颈腺癌),2例宫内膜肉瘤。9例癌前病变<50岁者6例(66.7%),98例恶性肿瘤≥50岁者70例(71.4%),两组差异显著(P<0.05)。85例腺癌患者中,早期宫内膜癌占82.9%(58/70),晚期卵巢腺癌占73.3%(11/15)。结论细胞学AGC诊断在随诊病理结果中多数为宫内膜腺癌或卵巢腺癌,少数为鳞状上皮内病变或鳞癌;<50岁者更多见于上皮内病变,≥50岁者有更高的恶性肿瘤风险。

液基细胞学与细胞块在子宫内膜癌筛查中的应用

目的探讨液基细胞学(liquid-based cytology,LBC)与细胞块(cell block,CB)在子宫内膜癌筛查中的应用价值。方法根据不同的细胞学制备方法将研究对象分为LBC组和CB组:2018年1月—12月在新疆医科大学附属肿瘤医院行宫腔镜检查的患者136例(LBC组),2019年1月—12月在新疆医科大学附属肿瘤医院行宫腔镜检查的患者199例(CB组)。一次性宫腔细胞刷取得细胞学标本,接着宫腔镜检查及诊刮取得组织学标本,细胞学标本通过LBC或CB处理后用于细胞学诊断。比较两组标本满意度、细胞学与组织学符合率以及两组细胞学诊断的准确率、灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)。结果LBC组标本满意度为94.6%,CB组为95.5%,差异无统计学意义(P=0.799)。LBC组细胞学与组织学符合率为93.0%,CB组为94.3%,差异无统计学意义(P=0.662)。LBC组细胞学诊断准确率为99.2%、灵敏度为96.4%、特异度为100.0%、PPV为100.0%、NPV为99.0%。CB组细胞学诊断准确性为96.0%、灵敏度为82.3%、特异度为98.0%、PPV为86.4%、NPV为97.4%,差异均无统计学意义。结论LBC诊断子宫内膜病变准确性高,值得临床推广用于内膜癌筛查;CB可作为其辅助工具提高诊断的准确性。

Aptima HPV E6/E7mRNA技术检出宫颈癌及癌前病变的临床效果研究

目的评估Aptima HPV E6/E7 mRNA检测技术在宫颈癌筛查人群和临床就诊患者中检出宫颈癌及癌前病变的效果。方法选取我国山西省长治市3个三甲医院参加宫颈癌筛查的21-70岁妇女及门诊病人共557人作为研究对象,采用LBC与HPV E6/E7 mRNA检测技术对宫颈细胞学标本进行检测,以病理学结果作为诊断金标准,评价两种方法检测宫颈癌及癌前病变的临床效果。结果 HPV E6/E7 mRNA阳性率随着细胞学和病理病变级别的升高而升高。在CIN2＋/CIN3＋中,HPV E6/E7 mRNA检测的灵敏度与特异度均高于LBC检测;HPV E6/E7mRNA检测的ROC曲线下面积均大于LBC检测。结论 HPV E6/E7 mRNA检测出宫颈癌及癌前病变的能力相比于LBC检测更具优越性。

Combining Endometrium Sampling Device and SurePath Preparation to Screen for Endometrial Carcinoma： A Validation Study

Background：The aim of this study was to compare specimen adequacy of SAP-I provided for cytology with that of dilation and curettage （D ＆ C） or hysteroscopy for histology,and evaluate the accuracy of combining endometrium sampling by SAP-1 and liquid-based cytology using SurePath preparation for screening endometrial carcinoma and its precursor.Methods：Endometrial specimens from women （n =1514） with risk factors were obtained using an SAP-l device for cytological analysis; histological samples were obtained from 375 of these women who underwent D ＆ C or hysteroscopy.Cytological specimens were prepared to liquid-based smear using SurePath technology and stained by Papanicolaou.Histological samples were processed in routine pathology and stained by hematoxylin and eosin.Results：Adequate specimens for cytology were obtained from 1458/1541 patients （96.3%）,while adequate samples for pathology were obtained from 285/375 patients （76%）.However,for postmenopausaI women,1006 of 1045 cytology （86.3%） were adequate,153 of 238 histology （64.3%） were adequate,it was easier to collect cytological specimens than histological specimens （P 〈 0.05）.The accuracy of endometrial cytology for detecting endometrial carcinoma and its precursor was 92.4% （sensitivity,73%; specificity,95.8%; positive predictive value,75%; and negative predictive value,95.3%）.Conclusions：Endometrial cytology using SAP-1 sampling and SurePath preparation may be a reliable approach for screening patients with endometrial carcinoma and its precursor.

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas diagnosed by endoscopic ultrasonography-guided fine-needle aspiration

Undifferentiated carcinoma with osteoclast-like giant cells, also formerly known as osteoclast-like giant cell tumor, is a rare neoplasm of the pancreas and usually diagnosed after pancreatectomy. The presence of non-neoplastic osteoclast-like giant cells is the histological hallmark of this tumor and the diagnosis is usually not difficult on tissue sections. However there have been relatively few reports regarding the cytological features of this type of tumor in literatures. Here we present a case of undifferentiated pancreatic carcinoma with osteoclast-like giant cells coexisting with ductal adenocarcinoma diagnosed by endoscopic ultrasonography （EUS）-guided fine-needle aspiration （FNA） and liquid-based cytology test. To our knowledge,