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.

Comparative Study between Intraoperative Frozen Section and Scrape Smear Cytology in the Diagnosis of Ovarian Neoplasm

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 supporting the histological diagnoses, and in some cases, provided additional useful information. Thus, cytology has a complementary role to frozen section in the intraoperative assessment of ovarian lesions. At the centers where the facilities of frozen section are not available, intraoperative scrape cytology is a useful tool for intraoperative diagnosis of tumor.

Effect of vaginal speculum lubrication on cervical cytology and discomfort during smear examination

AIM: To evaluate the role of lubricant gel in the cytology of a Pap smear and whether it results in an improvement in the discomfort experienced by women while undergoing Pap smear screening.METHODS: A total of 151 women were analyzed in the study. After screening for inclusion criteria, a Pap smear was taken with no lubricant in all the women and the discomfort experienced was rated on a visual analogue scale. The women underwent a second Pap smear on the next visit using a lubricant gel and were again rated on a visual analogue scale for the discomfort felt. The pathologist was blinded to the fact of whether the lubricating gel was used.RESULTS: The number of unsatisfactory smears in the no gel group was 3 vs 5 in the gel group, P < 0.05. However, a significant difference(P = 0.00) was observed in the visual analogue pain score in both groups, suggesting that application of lubricant gel over the speculum improves the pain experienced by women. CONCLUSION: Using a small amount of lubricant overthe speculum does not impair cervical cytology but significantly improves the discomfort experienced by women while undergoing a Pap smear.

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.

Study of Prevalence of Abnormal Cervical Cytology in Al-Shatby Maternity University Hospital

Introduction: Cervical cancer is the most common cause of preventable cancer related deaths;cervical cancer has a long pervasive phase (cervical dysplasia);the prevalence of cervical dysplasia varies according to the socioeconomic characteristics and geographic areas of the population studied. Low-grade lesions regress spontaneously in a significant number of patients, while high grade lesions will progress to an invasive cancer if left untreated. Cervical cancer screening is an important component of the World Health Organization (WHO) strategy for combating cervical cancer. The incidence and prevalence of cervical cancer has reduced remarkably over the last three decades in developed countries where there are effective, well-coordinated screening programs, and treatment of cervical dysplasia, while in developing countries it has been increasing and has constituted major health problems among women where there are no well-coordinated and effective screening programs, also resources are very low and no insurance can cover this programs. Aim of the work: The aim is to assess the prevalence of abnormal cervical cytology in Al Shatby Maternity University Hospital patients using Pap smear. Materials and methods: Inclusion criteria: 1) Married woman from 3 years or more;2) Women age from 21 to age 65 years. Exclusion criteria: 1) Previously known cervical cancer patient;2) Virgin females;3) Woman with active vaginal bleeding. Results: 83% of patients were -ve intraepithelial neoplasia {37.7% was normal cytology and 45.3% was inflammatory}. 17% was +ve intraepithelial neoplasia (abnormal cytology), {11.1% ASCUS, 2.9% LSIL, 1.3% HSIL, 1.1% ASC-H, 0.3% AGS-NO, 0.3% AGS-Favour Neoplastic}. Prevalence of abnormal cervical cytology in age group less than30 years was 8.4% which is lower than prevalence in the middle age group which was 19.9%. Prevalence of abnormal cervical cytology in women with normal vaginal delivery was higher than those with caesarean delivery. 39.8% of our patients were passive and active smokers 61.2% of their Pap smear was abnormal cytology. 78.9% of abnormal cytology was among patients from low socioeconomic class (rural areas). Abnormal cervical cytology in patients with high parity was 69% which is higher than abnormality found in lower parity. 60.2% of abnormal cervical cytology was in patients who became sexually active before age of 20 years. Prevalence of abnormal cervical cytology was higher in patients with multiple sexual partners (56.5%) than patients with single sexual partner (13.3%). Conclusion: Cervical cytology remains the gold standard for cervical cancer screening and the use of Bethesda system is a simple and accurate method for diagnosis and management of cases with abnormal cervical cytology.

Asymptomatic Bacterial Vaginosis in Cervical Cytology: A Preliminary Report of Incidental Finding in Routine Cervical Cancer Screening

Background: Bacterial vaginosis is a complex pathogenic group of bacteria which can cause a wide range of symptoms in affected women in Obstetric and Gynaecological practice. Its occurrence usually indicates alteration in the normal vaginal flora expected in majority of the women of reproductive age. Amongst the maintenance agents of the vaginal health, lactobacilli occupy a prominent place. Asymptomatic bacterial vaginosis is postulated to be linked to the development of cervical intraepithelial neoplasia by some researchers while some differ in this regard. Objective: To determine the rate of occurrence of asymptomatic bacterial vaginosis and associated factors in women who underwent cervical cytology for cervical cancer screening. Study Design: A cross sectional study involving microscopic examination of cervical smears of eligible clients presenting for routine Pap smear. Setting: The study was carried out in a well woman’s facility established and manned by female medical doctors in Enugu state with the assistance of trained nursing staff. Various female cancers and other communicable and non-communicable disease screening are performed at the centre. The services are available to the general public including various parts of the state and other nearby states. Methods: This preliminary study was carried out on women presenting for cervical cancer screening between February and July 2018 in a well woman’s centre in Enugu. Information on the socio-demographic and gynaecological history of the study participants were obtained and recorded in designated proformas. Smears that showed changes suggestive of bacterial vaginosis on microscopy were set aside for further evaluation. Such changes included: a conspicuous absence of normal flora of lactobacilli;filmy background of coccobacilli replacing the lactobacilli, individual squamous cells covered by a layer of bacteria (clue cells);viable squamous cells showing reactive changes identified as increased nuclear size, perinuclear halo and binucleation. Data entry and analysis were done using statistical package for social sciences (SPSS) computer software version 21.0. Results: 285 eligible women had cervical smear done during the first six months of the 2-year project at the centre. 50.9% were above reproductive age (>45 years), 38.2% were in second half of reproductive age (31 - 45), 10.9% were in the early reproductive age (15 - 30). 13% of the women were nulliparous, 51.9% were para 1 - 4, and 35.1% were grand multiparous. Of the 285 Pap smear slides viewed, 31 had bacterial vaginosis by the above criteria. This gave a prevalence of 10.8% in the reviewed cytological smears. There was an association of bacterial vaginosis with reproductive age. There was however, no association with age at coitarche and parity. There was also, no association of bacterial vaginosis with contraceptive use. There was no association between abnormal cervical cytology and asymptomatic bacterial vaginosis with absent lactobacilli. Conclusion: Prevalence of bacterial vaginosis is significant in our study population who were asymptomatic. Cervical smear should be taken advantage of as a tool for both cervical pre-cancer and bacterial vaginosis screenings since same sample can simultaneously be used for both conditions during cytology. Bacterial vaginosis may be unlikely involved in pathogenesis of cervical intraepithelial neoplasia. Recommendation: Researchers should harmonise the standards/criteria for the diagnosis of bacterial vaginosis because there are varied criteria for the diagnosis in the literature. Given, the dual advantage of pap smear in diagnosing cervical pre cancer stages and infections, more elaborate studies are needed to determine the usefulness of treatment or otherwise of bacterial vaginosis which constitutes significant incidental findings.

CERVICAL CYTOLOGICAL SCREENING AND MANAGEMENT IN PREGNANT AND POSTPARTUM WOMEN

Objeotive To examine and follow up cervical cytology of pregnant and postpartum women and study their cytopathologie characteristics, so as to determine screening and managing programs for abnormal cervical cytology. Mothods Totally 5296 patients in pregnancy and postpartum, in which 3729 by computer-assisted cytology test and 1567 by liquid-based monolayers cytology test, were examined and diagnosed by the Bethesda System made in 2001. Those proven epithelial abnormalities patients were followed up until the lesions regressed to normal. The remaining patients, who exhibited persistent abnormalities or progression, were given further examinations. Results The positive rate of cervical cytological test was 8.72% （462/5296）, including squamous carcinoma （SCA） 1 case （ 0.02% ）, high grade squamous intraepithelial lesion （HSIL） 34 cases （ 0.64% ）, low grade squamous intraepithelial lesion （LSIL） 145 cases （ 2.74% ）, atypical glandular cells （AGC） 5 cases （ 0.09% ）, atypical squamous cells cannot exclude HSIL （ASC-H） 14 cases （0.26%）, atypical squamous cells of undetermined significance （ASC-US） 263 cases （4.97%）. The 419 proven cytological abnormality cases were followed up successfully. The total transnegative rate in three months was 73.74% （309/419）, in which 303 cases （72.32%） persisted normal status for more than six months after regression. And the transnegative rate of ASC-US, ASC-H, AGC, LSIL, and HSIL were 79.56%, 64.29%, 100%, 72.14% and 44.12%, respectively. Forty-six cases received biopsy directed by colposcopy. The distribution of coincidence of cytopathologic and histopathologic diagnosis was： SCA 1 case （100%）, HSIL 10 cases （76.92%）, LSIL 13 cases （65%）, ASC-H 2 cases （50%）, ASC-US 3 cases （37.50%）, total 29 cases （63.04%）. Conclusions We should cast more attention to screening cervix lesions in pregnant and postpartum women. Their cytopathologic characteristics are liable to make the clinician give a false positive diagnosis. So we propose to follow up them closely and to lower the indication of biopsy.

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.

Cytological Changes of Oral Cavity and of High/Low Risk HPV Detection in Women with Cervical Pathology

Oropharyngeal tumor is the eight most common cause of cancer death worldwide. Among the causes of oropharyngeal carcinoma significant are cigarette smoking, abuse of alcohol, multi-partners, high risk HPV (Human Papillomavirus) and etc. Cytological material (oral Pap smear) was taken from oral fundus and cheek mucous by the cytobrush. 47 participants with cervix pathology and 42 participants of the control group were investigated. Oral smears were stained by the Papanicolaou method and were diagnosed by a double blind method. After the cytological examination, we carried out detecting low and high risk HPV by chromogenic in-situ hy-bridization (CISH method) to use a positive and negative control. The quantitative statistical analysis was performed by SPSS V.19.0. Numeral data were processed using Pearson correlation and X2 tests. Confidence interval of 95% was regarded statistically significant. Study group’s oral pap smear with atypical cytology was detected in 61.7%. Atypical cytological changes in the control group were confirmed in 38.0%. High risk HPV detection by the CISH, in study group, showed positivity in 46.8% and in the control group—in 4.8%. Participants with cervix pathology will be considered as a risk-group to develop oropharyngeal tumor. Screening program for oropharyngeal cancer combines Pap smear and high risk HPV test together. For the control group, it is recommended to use oral pap smear and in the case of atypical changes using high risk HPV test too.

国际标准化超细针穿刺甲状腺结节不同细胞学采集模式诊断率的比较

目的:评价甲状腺结节穿刺时不同留样顺序对细胞学诊断率的影响。方法:共入选591例甲状腺结节患者的613个甲状腺结节,所有甲状腺结节均行4针细针穿刺,分为两种模式进行。模式一:304个结节穿刺,前2针进行涂片细胞学检查,后2针再进行液基细胞学检查;模式二:309个结节穿刺,前2针进行液基细胞学检查,后2针再进行传统涂片细胞学制片。细胞病理医师采用盲法单独对每份样本进行读片。比较不同细胞学制片方法以及两种模式对细针穿刺诊断率的影响。结果:先液基后涂片的细胞学采集模式总体诊断率为82.2%,显著高于先涂片后液基的模式(74.7%)(P=0.023)。对于直径≥10 mm的结节来说,先液基后涂片的细胞学采集模式总体诊断率为83.2%,同样显著高于先涂片后液基模式的诊断率(75.4%)(P=0.048);同为前2针,单独液基方法诊断率为78.0%,显著高于单独涂片诊断率(63.8%)(P<0.001);对于直径≥10 mm的结节而言,单独液基诊断率为78.3%,亦显著高于单独涂片的诊断率(62.6%)(P<0.001)。结论:使用国际标准化超细针进行甲状腺细针穿刺,先液基再涂片的细胞学采集模式诊断率显著高于先涂片后液基的采集模式;如果仅以一种方式来收取细胞学标本,沉降式液基细胞采集制片的方法诊断率显著优于传统涂片制片方法。

细胞学涂片在肺结节术中的快速病理诊断价值

目的探讨细胞学涂片在肺结节术中的快速病理诊断价值。方法对胸腔镜手术术中送检的40例肺结节标本进行细胞学涂片,迪夫快速染色,光镜下观察,即时报告结果;与术中冷冻切片和术后石蜡切片结果进行对照。以术后石蜡切片诊断结果作为金标准,细胞学涂片和冷冻切片诊断结果分为确诊、误诊和延迟诊断,计算诊断准确度。结果在40例肺结节标本中,石蜡切片诊断腺癌28例,鳞癌2例,肺错构瘤1例,硬化性肺细胞瘤1例,肉芽肿病变3例,机化性病变或炎性病变5例;细胞学涂片确诊38例,准确率95.0%,1例误诊,1例延迟诊断;冷冻切片确诊39例,准确率97.5%,1例延迟诊断;细胞学涂片与冷冻切片检查对术中肺结节的诊断准确度差异无统计学意义(χ^(2)=0.000,P=1.000)。结论细胞学涂片检查在肺结节的术中快速病理诊断中有较高的准确率,具有临床实用价值。

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.

细胞蜡块结合免疫组化在浆膜腔积液诊断中的应用

目的探讨浆膜腔积液细胞蜡块结合免疫组化在病理诊断中的应用。方法回顾性分析钟祥市人民医院2022年6月至2023年6月接收的可疑恶性浆膜腔积液标本81例,所有样本均进行常规细胞学涂片及细胞蜡块结合免疫组化检查。以手术或活检病理诊断为金标准,对比分析两种检查方法的诊断结果及诊断效能。观察两种检查方法镜下细胞特征,结合免疫组化判断恶性浆膜腔积液的肿瘤来源。结果81例浆膜腔积液标本通过手术或活检病理诊断70例恶性。常规细胞学涂片诊断灵敏度为52.9%,特异度为54.5%,准确率51.9%;细胞蜡块结合免疫组化诊断灵敏度为95.7%,特异度为27.3%,准确率为92.6%。细胞蜡块结合免疫组化诊断灵敏度及准确率显著高于常规细胞学涂片,差异有统计学意义(P<0.05)。细胞蜡块结合免疫组化检出67例阳性,其中肺腺癌47例、乳腺癌4例、卵巢癌5例、消化道来源6例、甲状腺癌2例、肺小细胞癌1例、恶性间皮瘤2例。结论细胞蜡块结合免疫组化可提高浆膜腔积液细胞诊断准确率,通过免疫组化可明确判断肿瘤组织来源。

液基薄层细胞技术离心沉淀式涂片一步法在宫颈细胞学制片中的应用

目的比较液基离心沉淀式薄层细胞学技术(LCT)经典法与一步法的制片质量及在宫颈细胞学检查中的应用效果。方法收集南京金域医学检验所有限公司病理科2024年1月至2月宫颈液基细胞学检查的样本1000例,分别进行经典法和一步法两种方法制片,比较两种方法的制片质量、制片效率、宫颈病变阳性检出率的差异。结果经典法制片满意片499张,不满意片1张,满意率99.8%;一步法制片满意片498张,不满意片2张,满意率99.6%;两种方法制片质量比较无统计学差异(P>0.05)。从样本振荡开始到涂片完成,经典法一个批次制片12张,用时36 min,完成500例样本涂片制作用时共计1500 min;一步法一个批次制片12张,用时13 min,完成500例样本涂片制作用时共计541 min;结果显示:一步法涂片制作效率比经典法高176%。经典法检出阳性32例,阴性468例,阳性检出率为6.4%;一步法检出阳性33例,阴性471例,阳性检出率为6.4%;两种方法对阳性检出率比较无统计学差异(P>0.05)。结论LCT一步法用于宫颈癌液基细胞学检查与LCT经典制片方法相比质量相同,但效率更理想。

细胞病理学检查在原发性支气管肺癌诊断中的应用价值

目的:分析细胞病理学检查在原发性支气管肺癌诊断中的应用价值。方法:选取2021年2月-2023年3月遵义市正安县人民医院收治的原发性支气管肺癌患者65例为研究对象,均行支气管镜、肺穿刺、淋巴结活检及对应细胞学涂片检查。比较组织学检查与细胞学检查支气管镜、淋巴结穿刺以及肺穿刺的阳性率,统计组织学与细胞学的病理分型(小细胞癌、腺癌、鳞癌)符合率。结果:支气管镜细胞学检查阳性检出率为60.00%(39/65),肺穿刺细胞学检查阳性检出率为90.77%(59/60),淋巴结穿刺细胞学检查阳性检出率为100.00%(65/65)。细胞学支气管镜、肺穿刺以及淋巴结穿刺的诊断符合率分别为35.38%(23/65)、46.15%(30/65)、38.46%(25/65)。结论:在原发性支气管肺癌的临床诊断中,运用支气管镜、淋巴结穿刺以及肺穿刺获得的细胞学涂片阳性检出率较高,但是与病理组织分型的符合率不高,应根据实际情况,必要时采用联合检查方法,以提高检查准确率,为治疗和判断预后提供一定的参考依据。

宫颈液基细胞学涂片假阴性原因分析

目的回顾宫颈涂片中假阴性病例,分析产生假阴性的原因。方法利用TCT技术检测6 850例宫颈涂片,其中细胞学阴性而活检阳性63例,分别记录其细胞量、有无宫颈柱状细胞/化生细胞涂片、是否血涂片、病灶与宫颈管距离及其组织病理结果。结果原细胞学诊断阴性复查为阳性、缺乏宫颈柱状细胞和化生细胞涂片、细胞量<30%、有血涂片、病灶与宫颈管距离>1 cm者,在假阴性病例中分别占7.93%、19.04%、14.28%、20.6%、46.03%。病灶与颈管距离>1 cm且病变合并尖锐湿疣假阴性者与病灶离颈管距离<1 cm且病变合并扁平湿疣者比较,差异有显著性(P<0.05)。结论获取满意的宫颈细胞样本、改进标本处理、加强细胞学医师继续教育和提高自身诊断水平是降低宫颈涂片假阴性的有效方法。临床医师对症状体征可疑但细胞学阴性的病例采取阴道镜下多点活检可减少假阴性的发生。