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.

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.

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.

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.

Does human papillomavirus infection do harm to in-vitro fertilization outcomes and subsequent pregnancy outcomes？

Background Some studies suggested that human papillomavirus （HPV） infection could reduce the clinical pregnancy rate and double the spontaneous abortion rate compared with non-infected women after in-vitro fertilization and embryo transfer （IVF-ET）. But some other studies showed there was no difference between HPV infected and non-infected groups of ART outcomes. The role of HPV infection in infertile women undergoing IVF treatments has been a controversial issue which this article attempts to investigate. Methods This is a retrospective analysis of 3880 infertile women undergoing IVF treatment at Peking University Third hospital reproductive medical center in 2008. Patients with abnormal thin-layer preparation cytologic test （TCT） results who underwent fresh cycle embryo transfer were divided into an HPV positive group （n=56） and an HPV negative group （n=56）. The clinical parameters were compared （using Student＇s t-test and chi-squared test）. Univariate and multivariate analyses were taken to see if HPV infection affects the clinical pregnancy rate. Results Of the 3880 cases 157 had TCT abnormality （4.0%）. Of the 149 patients who had HPV test results, 112 women （81.2%） received a fresh cycle embryo transfer. Each group had 56 cases. The patients were of similar age and BMI, basic hormone levels, and infertile factors were similar. The gonadotropin use, oocyte retrieval number, clinical pregnancy rate, abortion rate and newborn condition were all similar between groups. Analyses showed neither HPV infection nor HPV hybrid capture （HC） II results affected clinical pregnancy rate after IVF treatments, but the FSH level did. Conclusion HPV positivity did not appear to impact assisted reproductive technology （ART） success. ＂Extensive treatment＂ for HPV before IVF was not recommended because treatment time will increase age and reduce ovarian function, which will lead to inferior IVF outcomes.

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,