This is to certify that the dissertation entitled A CORRELATIVESTUDYBETWEENCERVICALCYTOLOGY AND BIOPSYCERVIX submitted by Dr. G.VIMALA DEVI VIDYA to the Faculty of Pathology, The Tamilnadu Dr. M.G.R. Medical university, Chennai in partial fulfilment of the requirement for the award of M.D. Degree in Pathology is a bonafide work carried out by her during the period June 2005 – Nov 2007 under my direct supervision and guidance.
procedure. Kotaska et al.  and Obwegeser et al.  reported that cleaning the cervix with oversized swabs provided more adequate sam- ples, whereas Hans et al.  did not find any differences between removing the cervical secretions (CS) or not in their comparative study. However, none of these studies analyzed the content of the CS in order to clarify whether there is a real reason to perform cervical clean- ing or not. The Bethesda system (TBS)  states that a sample is considered inadequate if more than 75% of the cells on a slide are inflammatory cells, which would obscure the epithelial cells; and this is expected in the CS. We have recently performed a survey in which we questioned colposcopists and gynecolo- gists attending international colposcopy meet- ings (n ~ 50) on how they sample the cervix for a cytology specimen. The results showed that the CS is often removed and discarded if found in substantial quantity (unpublished data). CS is the result of exfoliated cells from the cervix and vaginal wall, and contains inflammatory cells and bacteria in addition to the mucus secreted from the endocervical glands, which are normally found in the cervical orifice. If the CS is removed with an oversized or normal- sized cotton swab, it is likely that the swab touches the cervical surface and may result in some CIN cells being removed; and these would hence not be present in the clean, second sam- ple (SS). In this study, we compared the CS removed without touching the cervical surface to the SS to evaluate the adequacy of both samples, and to obtain and compare their sen- sitivity, specificity, and positive and negative predictive values.
women were excluded. When a patient who fulfilled the criteria of the study, came to the Gynaecology OPD the procedure was explained to the patient in detail, clinical details were noted and entered into the proforma. The patient was put in dorsal position after emptying the bladder. Per speculum examination was done without using lubricants. Naked eye examination of the cervix was done to evaluate its colour, shape, size, presence of any lesions, discharge. The cervical smear was then taken by means of the scrape technique using the Ayre’s spatula.
longer sexual life which proves to be a significant risk factor in cervical dysplasia and also increases susceptibility of adolescent cervix to oncogenic irritation. The adolescent cervix is vulnerable to various potential oncogenic factors (HPV) when exposed and results in increase incidence of dysplasia and its further course. Majority of patients were multipara (80.4%), which was comparable to other studies by Rajput et al, Verma et al, Zainab et al, Bhalero et al, Schiff et al. 6,14,16,18,20 High
OBJECTIVE: To evaluate the accuracy of fine needle aspiration cytology (FNAC) of the breast at our institution and to perform quality assurance. STUDY DESIGN: Two hundred forty-six cases with pathologic confirmation were selected and reviewed. A pathologist performed most of the aspirations at an outpatient breast clinic. We correlated cytologic and histologic findings and evaluated the influence of the size, location, grade, and pathologic subtypes and fibrosis in breast lesions on diagnostic results. RESULTS: The likelihood ratios for malignant, suspicious, atypical, benign and unsatisfactory cytologic diagnoses were 98.71, 5.48, 1.09, 0.07 and 0.55, respectively. The absolute and complete sensitivities for malignant lesions were 64.5% and 90.3%, respectively. The specificity was 71.9%. False negative and positive rates were 4.3% and 0.7%, respectively. The predictive value for a malignant cytologic diagnosis was 98.4%. The rate of unsatisfactory samples was 9.3%. The rate of concordance between cytologic and histologic diagnosis was lower for large and diffusely growing lesions (benign and malignant), for malignancies with abundant fibrosis and of unusual types and for carcinomas of low grade. All axillary and recurrent chest wall lesions were diagnosed cytologically. Cell block sections were useful in a small number of cases. CONCLUSION: Understanding the performance and limitations of FNAC can enhance its value as a diagnostic technique in the management of breast disease
Benign cells show only 1-2 AgNOR per nucleus, which was attributed to the difficulty in perceiving the individual AgNORs, when they aggregated within a relatively small nucleus. In malignancy, or with increased cell proliferation, AgNORs get dispersed throughout the nucleus to a varying extent, enabling the histologist to count them more readily. Therefore, the quantification of AgNORs depends on the degree of dispersion or disaggregation of the relatively large number of AgNORs in the nucleus. One great advantage of this technique is that, previously stained cytology slides can be reused for silver staining, thus providing an excellent guide to the diagnosis especially in doubtful cases and when extra- unstained slides are not available.
Screening programmes for cervical cancer using the conventional paps smear technique have been in place since decades and have been successful in detecting cancers of the cervix significantly. However conventional paps smear technique has many limitations. In the conventional PAP tests, the false-negative rate for invasive carcinoma range from 16-82%. Attempting to find higher sensibility for the method, which according to a meta-analysis is 58% (varying from 11 to 99%) with specificity of 68% (varying from 14 to 97%), new techniques to collect and prepare the samples were developed so the liquid-based cytology (LBC) was introduced.
Furthermore 07 cases (17%) were reported as HSIL. Out of 07 cases, 04 cases on biopsy were reported as HSIL and 03 cases were lost to follow up. Main morphological parameters were cellular smears, hyperchromatic crowded cell groups with loss of polarity and associated with cellular abnormalities (Figure 2B). Background showed small dyskeratotic cells, which were conspicuous in LBC smears. 04 cases were reported as squamous cell carcinoma on LBC with histology confirming the same. Tumour diathesis (clinging) along with many dyskeratotic cells, tadpole cells, naked nuclei and moderate to dense inflammation were found in all cases (Figure 3 A, B).
With the added advantage of the immediate availability of VIA test result, VIA-positive women can be subjected to further investigative procedures to ensure diagnostic and treatment compliance with a "Single Visit" approach. Diagnostic triage of VIA-positive women by cytology or colposcopy directed biopsy are still not very feasible in low-resource country settings like ours where adequate expertise, facility, and infrastructure are still not available for cytology and histopathology confirmation, outside of the city limits. Also, poor patient compliance for further diagnostic or treatment visits and inadequate patient tracking system creates further barriers in the successful implementation of screening programs. Hence a "Single Visit" screen and treat strategy that uses VIA and colposcopy alone that eliminates the need for repeated visits due to delays in diagnostic results, will be highly attractive in terms of cost effectiveness and compliance to treatment, which is crucial to bring down the incidence and mortality due to cervical cancer.
smear usage clinically, deaths caused by cervical cancer have decreased dramatically (70% per year). Although Pap-smear test has 6%-50% false negative rates, this is still the most effective method for screening of pre- cancerous lesions. Colposcopic examination is used for clarifying cytological diagnosis, to determine the lesion’s place and size and biopsy of suspicious lesion to confirm the diagnosis. Unhealthy cervix is a group of cervical lesions, which include chronic cervicitis, cervical erosions, lacerations, polyps and leukoplakia. These lesions can harbour premalignant lesions even when Pap smear is negative. Under cervical screening programme, women with moderate or severe dyskaryosis or with persistent mild dyskaryosis of borderline change are referred for colposcopic examination of the cervix. Hence colposcopy might be of more use in detecting the premalignant lesions in these cases, than Pap smear alone. Our aim is to correlate cytology, colposcopy and histopathology for diagnosis of cervical lesions.
smear, clarity of background and increased specificity for detection of LSIL and HSIL lesions. On the other hand, colposcopic assessment is a critical step in the diagnosis of preinvasive cervical lesions, as the detection of abnormal cervicalcytology is dependent on precise visual localization of micropathological changes and precise biopsy of such tissue for subsequent histopathological diagnosis. Therefore, use of single visit approach in which cytology, colposcopy and biopsy are all done in one sitting and treated accordingly will help us to detect a significant number of cases in premalignant state which may otherwise be missed if the above-mentioned screening methods are used individually.
Then another cervical sample was taken with a cytobrush .The head of the brush was detached and placed into the liquid – Prep collection vial which was capped, labelled, and sent to the laboratory for processing and analysis. In the lab the specimen was mixed well using a vortex for 5 to 20 seconds and the entire contents were poured into a clean 15 ml centrifuge tube and it was centrifuged for 10 minutes at 1500 RPM. After centrifugation supernatant fluid was discarded and to the residual pellet cellular base (this component is for encapsulation and adherence of processed cells on a clean glass slide) was added .The specimen was mixed using vortex and pipette 50micro litre onto glass slide. The slide was allowed to dry, stained and was analysed.
Background: Cervical cancer, the most common malignancy among Indian women, is the second most common and fifth most fatal cancer in women world‑wide. Aim The study is aimed to determine the risk factors, incidence of cervical malignancy in women with grossly unhealthy cervix in a rural population and to get an overview of effectiveness of the existing screening programs. Subjects and Methods: This cross‑sectional prospective pilot study was carried in a tertiary care hospital in a span of 6 months. A total of 300 females with grossly unhealthy cervix with suspicions of malignancy, who had never undergone cervicalcytology or any other cervical neoplasia screening procedure, were included. Unaided visual inspection with Cusco’s speculum was performed followed by digital examination. Clinical staging was carried out in patients according to International Federation of Gynecology and Obstetrics (FIGO’S) Classification. Cervical punch biopsy was taken under colposcopic guidance and histopathological examinations were done. Data were analyzed using SPSS, version 15.0 (Chicago Illinois, USA) and presented as simple percentages. Results: Among 300 females, 63.4% (190/300) were aged between 40 and 59 years. Nearly, 70.7% were illiterate and 52.6% had monthly family income between Rs. 2,000 and 5,000. Majority was married and 72.7% had parity between 1 and 3 and 58.7% had early marriages. Unaided visual examination of the women showed 62.7% of them had visible growth and 48.7% of them had bleeding erosions. Visible growths along with bleeding erosions were present in 11.3% cases. Histopathological examination of cervicalbiopsy specimens revealed mild, moderate and severe dysplasia in 14, 22 and 36 cases, respectively. A total of 212 patients had invasive squamous cell carcinoma. Only 16 patients had normal histopathology findings. Nearly, 56.61% had Stage II disease; among them 27 had Stage IIa and 33 had Stage IIb disease, 26 patients had Stage I disease. Stage IIIa and IIIb have been found in 50 and 12 cases respectively. Four cases had cancer extending to urinary bladder and rectum (Stage IVa). Conclusions: Cervical carcinoma not only has a biomedical spectrum, but also has a wide cultural and socio‑economic background. Extensive screening campaigns needs to be implemented with immediate effect to early diagnose cases to decrease the social burden of the disease.
Confirmation of recurrent tumour is often possible cytologically; on the other hand, definitive diagnosis of primary lymphoma generally requires open biopsy. Respiratory samples often provide a preliminary cytological diagnosis. However, sufficient material for immunophenotyping and / or genotyping is usually considered necessary for definitive diagnosis. It has been suggested that BAL samples may be useful for this purpose 22 and that immunoelectrophoresis of
Chronic non specific lympadenitis includes follicular hyperplasia or sinus histiocytosis, which on FNA smears shows aggregates of macrophages/histiocytes, sdmixed with lymphocytes. In our study, the diagnoses were made based on these cytomorphological criteria (Figure 1-9). In 6 cases showing granulomatous lymphadenitis, ZN stain was used for confirming tubercular etiology, which showed AFB positivity in 4/6 cases (3.4% ) and negative in 2/6 cases (1.7%). The latter were given the diagnosis of granulomatous lymphadenitis and were advised for excisional biopsy for further confirmation. NHLs in children are almost always one of the three types: lymphoblastic, small non- cleaved type (Burkitt and non- Burkitt) and large cell type (ALCL and DLBCL ). These are high grade lymphomas. In our study, we diagnosed 2 cases of NHL, both as high grade, large cell type (Figure 7 & 8). Histopathological examination confirmed the findings. In children diagnosed with HL, MC, NLPHL, and NS are the subtypes more commonly seen (Thomas et al., 2002). In our study, we diagnosed 03 cases of HL, 2 MC and 1 NLPHL subtype (Figure 5 & 6). 2 cases were confirmed by HPE. 1 case was lost to follow-up. Primary diagnostic evaluation of childhood peripheral lymphadenopathy is mainly based on group of lymph nodes involved and FNA. A careful history and thorough physical examination are the first steps in establishing the cause of a neck mass. Location, size, consistency, and mobility of the mass provide clues and are useful for comparison during follow-up. Amongst diagnostic modalities, FNA is a rapid, simple, accurate diagnostic procedure and important initial step in the evaluation and management of enlarged cervical lymph nodes in children. It is very well tolerated by children, and there were no complications.
Since the late 1940’s ,the incidence and mortality for invasive carcinoma of the cervix have declined 70%-75% in the U.S. the widespread use of the Papanicolaou smear is generally cited has the major factor influencing these trends. A philosophy held by most cytopathologist is that a cytopathologic diagnosis should carry the same level accuracy as a histopathologic diagnosis. With these view, because surgery or chemo theraphy may result from the cytopathologic diagnosis, it is paramount that the pathologist understand the morphologic criteria that distinguish benign from malignant conditions.
INTRODUCTION: In developing country like India cervical malignancy is a common, preventable and curable cause of morbidity and mortality .Worldwide pap smear is the most commonly used screening test for cervical lesions .VIA guided biopsy has been defined to be the gold standard method in diagnosing precancerous lesions of the cervix & used in evaluation and management of cervical lesions. In present study we compare clinical performance of Visual Inspection With acetic acid (VIA), as a simple screening test and if it (VIA) would be an adequate alternative to PAP SMEAR , in the screening for cancer cervix in low resource settings. METHOD: A cross sectional study was conducted in a tertiary care referral institute in 100 symptomatic women of 30-70 years. PAP smears were performed by the conventional method and VIA was done for all 100 women who came with complaints of white discharge per vagina, intermenstrual, or postcoital bleeding, etc. Final correlation of the PAP smear and VIA were based on biopsy reports.
Cytospin is a cytocentrifuge which concentrates only cells in the liquid sample on to the slide. The supernatant fluid containing no cells and obscuring material like blood and mucus is absorbed by the filter card. The cytopsin is operated and cell spin rotor is subjected to 3,000 rpm for 10 minutes the slide with the resulting cell sample is now taken from the cell clip and stained by routine papanicolaou stain. Patients who were found to be with abnormal cytology reportes were subjected to colposcopy directed biopsy.
Enlargement of lymph nodes on a reactive inflammatory basis accounts for the largest number of benign cases for which five needle aspiration biopsy is requested reactive hyper plasia must absolutely be differentiate from metastatic malignant tumour and malignant lymphoma. The smear pattern is one of a mixture of cell types, with lymphocytes of various degrees of differentiation and stimulation, plasma cells and enlarged histiocytic phagocytes some of which contain nuclear debris. The peculiar paleness appears to be effect of drying, which can be eliminated by the immediate fixation of the smear.
Study population. This study is based on data from women in the Na- tional Cancer Institute (NCI)-KPNC Persistence and Progression (PaP) cohort who had a positive HPV test result (Hybrid Capture 2 [HC2], Qiagen, Germantown, MD, USA) between 2007 and 2011. KPNC intro- duced HPV cytology cotesting into routine practice in 2003 for cervical cancer screening at 3-year intervals among women age ⱖ 30 (11, 14). Starting in 2007, the PaP cohort was created by collecting residual cervical specimens in specimen transport medium (STM) (Qiagen) from a major- ity of women who tested positive with the Hybrid Capture 2 (HC2) (e.g., it was not possible to process specimens testing positive on Friday after- noons), as well as a random sample of HPV-negative specimens (which were not considered in the present study). After the specimens were used for HC2 testing for clinical purposes, the residual specimens were neutral- ized and archived, as described below (15).