Diagnostic benefits of the combined use of liquid-based cytology, cell block, and carcinoembryonic antigen immunocytochemistry in malignant pleural effusion

Woo, Chang Gok; Son, Seung-Myoung; Han, Hye‐Suk; Lee, Ki Hyeong; Choe, K.H.; An, Jin; Lim, Young Hyun; Lee, Ho-Chang; Lee, Ok-Jun

doi:10.21037/jtd.2018.07.139

Cited by 23 publications

(21 citation statements)

References 26 publications

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“…The details of collection and preparatory techniques of the SEC specimens were reported in 63 studies. The cytopreparations methods included: Cytospin, ThinPrep, CellprepPlus, SurePath, centrifugation, and Milipore filter in nine, six, one, one, and six study/studies, respectively. In two studies, touch smears were assessed, and in the rest of the studies, the smears and/or cell blocks were prepared from the sediments after centrifuging the serous fluid samples.…”

Section: Resultsmentioning

confidence: 99%

“…In two studies, touch smears were assessed, and in the rest of the studies, the smears and/or cell blocks were prepared from the sediments after centrifuging the serous fluid samples. The cytologic evaluation was performed on only smears in 43 and on both smears and cell blocks in 10 studies . In another 10 studies, cell blocks were prepared in addition to smears when the amount of serous fluid was sufficient …”

Section: Resultsmentioning

confidence: 99%

“…The cytopathologist(s) was/were blinded to the final diagnosis in six studies . The final diagnosis was rendered in six studies based on evaluation of surgical pathology specimens, and the rest applied a combination of tissue histology and clinical follow‐up as the reference test.…”

Section: Resultsmentioning

confidence: 99%

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Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Farahani

Baloch

2019

Diagnostic Cytopathology

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Background: Cytology is widely utilized in the initial evaluation of fluid accumulation in the body cavities. The aim of this study was to determine the accuracy of cytology in distinguishing between benign and malignant (MAL) effusions. Methods:A comprehensive and systematic review of the literature was conducted to evaluate the accuracy of serous effusion cytology (SEC) against tissue biopsy/resection histology, imaging, or clinical follow-up as the reference test. Risk of publication bias and level of heterogeneity in the included studies was assessed. Meta-regression was performed to assess the effect of various variables on the accuracy of SEC. Results: Eighty studies met the inclusion criteria for meta-analysis comprising of 34 941 samples; of which 52 (0.2%), 22 202 (72.7%), 194 (0.6%), 711 (2.3%), and 6507 (21.3%) could be reclassified as nondiagnostic (ND), negative for malignancy (NFM), atypical (atypia of uncertain significance-AUS), suspicious for malignancy (SFM), and malignant (MAL), respectively. On follow-up, the mean risk of malignancy for ND, NFM, AUS, SFM, MAL was 17.4%, 20.7%, 65.9%, 81.8%, and 98.9%, respectively. A total of 73 studies were included in estimating the diagnostic accuracy of SEC. The bivariate mixed-effect model estimated the SEC sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio as 73.1%, 99.9%, 7850.6%, 2112.2%, and 0.27%, respectively. Conclusion: Serous effusion cytology shows high specificity and moderate sensitivity in the evaluation of serous effusions. A tiered classification scheme can improve the consistency of terminology for reporting SEC results, thus improving communication between the pathologists and clinical team, and quality of patient care. K E Y W O R D S analysis, classification scheme, comprehensive review, risk of malignancy, serous effusion cytology 1 | INTRODUCTION Serous effusion cytology (SEC) has been widely utilized in the initial evaluation of the etiology of fluid accumulation in the body cavities. Serous fluid can form in body cavities due to various inflammatory, infectious, and benign or malignant neoplasms. Malignancy is the underlying cause of serous effusion in 10% to 61% cases. 1,2 A majority of malignant effusions are caused by metastasis from adenocarcinoma of lung, breast, gastrointestinal, and female genital tract. 2,3 Malignant mesothelioma caninitially present as a serous effusion in up to 10% to 53% cases. 4-8

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Farahani

Baloch

2019

Diagnostic Cytopathology

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“…Cell block preparations have been used as a complementary technique for increasing diagnostic accuracy in many fields 42 , such as endometrial cytology, malignant pleural effusion, and needle aspiration cytology of thyroid gland 43,44 . In this study, we first proposed a cell block technique for fixation of fNRBC samples.…”

Section: Discussionmentioning

confidence: 99%

Deep learning-based adaptive detection of fetal nucleated red blood cells

Sun

Wang

Zhao

et al. 2020

Preprint

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15Aim: this study, we established an artificial intelligence system for rapid 16 identification of fetal nucleated red blood cells (fNRBCs). 17Method: Density gradient centrifugation and magnetic-activated cell sorting were 18 used for the separation of fNRBCs from umbilical cord blood. The cell block 19 technique was used for fixation. We proposed a novel preprocessing method based on 20 imaging characteristics of fNRBCs for region of interest (ROI) extraction, which 21 automatically segmented individual cells in peripheral blood cell smears. The 22 discriminant information from ROIs was encoded into a feature vector and 23 pathological diagnosis were provided by the prediction network. 24Results: Four umbilical cord blood samples were collected and validated based on a 25 large dataset containing 260 samples. Finally, the dataset was classified into 3,720 and 26 1,040 slides for training and testing, respectively. In the test set, classifier obtained 27 98.5% accuracy and 96.5% sensitivity. 28Conclusion: Therefore, this study offers an effective and accurate method for 29 fNRBCs preservation and identification. 30 Keywords: fetal nucleated red blood cells, cell-block, deep learning, non-invasive 31 prenatal diagnosis 32 Introduction 33The clinical application of fNRBCs during pregnancy could be classified into two 34 main categories 1,2 . One is the prognosis of possible diseases in pregnant women by 35 counting fNRBCs in umbilical cord blood. Chronic tissue hypoxia results in increased 36 levels of erythropoietin, which, in turn, leads to stimulation of erythropoiesis and 37 increased numbers of circulating nucleated red blood cells (NRBCs) 1,3-5 . Increased 38 umbilical cord levels of erythropoietin have been reported in pregnancies complicated 39 by intrauterine growth restriction, maternal hypertension, preeclampsia, maternal 40 smoking, Rh isoimmunization, and maternal diabetes 5-8 . As expected, each of these 41 conditions has been associated with increased NRBCs in the newborn 9 . The other 42 objective is to screen and extract fNRBCs from maternal peripheral blood for 43 non-invasive prenatal diagnosis (NIPD) 10-12 . The choice of fNRBCs as ideal target 44 cells is based on the following parameters 13,14 : (1) presence of intact nuclei containing 45 the complete fetal genome in fNRBCs, which is a prerequisite for prenatal analysis; (2) 46 limited life span of fNRBCs in the maternal circulation, which can be differentiated 47 55 cells) 16,17 . Several fNRBC enrichment methods based on different principles have 56 been reported, such as density gradient centrifugation (DGC) 13,18 , 57 fluorescence-activated cell sorting (FACS) 19 , and magnetic-activated cell sorting 58 (MACS) 20 , dielectrophoresis, and microfluidics based technologies 21,22 . Nevertheless, 59 long-term preservation of samples and rapid identification of target cells (fNRBCs) 60 still present considerable challenges. 61 Since the identification of fNRBCs in large number of cell block slices represent a 62 huge manual burden on p...

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“…The diagnostic utility of various epithelial and mesothelial markers in discriminating metastatic carcinoma, especially adenocarcinoma, from mesothelial atypia in effusion samples had been extensively investigated over the past decades, with variable sensitivity and specificity values reported [16,[22][23][24][25][26]. Traditionally, reactive or malignant mesothelial cells are identified by revealing nonreactivity with epithelial markers including, but not limited to, Ber-EP4, MOC-31, CEA, B72.3, and CD15 (Leu-M1) [7].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Ang

Tan

Karim³

et al. 2019

Acta Cytologica

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Background: Differentiating reactive mesothelial cells from metastatic carcinoma in effusion cytology is a challenging task. The application of at least 4 monoclonal antibodies including 2 epithelial markers (Ber-EP4, MOC-31, CEA, or B72.3) and 2 mesothelial markers (calretinin, WT-1, CK5/6, or HBME-1) are often useful in this distinction; however, it is not readily available in many resource-limited developing countries. Aberrant immunoexpression of enhancer of zeste homolog 2 (EZH2), a transcriptional repressor involved in cancer progression, is observed widely in various malignancy. In this study, we evaluate the diagnostic value of EZH2 as a single reliable immunomarker for malignancy in effusion samples. Methods: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity. Results: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988. Conclusion: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.

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Diagnostic benefits of the combined use of liquid-based cytology, cell block, and carcinoembryonic antigen immunocytochemistry in malignant pleural effusion

Abstract: The sensitivity and specificity for the diagnosis of MPE could be improved by integrating the CB and CEA staining into LBC in routine clinical practice to improve diagnostic accuracy.

Cited by 23 publications

References 26 publications

Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Are we ready to develop a tiered scheme for the effusion cytology? A comprehensive review and analysis of the literature

Deep learning-based adaptive detection of fetal nucleated red blood cells

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

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