Imprint Cytology of Gastric Mucosa Biopsy – Fast, Simple and Reliable Method for Detection of Helicobacter Pylori Infection

The aim of the study was to determine the value of gastric mucosa imprint cytology in the detection of Helicobacter pylori infection. A total of 182 biopsy specimens, from 182 randomly selected patients undergoing gastroscopy with gastric mucosa biopsy, were analyzed. Specimens were first submitted to slide imprinting and then formalin fixed for further routine histopathology. One-hundred and fifty-five specimens proved adequate for definitive comparison of the methods used for detection of Helicobacter pylori infection. Helicobacter pylori was detected by histopathology in 51 specimens and by cytology in 54 specimens. Agreement between the findings obtained by the two methods was recorded in 130 of 155 (83.1%) specimens. Positive cytology and negative histology findings were obtained in 14, and vice versa in 11 specimens. Gastric mucosa imprint cytology provides a useful method for the detection of Helicobacter pylori infection. The method is advantageous for being fast, simple and inexpensive. When the sample is obtained exclusively for confirmation of the presence of Helicobacter pylori infection, cytology reduces the time and cost of the procedure, at the same time providing data on morphological changes of gastric mucosa. Every finding suspect of malignant transformation of the mucosa can also be verified by histopathology because imprint manipulation causes no damage to the sample

Diagnostic Pitfalls in Parathyroid Gland Cytology

The aim of this study is to establish possibilities of using cytology in the diagnosis of parathyroid gland adenoma. 475 patients, all suspected to have parathyroid gland disease, were examined over a three-year period (from 1 of January 2006 to 31 of December 2008) in the Clinical Department of Nuclear Medicine and Radiation Protection, University Hospital Center Zagreb, Croatia. Ultrasound guided fine needle aspiration biopsy (UG-FNAB) of suspected occurrences determined by ultrasound was done. Samples obtained by UG-FNAB were air-dried and stained using the May-Grünwald- -Giemsa (MGG) staining procedure. PTH levels were determined in all punctate and sera obtained on the day of UG- -FNAB. Samples adequate for cytological analysis were obtained from 288 patients, while 187 punctates did not contain epithelial elements. The parathyroid hormone (PTH) analysis was made for all punctates. The adenoma was diagnosed via morphological characteristics in 71 out of 288 punctates that were proven adequate for cytological analysis. Increased PTH levels were later on established in all diagnosed adenomas. All patients with cytology-based diagnosis of parathyroid gland adenoma were sent to surgery, and the cytological diagnosis was confirmed by pathohistology. In three cases, the parathyroid gland adenoma was established by pathohistology, although in these cases the cytological diagnosis was negative. The cytological diagnosis of parathyroid gland adenoma can be considered reliable in 96% of cases, provided that the echosonographic structure and localisation of the punctured node is noted, and assuming that material adequate for cytological analysis is obtained by FNAB. Possible pitfalls are oncocytic types of parathyroid adenoma, intranuclear inclusions and papillary formation of epithelial cells, and cystic degeneration of nodules. These errors can be avoided by defining the PTH level on the same punctate

Clinical Cytology and Primary Health Care of Children and Adults

Clinical cytology is a diagnostic branch of medicine, best known by the Papa test in gynaecology. But, cytology can be applied in almost all fields of clinical medicine. Its advantages – high accuracy, simplicity, with little or no aggressiveness and low cost – are not used as widely as they could be. Medical practice, as well as medical research, and also medical education, are nowadays often directed at profitable use and not at the real benefit of the patient. Primary practitioners do not have enough chance to get acquainted with clinical cytology as a whole although they need true information, based on the cost-effectiveness and patient-benefit. A panel discussion on this subject was organised at the 4th Croatian Congress of Clinical Cytology, in Split, October 11–14, 2009 by the Croatian Society for Clinical Cytology-Croatian Medical Asoctiation, to inform primary practitioners about the possibilities of cytodiagnostics in the health care of children and adults. Indications for cytodiagnostics in infectious diseases (T. Jeren and A. Vince), haematology (I. Kardum-Skelin), pulmonology (S. Smojver-Je`ek), thyroid diseases (A. Kne`evi}-Obad), breast diseases (I. Kardum-Skelin), gastroenterology and urology (G. Kai}) were discussed, as well as technical procedures and the interpretation of the cytological findings. Moderator (@. Znidar~i}) opened the panel with presentation about the role of clinical cytology, particularly in the primary health care. The discussion finally pointed at the necessity of better communication between primary practitioners and cytologists. This review article presents contents of the panel discussion

Diagnostic pitfalls in parathyroid gland cytology [Dijagnostičke pogreške u citologiji adenoma paratiroidnih žlijezda]

The aim of this study is to establish possibilities of using cytology in the diagnosis of parathyroid gland adenoma. 475 patients, all suspected to have parathyroid gland disease, were examined over a three-year period (from 1 of January 2006 to 31 of December 2008) in the Clinical Department of Nuclear Medicine and Radiation Protection, University Hospital Center Zagreb, Croatia. Ultrasound guided fine needle aspiration biopsy (UG-FNAB) of suspected occurrences determined by ultrasound was done. Samples obtained by UG-FNAB were air-dried and stained using the May-Grünwald-Giemsa (MGG) staining procedure. PTH levels were determined in all punctate and sera obtained on the day of UG-FNAB. Samples adequate for cytological analysis were obtained from 288 patients, while 187 punctates did not contain epithelial elements. The parathyroid hormone (PTH) analysis was made for all punctates. The adenoma was diagnosed via morphological characteristics in 71 out of 288 punctates that were proven adequate for cytological analysis. Increased PTH levels were later on established in all diagnosed adenomas. All patients with cytology-based diagnosis of parathyroid gland adenoma were sent to surgery, and the cytological diagnosis was confirmed by pathohistology. In three cases, the parathyroid gland adenoma was established by pathohistology, although in these cases the cytological diagnosis was negative. The cytological diagnosis of parathyroid gland adenoma can be considered reliable in 96% of cases, provided that the echosonographic structure and localisation of the punctured node is noted, and assuming that material adequate for cytological analysis is obtained by FNAB. Possible pitfalls are oncocytic types of parathyroid adenoma, intranuclear inclusions and papillary formation of epithelial cells, and cystic degeneration of nodules. These errors can be avoided by defining the PTH level on the same punctate

Clinical cytology and primary health care of children and adults [Klinička citologija i primarna zdravstvena zaštita djece i odraslih]

Clinical cytology is a diagnostic branch of medicine, best known by the Papa test in gynaecology. But, cytology can be applied in almost all fields of clinical medicine. Its advantages--high accuracy, simplicity, with little or no aggressiveness and low cost--are not used as widely as they could be. Medical practice, as well as medical research, and also medical education, are nowadays often directed at profitable use and not at the real benefit of the patient. Primary practitioners do not have enough chance to get acquainted with clinical cytology as a whole although they need true information, based on the cost-effectiveness and patient-benefit. A panel discussion on this subject was organised at the 4th Croatian Congress of Clinical Cytology, in Split, October 11-14, 2009 by the Croatian Society for Clinical Cytology-Croatian Medical Association, to inform primary practitioners about the possibilities of cytodiagnostics in the health care of children and adults. Indications for cytodiagnostics in infectious diseases (T. Jeren and A. Vince), haematology (I. Kardum-Skelin), pulmonology (S. Smojver-Jezek), thyroid diseases (A. Knezević-Obad), breast diseases (I. Kardum-Skelin), gastroenterology and urology (G. Kaić) were discussed, as well as technical procedures and the interpretation of the cytological findings. Moderator (Z. Znidarcić) opened the panel with presentation about the role of clinical cytology, particularly in the primary health care. The discussion finally pointed at the necessity of better communication between primary practitioners and cytologists. This review article presents contents of the panel discussion

Klinička citologija i primarna zdravstvena zaštita djece i odraslih

Clinical cytology is a diagnostic branch of medicine, best known by the Papa test in gynaecology. But, cytology can be applied in almost all fields of clinical medicine. Its advantages--high accuracy, simplicity, with little or no aggressiveness and low cost--are not used as widely as they could be. Medical practice, as well as medical research, and also medical education, are nowadays often directed at profitable use and not at the real benefit of the patient. Primary practitioners do not have enough chance to get acquainted with clinical cytology as a whole although they need true information, based on the cost-effectiveness and patient-benefit. A panel discussion on this subject was organised at the 4th Croatian Congress of Clinical Cytology, in Split, October 11-14, 2009 by the Croatian Society for Clinical Cytology-Croatian Medical Association, to inform primary practitioners about the possibilities of cytodiagnostics in the health care of children and adults. Indications for cytodiagnostics in infectious diseases (T. Jeren and A. Vince), haematology (I. Kardum-Skelin), pulmonology (S. Smojver-Jezek), thyroid diseases (A. Knezević-Obad), breast diseases (I. Kardum-Skelin), gastroenterology and urology (G. Kaić) were discussed, as well as technical procedures and the interpretation of the cytological findings. Moderator (Z. Znidarcić) opened the panel with presentation about the role of clinical cytology, particularly in the primary health care. The discussion finally pointed at the necessity of better communication between primary practitioners and cytologists. This review article presents contents of the panel discussion.Klinička je citologija medicinska dijagnostička struka, poznata poglavito kao Papa test u ginekologiji, ali se ona primjenjuje u gotovo svim medicinskim strukama. Njene su prednosti visoki stupanj točnosti, jednostavna tehnika, mala ili nikakva agresivnost i mali troškovi, ali se unatoč tome ne koristi dovoljno u praksi. U medicinskoj praksi, kao i u medicinskoj znanosti, a i u edukaciji, danas je na prvom mjestu profit, a ne stvarna dobrobit bolesnika. Liječnici u primarnoj zdravstvenoj zaštiti nemaju dovoljno prilike da upoznaju sve mogućnosti citološke dijagnostike, iako bi to bilo potrebno upravo zbog njene prednosti u smanjenju troškova i koristi za bolesnike. O toj temi održana je rasprava za okruglim stolom na 4. Hrvatskom kongresu kliničke citologije, održanom u Splitu od 11. do 14. listopada 2009. godine u organizaciji Hrvatskog društva za kliničku citologiju Hrvatskog liječničkog zbora, usmjerena na informiranje liječnika u primarnoj zdravstvenoj zaštiti djece i odraslih o mogućnostima citološke dijagnostike. Bilo je riječi o indikacijama za citodijagnostiku u zaraznim bolestima (T. Jeren i A. Vince), hematologiji (I. Kardum-Skelin), pulmologiji (S. Smojver- Ježek), bolestima štitnjače (A. Knežević-Obad) i dojke (I. Kardum-Skelin), te u gastroenterologiji i urologiji (G. Kaić), kao i o tehničkim postupcima te o interpretaciji citoloških nalaza. Voditeljica rasprave (Ž. Znidarčić) održala je uvodno izlaganje o kliničkoj citologiji i njenoj ulozi u primarnoj zdravstvenoj skrbi. U zaključku je naglašena potreba bolje komunikacije između liječnika primarne zdravstvene skrbi i citologa. U članku su prikazani tekstovi ove rasprave

Croatian Society for Clinical Cytology Guidelines for Thyroid Cytology

Osnovni je cilj citodijagnostike štitnjače razlučiti maligne i moguće maligne čvorove štitnjače od njezinih benignih čvorova. Svaki pacijent sa čvorom štitnjače kandidat je za njezinu citološku punkciju. Prije odluke o upućivanju na citološku punkciju potrebno je uzeti kompletnu anamnezu, izvršiti fizikalni pregled vrata i limfnih čvorova vrata, odrediti razinu tireotropina u serumu te učiniti ultrazvuk štitnjače. Čvorovi najvećeg promjera većeg od 1,5 cm ili ultrazvučno suspektni čvorovi bez obzira na njihovu veličinu indikacija su za citološku punkciju. Punkciju je poželjno raditi pod kontrolom UZ-a. Na obrascu koji prati punkciju treba zabilježiti identifikacijske podatke, položaj i veličinu čvora te važne kliničke i laboratorijske podatke. Citološka je dijagnoza bolesti štitnjače kliničko-citološka i temelji se na korelaciji citomorfološke slike i dostupnih kliničkih podataka. Citološka klasifikacija bolesti štitnjače temelji se na riziku od malignosti i sadržava četiri dijagnostičke kategorije: benigne promjene, promjene neodređenog značaja u pogledu malignosti, maligne tumore i nedijagnostičke nalaze. Dodatne metode (imunocitokemija, RT-PCR i protočna citometrija) mogu biti korisne u dvojbenim slučajevima.The main purpose of thyroid FNA (fine needle aspiration) is to separate malignant and possibly malignant nodules from benign thyroid lesions. Every patient with thyroid nodule is a candidate for FNA. Before a decision to perform an FNA, a complete history, a physical examination directed to the thyroid and cervical lymph nodes, a serum thyrotropin level, and thyroid ultrasound should be obtained. Thyroid lesion with a maximum diameter greater than 1.5 cm or nodule of any size with sonographically suspicious features is an indication for FNA. Ultrasound-guided FNA of the thyroid is recommended. The requisition form that accompanies FNA should contain the identifying data, location and size of the nodule, and relevant laboratory and clinical data. FNA diagnosis of thyroid disease is a clinicocytologic diagnosis, and correlation with clinical findings is mandatory for success. Thyroid FNA classification scheme consists of a four diagnostic categories according to the risk of malignancy: benign lesions, indeterminate lesions according to malignancy, malignant tumors, and non-diagnostic. Ancillary studies (immunocytochemistry, RT-PCR, flow cytometry) are usually helpful in borderline cases

CROATIAN SOCIETY FOR CLINICAL CYTOLOGY GUIDELINES FOR THYROID CYTOLOGY

Osnovni je cilj citodijagnostike štitnjače razlučiti maligne i moguće maligne čvorove štitnjače od njezinih benignih čvorova. Svaki pacijent sa čvorom štitnjače kandidat je za njezinu citološku punkciju. Prije odluke o upućivanju na citološku punkciju potrebno je uzeti kompletnu anamnezu, izvršiti fizikalni pregled vrata i limfnih čvorova vrata, odrediti razinu tireotropina u serumu te učiniti ultrazvuk štitnjače. Čvorovi najvećeg promjera većeg od 1,5 cm ili ultrazvučno suspektni čvorovi bez obzira na njihovu veličinu indikacija su za citološku punkciju. Punkciju je poželjno raditi pod kontrolom UZ-a. Na obrascu koji prati punkciju treba zabilježiti identifikacijske podatke, položaj i veličinu čvora te važne kliničke i laboratorijske podatke. Citološka je dijagnoza bolesti štitnjače kliničko-citološka i temelji se na korelaciji citomorfološke slike i dostupnih kliničkih podataka. Citološka klasifikacija bolesti štitnjače temelji se na riziku od malignosti i sadržava četiri dijagnostičke kategorije: benigne promjene, promjene neodređenog značaja u pogledu malignosti, maligne tumore i nedijagnostičke nalaze. Dodatne metode (imunocitokemija, RT-PCR i protočna citometrija) mogu biti korisne u dvojbenim slučajevima.The main purpose of thyroid FNA (fine needle aspiration) is to separate malignant and possibly malignant nodules from benign thyroid lesions. Every patient with thyroid nodule is a candidate for FNA. Before a decision to perform an FNA, a complete history, a physical examination directed to the thyroid and cervical lymph nodes, a serum thyrotropin level, and thyroid ultrasound should be obtained. Thyroid lesion with a maximum diameter greater than 1.5 cm or nodule of any size with sonographically suspicious features is an indication for FNA. Ultrasound-guided FNA of the thyroid is recommended. The requisition form that accompanies FNA should contain the identifying data, location and size of the nodule, and relevant laboratory and clinical data. FNA diagnosis of thyroid disease is a clinicocytologic diagnosis, and correlation with clinical findings is mandatory for success. Thyroid FNA classification scheme consists of a four diagnostic categories according to the risk of malignancy: benign lesions, indeterminate lesions according to malignancy, malignant tumors, and non-diagnostic. Ancillary studies (immunocytochemistry, RT-PCR, flow cytometry) are usually helpful in borderline case

CROATIAN SOCIETY FOR CLINICAL CYTOLOGY GUIDELINES FOR THYROID CYTOLOGY

Osnovni je cilj citodijagnostike štitnjače razlučiti maligne i moguće maligne čvorove štitnjače od njezinih benignih čvorova. Svaki pacijent sa čvorom štitnjače kandidat je za njezinu citološku punkciju. Prije odluke o upućivanju na citološku punkciju potrebno je uzeti kompletnu anamnezu, izvršiti fizikalni pregled vrata i limfnih čvorova vrata, odrediti razinu tireotropina u serumu te učiniti ultrazvuk štitnjače. Čvorovi najvećeg promjera većeg od 1,5 cm ili ultrazvučno suspektni čvorovi bez obzira na njihovu veličinu indikacija su za citološku punkciju. Punkciju je poželjno raditi pod kontrolom UZ-a. Na obrascu koji prati punkciju treba zabilježiti identifikacijske podatke, položaj i veličinu čvora te važne kliničke i laboratorijske podatke. Citološka je dijagnoza bolesti štitnjače kliničko-citološka i temelji se na korelaciji citomorfološke slike i dostupnih kliničkih podataka. Citološka klasifikacija bolesti štitnjače temelji se na riziku od malignosti i sadržava četiri dijagnostičke kategorije: benigne promjene, promjene neodređenog značaja u pogledu malignosti, maligne tumore i nedijagnostičke nalaze. Dodatne metode (imunocitokemija, RT-PCR i protočna citometrija) mogu biti korisne u dvojbenim slučajevima.The main purpose of thyroid FNA (fine needle aspiration) is to separate malignant and possibly malignant nodules from benign thyroid lesions. Every patient with thyroid nodule is a candidate for FNA. Before a decision to perform an FNA, a complete history, a physical examination directed to the thyroid and cervical lymph nodes, a serum thyrotropin level, and thyroid ultrasound should be obtained. Thyroid lesion with a maximum diameter greater than 1.5 cm or nodule of any size with sonographically suspicious features is an indication for FNA. Ultrasound-guided FNA of the thyroid is recommended. The requisition form that accompanies FNA should contain the identifying data, location and size of the nodule, and relevant laboratory and clinical data. FNA diagnosis of thyroid disease is a clinicocytologic diagnosis, and correlation with clinical findings is mandatory for success. Thyroid FNA classification scheme consists of a four diagnostic categories according to the risk of malignancy: benign lesions, indeterminate lesions according to malignancy, malignant tumors, and non-diagnostic. Ancillary studies (immunocytochemistry, RT-PCR, flow cytometry) are usually helpful in borderline case