Diagnostic/prognostic value of cytological grading system by Robinson's method and morphometric objectification in determining gradus of invasive breast cancer

CILJ: Cilj istraživanja bio je učiniti citološko i morfometrijsko gradiranje citoloških uzoraka invazivnog karcinoma dojke i prosuditi mogućnost rutinske primjene citološkog gradiranja s ili bez morfometrijske analize, umjesto dosadašnje procjene gradusa tumora na histološkom materijalu; prosuditi reproducibilnost, konzistentnost i varijabilnost tehnike gradiranja među citolozima; te opisati biološku varijabilnost morfometrijskih parametara unutar i između gradusa, u svrhu optimalizacije i utvrđivanja minimalne, trenutno nedefinirane, veličine uzorka potrebite za morfometrijsku analizu. ISPITANICI I METODE: Istraživanjem je obuhvaćeno 45 ispitanica (15 po svakom gradusu) u kojih je dijagnoza karcinoma dojke postavljena na citološkim aspiratima dojke u OB „Dr. J. Benčević“ tijekom 2012. godine. Citološko gradiranje učinjeno je Robinsonovom metodom gradiranja, a određivanje histološkog gradusa korištenjem Elstonove modifikacije Bloom-Richardson-ove metode. Morfometrijska analiza provedena je programom SFORM. REZULTATI: Slaganje tri promatrača u određivanju citološkog gradusa i njegovoj komparaciji s histološkim gradusom procijenjeno je Kendall T-B testom. T vrijednosti iznosile su od 0,64 do 0,82. T vrijednosti između promatrača uzetog kao standard (promatrač s najvećim volumenom pregledanih uzoraka karcinoma dojke) i druga dva promatrača (interobserver varijabilnost) iznosile su od 0,45 do 0,85. Slaganje pojedinog promatrača pri ponovljenom citološkom gradiranju (intraobserver varijabilnost) iznosilo je od 0,57 do 0,79. Dijagnostička/prognostička vrijednost citološkog sustava gradiranja po Robinsonu i morfometrijska objektivizacija u određivanju gradusa invazivnog karcinoma dojke 81 SAŽETAK S porastom gradusa uočava se pad ekspresije progesteronskih receptora, značajan, stupnjeviti porast ekspresije proliferacijskog biljega Ki-67, viši pT stadij, te veći udio postmenopauzalnih ispitanica. Analizom razlika u distribuciji morfometrijskih parametara po gradusu izdvaja se značajan, stupnjevit porast mjerenih značajki s porastom gradusa. Gradus je odgovoran za prosječno tek 26, odnosno 35% varijance morfometrijskih obilježja stanice i jezgre. Glavninu varijance obilježja čine interindividualne razlike, odnosno heterogenosti među ispitanicima unutar gradusa, uz minimalne intraindividualne varijacije. Minimalnu, trenutno nedefiniranu, veličinu uzorka potrebitu za morfometrijsku analizu normirali smo na 100 stanica po uzorku, budući da ista jamči usku marginu greške. ZAKLJUČAK: Citološko gradiranje aspirata karcinoma dojke reproducibilno je i neovisno o iskustvu morfologa te dobro korelira s histološkim gradusom. Posljedično tome predstavlja koristan parametar u predviđanju histološkog gradusa, odnosno biološkog ponašanja tumora. Gradiranje morfometrijskom metodom statistički je značajno, ali zbog niskog udjela gradusa u varijanci morfometrijskih obilježja, odnosno širokog raspona preklapanja morfometrijskih parametara među gradusima, morfometrija kao metoda nema diskriminacijsku nego samo indikativnu sposobnost.AIM: The aim of this study was to evaluate the cytological and morphometrical grading of breast cancer and to estimate the possibility of routine use of cytologic grading with or without morphometric analysis, instead of estimating the tumor grade only on histologic material; to estimate reproducibility, consistency and variability of grading techniques among cytologists and also to describe the biological variability of morphometric parameters within and between grades and to determine the minimum, currently undefined, of sample size required for morphometric analysis. MATERIAL AND METHODS: Forty five patients with histologically confirmed invasive breast carcinoma, treated in General Hospital Dr. J. Bencevic in 2012, were selected in the present study. Grading of breast carcinoma was done according to the Robinson’s method by three independent observers on two occasions. Histological grading was performed using Elston's modified Bloom Richardsons' scoring. Morphometric analysis was performed by means of the SFORM software. RESULTS: The agreement between observers in determining the cytological grade and it's comparison with histological grade was estimated with Kendall T-B test. T values ranged from 0.64 to 0.82. T values between standard observer (the one with highest volume of examined breast specimens) and the other two observers (interobserver varability) ranged from 0.45 to 0.85 for cytological grading. Agreement between the individual observer at the repeated cytological grading (intraobserver variability) ranged from 0.57 to 0.79. Dijagnostička/prognostička vrijednost citološkog sustava gradiranja po Robinsonu i morfometrijska objektivizacija u određivanju gradusa invazivnog karcinoma dojke 83 SUMMARY With increasing tumor grade we observed the decrease of progesterone receptors expression , significant increase in the expression of the proliferation marker Ki-67, higher pT stage, and large proportion of postmenopausal women. By analyzing differences in the distribution of morphometric parameters by grade we observed a significant, gradual increase in the measured characteristics with increasing grade. Gradus is responsible for an average of 26 or 35% of the variance of morphometric characteristics of cells and nuclei. The majority of the variance features make interindividual differences or heterogeneity among respondents within the grade. Minimal sample size which is currently undefined and not standardized and was needed for morphometric analysis, was normalized to 100 cells per sample, since the same guarantees a narrow margin of error. CONCLUSION: Cytological grading of aspirates of breast cancer is reproducible and independent of experience of morphologist and correlates well with established histological grade and as such can be predictor of histologic grade and provide relevant information about the biological behavior of invasive breast cancer. Morphometric grading method is statistically significant but due to low proportion of grade in variance of morphometric features and a wide range of overlapping morphometric parameters among grades differences, morphometry as a method does not have discriminatory but just indicative capacity

Pap Test – With or Without Vaginal Smear?

The aim of this study was to evaluate medical and economic justification of vaginal smears as a part of primary screening for cervical carcinoma and its precursors. Study included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were examined at Department of clinical cytology of University Hospital Center Osijek from 2003 till 2008. There were 12.639 (5.2%) abnormal findings, and they were divided into three groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E). These three groups were analysed in respect to cytological differential diagnosis and age of participants. It was estimated how many women could be additionally included in the screening, if vaginal smear would be included in the Pap test only after 50 years of age. In 6.9% of cytologically diagnosed lesions abnormal cells were found exclusively in vaginal smears (0.35% of all findings). As for squamous cell lesions, 91.2% were mild lesions (ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively by vaginal smear in either woman under 50 years of age, while in women over 50 years of age it was diagnosed in 2.3% of cases. Exclusively by vaginal smear was diagnosed 3.9% of all AGC and 6.3% of adenocarcinoma, while in 85.0% of glandular epithelium lesions abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is only 10.3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show that taking of vaginal smears along with cervical and endocervical smears as a part of primary screening for cervical carcinoma and its precursors in women under 50 years of age is not justifiable, since vaginal smear only has a role in detection of endometrial carcinoma that are extremely rare in younger age groups. If vaginal smear would be taken only in women over 50 years of age, additional 37.7% of women under 50, or 25.1% women over 50 years of age could be included in the screening

Morphometry of Tumor Cells in Different Grades and Types of Breast Cancer

The aim of the study was to compare morphometric characteristics of different types and grades of breast cancer. Morphometric analysis was performed using the SFORM software (Vamstec, Zagreb) on the May-Grünwald-Giemsa stained fine needle aspiration cytology (FNAC) breast tissue specimens. The study included 42 patients diagnosed with breast carcinoma by breast smear FNAC at Merkur University Hospital during the 2001–2005 period. Postoperative tumor histopathology and semi-quantitative tumor grading by the method of Elston and Ellis1 showed invasive ductal carcinoma grade I in 10, invasive ductal carcinoma grade II in 9, invasive ductal carcinoma grade III in 13, and invasive lobular carcinoma in 13 patients, the latter also including a subtype of invasive tubulolobular carcinoma. The following parameters were assessed by use of Statistica 7.1 and c2-test: tumor area, circumference, maximal radius, minimal radius, convexity, length, width, elongation, nucleus/cytoplasm ratio, and shape factor. Morphometric analysis yielded statistically significant differences among all study groups (p<0.001). Morphometric parameters showed significant individual correlation with tumor type and grade, whereby the area, convexity and circumference were most significant at both nuclear and cellular level

Diagnostic/prognostic value of cytological grading system by Robinson's method and morphometric objectification in determining gradus of invasive breast cancer

CILJ: Cilj istraživanja bio je učiniti citološko i morfometrijsko gradiranje citoloških uzoraka invazivnog karcinoma dojke i prosuditi mogućnost rutinske primjene citološkog gradiranja s ili bez morfometrijske analize, umjesto dosadašnje procjene gradusa tumora na histološkom materijalu; prosuditi reproducibilnost, konzistentnost i varijabilnost tehnike gradiranja među citolozima; te opisati biološku varijabilnost morfometrijskih parametara unutar i između gradusa, u svrhu optimalizacije i utvrđivanja minimalne, trenutno nedefinirane, veličine uzorka potrebite za morfometrijsku analizu. ISPITANICI I METODE: Istraživanjem je obuhvaćeno 45 ispitanica (15 po svakom gradusu) u kojih je dijagnoza karcinoma dojke postavljena na citološkim aspiratima dojke u OB „Dr. J. Benčević“ tijekom 2012. godine. Citološko gradiranje učinjeno je Robinsonovom metodom gradiranja, a određivanje histološkog gradusa korištenjem Elstonove modifikacije Bloom-Richardson-ove metode. Morfometrijska analiza provedena je programom SFORM. REZULTATI: Slaganje tri promatrača u određivanju citološkog gradusa i njegovoj komparaciji s histološkim gradusom procijenjeno je Kendall T-B testom. T vrijednosti iznosile su od 0,64 do 0,82. T vrijednosti između promatrača uzetog kao standard (promatrač s najvećim volumenom pregledanih uzoraka karcinoma dojke) i druga dva promatrača (interobserver varijabilnost) iznosile su od 0,45 do 0,85. Slaganje pojedinog promatrača pri ponovljenom citološkom gradiranju (intraobserver varijabilnost) iznosilo je od 0,57 do 0,79. Dijagnostička/prognostička vrijednost citološkog sustava gradiranja po Robinsonu i morfometrijska objektivizacija u određivanju gradusa invazivnog karcinoma dojke 81 SAŽETAK S porastom gradusa uočava se pad ekspresije progesteronskih receptora, značajan, stupnjeviti porast ekspresije proliferacijskog biljega Ki-67, viši pT stadij, te veći udio postmenopauzalnih ispitanica. Analizom razlika u distribuciji morfometrijskih parametara po gradusu izdvaja se značajan, stupnjevit porast mjerenih značajki s porastom gradusa. Gradus je odgovoran za prosječno tek 26, odnosno 35% varijance morfometrijskih obilježja stanice i jezgre. Glavninu varijance obilježja čine interindividualne razlike, odnosno heterogenosti među ispitanicima unutar gradusa, uz minimalne intraindividualne varijacije. Minimalnu, trenutno nedefiniranu, veličinu uzorka potrebitu za morfometrijsku analizu normirali smo na 100 stanica po uzorku, budući da ista jamči usku marginu greške. ZAKLJUČAK: Citološko gradiranje aspirata karcinoma dojke reproducibilno je i neovisno o iskustvu morfologa te dobro korelira s histološkim gradusom. Posljedično tome predstavlja koristan parametar u predviđanju histološkog gradusa, odnosno biološkog ponašanja tumora. Gradiranje morfometrijskom metodom statistički je značajno, ali zbog niskog udjela gradusa u varijanci morfometrijskih obilježja, odnosno širokog raspona preklapanja morfometrijskih parametara među gradusima, morfometrija kao metoda nema diskriminacijsku nego samo indikativnu sposobnost.AIM: The aim of this study was to evaluate the cytological and morphometrical grading of breast cancer and to estimate the possibility of routine use of cytologic grading with or without morphometric analysis, instead of estimating the tumor grade only on histologic material; to estimate reproducibility, consistency and variability of grading techniques among cytologists and also to describe the biological variability of morphometric parameters within and between grades and to determine the minimum, currently undefined, of sample size required for morphometric analysis. MATERIAL AND METHODS: Forty five patients with histologically confirmed invasive breast carcinoma, treated in General Hospital Dr. J. Bencevic in 2012, were selected in the present study. Grading of breast carcinoma was done according to the Robinson’s method by three independent observers on two occasions. Histological grading was performed using Elston's modified Bloom Richardsons' scoring. Morphometric analysis was performed by means of the SFORM software. RESULTS: The agreement between observers in determining the cytological grade and it's comparison with histological grade was estimated with Kendall T-B test. T values ranged from 0.64 to 0.82. T values between standard observer (the one with highest volume of examined breast specimens) and the other two observers (interobserver varability) ranged from 0.45 to 0.85 for cytological grading. Agreement between the individual observer at the repeated cytological grading (intraobserver variability) ranged from 0.57 to 0.79. Dijagnostička/prognostička vrijednost citološkog sustava gradiranja po Robinsonu i morfometrijska objektivizacija u određivanju gradusa invazivnog karcinoma dojke 83 SUMMARY With increasing tumor grade we observed the decrease of progesterone receptors expression , significant increase in the expression of the proliferation marker Ki-67, higher pT stage, and large proportion of postmenopausal women. By analyzing differences in the distribution of morphometric parameters by grade we observed a significant, gradual increase in the measured characteristics with increasing grade. Gradus is responsible for an average of 26 or 35% of the variance of morphometric characteristics of cells and nuclei. The majority of the variance features make interindividual differences or heterogeneity among respondents within the grade. Minimal sample size which is currently undefined and not standardized and was needed for morphometric analysis, was normalized to 100 cells per sample, since the same guarantees a narrow margin of error. CONCLUSION: Cytological grading of aspirates of breast cancer is reproducible and independent of experience of morphologist and correlates well with established histological grade and as such can be predictor of histologic grade and provide relevant information about the biological behavior of invasive breast cancer. Morphometric grading method is statistically significant but due to low proportion of grade in variance of morphometric features and a wide range of overlapping morphometric parameters among grades differences, morphometry as a method does not have discriminatory but just indicative capacity

Morphometry of tumor cells in different grades and types of breast cancer [Morfometrija tumorskih stanica kod različitih gradusa i tipova karcinoma dojke]

The aim of the study was to compare morphometric characteristics of different types and grades of breast cancer. Morphometric analysis was performed using the SFORM software (Vamstec, Zagreb) on the May-Grünwald-Giemsa stained fine needle aspiration cytology (FNAC) breast tissue specimens. The study included 42 patients diagnosed with breast carcinoma by breast smear FNAC at Merkur University Hospital during the 2001–2005 period. Postoperative tumor histopathology and semi-quantitative tumor grading by the method of Elston and Ellis1 showed invasive ductal carcinoma grade I in 10, invasive ductal carcinoma grade II in 9, invasive ductal carcinoma grade III in 13, and invasive lobular carcinoma in 13 patients, the latter also including a subtype of invasive tubulolobular carcinoma. The following parameters were assessed by use of Statistica 7.1 and c 2-test: tumor area, circumference, maximal radius, minimal radius, convexity, length, width, elongation, nucleus/cytoplasm ratio, and shape factor. Morphometric analysis yielded statistically significant differences among all study groups (p<0.001). Morphometric parameters showed significant individual correlation with tumor type and grade, whereby the area, convexity and circumference were most significant at both nuclear and cellular level

Papa test - Sa ili bez vaginalnog razmaza?

The aim of this study was to evaluate medical and economic justification of vaginal smears as a part of primary screening for cervical carcinoma and its precursors. Study included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were examined at Department of clinical cytology of University Hospital Center Osijek from 2003 till 2008. There were 12.639 (5.2%) abnormal findings, and they were divided into three groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E). These three groups were analysed in respect to cytological differential diagnosis and age of participants. It was estimated how many women could be additionally included in the screening, if vaginal smear would be included in the Pap test only after 50 years of age. In 6.9% of cytologically diagnosed lesions abnormal cells were found exclusively in vaginal smears (0.35% of all findings). As for squamous cell lesions, 91.2% were mild lesions (ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively by vaginal smear in either woman under 50 years of age, while in women over 50 years of age it was diagnosed in 2.3% of cases. Exclusively by vaginal smear was diagnosed 3.9% of all AGC and 6.3% of adenocarcinoma, while in 85.0% of glandular epithelium lesions abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is only 10.3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show that taking of vaginal smears along with cervical and endocervical smears as a part of primary screening for cervical carcinoma and its precursors in women under 50 years of age is not justifiable, since vaginal smear only has a role in detection of endometrial carcinoma that are extremely rare in younger age groups. If vaginal smear would be taken only in women over 50 years of age, additional 37.7% of women under 50, or 25.1% women over 50 years of age could be included in the screening.Cilj ove studije bio je procijeniti medicinsku i ekonomsku opravdanost uzimanja vaginalnog razmaza u sklopu primarnog probira cervikalnog karcinoma i njegovih prekursora. U studiju je uključeno 245.408 ispitanica čiji su VCE (vaginalni, cervikalni, endocervikalni) razmazi bili pregledani na Odjelu za kliničku citologiju Kliničkog bolničkog centra Osijek od 2003. do 2008. godine. Abnormalnih je nalaza bilo 12.639 (5,2%), a podijeljeni su u tri skupine: abnormalne stanice nađene samo u vaginalnom razmazu (V), abnormalne stanice nađene u vaginalnom i bar u još jednom razmazu (V+) i abnormalne stanice nisu nađene u vaginalnom razmazu (C/E). Te su tri skupine analizirane u odnosu na citološku diferencijalnu dijagnozu i životnu dob ispitanica. Procijenjeno je koliko bi se `ena moglo dodatno obuhvatiti probirom ukoliko bi se vaginalni razmaz uključio u PAPA test tek nakon pedesete godine života. U 6,9% citološki dijagnosticiranih lezija abnormalne su stanice nađene isključivo u vaginalnim razmazima (0,35% svih nalaza). Kod lezija pločastog epitela u 91,2% slučajeva radilo se o lakšim lezijama (ASC i LSIL). Invazivni pločasti karcinom isključivo vaginalnim razmazom nije dijagnosticiran niti u jedne žene mlađe od 50 godina, dok je u žena starijih od 50 godina dijagnosticiran u 2,3% slučajeva. Isključivo vaginalnim razmazom otkriveno je 3,9% svih AGC i 6,3% adenokarcinoma, dok kod 85,0% lezija žljezdanog epitela abnormalne stanice nisu nađene u vaginalnim razmazima. Dvije trećine adenokarcinoma dijagnosticiranih isključivo vaginalnim razmazom čini adenokarcinom endometrija, no to je samo 10,3% svih PAPA testom dijagnosticiranih endometralnih karcinoma. Iz navedenih se rezultata može zaključiti da čenama mlađim od pedeset godina nema opravdanja uz cervikalni i endocervikalni uzeti i vaginalni razmaz u sklopu primarnog probira cervikalnog karcinoma i njegovih prekursora, budući da vaginalni razmaz ima ulogu jedino u detekciji endometralnih karcinoma koji su u mlađim dobnim skupinama izuzetno rijetki. Ukoliko bi se vaginalni razmaz uzimao samo ženama starijim od 50 godina moglo bi se dodatno pregledati još 37,7% žena mlađih od 50 godina, ili 25,1% žena starijih od 50 godina

Value of Cytology in Small Cell Lung Carcinoma Diagnostic – Single-Center Study

Small cell carcinoma of the lung (SCLC) together with the large cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC), and atypical carcinoid (AC) make a group of morphologically identifiable neuroendocrine tumors. The differential diagnosis of SCLC includes, first of all, other neuroendocrine tumors, and primary or metastatic non-small cell carcinomas. Although the criteria for the morphologic separation from other tumors of the lung are defined, in everyday practice it can be a problem, both in cytology and with histological samples. Accurate and early differentiation of the SCLC is important because it exhibits aggressive behavior, rapid growth, early spread to distant sites, but also exquisite sensitivity to chemotherapy and radiation. The study included 127 patients who underwent bronchoscopic examination or percutaneous transthoracic fine-needle aspiration (PTTFNA) during the period from early 2003 to 2007 in University Hospital Center Osijek whose cytological diagnosis was SCLC. The value of cytological diagnosis was determined by comparing it with histological findings obtained from a biopsy sample during bronchoscopy or on a resection specimen in 50 patients. In the remaining 77 patients, histological verification of cytological diagnosis was not made and the patients were treated based on cytological diagnosis of small cell carcinoma. In 76% of cases (38/50) cytological diagnosis of small cell lung carcinoma was also confirmed histologically. In 8% of cases (4/50) adenocarcinoma was histologically confirmed, in 10% (5/50) of the cases the squamous carcinoma was confirmed, and there was one case of urothelial carcinoma, one case of sarcoma and one undifferentiated carcinoma. Cytological diagnosis of SCLC was made in all cases in a brush smear while the catheter aspirate was positive in only 32 cases (25,8%). Median survival in the group of patients with histologically confirmed small cell cancer was 238 days, for women 250 days, and for men 237 days. Cumulative survival was 63,2% for 6 months, 26,3% for 12 months, 13,2% for 18 months and 7,9% for two years. In conclusion, cytology is a reliable and relatively non-invasive method for patients. Our results confirm that there is a good correlation between cytology and histology diagnoses, especially when it comes to malignant lesions. In determining the type of tumor cytology must be supported with additional methods, especially in cases when it is not possible to take samples for histological verification

Citodijagnostika karcinoma malih stanica pluća

Small cell carcinoma of the lung (SCLC) together with the large cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC), and atypical carcinoid (AC) make a group of morphologically identifiable neuroendocrine tumors. The differential diagnosis of SCLC includes, first of all, other neuroendocrine tumors, and primary or metastatic non-small cell carcinomas. Although the criteria for the morphologic separation from other tumors of the lung are defined, in everyday practice it can be a problem, both in cytology and with histological samples. Accurate and early differentiation of the SCLC is important because it exhibits aggressive behavior, rapid growth, early spread to distant sites, but also exquisite sensitivity to chemotherapy and radiation. The study included 127 patients who underwent bronchoscopic examination or percutaneous transthoracic fine-needle aspiration (PTTFNA) during the period from early 2003 to 2007 in University Hospital Center Osijek whose cytological diagnosis was SCLC. The value of cytological diagnosis was determined by comparing it with histological findings obtained from a biopsy sample during bronchoscopy or on a resection specimen in 50 patients. In the remaining 77 patients, histological verification of cytological diagnosis was not made and the patients were treated based on cytological diagnosis of small cell carcinoma. In 76% of cases (38/50) cytological diagnosis of small cell lung carcinoma was also confirmed histologically. In 8% of cases (4/50) adenocarcinoma was histologically confirmed, in 10% (5/50) of the cases the squamous carcinoma was confirmed, and there was one case of urothelial carcinoma, one case of sarcoma and one undifferentiated carcinoma. Cytological diagnosis of SCLC was made in all cases in a brush smear while the catheter aspirate was positive in only 32 cases (25,8%). Median survival in the group of patients with histologically confirmed small cell cancer was 238 days, for women 250 days, and for men 237 days. Cumulative survival was 63,2% for 6 months, 26,3% for 12 months, 13,2% for 18 months and 7,9% for two years. In conclusion, cytology is a reliable and relatively non-invasive method for patients. Our results confirm that there is a good correlation between cytology and histology diagnoses, especially when it comes to malignant lesions. In determining the type of tumor cytology must be supported with additional methods, especially in cases when it is not possible to take samples for histological verification.Karcinom malih stanica pluća (SCLC) klasificira se u skupinu neuroendokrinih tumora pluća. Iako su kriteriji za njegovo morfološko odjeljivanje od ostalih tumora pluća dobro definirani, u praksi to može predstavljati problem, kako u citologiji tako i na histološkim uzorcima. Važnost točnog i ranog diferenciranja karcinoma malih stanica leži u njegovom agresivnom ponašanju, rapidnom rastu i stvaranju udaljenih metastaza, ali jednako tako i njegovoj osjetljivosti na kemoterapiju i zračenje. U studiju je uključeno 127 pacijenata kojima je u razdoblju od početka 2003. do kraja 2007. godine učinjen bronhoskopski pregled ili transtorakalna punkcija te je citološka dijagnoza bila karcinom malih stanica. Vrijednost citološke dijagnoze karcinoma malih stanica utvrđena je usporedbom s histološkom dijagnozom donesenom na bioptičkom ili resekcijskom materijalu. U 76% slučajeva (38/50) citološka dijagnoza SCLC je potvrđena i histološki. U 8% slučajeva (4/50) histološki je potvrđen adenokarcinom, 10% slučajeva (5/50) pločasti karcinom, a u po jednom slučaju metastaza karcinoma prijelaznih stanica i sarkoma te nediferencirani karcinom. U ostalih 77 pacijenata (77/ 127; 60,6%) nije učinjena patohistološka verifikacija te su oni liječeni u skladu s kliničkom prosudbom i citološkom dijagnozom SCLC. Citološka dijagnoza SCLC postavljena je kod svih slučajeva na brisu četkicom dok je kateter aspirat bio pozitivan samo u 32 slučaja (26%). Prosječno preživljenje pacijenata od prve citološke dijagnoze u grupi pacijenata s histološki potvrđenim SCLC iznosilo je 238 dana, za žene prosječno 250 dana, a za muškarce prosječno 237 dana. Zaključno, citologija je jednako vrijedna metoda kao i histologija u određivanju prisustva maligne bolesti, ali u određivanju tipa tumora potrebno ju je nadopuniti dodatnim metodama, prije svega imunocitokemijom, osobito u slučajevima kada nije moguće dobiti histološki uzorak

Diagnostic Value of Cytology of Voided Urine

There are 961 new cases and approximately 366 deaths from urothelial carcinoma registered annually in Croatia. Exfoliative urinary cytology has important role in detection of high grade urinary tumors, invasive and in situ lesions respectively. In contrast to cystoscopy and biopsy, cytology is a noninvasive method which is easily repeated. The aim of this retrospective study was to assess value of urinary cytology in our institution. For this purpose only patients with histological diagnosis and clinical follow up were considered. There were 138 urine specimens with cytological diagnosis of dyskaryosis, suspicious for malignancy or malignant and histology and follow up data examined at our Department of Clinical Cytology between 2004 and 2011. Cytological diagnosis suspicious for malignancy and malignant were considered positive and the results were correlated with histological diagnosis according to the WHO histological classification of tumors of the urinary tract. Patients with negative histological findings were followed for the next two years. The positive predictive value of cytological detection of malignant urothelial lesions was 91.8%. In 10 cases cytological diagnosis of malignancy was not confirmed histologically or clinically which makes the total of 8.2% of false positive reports. Of the total of detected malignant urothelial lesions 90.9% are high grade lesions and only 9.1% low-grade lesions; 67.3% are invasive lesions and 32.7% non-invasive lesions. Cytological findings of dyskariotyc cells requires further urological investigation because such findings in further processing prove the presence of tumor in 93.8% of cases. In conclusion: cytology is very good diagnostic tool for detection of high grade invasive and noninvasive carcinomas of the urinary tract. In order to make it more efficient we need to study its limits carefully, define diagnostic criteria and reach consensus in nomenclature

Hepatocellular carcinoma and impact of aflatoxin difuranocoumarin derivative system: A case report

Introduction. Hepatocellular carcinoma (HCC) is the most frequent type of liver malignancy. As a carcinogen, aflatoxin B1 (AFB1) causes HCC by inducing deoxyribonucleic acid adducts that lead to genetic changes in liver cells and may be the cause of HCC in up to 30% of cases. The incidence of HCC has been on the rise and is an issue in the countries of the Western Balkans. Case Outline. This paper presents a case of a 37-year-old woman who was diagnosed with HCC, without hepatitis B, hepatitis C, or liver cirrhosis. The patient consumed milk and dairy products in quantities of over two liters per day over the course of 20 years, which indicates the impact of aflatoxin in milk on HCC. A positive signal for the presence of AFB1 was detected by ELISA (enzyme-linked immunosorbent assay) in-house using immunoperoxidase screening test. Conclusion. As carcinogenic difuranocoumarin derivative, aflatoxin B1 is the most likely cause of malignant transformation of hepatocytes, which resulted in hepatocellular carcinoma in this patient