Acta Cytologica

Bashir, Shaarif; Loya, Asif; Hussain, Mudassar; Sheikh, Umer Nisar; Maqbool, Hina; Yusuf, Muhammed Aasim

2024 Acta Cytologica

doi: 10.1159/000541140pmid: 39197434

AbstractIntroduction: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a modern and minimally invasive technique to acquire diagnostic material from within the gastrointestinal tract, as well as from adjacent organs and structures, which can help in the diagnosis and staging of a variety of gastrointestinal malignancies, as well as for non-malignant conditions. Though well described in adults, there is limited literature on the diagnostic utility of EUS-FNA in paediatric patients. The objective of this study was to evaluate the diagnostic accuracy and clinical utility of EUS-FNA in paediatric patients performed at our centre over the last 17 years. Materials and Methods: After obtaining Institutional Review Board approval, 63 cases of paediatric EUS-FNA performed at SKMCH&RC from 2005 to 2022 were retrieved. A 22-gauge EUS-FNA needle was used for obtaining samples with the use of suction (when required). The sample was then smeared onto glass slides, with half being stained with RAPI stain while the rest with the Papanicolaou stain. Demographic details, indication for the procedure, results of rapid on-site adequacy status (ROSE), site of lesion, and cytological diagnosis were reviewed and analysed. Results: Of the 63 patients, 55 (87.3%) had an adequate sample (confirmed on ROSE). Forty-two (66.7%) were male and the mean age was 12.4 years. The most frequent indication of EUS-FNA was a sampling of enlarged lymph nodes (74.6%). The most common sites of nodal aspiration were sub-carinal (33.3%) and celiac lymph nodes (14.3%). EUS-FNA of a pancreatic lesion accounted for an additional 17.5% of cases. Involvement by Hodgkin’s lymphoma was the most common diagnosis (25.4%) followed by granulomatous inflammation (19.1%). Cases of solid pseudo-papillary tumour (4.8%) and recurrent Wilm’s tumour (3.2%) were also diagnosed. No patient suffered complications, and none required hospital admission, post-procedure. The sensitivity, specificity, PPV, and NPV of EUS-FNA were 98.1, 83.3, 96.4, and 90.9%, respectively. Conclusion: EUS-FNA is a safe, well-tolerated, minimally invasive outpatient setting procedure with high sensitivity and significant utility in the diagnosis and staging of disease.

2024 Acta Cytologica

doi: 10.1159/000541139pmid: 39191227

AbstractIntroduction: This study conducts the first meta-analysis to evaluate the diagnostic accuracy and the aggregated risk of malignancy associated with each category of the Papanicolaou Society of Cytopathology (PSC) system for reporting respiratory cytology. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science using the keywords “(Lung, Respiratory specimens) AND (Papanicolaou Society of Cytopathology System).” Articles were assessed for risk of bias using the QUADAS-2 tool. After excluding inadequate samples, sensitivity and specificity for various cut-off points. Summary receiver operating characteristic curves and diagnostic odds ratios were pooled to assess diagnostic accuracy. Results: Five studies, totaling 3,489 cases, were included. Sensitivity and specificity for the “Atypical and higher risk categories” considered positive were 60% (95% CI, 51–68%) and 87% (95% CI, 81–92%), respectively. For the “Suspicious for malignancy and higher risk categories” considered positive, sensitivity and specificity were 49% (95% CI, 40–58%) and 95% (95% CI, 92–97%), respectively. Sensitivity and specificity for the “Malignant” category considered positive for malignancy were 42% (95% CI, 33–52%) and 97% (95% CI, 92–99%), respectively. The pooled area under the curve ranged from 68 to 75% for each cut-off. Conclusion: This meta-analysis underscores the PSC system’s accuracy in reporting respiratory cytology. It highlights the diagnostic importance of the “Suspicious” and “Malignant” categories in identifying malignancy, and the utility of the “Atypical” category for initial screening. These findings support the PSC system’s role in enhancing diagnostic accuracy and clinical decision-making in respiratory cytology.