Direct comparison of liquid-based and smear-based cytology with and without rapid on-site evaluation for fine needle aspirates of thoracic tumors

Our plain-English summary of Direct comparison of liquid-based and smear-based cytology with and without rapid on-site evaluation for fine needle aspirates of thoracic tumors, by A. Mfokazi, C.A. Wright, M. Louw, et al (Diagnostic Cytopathology, 2016).

The study

• Authors: A. Mfokazi, C.A. Wright, M. Louw, F. Von Groote-Bidlingmaier, P.T. Schubert, C.F. Koegelenberg, A.H. Diacon
• Journal: Diagnostic Cytopathology
• Published: 2016;44(5):363-8
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Liquid-based cytology (LBC) and rapid on-site evaluation (ROSE) are proposed to improve the quality of fine needle aspirates (FNA) and their diagnostic yield compared with conventional smear cytology (CSC). This prospective study directly compared outcomes of sonar-guided FNA of thoracic tumors supported by LBC, CSC, or CSC with ROSE.

Methods: Three aspirates each for both LBC and CSC with separate 22G spinal needles in a randomized, alternating sequence during 64 transthoracic FNA of thoracic tumors were collected. Smears were prepared by cytology staff on site but evaluated with ROSE only when all six samples had been collected. If no diagnostic material was found on the first three CSC additional needle passes guided by ROSE were performed.

Results: Final diagnoses were non-small cell lung cancer in 50 (78.1%), small cell lung cancer in 11 (17.2%), mesothelioma in 1 (1.6%), and inflammation in 2 cases (3.1%), respectively. LBC and CSC were diagnostic in 42 (65.6%) and 49 (76.6%) cases, respectively (P = 0.039), with both methods diagnostic in 41 cases (64.1%). Fifteen cases (23.4%) remained undiagnosed following three passes for CSC but 9 (14.1%) of these were diagnosed using FNA and ROSE with a total yield of 58 cases (90.6%; P < 0.001).

Conclusion: The diagnostic yield of transthoracic FNA submitted for LBC is significantly lower than with CSC when slides are prepared professionally. ROSE significantly increases the yield of transthoracic FNA.

© 2016 Wiley Periodicals, Inc.

In plain English

This prospective, randomized study from Tygerberg, South Africa compared ways of preparing fine needle aspirates of thoracic tumors. The samples were taken with ultrasound guidance through the chest wall in 64 consecutive biopsies from February to December 2012. In each procedure, three needle passes went into a liquid preservative (liquid-based cytology) and three were smeared directly onto slides (conventional smear cytology), in random alternating order. Smears were checked on site (rapid on-site evaluation) only after all six passes, and extra passes were made if no diagnostic material was found. Conventional smears were diagnostic in 49 cases (76.6%) and liquid-based samples in 42 (65.6%), P = 0.039. Further passes guided by on-site evaluation diagnosed 9 more cases, raising the yield to 58 (90.6%; P less than 0.001). One case was a malignant mesothelioma. On cytology alone it would have been classified as adenocarcinoma, and it was identified on core biopsy histology. The authors concluded that smears with on-site evaluation gave the highest yield, and that liquid-based cytology is a viable alternative where no trained staff are available. The study did not examine asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective, randomized, single-center diagnostic comparison of specimen preparation methods (liquid-based cytology vs conventional smear cytology, with and without rapid on-site evaluation)
• Who was studied: 64 consecutive ultrasound-guided transthoracic fine needle aspiration biopsies of thoracic masses in adult patients, one patient biopsied twice at different sites, February to December 2012, Stellenbosch University and Tygerberg Academic Hospital, South Africa
• Exposure: No asbestos or other exposure was studied. The study compared specimen handling: three needle passes into BD CytoRich Red preservative for liquid-based cytology, three passes smeared on site for conventional smear cytology, and additional passes guided by rapid on-site evaluation when needed.
• Main results:
  • Within the six randomized passes without on-site evaluation, conventional smear cytology was diagnostic in 49 of 64 cases (76.6%) and liquid-based cytology in 42 (65.6%); the article reports P = 0.039 for this difference.
  • Both methods were diagnostic in 41 cases (64.1%). Conventional smears alone were diagnostic in 8 cases and liquid-based cytology alone in 1 case.
  • Of 15 cases (23.4%) undiagnosed after the first three smear passes, 9 (14.1%) were diagnosed with additional passes and on-site evaluation. This raised the smear yield from 49 to 58 cases (76.6% to 90.6%; P less than 0.001).
  • Six cases (9.4%) remained undiagnosed by the study procedure. Four were diagnosed by a repeat transthoracic cytological procedure, and one each by transbronchial needle aspiration and by transthoracic core biopsy.
  • One case of malignant mesothelioma showed no distinctive mesothelial features on cytology and would have been classified as adenocarcinoma. A core biopsy requested on site showed mesothelioma on histology.
  • In one case, liquid-based cytology showed adenocarcinoma while the conventional smear showed small cell carcinoma. The case was reported as small cell carcinoma after ancillary tests.
• The authors' conclusion: The authors concluded that conventional smear cytology with rapid on-site evaluation gave the highest diagnostic yield. They also concluded that smears prepared by trained staff were superior, but that liquid-based cytology is a viable alternative when no trained personnel are available.
• Limitations the authors state:
  • Because of the single-center design, the study could not measure how liquid-based cytology and smears compare when prepared without specialist support.
  • The authors' own experience with liquid-based cytology was limited. They speculated that the poorer cellularity of the liquid-based slides might have been remedied by aspirating more material.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytology, Aspirate, Non-Small Cell Lung Cancer, Small Cell Lung Cancer, Mesothelioma, Inflammation.

Related studies

• p40 is the best marker for diagnosing pulmonary squamous cell carcinoma: comparison with p63, cytokeratin 5/6, desmocollin-3, and sox2 — T. Tatsumori, K. Tsuta, et al. (2014)
• Thoracic splenosis diagnosed by fine-needle aspiration cytology: a case report — S. Syed, P. Zaharopoulos (2001)
• Fine-needle aspiration cytology of localized fibrous tumor of pleura — D. Dusenbery, M.M. Grimes, et al. (1992)
• Well-differentiated papillary mesothelioma of the peritoneum: a diagnostic dilemma on fine-needle aspiration cytology — J.G. Nasit, G. Dhruva (2014)
• Fine needle aspiration cytology of well-differentiated papillary mesothelioma: a case report — Y. Gong, R. Ren, et al. (2005)
• Fine needle aspiration cytology in malignant mesothelioma of the tunica vaginalis testis — R. Gupta, P. Dey, et al. (2011)

Browse more research in Diagnostic Cytopathology, or return to medical research.