The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience

Our plain-English summary of The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience, by E.D. Rossi, T. Bizzarro, F. Schmitt, et al (Cancer Cytopathology, 2015).

The study

• Authors: E.D. Rossi, T. Bizzarro, F. Schmitt, A. Longatto-Filho
• Journal: Cancer Cytopathology
• Published: 2015;123(4):258-66
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Fine-needle aspiration cytology (FNAC) of serous membrane effusions may fulfil a challenging role in the diagnostic analysis of both primary and metastatic disease. From this perspective, liquid-based cytology (LBC) represents a feasible and reliable method for empowering the performance of ancillary techniques (ie, immunocytochemistry and molecular testing) with high diagnostic accuracy.

Methods: In total, 3171 LBC pleural and pericardic effusions were appraised between January 2000 and December 2013. They were classified as negative for malignancy (NM), suspicious for malignancy (SM), or positive for malignancy (PM).

Results: The cytologic diagnoses included 2721 NM effusions (2505 pleural and 216 pericardic), 104 SM effusions (93 pleural and 11 pericardic), and 346 PM effusions (321 pleural and 25 pericardic). The malignant pleural series included 76 unknown malignancies (36 SM and 40 PM effusions), 174 metastatic lesions (85 SM and 89 PM effusions), 14 lymphomas (3 SM and 11 PM effusions), 16 mesotheliomas (5 SM and 11 SM effusions), and 3 myelomas (all SM effusions). The malignant pericardic category included 20 unknown malignancies (5 SM and 15 PM effusions), 15 metastatic lesions (1 SM and 14 PM effusions), and 1 lymphoma (1 PM effusion). There were 411 conclusive immunocytochemical analyses and 47 molecular analyses, and the authors documented 88% sensitivity, 100% specificity, 98% diagnostic accuracy, 98% negative predictive value, and 100% positive predictive value for FNAC.

Conclusions: FNAC represents a primary diagnostic tool for effusions and a reliable approach with which to determine the correct follow-up. Furthermore, LBC is useful for ancillary techniques, such as immunocytochemistry and molecular analysis, with feasible diagnostic and predictive utility.

© 2015 American Cancer Society.

In plain English

This study from the Agostino Gemelli Hospital in Rome, Italy, reviewed 3171 samples of fluid collected by needle between January 2000 and December 2013. Of these, 2919 came from around the lungs (pleural effusions) and 252 from around the heart (pericardic effusions). The samples were prepared with a liquid-based cytology method (ThinPrep). Leftover material was used for extra staining tests (immunocytochemistry) and, in 47 pleural samples from lung cancer, for EGFR gene testing. Samples were classed as negative (2721), suspicious (104) or positive for malignancy (346). The cancers found in pleural samples included 16 mesotheliomas. There were no false-positive results and 49 false-negative results, 48 of them in pleural samples. For all samples combined, the authors reported 88% sensitivity, 100% specificity and 98% diagnostic accuracy. Ten of the 47 samples tested had EGFR mutations. The authors concluded that combining microscopic evaluation with staining and molecular tests on liquid-based preparations is feasible and reliable. The article did not study asbestos exposure, and some of its figures conflict with one another.

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: single-institution series of cytology samples, assessing the diagnostic performance of liquid-based cytology and ancillary tests
• Who was studied: 3171 pleural (2919) and pericardic (252) fine-needle aspiration samples from 1708 men and 1463 women (median age 48, range 23-92), recorded at the Catholic University "Agostino Gemelli" Hospital, Rome, Italy, January 2000 to December 2013
• Exposure: No asbestos or other environmental exposure was studied. What was studied was a laboratory method: liquid-based cytology (ThinPrep) processing of the samples, with immunocytochemistry and EGFR mutation testing on stored material.
• Main results:
  • All 3171 samples: 2505 pleural and 216 pericardic were negative for malignancy; 93 pleural and 11 pericardic were suspicious; 321 pleural and 25 pericardic were positive
  • No false-positive results; 49 false-negative results (48 among pleural samples classed as negative, 1 pericardic)
  • Pleural and pericardic samples combined: 88% sensitivity, 100% specificity, 98% diagnostic accuracy, 98% negative predictive value, 100% positive predictive value
  • Sensitivity was 87% for pleural samples and 97% for pericardial samples (Table 4)
  • 16 pleural mesotheliomas were diagnosed (5 suspicious, 11 positive in Table 2). They stained positive for CAM 5.2, calretinin, HBME-1 and podoplanin, and negative for TTF-1.
  • Immunocytochemistry was carried out in 411 of 450 suspicious and malignant samples (91.3%)
  • Of 47 pleural positive samples from non-small cell lung cancer tested for EGFR mutations, 10 had mutations
  • In the authors' series, Wilms tumor-1 staining was not specific for separating ovarian metastatic carcinomas from mesotheliomas. CA 125 combined with other markers had good specificity for this.
• The authors' conclusion: The authors concluded that combining microscopic needle-sample evaluation with immunocytochemistry and molecular tests on liquid-based preparations is feasible and reliable. They concluded this combination is the best strategy, especially when morphology alone cannot give a conclusive diagnosis.
• Limitations the authors state:
  • The cases with an unknown primary cancer had no histologic follow-up
  • Liquid-based cytology does not allow samples to be assessed for adequacy or triaged for culture and flow cytometry
  • Nondiagnostic samples had too little material for further slides or ancillary tests

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Cytology, Fine-Needle Aspiration, Molecular Profiling, Mesothelioma, Myeloma.

Related studies

• Ancillary studies in pleural, pericardial, and peritoneal effusion cytology — K.E. Sundling, E.S. Cibas (2018)
• The utility of ancillary techniques in effusion cytology — K.V. Nance, J.F. Silverman (1992)
• Updates in Effusion Cytology — C.M. Lepus, M. Vivero (2018)
• Morphologic and immunocytochemical performances of effusion cell blocks prepared using 3 different methods — X. Jing, Q.K. Li, et al. (2013)
• The value of cytology in distinguishing malignant mesothelioma: An institutional experience of 210 cases reclassified according to the International System for Reporting Serous Fluid Cytopathology (ISRSFC) — P. Straccia, D. Magnini, et al. (2022)
• Accuracy and reproducibility of pleural effusion cytology — A. Fassina, U. Fedeli, et al. (2008)

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