Journal of Cytology最新文献

{"title":"Application of the Newer 2023 Bethesda System for Reporting Cytopathology of Thyroid Nodules and Estimating their Risk of Malignancy.","authors":"Sushma Bharti, Renu Singh, Manupriya Sharma","doi":"10.4103/joc.joc_33_25","DOIUrl":"10.4103/joc.joc_33_25","url":null,"abstract":"<p><strong>Introduction: </strong>Thyroid swellings are among the most common clinical presentations, yet not all cases necessitate surgical intervention. Fine-needle aspiration cytology (FNAC) is a widely accepted, minimally invasive diagnostic method that reduces the need for unnecessary surgeries and guides appropriate clinical management. This study is important as it provides population-specific data on the diagnostic accuracy of FNAC and evaluates the risk of malignancy (ROM) and risk of neoplasm (RON) in thyroid nodules (TNs) using the latest Bethesda System for Reporting Thyroid Cytopathology (2023 edition). By systematically categorizing thyroid lesions, the study offers insights into effective risk stratification and supports evidence-based, cost-efficient approaches to patient care.</p><p><strong>Materials and methods: </strong>A retro-prospective study was conducted over 2 years, enrolling 111 patients with TNs, after obtaining approval from the institutional ethical committee. FNAC was performed on all cases. Smears were stained with Papanicolaou and Giemsa stains and categorized according to the Bethesda classification. Statistical analysis was conducted using IBM Statistical Package for the Social Sciences statistics (version 21.0), and Fisher's exact test was applied.</p><p><strong>Results: </strong>This study demonstrated a sensitivity of 83.33%, specificity of 100%, and diagnostic accuracy of 90.24%. The positive predictive value was 100%, and the negative predictive value was 80.95%. ROM was 0% in Category I, 19.4% in Category II, and 100% in Categories IV, V, and VI. The overall RON was 21.62%. Papillary thyroid carcinoma was the most common malignancy observed.</p><p><strong>Conclusion: </strong>FNAC remains a highly effective and accessible tool for diagnosing thyroid lesions, particularly when combined with rapid on-site evaluation and cell block preparation. It enables accurate categorization, risk stratification, and a more individualized, cost-effective approach to the management of TNs.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 2","pages":"74-83"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Fascinating Realm of Crush/Imprint Cytology: A Window into Cellular Diagnosis.","authors":"Swati B Gadhave, Saroj Gaikwad, Sonali Datar, Amit Agrawal, Balwant Kowe","doi":"10.4103/joc.joc_68_25","DOIUrl":"10.4103/joc.joc_68_25","url":null,"abstract":"<p><strong>Background: </strong>Crush/imprint cytology, a diagnostic technique within the realm of cytological examinations, has emerged as a powerful tool for rapid and minimally invasive tissue evaluation. Its simplicity, cost-effectiveness, and rapidity make it indispensable in pathology practice.</p><p><strong>Aims and objectives: </strong>The aims and objectives were as follows: (1) to evaluate the diagnostic utility of crush/imprint cytology and (2) to correlate cytomorphological and histopathological (HP) findings for comprehensive diagnostic evaluation.</p><p><strong>Materials and methods: </strong>This prospective study was carried out in a tertiary health care hospital for a period of 1 year, and 56 cases were included in this study. Both benign and malignant lesions from different organ systems were included in this study. The cytological diagnosis was correlated with HP diagnosis to evaluate the sensitivity and specificity of crush cytology.</p><p><strong>Results: </strong>This study showed a male predominance (69%). Most lesions were from the respiratory system (33.33%), followed by head and neck (24.07%), lymphoreticular system (16.66%), gastrointestinal system (11.11%), skin (9.25%), and genitourinary system (5.55%). Malignant lesions showed good (44%) cell yield on crush/imprint cytology. The sensitivity was 100%, with 94.12% specificity for detecting benign and malignant lesions, and the overall diagnostic accuracy was 98.15%.</p><p><strong>Conclusion: </strong>The crush/imprint cytology stands as a cornerstone in the realm of cellular diagnosis, offering a rapid, cost-effective, and minimally invasive approach to evaluating tissue specimens. It is an indispensable tool in intraoperative diagnostics, offering rapid and accurate assessments of tissue pathology. It acts as a good complement to histopathology and can be of benefit for rapid preliminary diagnosis and intraoperative surgical management planning. Its use is highly recommended routinely.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 2","pages":"90-97"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutional Study on Unsatisfactory Pap Smears: Causes and Clinical Impact.","authors":"Santosh Tummidi, Varsha Kalambul Vijayalal, Souvik Bhattacharya, Indranil Chakrabarti, Subrat Panda","doi":"10.4103/joc.joc_107_25","DOIUrl":"10.4103/joc.joc_107_25","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical cancer screening using cervical Papanicolaou (Pap) smears has been well established since the mid-20th century. Specimen adequacy is considered the most relevant quality assurance component since the invention of the Bethesda system for reporting cervical cytology. Cervical smears that are reported as unsatisfactory (US) can significantly delay diagnosis and increase the risk of cancer in follow-up tests. They also lead to unnecessary use of resources.</p><p><strong>Materials and methods: </strong>The cases signed out as US for one and half year duration in the cytology laboratory were retrieved, and demographic details were collected.</p><p><strong>Results: </strong>Among the 4,139 Pap tests accepted and reported for the period, 240 (5.8%) were signed out as US. The ratio of conventional to ThinPrep smears was 2.4:1. 70% cases were conventional Pap smears. 66% (159/ 240) cases of the patients were in the fourth and fifth decade age group. Low squamous cellularity was the most common cause (80%) of US smears, obscured by inflammation (12%); other causes were obscuration by blood (0.8%) and mucus (0.4%), drying artifacts (1.6%) and cytolysis (0.4%).</p><p><strong>Discussion and conclusion: </strong>US smears largely depend on various factors, that is, the expertise of the person taking a sample, the date of collection in the menstrual cycle, the method of sampling, sampling devices and staining procedures. The variability in sample collection, including occasional collection by personnel with inadequate training, may also have contributed to the US smears. The result of our study is expected to have a significant impact on proper sampling and the use of adequate quality control measures. In addition, through our follow-up data, we could emphasize the importance of follow-up and human papilloma virus co-testing in patients with US smears.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 2","pages":"63-73"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Neutrophils with Bright Green Inclusion Bodies in Abdominal Drainage Fluid.","authors":"Zhuomei Chen, Xinping Liang, Zhenni Wang","doi":"10.4103/joc.joc_112_24","DOIUrl":"10.4103/joc.joc_112_24","url":null,"abstract":"","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 2","pages":"115-117"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Cytokeratin Fragment Antigen 21-1 Estimation in Fine-Needle Aspiration Washout Specimens in Diagnosis of Axillary Breast Cancer Metastasis.","authors":"Mohit Jadli, Gaurav Rajendra Shirsath, Akanksha Gupta, Erna Ahsan, Farhanul Huda, Nilotpal Chowdhury","doi":"10.4103/joc.joc_112_25","DOIUrl":"10.4103/joc.joc_112_25","url":null,"abstract":"<p><strong>Introduction: </strong>Fine-needle aspiration biopsy (FNAB) is a valuable technique for diagnosing axillary breast cancer metastasis. However, its sensitivity can sometimes be affected by sampling errors and technical artifacts.</p><p><strong>Aim: </strong>We examined whether cytokeratin fragment antigen 21-1 (CYFRA) estimation by manual enzyme-linked immunosorbent assay (ELISA) on FNAB needle washouts could add diagnostic information to FNAB.</p><p><strong>Materials and methods: </strong>This cross-sectional study involved FNAB from 138 lymph nodes in 108 suspected breast cancer patients. Papanicolaou and May-Grünwald-Giemsa smears were prepared for cytological examination. CYFRA was estimated by manual ELISA from fine-needle washouts after smear preparation. A cut-off of 1.93 ng/mL was considered to be a positive test for CYFRA.</p><p><strong>Results: </strong>The CYFRA estimates were significantly associated with the FNAB results (<i>P</i> < 0.001 by Kruskal-Wallis test). On FNAB, 84, 5, 36, and 13 cases were classified as malignant, suspicious, benign, and inadequate, respectively. CYFRA was reported as positive in 92 cases (75 in malignant FNAB, 3 in suspicious FNAB, 11 in benign FNAB, and 3 in inadequate FNAB). Six of 11 CYFRA positives in benign FNAB were confirmed by re-examination of cytology slides; the remaining 5 CYFRA-positive cases did not have further biopsy. Only two inadequate FNAB had histopathology follow-up; both revealed metastasis, of which one was CYFRA positive. Sensitivity and specificity with 95% confidence intervals of CYFRA for detecting axillary metastasis were 0.876 [0.794, 0.934] and 0.833 [0.653, 0.954], respectively.</p><p><strong>Conclusion: </strong>CYFRA estimation by manual ELISA is a simple and accurate test which supplements and enhances the diagnostic usefulness of axillary FNAB in suspected breast cancer metastasis.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 2","pages":"84-89"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elusive Cytomorphology of a <i>Medicopsis romeroi</i> Subcutaneous Abscess: A Case Report of Phaeohyphomycosis.","authors":"Ashish C Philip, Garima Garima, Nadeem Tanveer, Gargi Rai, Shukla Das, Sonal Sharma","doi":"10.4103/joc.joc_153_24","DOIUrl":"10.4103/joc.joc_153_24","url":null,"abstract":"","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 2","pages":"111-114"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Cell Carcinoma Metastasis to Cervical Lymph Node: An Unusual Phenomenon Diagnosed by Fine-Needle Aspiration.","authors":"Lokeswari Srinivasan, Soundarya Ravi, Debasis Gochhait, Neelaiah Siddaraju","doi":"10.4103/joc.joc_7_24","DOIUrl":"10.4103/joc.joc_7_24","url":null,"abstract":"<p><p>The fine-needle aspiration (FNA) technique has emerged as a rapid diagnostic modality in diagnosis of metastatic tumors of unknown primary. Renal cell carcinoma (RCC) is well known for its potential to metastasize to remote sites. However, RCC primarily presenting with cervical lymph node metastasis is an unusual phenomenon. Herein, we describe a case of RCC with cervical lymph node metastasis as the initial clinical presentation, which was diligently diagnosed in FNA smears by appreciating the classic cytomorphological features and with wise use of an immunocytochemical panel.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 2","pages":"107-110"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver Reproducibility of the IAC Yokohama System for Breast FNAC: A Multirater Kappa Agreement Study.","authors":"Savita Agarwal, Sunita Kumari Meena, Ruovinuo Sachu, Pinki Pandey, Beant Kaur, Siddique Anam Irfan Ahmad, Jyotika, Shraddha Tewari","doi":"10.4103/joc.joc_120_25","DOIUrl":"10.4103/joc.joc_120_25","url":null,"abstract":"<p><strong>Background: </strong>The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Cytopathology (IAC YSRB) aims to standardize breast fine needle aspiration cytology (FNAC) reporting by categorizing cytologic findings into five diagnostic groups. IAC YSRB is widely adopted; however, its reproducibility among cytopathologists with varying experience, especially in intermediate categories, remains a concern.</p><p><strong>Objective: </strong>To assess the interobserver reproducibility of the IAC YSRB among four cytopathologists using archived breast FNAC cases.</p><p><strong>Materials and methods: </strong>This retrospective study included 239 breast FNAC cases reported in 2022 at a tertiary care center. Four cytopathologists with 20, 14, 5, and 3 years of experience independently reviewed smears and assigned each case to one of five IAC YSRB diagnostic categories. Observers were blinded to prior diagnoses and one another's assessments. Interobserver agreement was analyzed using Fleiss' kappa (<i>κ</i>) and pairwise <i>κ</i> values, with category-wise and overall concordance calculated.</p><p><strong>Results: </strong>Overall interobserver agreement was substantial (<i>κ</i> = 0.69). The highest agreement was observed for malignant (<i>κ</i> = 0.95) and benign (<i>κ</i> = 0.72) categories. Atypical (<i>κ</i> = 0.22) and suspicious (<i>κ</i> = 0.26) categories showed fair agreement. Pairwise comparisons revealed higher concordance between more experienced cytopathologists (<i>κ</i> = 0.80) than less experienced ones. Complete agreement among all four raters was achieved in 81% of cases. Disagreements were mainly concentrated in intermediate categories.</p><p><strong>Conclusion: </strong>IAC YSRB shows good interobserver reproducibility in breast FNAC reporting, particularly in benign and malignant categories. Interpretive variability in intermediate categories highlights the need for training, standardization, and ancillary tools to improve reliability.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 1","pages":"17-23"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ensemble Learning to Categorize the Bethesda System of Reporting of Cervical Cytology.","authors":"Pranab Dey","doi":"10.4103/joc.joc_130_25","DOIUrl":"10.4103/joc.joc_130_25","url":null,"abstract":"<p><strong>Aims and objectives: </strong>To evaluate the performance of a soft-voting ensemble deep learning (DL) model incorporating five transfer learning (TL) architectures for categorizing cervical smears according to the Bethesda system.</p><p><strong>Materials and methods: </strong>A total of 259 cervical cytology cases processed by SurePath liquid-based cytology were included, yielding 1016 representative microphotographs. Images were divided into training (70%), validation (15%), and test (15%) sets. An ensemble model comprising VGG16, ResNet50, InceptionV3, DenseNet121, and MobileNetV2 was trained using TL with soft-voting integration. Diagnostic performance was assessed using standard metrics, including 95% confidence intervals (CI).</p><p><strong>Results: </strong>In the test set, the model correctly classified 27/31 negative for intraepithelial lesions and malignancy (NILM) images and 56/58 carcinoma images. For NILM, the sensitivity was 0.871 (95% CI: 0.72-0.95), specificity 0.977 (95% CI: 0.94-0.99), accuracy 0.956 (95% CI: 0.92-0.98), and area under the curve of receiver operating characteristic (AUROC) 0.98 (95% CI: 0.96-1.00). For carcinoma, the sensitivity was 0.966 (95% CI: 0.88-1.00), specificity 0.960 (95% CI: 0.87-0.99), accuracy 0.962 (95% CI: 0.93-0.99), and AUROC 0.99 (95% CI: 0.98-1.00). Intermediate categories demonstrated variable performance, with lower sensitivity for low-grade squamous intraepithelial lesion (0.20), though the specificity remained high (1.00). Overall, AUROC values were high across all categories (0.93-0.99). Among all the models, the ensemble learning (EL) model had the best performance.</p><p><strong>Conclusions: </strong>The proposed EL approach demonstrates high diagnostic accuracy and excellent discrimination for clinically critical categories such as high-grade squamous intraepithelial lesion (HSIL) and carcinoma. This model highlights the potential of DL-based ensemble frameworks in improving the reliability of cervical cytology interpretation. Larger datasets and whole-slide image analysis may further refine the performance for intermediate-grade lesions.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 1","pages":"39-46"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calvarial Pyramid Presenting as Occult Metastasis of Follicular Thyroid Carcinoma.","authors":"Neha Bhardwaj, Manish Rohilla, Radhika Srinivasan, Treshita Dey, Nagarjun Ballari","doi":"10.4103/joc.joc_6_24","DOIUrl":"10.4103/joc.joc_6_24","url":null,"abstract":"<p><p>Follicular thyroid carcinoma (FTC) is a malignant follicular cell-derived neoplasm with prominent hematogenous spread. Metastases may be the presenting symptom; however, scalp metastasis is uncommon. A 66-year-old woman presented with progressive scalp swelling since 4 years accompanied by bilateral lower limb weakness and incontinence. On examination, there was a large 10-cm parietal scalp mass. Fine-needle aspiration smears prepared from the pyramidal scalp swelling showed microfollicular arrangement of uniform tumor cells. Diffuse positivity for pancytokeratin, PAX 8, and thyroglobulin on cell block immunocytochemistry confirmed the diagnosis of metastatic FTC. fluorodeoxyglucose avid lesions in the right lobe of the thyroid and multiple skeletal lesions were seen on positron emission tomography-computed tomography done subsequently. Despite I-131 treatment, she succumbed to death 6 months post-diagnosis. The index case highlights the utility of fine-needle aspiration cytology and the application of immunocytochemistry on cell blocks changing the norms for diagnosing carcinomas with an unknown primary.</p>","PeriodicalId":50217,"journal":{"name":"Journal of Cytology","volume":"43 1","pages":"54-57"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}