Kowalewski A, Borowczak J, Choussy O
… +3 more, Lesnik M, Badois N, Klijanienko J
Cancer Cytopathol
· 2025 Sep · PMID 40853710
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BACKGROUND: A comparative analysis of the International Academy of Cytology-International Agency for Research on Cancer-World Health Organization Reporting System for Head and Neck Cytopathology (WHO) and the Milan Syste...BACKGROUND: A comparative analysis of the International Academy of Cytology-International Agency for Research on Cancer-World Health Organization Reporting System for Head and Neck Cytopathology (WHO) and the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was performed. METHODS: A total of 2218 salivary gland fine-needle aspiration samples collected at the Institut Curie, Paris (1954-2022) were evaluated, with 1356 having histological follow-up. Samples were classified according to the MSRSGC (nondiagnostic [ND], nonneoplastic [NN], atypia of undetermined significance [AUS], benign neoplasm [BN], salivary gland neoplasm of uncertain malignant potential [SUMP], suspicious for malignancy [SM], and malignant [M]) and the WHO system (insufficient/inadequate/nondiagnostic, benign, atypical, neoplasm of uncertain malignant potential [NUMP], suspicious for malignancy [SM], and malignant [M]). The risk of malignancy (ROM) was calculated for each category, and diagnostic performance metrics were assessed. RESULTS: In the MSRSGC, the ROM was ND, 50% (n = 2); NN, 16.8% (n = 149); AUS (no cases); BN, 4.3% (n = 514); SUMP, 50% (n = 2); SM, 56.1% (n = 66); and M, 98.2% (n = 623). In the WHO system, the ROM was insufficient/inadequate/nondiagnostic, 50% (n = 2); benign, 7.1% (n = 663); atypical (no cases); NUMP, 50% (n = 2); SM, 56.1% (n = 66); and M, 98.2% (n = 623). The WHO's "benign" category, which combines NN and BN, balanced the NN's higher ROM (16.8%) and BN's lower ROM (4.3%) into 7.1%. Excluding the ND and SUMP/NUMP categories, both systems demonstrated high diagnostic performance: sensitivity, 93.3%; specificity, 93.9%; positive predictive value, 94.2%; and negative predictive value, 92.9%. CONCLUSIONS: Both systems effectively identify malignancy. The WHO system's merger of NN and BN into the benign category streamlines reporting and reduces variability, although it may mask clinically significant differences between nonneoplastic and benign neoplastic lesions.
Sirohi D, Cornelia Ding CK, Stohr BA
… +5 more, Balassanian R, Vohra P, Aggarwal R, Chan E, Greenland NY
Cancer Cytopathol
· 2025 Sep · PMID 40847760
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BACKGROUND: Current American Society of Clinical Oncology guidelines state that patients with metastatic prostate cancer (MPC) should undergo germline and somatic DNA sequencing. The authors examined the utility of next-...BACKGROUND: Current American Society of Clinical Oncology guidelines state that patients with metastatic prostate cancer (MPC) should undergo germline and somatic DNA sequencing. The authors examined the utility of next-generation sequencing (NGS) on fine-needle aspiration (FNA) biopsies in which NGS was performed on cell block (CB) and/or smears. METHODS: A retrospective review was performed of cytology cases with diagnosis of MPC either before and/or after NGS on FNA material. Clinical and NGS data were obtained from the medical record. Androgen receptor, NKX3.1, INSM1, synaptophysin, chromogranin, Rb, PTEN, and Ki67 immunohistochemical stains were performed on CB if not originally done. RESULTS: Slides and NGS data were available for 46 MPC FNA biopsies from 45 patients from 2015 to 2024. Metastatic sites included 20 lymph node, 12 liver, five lung, four soft tissue, two pleura, two bone, and one adrenal gland. Ten patients (22%) had change or potential change in therapy based on NGS results. For one patient with poorly differentiated carcinoma previously thought to be urothelial, a TMPRSS2:ERG fusion confirmed prostatic origin. NGS confirmed lung origin for one patient diagnosed initially as metastatic prostatic adenocarcinoma. For one patient, NGS demonstrated TP53 and RB1 mutations, supporting transformation to high-grade neuroendocrine carcinoma. Change or potential change in therapy was planned for two patients with CDK12 mutations, one with IDH1 mutation, three with BRCA2 mutations, and one with PTEN and TP53 mutations. CONCLUSIONS: NGS on cytology material showed diagnostic and therapeutic utility in a subset of patients, with 10 of 46 patients (22%) having a change or potential in therapy based on NGS results.
Kowalewski A, Borowczak J, Brisse HJ
… +2 more, Choussy O, Klijanienko J
Cancer Cytopathol
· 2025 Sep · PMID 40833868
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BACKGROUND: Soft tissue and bone tumors of the salivary gland were compared using classic 4-tier, Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), and the International Academy of Cytology-International...BACKGROUND: Soft tissue and bone tumors of the salivary gland were compared using classic 4-tier, Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), and the International Academy of Cytology-International Agency for Research on Cancer-World Health Organization (IAC-IARC-WHO) Reporting System for Soft Tissue Cytopathology. METHODS: The authors retrospectively analyzed 2219 salivary gland fine-needle aspiration (FNA) samples collected at the Institut Curie in Paris between 1954 and 2022. A total of 86 cases (3.9%) were identified as soft tissue and bone tumors, with histological follow-up in 63 cases (73%). Cytology was classified according to the classic European 4-tier system, the MSRSGC, and the IAC-IARC-WHO System. RESULTS: According to the MSRSGC, eight cases were classified as nonneoplastic, 30 as benign, one as salivary gland neoplasm of uncertain malignant potential, five as suspicious for malignancy, and 42 as malignant. Benign or malignant nature was accurately assessed in 78 cases (90.7%), with exact histologic-cytologic concordance in 51 cases (59.3%). FNA correctly identified 42 of 44 malignant tumors (95.5%), with exact diagnostic matches in 30 cases (68.2%). The MSRSGC achieved 88.3% overall accuracy, 93.6% sensitivity, and 82.7% specificity. Risk of malignancy (ROM) was comparable for malignant tumors across the classic European system, the MSRSGC, and the IAC-IARC-WHO System, with minor discrepancies observed in benign and indeterminate categories. No cases were assigned as nondiagnostic, atypia of undetermined significance, atypical. CONCLUSIONS: Despite their rarity, soft tissue and bone tumors of the salivary gland can be effectively diagnosed using the MSRSGC, with a high accuracy achieved for malignant cases. Minor discrepancies in ROMs were observed between specific categories of the classic European system, the MSRSGC, and the IAC-IARC-WHO System.
Cancer Cytopathol
· 2025 Aug · PMID 40762622
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Urinary cytology is an important tool for diagnosing high-grade urothelial carcinoma (HGUC) and plays a vital role in monitoring for disease recurrence. However, its diagnostic utility is often complicated by interpretiv...Urinary cytology is an important tool for diagnosing high-grade urothelial carcinoma (HGUC) and plays a vital role in monitoring for disease recurrence. However, its diagnostic utility is often complicated by interpretive challenges, particularly when degenerative artifacts, sparse cellularity, or reactive atypia obscure key cytologic features. The Paris System for Reporting Urinary Cytology has significantly enhanced diagnostic reproducibility by establishing standardized criteria for the diagnosis of HGUC, but misclassification remains a risk, especially when evaluating subtle atypia, tissue fragments, or confounding factors like degenerative changes. One of the most frequent pitfalls in urinary cytology is differentiating HGUC from benign mimics, particularly in specimens affected by prolonged urine exposure, inflammation, or instrumentation artifacts. Similarly, the classification of atypical urothelial cells presents a diagnostic gray zone because its predictive value varies widely, depending on clinical context. Low-grade urothelial neoplasms further complicate risk stratification because these tumors infrequently exfoliate in voided specimens and can appear indistinguishable from reactive urothelial cells in these samples. Consequently, the goal of The Paris System for Reporting Urinary Cytology is to focus on the detection of HGUC to preserve the specificity and the positive predictive value of urinary cytology. Advancements in molecular profiling and artificial intelligence-driven cytopathology promise enhanced reproducibility and risk stratification, refining the role of urinary cytology in precision medicine. However, the success of urinary cytology remains rooted in a balanced approach, integrating morphologic expertise, molecular insights, and clinical data. By applying these essential practices, cytopathologists can improve diagnostic accuracy, reduce misclassification, and optimize patient management.
Jug R, Foo WC, Wildman-Tobriner B
… +1 more, Jiang XS
Cancer Cytopathol
· 2025 Aug · PMID 40699188
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Thyroid ultrasound is typically the first step in the workup of thyroid nodules. Ultrasonographic features of thyroid nodules can be used to evaluate their risk of malignancy using risk stratification systems to determin...Thyroid ultrasound is typically the first step in the workup of thyroid nodules. Ultrasonographic features of thyroid nodules can be used to evaluate their risk of malignancy using risk stratification systems to determine whether a nodule is suspicious enough to warrant a more invasive fine-needle aspiration (FNA) for further evaluation. For this review, the authors described and compared two major risk stratification systems, the American Thyroid Association classification system and the American College of Radiology Thyroid Imaging Reporting and Data System, and explored corresponding ultrasound and cytology findings in the thyroid for commonly encountered entities in cytopathology practice.
Cancer Cytopathol
· 2025 Aug · PMID 40689864
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BACKGROUND: Hepatocyte nuclear factor 4 alpha (HNF4α) contributes to tumorigenesis and cancer progression. This study evaluated the diagnostic potential of HNF4α for detecting endocervical glandular lesions (EGLs), inclu...BACKGROUND: Hepatocyte nuclear factor 4 alpha (HNF4α) contributes to tumorigenesis and cancer progression. This study evaluated the diagnostic potential of HNF4α for detecting endocervical glandular lesions (EGLs), including endocervical adenocarcinomas (ECAs), adenocarcinomas in situ (AIS), and lobular endocervical glandular hyperplasias (LEGH) using alcohol-fixed cytological smears. METHODS: HNF4α expression was immunocytochemically assessed in alcohol-fixed smears and paired formalin-fixed paraffin-embedded tissue specimens obtained from 14 patients with histologically confirmed EGLs: eight papillomavirus-associated (HPVA) ECAs, one non-NHPVA ECA, two HPVA AIS, and three patients with LEGHs. Three cases of squamous cell carcinomas (SCCs) and two cases of non-neoplastic lesions were also analyzed as non-EGL controls. HNF4α positivity was defined as nuclear staining in one or more cell(s)/slide, regardless of intensity. RESULTS: Histologically confirmed EGL cases were cytologically diagnosed as four adenocarcinomas, eight atypical glandular cells, one misclassified atypical squamous cells of undetermined significance, and one misclassified SCC, with a sensitivity of 85.7% and specificity of 100%. Strong and diffuse nuclear HNF4α expression was observed in atypical glands in both smears and tissue specimens, whereas non-neoplastic glands and non-neoplastic/neoplastic squamous epithelium were HNF4α-negative. HNF4α expression showed 73.7% concordance between tissue and smear samples. Notably, HNF4α immunocytochemistry demonstrated 100% sensitivity and specificity for detecting EGLs, outperforming cytomorphological or immunohistochemical diagnosis (sensitivity, 71.4%; specificity, 100%). CONCLUSIONS: HNF4α is a reliable diagnostic marker when using alcohol-fixed smears, showing enhanced accuracy for EGLs detection regardless of human papillomavirus status. Immunocytochemical analysis of HNF4α in cervical smears can be used for EGL detection and early diagnosis of cervical cancer.
Cancer Cytopathol
· 2025 Aug · PMID 40637392
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INTRODUCTION: Neoplastic mucinous cysts (NMC) are premalignant lesions that can be diagnosed on pancreatic cyst fluid (PCF) based on elevated carcinoembryonic antigen or thick extracellular mucin (ECM) without mucinous e...INTRODUCTION: Neoplastic mucinous cysts (NMC) are premalignant lesions that can be diagnosed on pancreatic cyst fluid (PCF) based on elevated carcinoembryonic antigen or thick extracellular mucin (ECM) without mucinous epithelium. Under the World Health Organization classification, such cases are considered "pancreaticobiliary neoplasm, low-risk/grade." This study evaluates the diagnostic accuracy and risk of cysts diagnosed as NMC without mucinous epithelium. MATERIALS AND METHODS: A total of 609 PCF specimens (493 patients) diagnosed as NMC were identified; 279/609 (45.8%) had no mucinous epithelium: 182 and 61 were diagnosed based only on elevated carcinoembryonic antigen ≥192 ng/mL or ECM, respectively. RESULTS: Among PCF without mucinous epithelium and with molecular correlation, 110/165 (66.7%) harbored KRAS/GNAS/RNF43 mutations. High-risk mutations (TP53/CDKN2A/SMAD4) occurred at similar rates in cysts with low-grade mucinous epithelium as in those without mucinous epithelium (6.5% vs. 3.6%, p = .224). A total of 63/71 (88.7%) resections from cysts without mucinous epithelium were confirmed as NMC: 40 (56.3%) had low-grade dysplasia and 23 (32.4%) had at least high-grade dysplasia. A total of 142/279 (50.9%) PCF without mucinous epithelium were molecularly or histologically confirmed as NMC. No significant differences were found in the rates of new worrisome radiologic features, invasive carcinoma, or disease-related mortality between the groups. Patient survival trended lower in the cohort with mucinous epithelium, though rates were comparable upon subanalysis of only "pancreaticobiliary neoplasm, low-risk/grade" cysts. CONCLUSIONS: Even though PCF diagnosed as NMC without mucinous epithelium defaults to a low-risk category, the rates of high-grade neoplasia/high-risk outcomes are comparable to those with low-grade mucinous epithelium, supporting continued utility of carcinoembryonic antigen and ECM as diagnostic criteria for NMC in the absence of mucinous epithelium.
Aissani MS, Gerges KM, Msherghi A
… +10 more, Farrara H, Alatefi D, Chenfouh I, Kara AO, Abuajamieh M, Kareem G, Benhammou M, Ali ME, Wintermark M, Elhadi M
Cancer Cytopathol
· 2025 Aug · PMID 40614167
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BACKGROUND: Malignant pleural effusion (MPE) is a common complication of advanced malignancies, requiring differentiation from benign pleural effusion for appropriate management. Cytology and biopsy have limitations, nec...BACKGROUND: Malignant pleural effusion (MPE) is a common complication of advanced malignancies, requiring differentiation from benign pleural effusion for appropriate management. Cytology and biopsy have limitations, necessitating more sensitive, less invasive diagnostic techniques. The objective of this study was to evaluate the diagnostic accuracy of methylated SHOX2 (short-stature homeobox 2) and RASSF1A (Ras association domain family member 1A) genes in detecting MPE. METHODS: A systematic review and meta-analysis included studies that compared benign pleural effusion and MPE cohorts using methylation of SHOX2 and RASSF1A genes in pleural fluid as the index test and cytology/histopathology as the reference standard. A random-effects model was used to calculate sensitivity, specificity, predictive values, and diagnostic odds ratios. Subgroup analysis assessed performance in lung-predominant versus nonlung-predominant MPE. RESULTS: Four studies with a total of 534 participants were included. The pooled sensitivity and specificity were 85% (95% confidence interval [CI], 53%-96%; heterogeneity [I] = 0.00%) and 92% (95% CI, 88%-95%; I = 24.8%), respectively. The positive and negative predictive values were 93% (95% CI, 85%-97%; I = 61.5%) and 84% (95% CI, 53%-96%; I = 0.00%), respectively. The diagnostic odds ratio was 22.78 (95% CI, 11.00-47.17; I = 25.8%). Subgroup analysis showed a slight decrease in sensitivity (70%; 95% CI, 64%-76%; I = 0.00%) and specificity (91%; 95% CI, 86%-94%; I = 26.1%) when excluding the study with a lung cancer-predominant population. CONCLUSIONS: The combined analysis of SHOX2 and RASSF1A methylation demonstrated promising diagnostic accuracy for MPE detection, outperforming cytology. This less invasive method could reduce reliance on more invasive procedures, although further research is needed to confirm its efficacy across diverse populations and cancer types.
Wang Y, Li G, Kong W
… +5 more, Hu J, Bao L, Pan X, Li X, Wang J
Cancer Cytopathol
· 2025 Aug · PMID 40608056
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BACKGROUND: This study aimed to investigate the prevalence and cytological features of Dicer 1, Ribonuclease III (DICER)-mutant fine-needle aspiration (FNA) specimens in thyroid nodules classified as Bethesda II, III, an...BACKGROUND: This study aimed to investigate the prevalence and cytological features of Dicer 1, Ribonuclease III (DICER)-mutant fine-needle aspiration (FNA) specimens in thyroid nodules classified as Bethesda II, III, and IV categories. The authors also sought to explore the relationship between DICER1 and BRAF mutations in Bethesda III thyroid nodules. METHODS: The authors collected a series of consecutive FNA cases diagnosed as Bethesda category II, III, and IV from a medical center over the course of 1 year. DICER1 exons 24 and 25 and TERT promoter mutations were detected by Sanger sequencing in all cases, and BRAF mutations were detected by amplification refractory mutation system PCR in Bethesda III and IV cases. RESULTS: A total of 899 patients were included in the study. DICER1 mutations were identified in 52 patients: 20 in Bethesda category II (6.2%, 20 of 322), 25 in Bethesda category III (4.9%, 25 of 510), and seven in Bethesda category IV (10.4%, 7 of 67). Among the 510 Bethesda III FNA samples, 76 harbored the BRAF mutation and 25 harbored DICER1 mutations. BRAF and DICER1 mutations were mutually exclusive. In Bethesda category II and III cases, patients with DICER1-mutant nodules were younger and had larger nodule volumes compared to those without DICER1 mutations. All DICER1-mutant Bethesda III FNAs were classified as atypia of undetermined significance (AUS)-other. TERT promoter mutations (c. -118G>T and c. -144 C>T) were identified in two FNA samples. CONCLUSION: The findings of this study suggest that DICER1-mutant nodules are unlikely to be BRAF-mutant carcinomas. Further study of the molecular characteristics of DICER1-mutant FNAs will contribute to more accurate cytological diagnosis.
Elishaev E, Harinath L, Ye Y
… +8 more, Matsko J, Colaizzi A, Wharton S, Bhargava R, Pantanowitz L, Hanna MG, Harrington S, Zhao C
Cancer Cytopathol
· 2025 Jul · PMID 40543043
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BACKGROUND: Medical technologies powered by artificial intelligence are quickly transforming into practical solutions by rapidly leveraging massive amounts of data processed via deep learning algorithms. There is a neces...BACKGROUND: Medical technologies powered by artificial intelligence are quickly transforming into practical solutions by rapidly leveraging massive amounts of data processed via deep learning algorithms. There is a necessity to validate these innovative tools when integrated into clinical practice. METHODS: This study evaluated the performance of the Hologic Genius Digital Diagnostics System (HGDDS) with a cohort of 890 previously reviewed and diagnosed ThinPrep Papanicolaou (Pap) tests with the intent to deploy this system for routine clinical use. The study included all diagnostic categories of The Bethesda System, with follow-up tissue sampling performed within 6 months of abnormal Pap test results to serve as the ground truth. RESULTS: The HGDDS demonstrated excellent performance in detecting significant Pap test findings, with close to 100% sensitivity (98.2%-100%) for cases classified as atypical squamous cells of undetermined significance and above within a 95% confidence interval and a high negative predictive value (92.4%-100%). CONCLUSIONS: The HGDDS streamlined workflow, reduced manual workload, and functioned as a stand-alone system.
Cancer Cytopathol
· 2025 Jul · PMID 40522771
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In recent years, cytopathology practices increasingly are considering the adoption of digital modalities to support remote rapid on-site evaluation (ROSE) of fine-needle aspiration biopsies. Currently, various digital op...In recent years, cytopathology practices increasingly are considering the adoption of digital modalities to support remote rapid on-site evaluation (ROSE) of fine-needle aspiration biopsies. Currently, various digital options are available, each of which has unique advantages and limitations. This review covers all relevant aspects of telecytology for ROSE, including digital pathology options, operators, validation, quality assurance, reimbursement, and recommendations from professional organizations. The evolving landscape of telecytology for ROSE, including the development of devices for standardized specimen preparation and staining, next-generation digital microscopy techniques, and deep-learning-based artificial intelligence tools as decision-support aids for the interpretation of digital images, also is outlined.
Cancer Cytopathol
· 2025 Jun · PMID 40424173
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Medullary thyroid carcinoma (MTC) is a rare but potentially aggressive neuroendocrine tumor arising from the thyroid C cells (parafollicular cells) that produce calcitonin, representing 1%-3% of thyroid malignancies but...Medullary thyroid carcinoma (MTC) is a rare but potentially aggressive neuroendocrine tumor arising from the thyroid C cells (parafollicular cells) that produce calcitonin, representing 1%-3% of thyroid malignancies but contributing to up to 15% of thyroid cancer-related deaths. Early detection is critical for improving survival and outcomes because its tumor origin, treatment, and prognosis differ completely from papillary thyroid carcinoma. However, the low incidence of MTC and its variable cytomorphology can pose significant diagnostic challenges for cytopathologists. Referred to as the great mimicker, MTC can resemble various primary and metastatic tumors, complicating its identification, particularly in fine-needle aspiration (FNA) biopsies. Reported FNA sensitivity for a specific MTC diagnosis varies widely from 12.5% to 88.2%, with a 2014 meta-analysis estimating an overall sensitivity of 56.5% when including suspicious lesions. False-negative FNA results, often caused by misinterpretation of cytologic features or inadequate specimen quality, can lead to delayed or suboptimal treatment. Pathologists must be familiar with MTC's diverse cytopathologic presentation and maintain a low threshold for additional diagnostic tests to ensure an accurate preoperative diagnosis. This review article provides practical guidance on diagnosing MTC, emphasizing cytologic features, ancillary studies, mimickers, and common diagnostic pitfalls, serving as a valuable resource for cytopathologists, general pathologists, and trainees to improve diagnostic accuracy and patient care.
Rivera Rolon MDM, Gustafson E, Cole R
… +6 more, Matos J, Hicken K, Hicks J, Cahoon B, de Socarraz M, Santa-Rosario JC
Cancer Cytopathol
· 2025 Jun · PMID 40387263
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BACKGROUND: Recent advancements in digital pathology have extended into cytopathology. Laboratories screening cervical cytology specimens now choose between limited imaging options and traditional manual microscopy. The...BACKGROUND: Recent advancements in digital pathology have extended into cytopathology. Laboratories screening cervical cytology specimens now choose between limited imaging options and traditional manual microscopy. The Techcyte SureView™ Cervical Cytology System, designed for digital cytopathology, was validated at CorePlus, a pathology laboratory in Puerto Rico, and adopted as a 100% quality control (QC) tool. METHODS: The validation study included 1442 whole slide images (WSIs) from 1273 ThinPrep® and 169 SurePath™ cervical cytology slides, digitized with the 3DHISTECH Panoramic 1000 DX scanner using dry and water immersion scanning profiles. These WSIs were processed by the Techcyte SureView™ system, with a board-certified cytopathologist reviewing artificial intelligence (AI)-identified objects of interest and comparing them to traditional light microscopy results. RESULTS: Techcyte SureView™ with the water immersion scanning profile outperformed both the dry scanning profile and light microscopy in detecting squamous and glandular abnormalities. It achieved 97% accuracy, 82% sensitivity, 99% specificity, 98% negative predictive value, and 86% positive predictive value. Additionally, the review time was rapid. The system has been operational for several months, enhancing accuracy and workflow efficiency. CONCLUSIONS: This study demonstrates that digital cytopathology, particularly through the Techcyte SureView™ system, can improve laboratory workflow and performance. Successful validation led CorePlus to integrate the AI algorithm into their workflow as a 100% QC review tool, resulting in improved accuracy, benefiting both laboratory professionals and patients.
Mangla M, Palo S, Devalla A
… +1 more, Kanikaram PK
Cancer Cytopathol
· 2025 Jun · PMID 40384626
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BACKGROUND: Accurate intraoperative assessment of ovarian tumors is crucial for guiding surgical management. The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of imprint an...BACKGROUND: Accurate intraoperative assessment of ovarian tumors is crucial for guiding surgical management. The objective of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of imprint and scrape cytology for intraoperative risk stratification of ovarian tumors. METHODS: A comprehensive literature search was conducted across multiple databases to identify studies that assessed the sensitivity, specificity, positive predictive value, and negative predictive value of imprint and scrape cytology in distinguishing benign and malignant ovarian tumors. Data were pooled using a bivariate random-effects model. The methodological quality of included studies was assessed using the quality assessment of diagnostic accuracy studies 2 tool. RESULTS: In total, 34 studies comprising 3318 ovarian tumors were included in the current review. Analysis indicated that the pooled sensitivity of imprint cytology was 89%, whereas the pooled specificity was 92%. The positive and negative likelihood ratios, calculated using a random-effects model, were 8.47 (95% confidence interval [CI], 5.27-13.61) and 0.16 (95% CI, 0.12-0.21), respectively. The pooled diagnostic odds ratio was 63.42 (95% CI, 37.5-107.27). For scrape cytology, the pooled sensitivity and specificity were 89% and 97%, respectively. The positive and negative likelihood ratios were 21.05 (95% CI, 12.36-35.84) and 0.14 (95% CI, 0.09-0.22), respectively. The pooled diagnostic odds ratio was 180.46 (95% CI, 88.01-370.03). Both techniques demonstrated high diagnostic accuracy, and scrape cytology was particularly effective in detecting malignancies. CONCLUSIONS: Imprint and scrape cytology are valuable intraoperative diagnostic tools for ovarian tumor stratification, offering rapid and reliable results. Their integration into surgical decision making may enhance intraoperative management, particularly in resource-limited settings. Further studies with standardized protocols are needed to refine their clinical utility.