|Year : 2018 | Volume
| Issue : 3 | Page : 47-50
Diagnostic utility of touch imprint cytology in the evaluation of intraabdominal tumors
Amit Kumar Adhya1, Madhabananda Kar2, Ranjan Mohanty3
1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
3 Department of Surgical Oncology, Hemalata Cancer Hospitals and Research Centre, Bhubaneswar, Odisha, India
|Date of Web Publication||21-Sep-2018|
Dr. Amit Kumar Adhya
Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
Source of Support: None, Conflict of Interest: None
Objectives: Touch imprint cytology (TIC) of biopsy specimen can be utilized for a rapid on-site evaluation of tumors. Its usefulness for intraoperative diagnosis is well known. We evaluated the advantages and limitations of TIC of trucut biopsies of intraabdominal tumors. Materials and Methods: TIC was obtained in 42 consecutive cases of intraabdominal masses. The sensitivity, specificity, and diagnostic accuracy of TIC were evaluated by comparing it with the final biopsy diagnosis. Results: The study included retroperitoneal tumors (13 cases, 30.95%), liver mass (11 cases, 26.19%), gall bladder mass (4 cases, 9.53%), pelvic mass (3 cases, 7.14%), iliac bone mass (2 cases, 4.76%), mesenteric nodule (4 cases, 9.53%), kidney mass (3 cases, 7.14%), and 1 case (2.38%) each of epigastric mass and loin mass. Thirty-two (76.19%) cases were diagnosed as malignant and 10 (23.81%) cases were diagnosed as benign/negative on TIC. The overall sensitivity was 87.88%, the specificity was 77.78%, the positive predictive value was 93.55%, and the negative predictive value was 63.60%. The accuracy of the test was 85.71%.Conclusions: TIC is a simple and cost-effective method that aids in the diagnostic evaluation of tumors. It is fairly accurate with high positive predictive value and hence can be used as an adjunct to the biopsy diagnosis.
Keywords: Accuracy, intraabdominal tumor, touch imprint cytology, trucut biopsy
|How to cite this article:|
Adhya AK, Kar M, Mohanty R. Diagnostic utility of touch imprint cytology in the evaluation of intraabdominal tumors. Oncol J India 2018;2:47-50
|How to cite this URL:|
Adhya AK, Kar M, Mohanty R. Diagnostic utility of touch imprint cytology in the evaluation of intraabdominal tumors. Oncol J India [serial online] 2018 [cited 2019 May 19];2:47-50. Available from: http://www.ojionline.org/text.asp?2018/2/3/47/241841
| Introduction|| |
Diagnostic evaluation of intraabdominal masses is routinely done by radiology-guided fine-needle aspiration cytology (FNAC) or trucut biopsy. Biopsy is the preferred method of tissue diagnosis to confirm malignancy in suspected cases. However, the biopsy sections are available only after 3–7 days depending upon the resources available. The delay in obtaining a tissue diagnosis leads to unnecessary apprehension among the patients and delay in definitive workup and treatment of patients. Hence, there is a need for a rapid on-site evaluation of material obtained during the biopsy procedure.
Touch imprint cytology (TIC) is a very simple and cheap method and can be used for a rapid tissue diagnosis. It has been used as an adjunct to frozen section for intraoperative diagnosis of cancer, evaluation of sentinel nodes for metastasis, for assessing adequacy of computed tomography (CT)/endoscopic ultrasound-guided core biopsies of masses of various organs, and in the diagnosis of impalpable breast lumps and for various other sites of the body.,,,,, More recently, TIC has been shown to be of value in the enrichment of tumor cells for molecular analysis.
We evaluated the utility of TIC as a preoperative diagnostic tool for intraabdominal tumors. The diagnostic accuracy and causes of false-positivity and false-negativity were evaluated.
| Materials and Methods|| |
The study was a collaborative study between the Department of Surgical Oncology and the Department of Pathology, from a research cancer institute of Eastern Zone of India, during the period of December 2008–December 2017. Informed consent from all patients and ethical clearance were obtained from the local governing body. We received 42 TIC cases of biopsies taken from various sites which included retroperitoneal tumors (13 cases 30.95%), liver masses (11 cases, 26.19%), gall bladder mass (4 cases, 9.53%), pelvic mass (3 cases, 7.14%), iliac bone mass (2 cases, 4.76%), mesenteric nodule (4 cases, 9.53%), kidney mass (3 cases, 7.14%), and 1 case each of epigastric mass and loin mass [Table 1].
The touch imprints were made by the surgeon immediately after obtaining the biopsy tissue from the lesion. In all the cases, touch imprints were obtained by gently pressing the fresh unfixed tissue to clean glass slides. At least four imprint smears were made in each case avoiding blood and mucus. Two of the smears were air-dried and two were immediately fixed in isopropyl alcohol for 15–20 min. The air-dried smears were stained with May–Grunwald–Giemsa stain and the alcohol-fixed smears were stained with hematoxylin and eosin stain by the standard methods. The tissue was then put in formalin and submitted for routine histopathological study.
The cytological interpretation was carried out within 30 min of obtaining the biopsy. Although Diff-Quik stain can be used for rapid staining within 4–5 min, nuclear character is better appreciable in alcohol-fixed smears. In this study, the primary intention was the assessment of diagnostic accuracy; hence, crisp nuclear staining was important. Histological examination of the permanent sections was carried several days later.
By comparing the initial diagnosis of TIC to the final diagnosis on biopsy sections, the cases were designated as true positive (if a diagnosis of malignancy on TIC was found to be correct on biopsy sections), true negative (if a diagnosis of benign lesion on TIC was confirmed to be benign on biopsy), false-positive (if a diagnosis of malignancy given on TIC was found to be benign on biopsy), and false-negative (if a benign diagnosis on TIC was found to be malignant on biopsy). Based on these findings, the overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TIC diagnosis were evaluated.
| Results|| |
A total of 42 cases of intraabdominal lesions were studied. The age of the patients ranged from 4 to 73 years with a mean of 48.4 years; adequate and satisfactory materials on touch imprint were obtained in 40 (95.23%) cases. Inadequate material was obtained in 2 (4.76%) cases. Repeat biopsy was obtained from the lesions which were found to be inadequate and touch imprints were made from it. Thirty-two (76.19%) cases were diagnosed as malignant and 10 (23.81%) cases were diagnosed as benign/negative on TIC. The comparison between the diagnosis offered on TIC and the final diagnosis made on histopathological sections is shown in [Table 1].
The overall sensitivity was 87.88%, the specificity was 77.78%, the positive predictive value was 93.55%, and the negative predictive value was 63.60%. The accuracy of the test was 85.71% [Table 2].
| Discussion|| |
TIC is a very cheap and rapid method of evaluation of biopsy material and has proven to be fairly accurate for diagnosis of cancer. A study by Kubik et al., has found 91% diagnostic accuracy of TIC when used as an adjunct to core needle biopsies of tumors of various sites such as lungs, liver, and prostate. Moghadamfalahi et al. has also shown a very high sensitivity, specificity, and diagnostic accuracy of TIC of CT-guided core biopsies obtained from various sites such as liver, lungs, and soft-tissue masses. Similarly, a high rate of sensitivity (96.9%), specificity (97.4%), and accuracy (97.1%) of TIC in preoperative diagnosis or cancer at various sites of the body was demonstrated by Adhya and Mohanty.
Another method of tissue diagnosis of intraabdominal mass lesion is radiology-guided FNAC. Hahn et al. has compared the accuracy of FNAC and TIC of core needle biopsy specimens and found that their efficacies were equivalent. However, the TIC smears have the added advantage of assessing the tumor cell architecture. The FNAC smears show more dispersed cells and tiny cell clusters, whereas TIC smears show larger cell clusters and hence assessment of tumor architecture is also possible. The cytological details are similar in both types of smears. Frozen section is another alternative to TIC. However, it requires costly instruments and more special technical expertise. TIC is an easy and cheap method and requires no special instruments.
In the present study, we evaluated 42 cases of intraabdominal masses. Rapid hematoxylin and eosin stain (short exposure to hematoxylin and eosin) was used to stain the smears. Immediate TIC evaluation helped to assess the cellular adequacy of biopsy and prevented delay in diagnosis due to inadequate material of biopsy. Non-Hodgkin's lymphoma could be easily distinguished from carcinomas and granulomatous tubercular lesions. However, in our study, a case of Hodgkin's lymphoma was misinterpreted as a reactive lymph node (false-negative). The true nature of the lesion was revealed after immunohistochemical evaluation of the biopsy material. Another case was suspected to be non-Hodgkin's lymphoma which, however, turned out to be a reactive lymph node (false-positive case). TIC could differentiate between metastatic carcinoma, round-cell sarcoma, and lymphomas.
In the present study, the sensitivity of TIC was found to be 87.88% and specificity was found to be 77.88%, which is similar to the previous studies. These results in addition to the positive predictive value of 93.55% and the overall diagnostic accuracy of 85.71% of TIC in intraabdominal mass lesions make it highly acceptable as a tool for preoperative diagnosis of cancer. It is also possible to perform immunocytochemistry on these smears. The smears can be fixed in alcohol and stored. Immunocytochemistry may be performed later if immunohistochemistry on biopsy material is unsatisfactory due to fixation- or processing-related problems.
| Conclusions|| |
The present study showed that TIC of core needle biopsy specimens of intraabdominal masses provides adequate cytological material for evaluation of malignancy. TIC can be used as an adjunct to biopsy for cytological evaluation of biopsy material. It also can be used as a method of rapid on-site evaluation of biopsy material for adequacy.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]