Nalini Gupta

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration vs Conventional Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis

BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is superior to conventional transbronchial needle aspiration (cTBNA) in the staging of lung cancer. However, its efficiency in diagnosis of sarcoidosis when combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB) has not been studied. This randomized controlled trial compares diagnostic yield of EBUS-TBNA vs cTBNA in combination with EBB and TBLB. METHODS Patients with clinical diagnosis of sarcoidosis were randomized 1:1 to EBUS-TBNA or cTBNA. All patients underwent TBLB and EBB. The primary outcome was detection of granulomas. The secondary end points were the individual and cumulative yields of various procedures, serious adverse events, and procedure time. RESULTS Of the 130 patients, sarcoidosis was diagnosed in 117 (62 cTBNA, 55 EBUS-TBNA). The two groups were similar at baseline. Granulomas were demonstrated in 104 (53 cTBNA, 51 EBUS-TBNA) patients and were similar in two groups (85.5% vs 92.7%, P = .34). Individually, EBUS-TBNA had the highest yield (41 of 55, 74.5%), which was better than cTBNA (30 of 62, 48.4%, P = .004) or EBB (40 of 111, 36.3%, P < .0001) but not TBLB (78 of 112, 69.6%, P = .54). Adding EBB/TBLB to cTBNA led to an increase in granuloma detection, whereas the addition of TBLB (but not EBB) significantly enhanced the yield of EBUS-TBNA. The procedure time was significantly longer with EBUS-TBNA. No major adverse events occurred. CONCLUSIONS Individually, EBUS-TBNA has the highest diagnostic yield in sarcoidosis, but it should be combined with TBLB for the optimal yield. The diagnostic yield of cTBNA (plus EBB and TBLB) is similar to EBUS-TBNA plus TBLB. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01908868; URL: www.clinicaltrials.gov.

Fine needle aspiration cytology of primary thyroid lymphoma: a report of ten cases

Primary lymphoma is an uncommon malignancy of the thyroid, comprising of 0.6 to 5 per cent of thyroid cancers in most series. Primary thyroid lymphomas (PTL) occur most commonly in elderly women and are commonly of B- cell origin. These frequently present in clinical stage IE and IIE. We report here ten cases of PTL diagnosed over a period of about 7 years in our institute. Out of these ten cases, nine were diagnosed on fine needle aspiration cytology (FNAC) and one case was misdiagnosed as lymphocytic thyroiditis. This case was diagnosed as Non- Hodgkins lymphoma on surgical specimen. Five patients are disease free and doing well, while two died of disease and the other two were lost to follow-up. One patient is currently on chemotherapy. The salient clinical, biochemical, radiological features, FNA findings along with diagnostic difficulties are discussed.

Human papilloma virus associated head and neck cancer: A PCR based study.

Head and neck cancers (HNC), 90% of which are squamous cell carcinomas (SCC), rank sixth among all malignancies worldwide and comprise 40–50% of the total number of malignancies in India. In addition to alcohol and tobacco usage, which is the major source of oral carcinogens, viruses such as human papilloma virus (HPV) may also contribute to development of the malignancy. The aim of this study was to identify the prevalence of HPV in head and neck cancers using material from metastatic site.

Cervical screening in England: The past, present, and future†‡

Cervical screening in England commenced in a disorganized fashion in 1964. The flaws of this approach became apparent in the mid‐1980s and led to the inception of the National Health Service Cervical Screening Programme (NHSCSP). The main features of this program are its population‐based registry, accessibility to all women within the screening age range, its systematic process of call and recall, national coordination, and quality assurance. Its success is in part based on its ability to evolve as evidence necessitates, and throughout the period of 2000‐2010, it embarked upon a series of developments involving liquid‐based cytology, which also provided the means to conduct reflex high‐risk human papillomavirus (HR‐HPV) testing and the potential to automate the screening process. As a result of evidence acquired since 2000, the NHSCSP is currently based on a system of primary cytology with HPV triage for low‐grade abnormalities combined with cytology plus a HR‐HPV “test of cure” for women who have received treatment for cervical intraepithelial neoplasia. Future challenges for the program will involve finding solutions to increasing screening uptake among women <30 years of age—a problem that may be exacerbated when vaccinated women reach the screening age, while making plans to accommodate HPV primary screening. Cancer (Cancer Cytopathol) 2012;.

Histoplasmosis: cytodiagnosis and review of literature with special emphasis on differential diagnosis on cytomorphology.

N. Gupta, S. K. Arora, A. Rajwanshi, R. Nijhawan and R. Srinivasan
Histoplasmosis: cytodiagnosis and review of literature with special emphasis on differential diagnosis on cytomorphology

Immunochemistry for oestrogen receptor, progesterone receptor and HER2 on cell blocks in primary breast carcinoma.

K. Kumar S, N. Gupta, A. Rajwanshi, K. Joshi and G. Singh

Functional biomarkers in cervical precancer: an overview.

Cervical cancer develops over a long time through precursor lesions that can be detected by cytological screening. Majority of these lesions regress spontaneously. Therefore, the challenge of cervical cancer screening is to detect the lesions that have a high risk of progression. Several promising biomarkers have been described that may improve screening of cervical cancer, but to date, new biomarkers have not been thoroughly validated in high‐quality studies.

Pathology of supraclavicular lymphadenopathy in Chandigarh, north India: an audit of 200 cases diagnosed by needle aspiration

Objective:  Fine needle aspiration cytology (FNAC) of lymph nodes can be used routinely as a first‐line diagnostic test. The majority of studies reveal a malignant cause for palpable supraclavicular lymph nodes. The present audit further emphasizes the use of FNAC as a first‐line investigation for the evaluation of enlarged supraclavicular lymph nodes.

Cryptococcal lymphadenitis diagnosed by fine needle aspiration cytology: a review of 15 cases.

OBJECTIVE To review the cases of cryptococcal infection presenting primarily with lymphadenopathy and diagnosed on fine needle aspiration cytology (FNAC) and to evaluate the various cellular reactions in this infection. STUDY DESIGN Retrospective review of 15 cases of cryptococcal lymphadenitis diagnosed on FNAC between 1999 and 2007. RESULTS A total of 15 cases of cryptococcal lymphadenitis were diagnosed, out of which 10 occurred in a setting of immunosuppression, and in 5 cases there was no obvious immunocompromised clinical setting. Eight patients had human immunodeficiency virus infection, and 2 were post-renal transplant. These patients presented with lymphadenopathy at various sites, with size ranging from 0.5 to 3 cm. The aspirate in most of the cases was fluid material. Detailed cytologic examination of the smears revealed a predominantly chronic inflammatory infiltrate and showed the presence of numerous organisms of varying size present both intracellularly as well as extracellularly. The 2 patients with renal transplant had a low load of organisms. Three cases showed well-formed granulomas, and a giant cell reaction was seen in 9 cases. The periodic acid-Schiff/Alcian blue stain was applied in all cases and confirmed the mucopolysaccharide capsule. One case represented dual infection with Mycobacterium tuberculosis and Cryptococcus. Unlike other fungal infections, the granulomatous reaction and associated inflammatory response in cryptococcal infection is very slight or absent. CONCLUSION FNAC can expedite an accurate diagnosis of cryptococcal lymphadenitis, which helps in the prompt initiation of treatment. The cellular response and the organism load are variable.

Fine needle aspiration cytology in ovarian lesions: an institutional experience of 584 cases

N. Gupta, A. Rajwanshi, L. K. Dhaliwal, N. Khandelwal, P. Dey, R. Srinivasan and R. Nijhawan 
Fine needle aspiration cytology in ovarian lesions: an institutional experience of 584 cases