4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

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4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije 48 Klinička citologija - Plenarna i pozvana predavanja FLOW CYTOMETRY IMMUNOPHENOTYPING (FCI) OF FINE NEEDLE ASPIRATES (FNAs) OF LYMPH NODES Kardum Paro MM1 , Šiftar Z1 , Kardum- Skelin I2 , Šušterčić D2 , Nazor A1 , Flegar- Meštrić Z1 , Jakšić B3 1 Institute of Clinical Chemistry, University Hospital „Merkur“, Zagreb, Croatia 2 Laboratory for Cytology and Hematology, Department of Internal Medicine University Hospital „Merkur“, Zagreb, Croatia 3 Department of Internal Medicine, University Hospital „Merkur“, Zagreb, Croatia Flow cytometry immunophenotyping (FCI) has an important role in the clinic work-up of fine needle aspirates (FNAs) of lymph nodes. Its standardization has been defined by proposed analytical protocols and procedures used to assure proper analytical results also in those non- rutine samples. In Institute of Clinical Chemistry University Hospital „Merkur“ FCI is accredited method according to laboratory accreditation standard ISO 15189. According to this laboratory accreditation standard, participation in external quality assessment (EQA) programs is a prerequisite for assuring integrity and quality of the entire laboratory process. A critical analysis of our institutional experience in the feasibility of FCI of the material obtained by FNA of lymph nodes with suspected lymphoma represented the purpose of the study. During an eight- year period in Institute of Clinical Chemistry, University Hospital „Merkur“, a total of 1295 FNA analysis was done, 245 of them with a possible diagnosis of B- cell Non- Hodgkin lymphomas (B- NHL) formed the basis of the study. Lymphocytes were isolated on density gradient according to Boyum et al. The average feasibility of FNAs for FCI analysis was 86 % (ranged 78 - 93%). An acceptable total cell number in FNAs for FCI analysis (4257) was established. In total population of respondents statistical significances in expressions of cellular antigens CD3, CD5, CD22, CD23, CD19 and CD5 on B- cells (CD5+CD19+) between patients with final diagnosis of benign, reactive lymphoid proliferations and patients with diagnosis of B- NHL were found. EQA results analysis showed that all results were either inside target values (X ± 1stdev) or or inside accepted values (X ± 2 stdev). Compatibility of the restriction of imunoglobulins light chains determinated by FCI and cytomorphology diagnosis depends on the choice of criterion values of the light chains ratio which determine the monoclonality. According to the matrix of shares of all classified data of retained neural network, ranges of diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and prevalency of 82%, 72%, 93%, 48%, and 72% were produced. As a conclusion, FCI is a reliable methodology for phenotyping FNAs of lymph nodes with suspected B- NHLs detecting their clonality easily. mariana.kardum@zg.htnet.hr
Clinical Cytology - Plenary and Invited Lectures FINE NEEDLE ASPIRATION CYTOLOGY OF THE PANCREAS: A GUIDE TO DIAGNOSTIC APPROACH Kocjan G Department of Cellular Pathology, University College London, United Kingdom The incidence of pancreatic cancer as on of the top ten leading causes of cancer death is relatively uniform among different countries and has a peak incidence in the 7th to 8th decades of life. The majority of tumours in the pancreas are ductal adenocarcinomas. However, there is a wide variety of non-neoplastic, benign neoplastic and malignant solid and cystic lesions which are becoming more accessible due to our ability to recognize and delineate pancreatic masses and to detect them and sample them earlier as smaller mass lesions by virtue of modern imaging techniques that utilize CT, US or EUS. However, there is significant overlap in the clinical and radiological features of solid and cystic mass lesions of the pancreas precluding definitive management decisions based on clinical and radiological features alone. Mass in the pancreas is potentially a life threatening condition and management options vary significantly, usually involving major surgery. The management of patients with neoplastic cysts is based on the preoperative distinction of non-mucinous and mucinous cysts in general, and benign and malignant cysts in particular. The cytopathologist therefore plays a critical role in the management decisions. A cytological diagnosis can be obtained with minimally invasive techniques. EUS guided FNA is evolving as the diagnostic method of choice due to the higher resolution, shorter biopsy trajectory, decreased risk of tumour seeding and ability to more accurately stage the patient during a single procedure using EUS. A diagnostic algorithm for the cytopathologist starts with the initial basic information from the radiological image: Is the lesion solid or cystic? If solid, differential diagnosis includes: a) Malignant disease ( in 90% primary adenocarcinoma, conventional or variant , other malignancy: lymphoma, sarcoma, germ cell tumour, other haematopoetic malignancy, metastasis, primary neuroendocrine tumour, solid pseudopapillary neoplasm, acinar cell carcinoma and pancreatoblastoma. b) Indeterminate for malignancy or neoplasm (atypical or suspicious) in cases where cellular proliferation that is quantitatively and qualitatively insufficient for a confident malignant or neoplastic interpretation (Glandular ductal pattern: rule out carcinoma, monomorphic cell pattern: rule out solid cellular neoplasm).c) Negative for malignancy (Chronic pancreatitis, autoimmune pancreatitis, normal pancreatic tissue if the radiological studies define a “fullness” or “vague” mass) d) Non-diagnostic (Normal pancreatic tissue if the radiological studies clearly highlight a well defined mass or cyst, GI contamination only, lesional tissue obscured by blood or preparation artefact, insufficient cellularity for evaluation). If the lesion is cystic ( see Table 1)it can be one of the following : a) Pseudocyst -has no epithelial component and has non-mucoid cyst fluid grossly, is unilocular, contains inflammatory cyst debris, history of pancreatitis, high amylase and low CEA, no K-ras or LOH mutations. b) Serous cyst (Microcystic, rarely macrocystic and unilocular, low amylase and CEA) c) Mucinous cyst: (Intraductal papillary mucinous neoplasm (IPMN) or Mucinous cystic neoplasm (MCN), CEA > 200 ng/ml (at MGH), positive mucin stains , K-ras mutation or ≥ 3 LOH mutations supportive d) gastrointestinal duplication cyst , rarely (CEA can be elevated). Diagnostic accuracy of pancreatic FNA depends primarily on the nature of the lesion and the quality and quantity of the material available but also on the experience of both, the aspirator and the interpreter, and most importantly on the communication between the radiological, surgical and pathology teams. g.kocjan@ucl.ac.uk 49 4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology
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4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

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