Gayatri Ravikumar

The prognostic role of omental, ovarian chemotherapy response score and CA125 in predicting survival in patients with tubo-ovarian high-grade serous carcinoma/primary peritoneal carcinoma receiving neoadjuvant chemotherapy

Abstract Objective: To assess the role of omental and ovarian chemotherapy response score (CRS) and CA125 as a predictor of prognosis in patients with tubo-ovarian high-grade serous carcinoma (HGSC)/primary peritoneal carcinoma (PPC) receiving neoadjuvant chemotherapy (NACT). In addition, to study the correlation of omental CRS with chemoresistance. Methods: A retrospective record review of patients with tubo-ovarian HGSC/PPC receiving NACT followed by interval debulking surgery (IDS) between January 2012 and May 2020 was done. The slides of the omentum and ovarian tissue of the patients were retrieved and reviewed by a trained pathologist. During analysis, CRS 1 and CRS 2 were merged together for comparison against CRS 3. Results: A total of 44 patients with a mean age of 54 years were included in the study. Among the patients, 29.5%, 38.6%, and 31.8% had a CRS of 1, 2, and 3, respectively, on the omental specimen and 31.8%, 43.2%, and 25% on the ovarian specimen. Median PFS and OS was significantly better with omental CRS 3 (P = < 0.0001 and P = < 0.00065). No significant difference in median OS of patients was noted with ovarian CRS 1, 2, or 3 (P = 0.057); however, the median PFS was significantly better in patients with CRS 3 on ovarian tissue (P = 0.036). Platinum resistance was significantly lower in patients with CRS 3 on omentum (P = 0.001). The value of CA125 post NACT had a significant association with PFS on both univariate and multivariate analyses. There was no statistically significant correlation between CA125 and omental CRS. Conclusion: Omental CRS has a prognostic significance for patients with tubo-ovarian HGSC/PPC receiving NACT and correlates significantly with PFS and OS. Ovarian CRS correlates significantly only with PFS. Post NACT CA125 value had a significant association with PFS.

Quality metrics in cervical cytopathology: A single institutional study

AbstractObjectivesImplementation of quality control measures ensures acceptable performance by a laboratory. This study aims to assess the quality of cervical cytopathology reporting using quality metrics like atypical squamous cells (which include both atypical squamous cells of undetermined significance and atypical squamous cell ‐cannot rule out high grade squamous intraepithelial lesion)/squamous intraepithelial lesion (ASC/SIL), cytohistological correlation (CHC) and positive predictive value (PPV) of Papanicolaou (Pap) smears for squamous lesions of cervix.MethodsA retrospective study of Pap smears from 2015 to 2020 was performed. The quality metrics analysed include diagnoses of ASCUS, ASC‐H and ASCUS/SIL ratio, CHC and PPV. Cases with cervical biopsies/hysterectomy were included for CHC, and discrepancy was defined as discordance in diagnostic category between cytology and histology in the CHC.ResultsA total of 22,695 cervical cytology smears were reported. Unsatisfactory smears (n = 290) were excluded. Squamous lesions were reported in 233 smears, and the Bethesda system of nomenclature was followed. A definitive diagnosis (SILs and SCC) was given in 74% of cases. ASCUS and ASC‐H were reported in 47 and 14 cases, respectively. The most common lesion on Pap smear was high‐grade squamous intraepithelial lesion (HSIL; n = 92), followed by low‐grade squamous intraepithelial lesion (LSIL; n = 64), and two were ungradable SIL. Squamous cell carcinoma (SCC) was reported in 14 smears. The ASC/SIL ratio was 0.38. CHC (n = 139) was 100% for ASC‐H, LSIL, SCC and 84.7% for HSIL. A review of discrepant cases suggested sampling and interpretational discrepancy in five and one cases, respectively. The PPV of Pap smear for squamous lesions was 96.4%.ConclusionIt is essential to have good quality cytopathology reports for early identification, which enables appropriate management. The most commonly used quality indicator for cytopathology is the ASCUS/SIL ratio. This study suggests the inclusion of the CHC and PPV values as quality metrics for Pap smear, since these are easily measurable and serve as a good indicator of quality in cervical cytopathology reporting.