Seetu Palo

Evaluating the diagnostic accuracy of imprint and scrape cytology for intraoperative risk stratification of ovarian tumors: A systematic review and meta‐analysis

AbstractBackgroundAccurate 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.MethodsA 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.ResultsIn 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.ConclusionsImprint 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.

Non-gestational choriocarcinoma: unraveling the similarities and distinctions from its gestational counterpart

Choriocarcinoma is a highly vascular and invasive tumor of anaplastic trophoblast, predominantly made up of cytotrophoblasts and syncytiotrophoblasts without villi. Based on its origin, choriocarcinoma can be either gestational or non-gestational. Non-gestational choriocarcinoma can be of germ cell origin, or can be seen in association with a somatic high-grade malignancy. It is difficult to differentiate gestational from non-gestational choriocarcinoma, especially in the reproductive age group. It is important to distinguish between the two, for accurate staging and prognostication, deciding the primary treatment modality, (ie, surgery or chemotherapy), and tailoring follow-up timeframes after diagnosis. An extensive literature search was performed regarding all cases of non-gestational choriocarcinoma, published before March 2023. A note was made of whether the origin of choriocarcinoma was ascertained and how gestational choriocarcinoma was differentiated from non-gestational choriocarcinoma. The keywords used for literature search were "non-gestational choriocarcinoma", "primary choriocarcinoma", "ovarian choriocarcinoma", "ovarian germ cell tumors", or "choriocarcinomatous differentiation". This review aims to summarize the similarities and differences in the epidemiology, pathogenesis, clinical presentation, and management guidelines between gestational and non-gestational choriocarcinoma, which can form an important educational resource for clinicians and laboratory physicians dealing with such cases.