Naito Yoshiki, Kawahara Akihiko, Makino Ryo, Tokumitsu Takako, Nagayama Daisuke, Sadashima Eiji, Nakamura Kaori, Nishizaki Ryoji, Nagatomo Tadasuke, Fujino Yukina, Hayakawa Chie, Mizuguchi Keishi, Mori Tatsuya, Hirabayashi Kenichi, Tajiri Takuma
Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan.
Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
Acta Cytol. 2025 Feb 28:1-11. doi: 10.1159/000544997.
The use of liquid-based cytology (LBC) in non-gynecological fields has progressively increased. However, studies focusing on the application of LBC in bile cytology are limited, and its efficacy remains uncertain. In this study, we assessed the potential of LBC in bile cytology by evaluating the interobserver agreement.
Bile cytology specimens were collected between 2015 and 2022 by using endoscopic retrograde cholangiopancreatography. Eleven cytotechnologists participated in the evaluation. Digital images of bile cytology specimens prepared using conventional smear (CS), ThinPrep LBC (TP-LBC), and SurePath LBC (SP-LBC) methods (20 cases per preparation method) were assessed for interobserver agreement on 21 diagnostic criteria. The diagnostic accuracy was evaluated using 50 bile cytology cases per preparation method.
High interobserver agreement (exact kappa > 0.6) was observed for features, including the loss of nuclear polarity, irregular nuclear spacing, nuclear size variation, and increased nuclear-to-cytoplasmic ratio across the CS, TP-LBC, and SP-LBC methods. Malignant cells in TP-LBC appeared smaller and rounder, and formed flat aggregates compared with those in CS. In contrast, the malignant cells in SP-LBC formed three-dimensional clusters that overlapped and exhibited higher cellularity than those in CS. The sensitivity of bile cytology was 76.4%, 84.8%, and 93.2% for CS, TP-LBC, and SP-LBC, respectively.
The observers consistently recognized malignant cell features in bile cytology, irrespective of the preparation method. Understanding common features and method-specific cellular morphology is crucial for enhancing diagnostic accuracy. Our findings suggest that LBC methods can be effectively applied to bile cytology, potentially offering improved diagnostic accuracy compared with conventional methods.
液基细胞学（LBC）在非妇科领域的应用逐渐增多。然而，关注LBC在胆汁细胞学中应用的研究有限，其有效性仍不确定。在本研究中，我们通过评估观察者间的一致性来评估LBC在胆汁细胞学中的潜力。
2015年至2022年间，通过内镜逆行胰胆管造影术收集胆汁细胞学标本。11名细胞技术专家参与了评估。对使用传统涂片（CS）、ThinPrep LBC（TP-LBC）和SurePath LBC（SP-LBC）方法制备的胆汁细胞学标本的数字图像（每种制备方法20例），就21项诊断标准评估观察者间的一致性。每种制备方法使用50例胆汁细胞学病例评估诊断准确性。
在CS、TP-LBC和SP-LBC方法中，对于包括核极性丧失、核间距不规则、核大小变异和核质比增加等特征，观察到观察者间高度一致（精确kappa>0.6）。与CS中的恶性细胞相比，TP-LBC中的恶性细胞显得更小、更圆，并形成扁平聚集体。相比之下，SP-LBC中的恶性细胞形成三维簇，相互重叠，且细胞密度高于CS中的恶性细胞。CS、TP-LBC和SP-LBC的胆汁细胞学敏感性分别为76.4%、84.8%和93.2%。
无论制备方法如何，观察者在胆汁细胞学中均能一致识别恶性细胞特征。了解常见特征和特定方法的细胞形态对于提高诊断准确性至关重要。我们的研究结果表明，LBC方法可有效应用于胆汁细胞学，与传统方法相比可能提供更高的诊断准确性。
