The diagnostic and prognostic role of liquid-based cytology: are we ready to monitor therapy and resistance?

Abstract

Here, we evaluate the diagnostic and prognostic role of liquid-based cytology (LBC) in different body lesions, including thyroid, lung, effusions and malignant breast lesions. LBC has gained consensus after being applied to both non-gynecologic and fine-needle aspiration cytology. Although some remain sceptical regarding the diagnostic efficacy of LBC, mainly when used alone, in recent years, good results have been obtained as long as it showed a high diagnostic accuracy. Here, we discuss the additional possibility of storing material for the application of ancillary techniques (immunocytochemistry–molecular analysis) with several diagnostic and prognostic advantages, which may pave the way for the challenging evaluation of both monitoring responses to treatment and resistance to targeted therapies in thyroid, lung, breast carcinoma or malignant effusions. Furthermore, it provides the use of several molecular spots as specific targets for personalized therapy.

Keywords:

• effusions
• immunocytochemistry
• liquid-based cytology
• malignancy
• molecular analysis
• nodular lesions
• targeted therapies

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Liquid-based cytology offers several advantages in the management and diagnostic evaluation of different body lesions based on a uniform, thin-layer distribution of cells.

• This technique introduces some cytomorphological features that are dissimilar from those of conventional cytology, including both architectural and cellular findings.

• Some authors demonstrated a higher statistical significant improvement in sensitivity and diagnostic accuracy after a 6-month period of training.

• Standardization in the method with uniform yields and homogenous cell distribution is one of the major strength attributed to this method.

• Liquid-based cytology residual material may be used for the application of ancillary techniques, including immunocytochemistry, molecular analysis and in situ hybridization with feasible and reliable results.

• The additional costs to the laboratory are counterbalanced by the decreased number of slides and the reduced slide surface.

• The application of molecular analysis with excellent results paves the way for the presurgical management of specific tailored therapies.

• Future research will provide great opportunities to analyze tumor genetics with a small quantity of cells and material as we have on cytology. This may offer new insights for the resistances to some specific therapies.