A Comparative Study Of Liquid-Based Cytology And Conventional Smear Cytology In The Diagnosis Of Nipple Discharge

ObjectiveWe applied the liquid-based cytology method to the diagnosis of nipple discharge innovatively,and a comparative study was conducted with conventional smear cytology to compare the differences in diagnostic efficacy and image quality between two methods used in nipple discharge.And we combined the detection of nipple discharge tumor markers to explore the clinical application value of liquid-based cytology in the diagnosis of nipple discharge.Materials and methodsIn this study,a total of 99 patients with nipple discharge who attended the Department of Breast Surgery of Qilu Hospital,Shandong University from December 1,2020 to January 31,2022,and were treated with surgery,10 of whom had bilateral nipple discharge.A total of 109 nipple discharge specimens were collected before surgery,and the characteristics of nipple discharge were recorded,liquid-based cytology and conventional smear cytology were performed at the same time.Patients with a large amount of nipple discharge were simultaneously detected for nipple discharge tumor markers CEA and CA153 before surgery.The patient’s basic clinical and pathological data,cytology results,and nipple discharge tumor marker results were collected.Statistical methods were used to analyze the data.Differences were considered statistically significant at P<0.05.Results1.Among the 109 specimens,34 cases(31.19%)were breast cancer,44 cases(40.37%)were intraductal papilloma,9 cases(8.26%)were atypical ductal hyperplasia,and a total of 22 cases(20.18%)were other pathological types(include breast hyperplasia,ductal ectasia,fibroadenoma,sclerosing adenosis).Among the 34 breast cancer patients,28 cases(82.35%)had palpable masses on clinical examination,more than those with benign lesions(17,22.67%).Bloody nipple discharge was observed in 55.88%of patients with breast cancer and in only 26.67%of patients with benign lesions.There were no statistical differences in the comparison of other clinical features.2.Among the 109 specimens,38(34.86%)were positive for liquid-based cytology,and 23(21.10%)were positive for conventional smear cytology,the positive detection rate of liquid-based cytology was higher.Among the 44 patients with intraductal papilloma,17(38.64%)were positive for liquid-based cytology,11(18.18%)were positive for conventional smear cytology,the positive detection rate of liquid-based cytology was higher.In patients with breast cancer,there was no statistically significant difference in positive detection rate between the two cytology methods.3.The microscopic cytological features of liquid-based cytology and conventional smear cytology were analyzed.The background of liquid-based cytology was clear,cells were evenly distributed,and cancer cells with large and deep-stained nuclei and irregular shapes could be found.The cells overlapped in conventional smear cytology and the background of conventional smear cytology was blurred,especially in bloody nipple discharge specimens,the background had more blood cells,affecting the reading observation.4.The differences in the volume of nipple discharge between different groups were compared,expressed in quartile.The distribution of nipple discharge was the same as that of the benign lesion group in the breast cancer group.The volume of nipple discharge in the liquid-based cytology positive group was 25μl(15μl-80μl)and 20μl(10μl-40μl)in the liquid-based cytology negative group,there was no statistical difference between the two groups in terms of the volume of nipple discharge.5.The diagnostic efficacy of two cytology tests were compared.The sensitivity,specificity,positive predictive value,negative predictive value and the Kappa value of liquid-based cytology were higher than those of conventional smear cytology.The AUC(Area under curve)of liquid-based cytology was 0.7184,which had a certain diagnostic ability;the AUC of conventional smear cytology was 0.5752,which had limited diagnostic value.6.The diagnostic efficacy of liquid-based cytology and conventional smear cytology combined with the nipple discharge tumor markers CEA and CA153,respectively,was compared in 86 specimens.The AUCs of both liquid-based cytology and conventional smear cytology combined with CEA and/or CA153 were larger than those of cytology applied alone,and the differences were statistically significant.Among them,liquid-based cytology combined with both CEA and CA153 had the best diagnostic ability.Conclusions1.Liquid-based cytology has a clear background under the microscope,the positive detection rate is higher than that of conventional smear cytology,which has certain diagnostic ability and can replace conventional smear cytology as a new clinical screening diagnostic tool for patients with nipple discharge.2.The diagnostic ability of liquid-based cytology combined with nipple discharge tumor markers CEA and CA153 is higher than that of one diagnostic method alone,which can be used to distinguish the benignity and malignancy of breast lesions.3.The volume of nipple discharge has nothing to do with the benign or malignant lesions,nor does it have anything to do with whether the cytology result is positive,and cannot be used as a reference for clinical judgment to determine the nature of the lesion.4.Patients with bloody nipple discharge are more likely to have breast cancer than patients with other nipple discharge traits,and patients with nipple discharge accompanied by clinically palpable masses are more likely to have breast cancer than patients with non-palpable masses.