AgNOR Proliferative Index in Malignant Pleural and Peritoneal Effusions

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

AgNOR Proliferative Index in Malignant Pleural and Peritoneal Effusions

Shazia N. Ibnerasa, Naseer Ahmed Chaudhry* and Saeed Akthar Khan**
Department of Pathology, Postgraduate Medical Institute, Lahore
* Department of Pathology, University of Health Sciences, Lahore
** Department of Pathology, Lahore Medical & Dental College, Lahore.

Introduction: The inability to decide on the presence or absence of malignant cells in cytologic specimens casts a difficult
problem in clinical management. Over the last decade, silver staining of the nucleolar organizer regions-associated proteins
(AgNORs) in interphase cells has become a widely used alternative method for assessing proliferation in tumour pathology. A
great deal of work has been done to evaluate the usefulness of AgNOR counts in the study of various neoplasms. It has been
established that new predictor of biologic aggressiveness in a neoplasm, AgNOR proliferative index (pAgNOR) correlates
with the proliferative activity of a cell. In this study, AgNOR silver staining was done on 40 cases of cytologically positive
malignant effusions and both mean AgNOR (mAgNOR) and pAgNOR counting was done.
Objectives: To measure AgNOR counts and their distribution in malignant effusions in relation to a new parameter, AgNOR
proliferative index (pAgNOR) which reflects the proliferative activity of a cell.
Place and Duration of Study: The study was carried out in the Department of Pathology, Postgraduate Medical Institute Lahore while the cases were collected from Surgical, Medical, Gynaecological and Oncology units of Services hospital, Mayo Hospital, Gulab Devi hospital and Lahore General hospital from March 1997 to November 1999.
Patients and Methods: Forty patients were selected with different types of malignancies and having cytologically positive
effusions. Pleural and peritoneal fluid was collected aseptically and smears were made from the cell button after centrifugation. AgNOR silver staining technique was performed on each smear.
Results: Using the criteria of Ahsan et al 91-92, in our study highly significant (p < 0.001) difference was noted when AgNOR size of malignant effusions between 2+ and 3+ was compared with 0 – 1+. Similar significant relationship was seen (p < 0.001) when AgNOR distribution of 2+ and 3+ was compared with 0 – 1+ distribution. Most of the cases with malignant effusions had AgNOR proliferative index above 90%. However, when AgNOR proliferative index between pleural and peritoneal effusions were compared, the difference was not significant. Conclusion: The two simple AgNOR counting methods can be used reliably to evaluate tumour cell kinetics especially in situations in which the tissue is insufficient for flow cytometry, for example, in small biopsies and limited needle aspirates. Key words: Effusions, malignant, AgNOR, AgNOR Proliferative index.


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