- Email: [email protected]
Diagnosis of Malignant Mesothelioma (MM) on Fluid Cytology: Can It And Should It Be Done?
S8 PP 10 Histone (H1.5) and Prolmyelocytic Leukemia Zinc Finger (PLZF) Staining Patterns Differentiate Carcinoid from Small Cell Carcinoma in Fine Needle Aspirations (FNA) Dianne Grunes, MD, Yayoi Kinoshita, DMD, Mary Beth Beasley, MD, Maoxin Wu, MD, David Burstein, MD. Pathology, The Mount Sinai School of Medicine, New York, New York Introduction: Typical (TC) and atypical carcinoid (AC) can be difficult to differentiate from high grade neuroendocrine carcinomas, particularly small cell carcinoma (SCC) on cytologic samples and often have overlapping immunohistochemical markers. Promyelocytic Leukemia Zinc Finger (PLZF) and Histone H1.5 (H1.5) have recently been presented as markers of low and high malignant potential, respectively, in tissue biopsies of pulmonary neuroendocrine tumors. PLZF is a transcriptional repressor, mostly studied in leukemia, with tumor suppressor like activity. H1.5, conversely, is associated with active transcription. Materials and Methods: We applied these findings to FNAs not limited to the lung. We retrieved cell blocks from 48 cases including SCC (nZ28; 22 pulmonary, 3 mediastinal, 2 cervical lymph nodes, 1 abdominal wall), TC (nZ19; 12 pulmonary, 2 rectal, 2 liver, 1 pancreas, 1 duodenal, 1 mediastinal), and AC (nZ1 pulmonary) and performed immunohistochemical stains for anti PLZF using concentrations varying from 1:500-1:2000 and H1.5 (conc. 1:800-1:2000). The intensity and location of the stain were recorded and the difference in staining patterns between SCC and carcinoid tumors was examined. Results: H1.5 stained 28 (100%) of the SCC and 5 (25%) of the carcinoids (5 TC; 4 pulmonary, 1 mediastinal, 0 AC) (p<0.01). PLZF was positive in 13 (65%) of the carcinoids (12 TC; 9 pulmonary, 2 rectal, 1 liver, 1 AC) and negative in all of the SCC (p<0.01). H1.5 is very sensitive for SCC (100% sensitivity; 63% specificity). The positive predictive value for SCC staining with H1.5 was 84% with a 100% negative predictive value. PLZF is specific for carcinoid when differentiating it from SCC (100% specificity; 65% sensitivity). The positive predictive value for carcinoid staining with PLZF was 100% with an 80% negative predictive value. H1.5 and PLZF stains are exclusively nuclear. The H1.5 staining was more intense than that for PLZF in all cases. PLZF staining was diffuse in 80%, patchy in 20% of the positive specimens; moderate in 90%, weak in 10%. H1.5 was strong in 77%, weak in 23% of the positive specimens. No difference in staining pattern was noted between pulmonary and extrapulmonary sites. Conclusions: Either positive staining with PLZF or negative staining with H1.5 excludes SCC. PLZF positivity is suggestive of TC or AC; H1.5 positivity is suggestive of SCC. These findings are consistent with previous studies done on pulmonary biopsies. PLZF and H1.5 may be diagnostically useful in cytologic preparations where the differences between carcinoid tumors and SCC are often subtle. PP 11 Endosalpingiosis in Peritoneal Washings in Women with Benign Gynecologic Conditions: A Report of 34 Cases Confirmed with Pax-8 Immunohistochemical Staining and Correlation with Surgical Biopsy Findings Marilyn Dawlett, CT(ASCP), Teresa Kologinczak, CT(ASCP), IAC, Nour Sneige, MD. Pathology, UT MD Anderson Cancer Center, Houston, Texas Introduction: Endosalpingiosis can be recognized in peritoneal washings (PWs) on the basis of the presence of tubular or papillary structures, often forming a single layer of epithelium surrounding psammoma bodies. Distinguishing between endosalpingiosis and low-grade carcinoma of Mullerian origin or mesothelial hyperplasia may be difficult because of shared cytomorphologic features. Published studies of endosalpingiosis in PWs are rare and have included only a small number of cases. To fully evaluate the presentation of endosalpingiosis in PWs and, thus, facilitate its distinction from its mimickers, we examined PWs in women who
Abstracts underwent surgery and pathologic staging of lesions other than Mullerian malignancies and correlated the findings with surgical specimens. Materials and Methods: We retrospectively reviewed the medical records and PW specimens of 80 consecutive patients who had PW specimens coded as “endosalpingiosis” and/or “negative for carcinoma” between 2002 and 2010 at The University of Texas MD Anderson Cancer Center. Thirtyfour of the 80 patients met the inclusion criteria (no gynecologic malignancies). Specimens had been prepared using cytocentrifugation and were stained using the Papanicolaou method. Two to four cytospin smears were available per case. Cytologic findings evaluated were cell arrangement, number of cell groups per case, cytologic atypia, and psammoma bodies. Smears were also assessed for Pax-8 immunostaining (a Mullerian marker). We compared patients’ staging biopsy findings with those of our reviews of the PWs. Results: The patients’ ages ranged from 17 to 74 years (mean, 44 years). Endosalpingiosis was displayed as small clusters or branching tubular structures, some with associated psammoma bodies. The number of clusters per case ranged from 2 to 12 (mean, 6 groups). Two cases had approximately 50 small cell groups each. The cells were low cuboidal (most cases) or tall columnar and exhibited round nuclei with mild to moderate atypia and a slight increase in the nucleus to cytoplasm ratio. The corresponding surgical findings were endometriosis (6), endosalpingiosis (5), both endometriosis and endosalpingiosis (1), hemorrhagic corpus luteum cyst (5), uterine fibroid (5), ovarian cystadenofibroma (5), ovarian epidermoid cyst (4), and localized appendiceal carcinoma (3). Pax 8 was positive in all the cases, confirming the Mullerian origin of the clusters. Conclusions: Endosalpingiosis displays distinct morphologic and immunophenotypic characteristics in PWs that should differentiate it from reactive mesothelial hyperplasia or carcinoma. When evaluating PW specimens of patients with gynecologic malignancies, one should be aware that the presence of Mullerian epithelium in PWs is common and not be mistaken for serous/endometrioid neoplasms. To ensure an accurate diagnosis, PW findings are best interpreted with complete knowledge of the surgical biopsy findings of the pelvic lesions. PP 12 Diagnosis of Malignant Mesothelioma (MM) on Fluid Cytology: Can It And Should It Be Done? Ajit Paintal, MD1, Kirtee Raparia, MD1, Maureen Zakowski, MD2, Ritu Nayar, MD1. 1Department of Pathology, Northwestern Memorial Hospital and Feinberg School of Medicine, Chicago, Illinois; 2Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York Introduction: Per the WHO classification of tumors of the lung and pleura, “differentiation of mesothelioma from benign mesothelial hyperplasia with reactive atypia may be very difficult or impossible in cytologic specimens, since tissue invasion cannot be evaluated”. At our institution, a primary diagnosis of mesothelioma (MM) is made on fluid cytology specimens. In an effort to estimate the practice at other institutions, we sent out a survey regarding cytologic diagnosis of MM. We also evaluated two decades worth of our own institution’s experience with primary cytologic diagnosis of MM. Materials and Methods: Patients with histologically confirmed MM at our institution were identified from 1992-2011. Fluid cytology specimens immediately preceding or concurrent with histologic specimens were reviewed. A survey was sent to 50 cytology laboratories. Results: At our institution 29 cases of MM had cytologic specimens immediately preceding or concurrent with the diagnostic histologic material. The diagnoses were: 12 positive for MM, 2 positive for adenocarcinoma, 1 suspicious for malignancy, 4 atypical, 10 negative. If positive and suspicious results are pooled, the sensitivity of fluid cytology in our hands is 45% (epithelioid: 54%, biphasic: 50%, sarcomatoid 40%). In 2 instances, cases of MM were misclassified as adenocarcinoma (AC). We had no false positive diagnoses of MM. 42 laboratories responded to the survey of which 86% were university based medical centers. 66% make a definitive diagnosis of MM in cytology and 96% of these do so for both primary diagnosis and recurrence. 88% do
Abstracts
S9
soon fluid specimens. 100% routinely do IHC to distinguish AC from MM. 57% do additional IHC or FISH for p16 to help distinguish benign from malignant mesothelial proliferations. Those who do not definitively diagnose MM in fluid specimens note inability to identify invasion and overlap with reactive mesothelial proliferation as factors supporting this opinion. A suspicious or atypical diagnosis with concern for MM is followed by an open biopsy confirmation in 76% of labs; only 5% obtain repeat cytologic specimens. When asked if clinicians will treat based solely on a cytologic (fluid/FNA) diagnosis of MM, 63% replied in the affirmative. Conclusions: A primary diagnosis of MM in fluid specimens is highly accurate when made in the context of clinical data, radiologic findings, and ancillary studies and does not necessarily need histologic confirmation to initiate treatment.
Table 2
Cellularity and DNA yield
Number of cell groups
Number of cases
DNA range (ng)
Median (ng)
Mean (ng)
Standard deviation
1-5 6-10 11-20 >20
10 7 5 11
168-934 146-1352 236-4932 1572-53907
543 716 1912 3232
594.1 727.6 1984.6 10036.9
272.5 352.9 1833 15244.3
Conclusions: Cellularity is a main contributor for rendering atypical cytologic diagnoses, as atypical diagnoses were decreased 50% when sample cellularity increased from 1+ to 3+. We have systematically evaluated the DNA yields in thyroid FNA samples and correlated them with cellularity. The minimal number of cells needed for molecular testing can be assessed based on the number of cell groups on corresponding ThinprepÒ slides. When using 6 groups of at least 10 follicular cells as a cutoff, nearly 96% of thyroid FNA cases contain enough genomic DNA for further molecular testing.
PP 13 Assessment of Cellularity and Genomic DNA Yields from Thyroid FNA Samples Kathryn Dyhdalo, MD1, Rosemarie Read, MT(ASCP), PhD2, Jennifer Brainard, MD1, Dawn Underwood, CT(ASCP)1, Raymond Tubbs, MD2, Bin Yang, MD, PhD1. 1Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio; 2Molecular Pathology, Cleveland Clinic Foundation, Cleveland, Ohio Introduction: BRAF mutation is considered a specific marker for papillary thyroid carcinoma (PTC) and is present in approximately 40% of PTC. Molecular testing for BRAF mutations has been applied to paraffinembedded resection tissue in order to predict prognosis and guide therapy. Prior reports indicate BRAF mutation testing may enhance cytologic diagnosis of PTC. An important question is: what is the minimal cell number from an FNA sample required to conduct successful clinical testing of BRAF mutation in liquid-based cytologic samples. We report our laboratory experience validating BRAF mutational analysis in cytologic liquid-based specimens from 33 thyroid FNA’s. Materials and Methods: Residual material from thyroid FNA’s was collected after rendering cytologic diagnoses of either positive for PTC, atypical cannot rule out PTC (ACR), atypical suspicious for PTC (ASM), atypical suspicious for follicular neoplasm (AFN) and atypia of undetermined significance (AUS). A ThinprepÒ slide from each vial was prepared before nucleic acid extraction. Cellularity was evaluated in a blinded fashion using a semi-quantitative scale. A group composed of at least 10 cells was counted as one unit. The cellularity was divided into four grades based on number of groups on the slide: 1+ (1-5), 2+ (6-10), 3+ (11-20) and 4+ (>20 groups). Genomic DNA was extracted using Gentra Puregene kit following manufacturer’s instructions. DNA concentration, protein/nucleic acids and DNA/ RNA ratio for purity was measured using NanoDrop. Cellularity and DNA yield was correlated and calculated with T-test statistical analysis. Results: 33 cases including: 2 AUS, 5 ACR, 4 AFN, 5 ASM and 16 positive for PTC were studied. Correlation of cellularity and cytologic diagnoses is shown in Table 1. DNA yields generated from the leftover liquid specimens correlate proportionally with cellularity on ThinprepÒ slides (see Table 2). The range of DNA yields of all specimens is between 146 ng and 53,907 ng. DNA concentration increases 3.4 times from 1+ to 3+ cellularity and increases nearly 17 times from 1+ to 4+ cellularity. Analytically a minimum of 200 ng is required to run duplicate tests of BRAF mutation for clinical utility. Overall 91% (30/33) of cases yielded a satisfactory amount of DNA for testing and only 9% (3/33) of FNA cases generated DNA yields less than 200 ng, including 2 cases from the 1+ cellularity group and one case from the 2+ cellularity group. When using 6 groups of follicular cells with at least 10 cells per group as a cutoff, 95.7% of the cases yield enough genomic DNA for molecular testing. Table 1
PP 14 Enhancing Diagnosis of Pleural Effusions Using High-throughput Deformability Cytometry Henry Tse, PhD1, Daniel Gossett, PhD1, Irma Oliva, MD2, Yong Ying, CT(ASCP)2, Natasha Natarajan2, JianYu Rao, MD, FCAP2, Dino Di Carlo, PhD1. 1Bioengineering, University of California, Los Angeles, California; 2Pathology and Laboratory Medicine, University of California, Los Angeles, California Introduction: Mechanical properties of cells, arising from cytoskeletal and nuclear composition and organization, are potential label-free biomarkers of cell state or malignant transformation. In a clinical setting, an accurate and automated measure of states such as activation or malignancy would have significant impact in diagnostics and monitoring. However, until now the tools to measure mechanical biomarkers have been of too low throughput to analyze the heterogeneity of clinical samples or too technically demanding to be practically useful. We have developed Deformability Cytometry (DC) a label-free and accessible technology with the throughput of flow cytometry but without the variability or labor-intensive sample preparation. In this work, we have applied this tool for the analysis of pleural effusions and compared the diagnostic accuracy to cytology. Materials and Methods: DC is a microfluidic method which uses fluid forces to deform cells on short time scales (100 ms; Figure 1), similar to a water balloon impacting a surface. The shape change in response to this large mechanical stress is a function of intrinsic mechanical properties of a cell. The deformability parameter (D) is the ratio of major to minor axis of a cell at its maximum deformation.
Correlation of cellularity and cytologic diagnosis
Number of cell groups
AUS
ACR
AFN
ASM
Positive
Total number of cases
Atypical diagnoses
1-5 6-10 11-20 >20
2 0 0 0
2 1 1 1
1 2 0 1
3 1 1 1
2 3 3 8
10 7 5 11
80% 57% 40% 27%
Figure 1 Deformability cytometry microfluidic chip. a) Photograph of chip (Scale bar Z 3 cm). b) Device schematic with deformation junction region highlighted in red. c) Deformation junction expanded to show a theoretical deformation of a cell.
Abstracts underwent surgery and pathologic staging of lesions other than Mullerian malignancies and correlated the findings with surgical specimens. Materials and Methods: We retrospectively reviewed the medical records and PW specimens of 80 consecutive patients who had PW specimens coded as “endosalpingiosis” and/or “negative for carcinoma” between 2002 and 2010 at The University of Texas MD Anderson Cancer Center. Thirtyfour of the 80 patients met the inclusion criteria (no gynecologic malignancies). Specimens had been prepared using cytocentrifugation and were stained using the Papanicolaou method. Two to four cytospin smears were available per case. Cytologic findings evaluated were cell arrangement, number of cell groups per case, cytologic atypia, and psammoma bodies. Smears were also assessed for Pax-8 immunostaining (a Mullerian marker). We compared patients’ staging biopsy findings with those of our reviews of the PWs. Results: The patients’ ages ranged from 17 to 74 years (mean, 44 years). Endosalpingiosis was displayed as small clusters or branching tubular structures, some with associated psammoma bodies. The number of clusters per case ranged from 2 to 12 (mean, 6 groups). Two cases had approximately 50 small cell groups each. The cells were low cuboidal (most cases) or tall columnar and exhibited round nuclei with mild to moderate atypia and a slight increase in the nucleus to cytoplasm ratio. The corresponding surgical findings were endometriosis (6), endosalpingiosis (5), both endometriosis and endosalpingiosis (1), hemorrhagic corpus luteum cyst (5), uterine fibroid (5), ovarian cystadenofibroma (5), ovarian epidermoid cyst (4), and localized appendiceal carcinoma (3). Pax 8 was positive in all the cases, confirming the Mullerian origin of the clusters. Conclusions: Endosalpingiosis displays distinct morphologic and immunophenotypic characteristics in PWs that should differentiate it from reactive mesothelial hyperplasia or carcinoma. When evaluating PW specimens of patients with gynecologic malignancies, one should be aware that the presence of Mullerian epithelium in PWs is common and not be mistaken for serous/endometrioid neoplasms. To ensure an accurate diagnosis, PW findings are best interpreted with complete knowledge of the surgical biopsy findings of the pelvic lesions. PP 12 Diagnosis of Malignant Mesothelioma (MM) on Fluid Cytology: Can It And Should It Be Done? Ajit Paintal, MD1, Kirtee Raparia, MD1, Maureen Zakowski, MD2, Ritu Nayar, MD1. 1Department of Pathology, Northwestern Memorial Hospital and Feinberg School of Medicine, Chicago, Illinois; 2Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York Introduction: Per the WHO classification of tumors of the lung and pleura, “differentiation of mesothelioma from benign mesothelial hyperplasia with reactive atypia may be very difficult or impossible in cytologic specimens, since tissue invasion cannot be evaluated”. At our institution, a primary diagnosis of mesothelioma (MM) is made on fluid cytology specimens. In an effort to estimate the practice at other institutions, we sent out a survey regarding cytologic diagnosis of MM. We also evaluated two decades worth of our own institution’s experience with primary cytologic diagnosis of MM. Materials and Methods: Patients with histologically confirmed MM at our institution were identified from 1992-2011. Fluid cytology specimens immediately preceding or concurrent with histologic specimens were reviewed. A survey was sent to 50 cytology laboratories. Results: At our institution 29 cases of MM had cytologic specimens immediately preceding or concurrent with the diagnostic histologic material. The diagnoses were: 12 positive for MM, 2 positive for adenocarcinoma, 1 suspicious for malignancy, 4 atypical, 10 negative. If positive and suspicious results are pooled, the sensitivity of fluid cytology in our hands is 45% (epithelioid: 54%, biphasic: 50%, sarcomatoid 40%). In 2 instances, cases of MM were misclassified as adenocarcinoma (AC). We had no false positive diagnoses of MM. 42 laboratories responded to the survey of which 86% were university based medical centers. 66% make a definitive diagnosis of MM in cytology and 96% of these do so for both primary diagnosis and recurrence. 88% do
Abstracts
S9
soon fluid specimens. 100% routinely do IHC to distinguish AC from MM. 57% do additional IHC or FISH for p16 to help distinguish benign from malignant mesothelial proliferations. Those who do not definitively diagnose MM in fluid specimens note inability to identify invasion and overlap with reactive mesothelial proliferation as factors supporting this opinion. A suspicious or atypical diagnosis with concern for MM is followed by an open biopsy confirmation in 76% of labs; only 5% obtain repeat cytologic specimens. When asked if clinicians will treat based solely on a cytologic (fluid/FNA) diagnosis of MM, 63% replied in the affirmative. Conclusions: A primary diagnosis of MM in fluid specimens is highly accurate when made in the context of clinical data, radiologic findings, and ancillary studies and does not necessarily need histologic confirmation to initiate treatment.
Table 2
Cellularity and DNA yield
Number of cell groups
Number of cases
DNA range (ng)
Median (ng)
Mean (ng)
Standard deviation
1-5 6-10 11-20 >20
10 7 5 11
168-934 146-1352 236-4932 1572-53907
543 716 1912 3232
594.1 727.6 1984.6 10036.9
272.5 352.9 1833 15244.3
Conclusions: Cellularity is a main contributor for rendering atypical cytologic diagnoses, as atypical diagnoses were decreased 50% when sample cellularity increased from 1+ to 3+. We have systematically evaluated the DNA yields in thyroid FNA samples and correlated them with cellularity. The minimal number of cells needed for molecular testing can be assessed based on the number of cell groups on corresponding ThinprepÒ slides. When using 6 groups of at least 10 follicular cells as a cutoff, nearly 96% of thyroid FNA cases contain enough genomic DNA for further molecular testing.
PP 13 Assessment of Cellularity and Genomic DNA Yields from Thyroid FNA Samples Kathryn Dyhdalo, MD1, Rosemarie Read, MT(ASCP), PhD2, Jennifer Brainard, MD1, Dawn Underwood, CT(ASCP)1, Raymond Tubbs, MD2, Bin Yang, MD, PhD1. 1Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio; 2Molecular Pathology, Cleveland Clinic Foundation, Cleveland, Ohio Introduction: BRAF mutation is considered a specific marker for papillary thyroid carcinoma (PTC) and is present in approximately 40% of PTC. Molecular testing for BRAF mutations has been applied to paraffinembedded resection tissue in order to predict prognosis and guide therapy. Prior reports indicate BRAF mutation testing may enhance cytologic diagnosis of PTC. An important question is: what is the minimal cell number from an FNA sample required to conduct successful clinical testing of BRAF mutation in liquid-based cytologic samples. We report our laboratory experience validating BRAF mutational analysis in cytologic liquid-based specimens from 33 thyroid FNA’s. Materials and Methods: Residual material from thyroid FNA’s was collected after rendering cytologic diagnoses of either positive for PTC, atypical cannot rule out PTC (ACR), atypical suspicious for PTC (ASM), atypical suspicious for follicular neoplasm (AFN) and atypia of undetermined significance (AUS). A ThinprepÒ slide from each vial was prepared before nucleic acid extraction. Cellularity was evaluated in a blinded fashion using a semi-quantitative scale. A group composed of at least 10 cells was counted as one unit. The cellularity was divided into four grades based on number of groups on the slide: 1+ (1-5), 2+ (6-10), 3+ (11-20) and 4+ (>20 groups). Genomic DNA was extracted using Gentra Puregene kit following manufacturer’s instructions. DNA concentration, protein/nucleic acids and DNA/ RNA ratio for purity was measured using NanoDrop. Cellularity and DNA yield was correlated and calculated with T-test statistical analysis. Results: 33 cases including: 2 AUS, 5 ACR, 4 AFN, 5 ASM and 16 positive for PTC were studied. Correlation of cellularity and cytologic diagnoses is shown in Table 1. DNA yields generated from the leftover liquid specimens correlate proportionally with cellularity on ThinprepÒ slides (see Table 2). The range of DNA yields of all specimens is between 146 ng and 53,907 ng. DNA concentration increases 3.4 times from 1+ to 3+ cellularity and increases nearly 17 times from 1+ to 4+ cellularity. Analytically a minimum of 200 ng is required to run duplicate tests of BRAF mutation for clinical utility. Overall 91% (30/33) of cases yielded a satisfactory amount of DNA for testing and only 9% (3/33) of FNA cases generated DNA yields less than 200 ng, including 2 cases from the 1+ cellularity group and one case from the 2+ cellularity group. When using 6 groups of follicular cells with at least 10 cells per group as a cutoff, 95.7% of the cases yield enough genomic DNA for molecular testing. Table 1
PP 14 Enhancing Diagnosis of Pleural Effusions Using High-throughput Deformability Cytometry Henry Tse, PhD1, Daniel Gossett, PhD1, Irma Oliva, MD2, Yong Ying, CT(ASCP)2, Natasha Natarajan2, JianYu Rao, MD, FCAP2, Dino Di Carlo, PhD1. 1Bioengineering, University of California, Los Angeles, California; 2Pathology and Laboratory Medicine, University of California, Los Angeles, California Introduction: Mechanical properties of cells, arising from cytoskeletal and nuclear composition and organization, are potential label-free biomarkers of cell state or malignant transformation. In a clinical setting, an accurate and automated measure of states such as activation or malignancy would have significant impact in diagnostics and monitoring. However, until now the tools to measure mechanical biomarkers have been of too low throughput to analyze the heterogeneity of clinical samples or too technically demanding to be practically useful. We have developed Deformability Cytometry (DC) a label-free and accessible technology with the throughput of flow cytometry but without the variability or labor-intensive sample preparation. In this work, we have applied this tool for the analysis of pleural effusions and compared the diagnostic accuracy to cytology. Materials and Methods: DC is a microfluidic method which uses fluid forces to deform cells on short time scales (100 ms; Figure 1), similar to a water balloon impacting a surface. The shape change in response to this large mechanical stress is a function of intrinsic mechanical properties of a cell. The deformability parameter (D) is the ratio of major to minor axis of a cell at its maximum deformation.
Correlation of cellularity and cytologic diagnosis
Number of cell groups
AUS
ACR
AFN
ASM
Positive
Total number of cases
Atypical diagnoses
1-5 6-10 11-20 >20
2 0 0 0
2 1 1 1
1 2 0 1
3 1 1 1
2 3 3 8
10 7 5 11
80% 57% 40% 27%
Figure 1 Deformability cytometry microfluidic chip. a) Photograph of chip (Scale bar Z 3 cm). b) Device schematic with deformation junction region highlighted in red. c) Deformation junction expanded to show a theoretical deformation of a cell.