運用睪丸組織轉印抹片技術即時判讀無精症患者之造精診斷

許程皓¹、蔡承翰^1,2、黃奕燊^1,2、陳威任^1,2、彭昱璟³、黃志賢^1,2
1臺北榮民總醫院泌尿部; ²國立陽明交通大學書田泌尿科學研究中心;
³臺北榮民總醫院病理檢驗部

Immediate assessment of spermatogenesis at testicular biopsy

for azoospermic males using touch print smear

Chen-Hao Hsu, M.D., M.T.M¹, Cheng-Han Tsai, M.D.^1,2, I-Shen Huang, M.D.^1,2,

Wei-Jen Chen, M.D. ^1,2, Yu-Ching Peng, M.D.³, William J. Huang, M.D., Ph.D. ^1,2

¹ Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

² Department of Urology, School of Medicine, College of Medicine and Shu-Tien Urological
Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

³ Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan

Purpose: Touch print smear (TPS) of testicular specimens has been shown to provide immediate diagnostic results that are comparable both with histopathology (for biopsy) and in vitro fertilization (IVF) laboratory (for sperm retrieval) findings. In this study, we seek to further validate TPS’ role as not only a quick assessment tool on spermatogenesis but also a valuable companion to histopathology to avoid overlooking or over-diagnosis of the post-meiotic germ cells.

Materials and methods: We retrospectively enrolled 495 azoospermic patients (274, 55.3% were with obstructive) who had undergone testis needle biopsy between 2015 and 2022. The specimens retrieved were immediately smeared onto a sterile slide before being transferred into a tube containing Bouin’s solution as standard pathological diagnosis. The smeared slide was then stained with thionine and read under a light microscope. The development of spermatogenesis was compared between TPS findings and the histopathology reports. Diagnostic categories of spermatogenesis are according to the presence or absence of post-meiotic germ cells. The former includes normal spermatogenesis, hypospermatogenesis and late maturation arrest, and the latter comprises early maturation arrest and Sertoli cell-only.

Results: 98.2% (269/274) of the OA group showed a concordant result between TPS and histopathology, but only 75.6% (167/221) of the NOA group displayed concordance. Among the NOA patients with discordancy between TPS and histopathological result, 74.1% (40/54) exhibited a more advanced spermatogenesis through TPS. In 20 patients showing post-meiotic germ cells by TPS but not by histopathology, 95% (19/20) of them were confirmed with successful sperm retrieval at later microdissection testicular sperm extraction (mTESE). Among the 25.9% of the NOA group showing a less advanced diagnosis by TPS compared with histopathology, the diagnosis of normal spermatogenesis by histopathology was non-distinguishable with the picture of late maturation arrest, while TPS were able to further differentiate.

Conclusion: In the present study, TPS cytology allows immediate interpretation and confirmation of post-meiotic germ cells, especially in diagnosing OA. In NOA patients, TPS and histopathology results were discordant in 24.4%. Notably, NOA patients identified with post-meiotic germ cells through TPS exhibited a high success rate (95%) in sperm retrieval. Conversely, if post-meiotic germ cell could not be identified by TPS, histopathology result can be used as a rescue, with sperm retrieval rates decreased to only 57.1%.