Pediatric bone and soft tissue (BST) lesions typically undergo biopsy prior to treatment, which commonly involves core needle biopsy (CNB) and/or fine-needle aspiration biopsy (FNAB). This study ...looks at the utility of small biopsies in the current diagnosis of pediatric BST lesions from 2 institutions.
A retrospective search of BST small biopsies obtained during a 2-year time period (2018-2019) at 2 academic institutions was performed to look at clinicopathologic features, biopsy diagnoses, and correlation with follow-up.
A total of 96 pediatric patients (average age 11.2 years, range: 10 months-19 years) with BST lesions underwent a small biopsy, which represents 5% of the total BST lesions biopsied. The results show that the majority of lesions were benign (65%), and diagnosed by CNB alone (73%); a combination of FNAB and CNB (16%), and FNAB alone (11%), were less frequent. The CNB was effective in making a definitive diagnosis in 93% of cases and overall small biopsy was effective in 91% of the cases. Cases with definitive diagnoses on small biopsy were more likely to have concurrent CNB or characteristic ancillary studies performed.
Although pediatric BST lesions constitute only 5% of all BST lesions biopsied, minimally invasive small biopsies with cytologic evaluation for triage and appropriate ancillary study utilization can help render specific diagnoses that help to determine the appropriate treatment for young patients with BST lesions. The current diagnostic approach frequently involves CNB with intraprocedural evaluation or concurrent FNAB, with fewer biopsied by FNAB alone.
•Multiple different types of biopsy approaches are used for diagnosing musculoskeletal lesions in children, based on different preferences of the institutional and clinical teams. However, small biopsy techniques (including fine-needle aspiration biopsy (FNAB), core needle biopsy (CNB), or a combination, with intraprocedural cytological evaluation can be helpful for diagnosis and for triaging the specimen for ancillary studies (eg, FISH, molecular testing).•Although pediatric musculoskeletal tumors are rare overall in this multi-institutional study, these lesions are more likely to be primary neoplasms than the more common metastatic lesions seen in adult populations.•Minimally invasive preoperative small biopsy techniques (such as FNAB and/or CNB) allow for ancillary testing to determine a specific diagnosis, opposed to intraoperative frozen section evaluation, and thus may have a greater utility in children when hematolymphoid and primary musculoskeletal tumors are in the differential and have different treatment recommendations.
Vaping is the inhalation of heated aerosol from a small battery-powered device as a method to deliver nicotine or other substances. A recent outbreak of severe respiratory illness primarily in the ...United States has put a spotlight on vaping and its potential risks.
To familiarize pathologists with vaping, the cytologic and histopathologic features of vaping-associated acute lung injury, and the role of pathology in this diagnosis.
A targeted literature review was performed.
Most cases of vaping-associated lung injury have been linked to vaping products containing tetrahydrocannabinol or other cannabinoids. Lung biopsies show a spectrum of nonspecific acute lung injury patterns (organizing pneumonia, diffuse alveolar damage, acute fibrinous, and organizing pneumonia, or combinations of the above), accompanied by prominent, foamy macrophage accumulation. Injury is usually accentuated around small airways. Lipid-laden macrophages can be identified in bronchioloalveolar lavage fluid in most patients and these can be highlighted using lipid stains, such as oil red O, but the clinical utility of this finding remains unclear, as lipid-laden macrophages can be seen in a wide variety of processes and should not be relied upon to make the diagnosis. Classic histologic features of exogenous lipoid pneumonia have not been identified in tissue samples. Lightly pigmented macrophages, similar to those seen with traditional cigarette smoking, are present in some cases but are usually a minor feature. To date, no specific pathologic features for vaping-related injury have been identified, and it remains a diagnosis of exclusion that requires clinicopathologic correlation.
Introduction
Immunotherapy has shown promising results in non‐small cell lung cancer (NSCLC), for which tumour‐infiltrating cytotoxic (CD8+) T cells play a critical role. We investigated the utility ...of image analysis (IA) to quantify CD8+ T cells in a series of matched small biopsies and resections of NSCLC.
Methods
CD8 immunohistochemistry was performed on cell‐blocks (CB), core needle biopsies (CNB) and corresponding resections from primary NSCLCs. Slides were digitised using an Aperio AT2 scanner (Leica) and annotated by whole slide image (WSI) or fields of view occupied by tissue spots (TS). Quantitative IA was performed with a customised Aperio algorithm (Leica). CD8 scores (number of T cells with 1‐3+ staining/total area) were then compared.
Results
Forty‐four cases with CB or CNB material and a corresponding resection were analysed. Average CD8 score was determined in CB (7.67 WSI, 77.67 TS) and/or CNB (47.35 WSI, 325.67 TS), and corresponding resections (190.35 WSI, 336.58 TS). CD8 score concordance was highest (78.6%) for CNBs using WSI annotation. Overall, small biopsies (CB or CNB) correlated with the resection in 71.4% cases using WSI and 63.3% cases using TS annotation. IA performed better for low CD8 scores.
Conclusions
These findings show that CD8 density in NSCLC can be quantified by IA in small biopsies and cell blocks, achieving the best concordance using WSI scores. Discrepancies were attributed to values near the cut‐off and background detection of staining. These data warrant future studies with more cases and follow‐up data to further investigate the clinical utility of IA for CD8 analysis in NSCLC.
This study looks at the feasibility of using image analysis to quantitate CD8‐positive T‐cells in a series of primary non‐small cell carcinomas. The authors used matched small biopsies (core needle biopsies and/or cell bslocks) with matched resections to evaluate the concordance of the CD8 score in different specimens and using different annotation methods.
Cytopathology is one of the most sought-after fellowships within pathology, with a lower fellowship vacancy rate compared with most other subspecialties. The Accreditation Council for Graduate ...Medical Education (ACGME) actively tracks annual program data for cytopathology fellowship programs, and evaluating this longitudinal data looking at trends in programs and positions over the past 10 years could provide insights into the future of cytopathology and its training programs.
Data obtained from the ACGME was examined in detail for all ACGME-accredited cytopathology fellowship programs over the past decade (2011-2021). Additional responses from program directors (PDs) from a 2021 American Society of Cytopathology (ASC) survey are also included.
The total number of ACGME-approved cytopathology training programs and cytopathology fellowship positions remained relatively constant over the past 10 years, but the vacancy rate and number of programs with 1-2 unfilled spots has gradually but steadily risen over the past 6 years. In a 2021 ASC PD survey with 66% response rate, 53% of PDs reported having recruitment problems at least occasionally and 46% reported an increase in unexpected fellowship openings.
Although the number of cytopathology positions has been relatively constant over the past decade, there has been a recent increase in cytopathology fellowship vacancies that may indicate changes in career choices or the job market, with fellows choosing jobs over additional fellowships, and potentially signal a growing shortage of fellowship-trained, Board-certified cytopathologists in the coming years.
•The total numbers of cytopathology fellowship programs and positions have remained relatively constant over the past decade.•The cytopathology fellowship vacancy rate and number of unfilled programs have risen over the past 6 years.•Trends in cytopathology fellowship fill rates could indicate a shortage of cytopathologists in the future.
Background
A number of ancillary tests have been developed that aid in the diagnosis of mesothelioma in cytology specimens. The aim of this retrospective study was to determine whether testing for ...BAP1 and CDKN2A/p16 status in effusion specimens preceding the tissue diagnosis of mesothelioma would improve diagnostic accuracy and allow an earlier diagnosis of malignancy.
Methods
The study cohort included 99 matched cytology fluid specimens from 74 patients with a surgical specimen diagnosis of malignant mesothelioma (67 epithelioid, 7 biphasic, 55 pleural, and 19 peritoneal). BAP1 immunohistochemistry and p16 fluorescence in situ hybridization (FISH) were performed retrospectively.
Results
BAP1 or p16 FISH testing revealed a loss in 7 of 18 (39%) samples originally categorized as benign/reactive, 20 of 33 (61%) interpretable samples categorized as atypical, and 10 of 14 (71%) cases suspicious for mesothelioma. In some cases, the diagnosis of mesothelioma could have been made up to 9 months before biopsy. Similarly, loss of BAP1 or p16 was found in 28 of 30 (93%) samples categorized as malignant, with some cases diagnosable up to 6 months before biopsy. Overall, loss of BAP1 and/or CDKN2A/p16 homozygous deletion would change the diagnostic interpretation in 37 of 60 (62%) (P = .07) effusion specimens, particularly in pleural effusions (32 of 48 samples) (P = .002). The sensitivity of morphologic interpretation alone was 30.3%; however, adding testing for BAP1 and p16 resulted in an increase in sensitivity to 68.7%. (P < .0001).
Conclusion
These findings suggest that routine use of BAP1 immunochemistry and p16 FISH as adjunctive tests improves the diagnostic accuracy of cytology specimens and potentially allows an earlier diagnosis of malignant mesothelioma.
Testing for BAP1 by immunohistochemistry and/or CDKN2A/p16 deletion can improve the diagnostic accuracy of mesothelial proliferations in effusion specimens. The diagnosis of mesothelioma can be established earlier.
Fine-needle aspiration biopsy (FNAB) has a well-established role in the evaluation of an adult head and neck mass (HNM) but remains underused in children. The objectives of this study were to assess ...the diagnostic accuracy, safety profile, use of anesthesia, and influence on surgical decision making of FNAB of HNM in the pediatric population.
Case series with chart review.
Tertiary care children's hospital.
In total, 257 consecutive patients with HNM who underwent 338 FNABs from July 2007 to July 2014 were reviewed. Patients ranged in age from 0 to 21 years (mean, 9.3 years); lesions ranged in size from 0.3 to 12.5 cm (mean, 2.4cm). Fine-needle aspiration biopsies were performed in the interventional radiology suite, operating room, clinic, or ward.
The most common patient final diagnoses included reactive lymphadenopathy (n = 99, 38.5%), benign thyroid colloid nodule (n = 31, 12.1%), malignancies (n = 21, 8.2%), and atypical mycobacterial infection (n = 15, 5.8%). On surgical histopathologic and clinical follow-up, overall sensitivity of FNAB was 94.6% and specificity was 97.7%. The complication rate was 2.1%, and general anesthesia or sedation was used for 73% of FNAB. Surgery occurred only 9 times following the 191 patients with negative FNAB results, indicating that 95.3% of unnecessary surgeries were avoided with the assistance of the FNAB result.
Fine-needle aspiration biopsy is an accurate and safe diagnostic tool for guiding management of persistent lymphadenopathy, thyroid nodules, and other HNM in pediatric patients. Negative FNABs can often obviate the need for surgical intervention.
Core needle biopsies (CNBs) have proven to be an excellent source of tissue for diagnosis and ancillary testing in the era of personalized medicine, commonly yielding sufficient material for testing ...via a relatively minimally invasive technique. Thus, there has been an increase in touch preparations (TPs) evaluated with rapid onsite evaluation (ROSE) of these small biopsies either in isolation or with concurrent fine needle aspiration (FNA). This in turn has forced cytopathology practices to make decisions with regard to processing and workflow of CNBs, which affects cytopathology fellowship education substantially.
The present review is based on a review of recent literature and an evaluation of the authors' personal experiences.
Deciding whether CNBs with associated TPs should be assigned to the cytology service, the subspecialty or general surgical pathology service, or a split between cytopathology and surgical pathology, is complicated. The workflow is variable at different institutions depending on multiple factors. Each of these routes has benefits and disadvantages that can affect patient care and laboratory workflow, in addition to having downstream effects on the quality and type of education our pathology trainees receive. Herein, the advantages and disadvantages of the different approaches for CNB triage are discussed, with an emphasis on the impact upon cytopathology fellowship education.
•CNB with touch imprint ROSE has become a more common method for obtaining tissue, as it is an excellent source for diagnosis and ancillary testing in the era of personalized medicine.•Cytopathologists have become increasingly experienced with this methodology, and this in turn has forced cytopathology practices to make major decisions with regard to processing and workflow of CNBs.•However, many institutions have moved toward subspecialty histopathologic signout, resulting in split of the specimen, which affects cytopathology fellowship education considerably.•In this paper members of cytopathology program director’s committee discuss the advantages and disadvantages of the different approaches their institutions have taken, towards disposition of core needle biopsy and touch imprint cytology, with an emphasis on the impact upon education of the trainees.
Introduction
There are limited publications that address technical and practical informatics considerations when implementing telecytology for rapid on‐site evaluation (ROSE). Our aim was to share ...the experience of deploying telecytology for ROSE at our institution.
Materials and methods
Key informatics issues relevant to adopting telecytology for ROSE at our institution were appraised including workflow, information technology (IT), validation, training, and quality assurance (QA).
Results
A dynamic telemicroscopy solution was selected that required trained cytotechnologists to attend on‐site procedures for ROSE. For validation 60 cases were reviewed using the first camera at each facility, but only 20 cases to validate subsequent cameras. A concordance rate of >90% between ROSE interpretation performed digitally to original interpretations was required for clinical validation. After reviewing 440 cases from two comparable time periods before and after implementation, employing telecytology was shown to decrease cytopathologists’ work time per ROSE case from an average of 20.95 min per case to 2.91 min per case (86% time savings). The non‐diagnostic rate for traditional ROSE was 7.7% compared with 4.1% after the implementation of telecytology, and the deferral rate went from 43.6% for traditional ROSE to 44.1% with telecytology. Traditional ROSE diagnoses correlated with final diagnoses in 91.8% cases, compared to 95.5% with telecytology.
Conclusions
Challenges when implementing telecytology for ROSE included technical issues, workflow concerns, and incorporating trainees into daily practice. The end result of our implementation was the adoption of an innovative way to deliver a ROSE service that maximised efficiency for cytopathologists without compromising diagnostic performance.
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