The ability to detect clinically relevant genetic alterations by repurposing previously discarded cytology samples provides an exciting new dimension to the practice of cytopathology. Repurposing ...otherwise discarded residual fluid and supernatant fluid from fine‐needle aspiration samples allows for better use of cytology specimens.
Background
The International System for Reporting Serous Fluid Cytopathology was recently proposed as a tiered structure to provide consistent reporting terminology for serous effusions. Because of ...the variation in reporting practices for indeterminate serous effusions, namely, the atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) groups, the authors retrospectively reviewed cases in these 2 categories at their institution and determined the associated risk of malignancy (ROM).
Methods
Pleural, peritoneal, and pericardial effusions that were reported as AUS or SFM over a 1‐year period were reviewed, and their associated ROMs were calculated based on confirmation of malignancy by previous and/or subsequent fluid and/or tissue biopsy specimens from the same general location.
Results
In total, 145 AUS and 98 SFM serous effusion cases were identified. The AUS category was used when the cells in question lacked the requisite quantitative (cell number) and/or qualitative (morphologic) features for a definitive diagnosis. Immunohistochemistry (IHC) or flow cytometry (FCM) was available in 15% of cases (n = 22) with inconclusive results. The ROM based on 69 cases with available follow‐up results was 39%. In contrast, the SFM category demonstrated cells that were morphologically suspicious for malignancy but sparse, precluding IHC or FCM (n = 63; 64%) or yielding inconclusive results (n = 35; 36%). The ROM in the SFM category, based on follow‐up results of 61 cases, was 64%.
Conclusions
The ROM for SFM was significantly higher than that for AUS (P < .01), supporting separate diagnostic categories for these 2 groups.
There is considerable variation in the reporting practices for indeterminate serous effusions, namely, the categories atypia of undetermined significance and suspicious for malignancy, with limited literature on their associated risk of malignancy. The reporting practice at a single institution is examined and demonstrates that the risk of malignancy in the suspicious for malignancy category is significantly higher than that for the atypia of undetermined significance category, thus providing support for retaining these as 2 separate diagnostic categories in the tiered reporting system for serous effusions.
Biomarker testing in patients with advanced stage non–small cell lung cancer provides essential information that can be used to select the most appropriate therapy. The regular updates of guideline ...recommendations reflect the growing number of biomarkers that must be assessed, and as such signal the shift from single‐gene assays to more comprehensive genomic profiling using next‐generation sequencing modalities. Cytology and small biopsy specimens have proven to be more than adequate substrates for these types of ancillary molecular testing; however, other alternative testing substrates are beginning to emerge. These include so‐called liquid biopsies as well the supernatant fluid from cytology specimens, both of which have demonstrated promise for use in the clinical realm. This review will briefly cover the current state of non–small cell lung cancer biomarker testing in the United States, with a focus on these novel nonconventional substrates that are increasingly being incorporated into testing paradigms.
Current guideline recommendations for non–small cell lung cancer emphasize the need for broad biomarker testing to direct therapeutic decisions. Cytology specimens have been used successfully for biomarker testing, but other substrates, including liquid biopsy and supernatant fluid, are beginning to emerge.
With advancments in technology for minimally invasive sampling techniques, pathology laboratories are receiving increasing numbers of small biopsy and cytology specimens for multiple ancillary ...studies to help in the diagnosis and management of pulmonary diseases. A recently published evidence‐based guideline from the College of American Pathologists (CAP), in collaboration with 8 other professional medical societies, provides recommendations to clinicians for the collection of adequate material for diagnostic and ancillary testing as well as optimal handling in an attempt to prioritize ancillary testing. The primary goal of developing this CAP guideline is to assist pathologists and their clinical colleagues to better collect and handle small thoracic pathology specimens to help guide therapeutic decisions.
Genomic profiling of tumor from malignant effusions have conventionally been performed on tumor cells derived from cytologic preparations such as cell block preparations, direct smears, cytospin ...preparations and liquid based cytologic preparations. The study by Yang et al. exemplifies the rapid progress of molecular cytopathology as cytopathologists increasingly delve into novel sources for genomic testing in an attempt to provide the theranostic information necessary for patient care.
Objectives
The practice of cytopathology has evolved over the past decade with a growing need for doing more with less tissue. Changes in clinical practice guidelines and evolving needs in tissue ...acquisition for diagnosis and treatment have affected various areas of cytopathology in different ways. In this study, we evaluated the changing trends in cytopathological practice at our institution over the past decade.
Methods
We performed a retrospective review of our institutional database for cytopathology cases from calendar years 2009 (n = 28038) and 2019 (n = 31386) to evaluate the changing trends in practice.
Results
The overall number of exfoliative cases decreased 10% over the past decade, primarily due to a 64% decrease in gynaecological Pap testing. However, the volume of serous body cavity and cerebrospinal fluids increased 125% and 44%, respectively. The overall volume of fine needle aspiration (FNA) cases increased 38% from 2009 to 2019. The number of FNA cases increased across most body sites, driven primarily by a 180% increase in endobronchial ultrasound‐guided transbronchial needle aspiration cases. In contrast, breast FNA volume decreased 43%. Ancillary studies increased substantially over the past decade, including immunostains (476%) and molecular testing (250%).
Conclusions
The trends in our cytopathological practice showed an increased volume of cases, especially in non‐gynaecological specimens. As expected, the number of FNA cases used for immunostains and molecular testing increased substantially, indicating an upward trend in ancillary studies in cytopathological practice.
The trends in our cytopathological practice showed an increased volume of cases, especially in non‐gynaecological specimens. The number of FNA cases used for immunostains and molecular testing increased substantially, indicating an upward trend in ancillary studies in cytopathological practice.
Modern Cytopathology: An evolving field Troncone, Giancarlo; Roy‐Chowdhuri, Sinchita
Cytopathology (Oxford),
September 2021, 2021-09-00, 20210901, Letnik:
32, Številka:
5
Journal Article
Recenzirano
The modern‐day cytopathologist is equipped with an armamentarium of useful tools that have refined cytological diagnoses, provided predictive and prognostic information to guide patient care, and ...enabled more therapeutic options for patients. This Special Issue aims to highlight some of the aspects that are inherent to the role of Modern Cytopathology for diagnosis and therapeutic management of patients with cancer.
Background
NUT carcinoma (NC) is an aggressive neoplasm that often presents with alarge tumor burden and metastases; cytology is frequently one of the primary diagnostic modalities. Primary pulmonary ...NCs are very rare and cytology descriptions are limited. The current study was performed to analyze the cytomorphological features of primary pulmonary NCs in different cytology samples and preparations.
Methods
A total of 15 cytology specimens from 10 patients with primary pulmonary NCs diagnosed primarily on histology were retrieved and reviewed.
Results
Fifteen cytology samples, including aspirates from primary (5 samples) and metastatic (5 samples) sites, sputum (1 sample), and effusions (4 samples), that were prepared as direct smears, centrifuged smears, and cell blocks were reviewed. Aspirate smears from all cases were cellular and demonstrated fragments and cohesive clusters of primitive tumor cells with scant cytoplasm, ovoid nuclei with coarse granular chromatin, and consistently conspicuous single nucleoli in a frequently neutrophil‐rich necrotic background with dispersed bare tumor nuclei. In fluid cytology, tight, 3‐dimensional tumor clusters and singly lying tumor cells were observed. Squamous differentiation in the form of sheets and singly lying polygonal tumor cells with abundant dense cytoplasm was noted focally in rare cases. The diagnoses during original sign‐outs were poorly differentiated carcinoma, poorly differentiated squamous cell carcinoma, and malignant small round cell tumor. NUT‐1 (NUT family member 1 protein) immunocytochemistry performed on cell blocks demonstrated characteristic speckled nuclear staining in tumor cells.
Conclusions
Pulmonary NC presents as a poorly differentiated carcinoma with focal to absent squamous differentiation on cytology. Cellular fragments of primitive tumor cells with conspicuous nucleoli should raise suspicion of NUT carcinoma and prompt ancillary testing.
Pulmonary NUT carcinomas appear as fragments and cohesive clusters in aspiration specimens and as tight 3‐dimensional balls in fluid specimens. They are composed of primitive tumor cells with ovoid nuclei, coarse granular chromatin, consistently conspicuous single nucleoli, and scant cytoplasm in a frequently neutrophil‐rich inflammatory background with dispersed bare nuclei. A high index of suspicion with the judicious use of immunocytochemistry (p40, NUT) is necessary for an early and accurate diagnosis on cytology.
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