Neutrophil cannibalism or engulfment by tumor cells is a feature often associated with aggressive malignancies. Although metastatic squamous cell carcinoma is commonly diagnosed by fine needle aspiration cytology, there are only rare reports of neutrophil cannibalism by squamous cell carcinoma in current cytology literature. We present two cases of metastatic squamous cell carcinoma featuring prominent neutrophil cannibalism diagnosed by fine needle aspiration cytology, describe their unique cytologic features, and discuss the prognostic implications of this diagnosis.
{"title":"Neutrophil Cannibalism by Tumor Cells in Squamous Cell Carcinoma: Cytologic Features and Clinical Implications.","authors":"Sophia Zhang, Jan F Silverman","doi":"10.1002/dc.70071","DOIUrl":"https://doi.org/10.1002/dc.70071","url":null,"abstract":"<p><p>Neutrophil cannibalism or engulfment by tumor cells is a feature often associated with aggressive malignancies. Although metastatic squamous cell carcinoma is commonly diagnosed by fine needle aspiration cytology, there are only rare reports of neutrophil cannibalism by squamous cell carcinoma in current cytology literature. We present two cases of metastatic squamous cell carcinoma featuring prominent neutrophil cannibalism diagnosed by fine needle aspiration cytology, describe their unique cytologic features, and discuss the prognostic implications of this diagnosis.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epithelioid malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue sarcoma variant, seldom presenting with lymph node or pleural metastasis. We report a rare instance of a 22-year-old female with recurrent epithelioid MPNST metastasizing to cervical lymph nodes and pleural fluid—a phenomenon rarely documented in literature. Clinical history, cytomorphological assessment, and immunohistochemistry were pivotal in establishing the diagnosis. This case underscores the diagnostic complexity and extreme rarity of epithelioid MPNST metastasizing to serous cavities.
{"title":"When the Rare Becomes Rarer: Metastasis of Epithelioid Malignant Peripheral Nerve Sheath Tumor (MPNST) to Lymph Node and Pleural Fluid","authors":"Nitika Gupta, Nilay Nishith, Pranab Dey","doi":"10.1002/dc.70070","DOIUrl":"10.1002/dc.70070","url":null,"abstract":"<div>\u0000 \u0000 <p>Epithelioid malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue sarcoma variant, seldom presenting with lymph node or pleural metastasis. We report a rare instance of a 22-year-old female with recurrent epithelioid MPNST metastasizing to cervical lymph nodes and pleural fluid—a phenomenon rarely documented in literature. Clinical history, cytomorphological assessment, and immunohistochemistry were pivotal in establishing the diagnosis. This case underscores the diagnostic complexity and extreme rarity of epithelioid MPNST metastasizing to serous cavities.</p>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"E76-E81"},"PeriodicalIF":1.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Respiratory cytology plays a vital role in the early diagnosis of pulmonary diseases, particularly lung cancer, which remains a leading cause of cancer-related mortality worldwide. To enhance standardization and reduce inter-observer variability in lung cytology reporting, the World Health Organization (WHO), in collaboration with the IAC and IARC, introduced a new five-tiered reporting system for lung cytopathology in 2023. This study aims to retrospectively apply the WHO system to respiratory samples at a tertiary care center in India and evaluate diagnostic performance and risk of malignancy (ROM) for each category.
Material and Methods
A retrospective observational study was conducted from June 2022 to May 2024, analyzing 736 respiratory cytology samples, including BAL, EBUS-TBNA, bronchial wash, bronchial brush, and sputum. Samples were reclassified using the WHO system, and 193 cases had histopathological correlation. ROM was calculated for each category, and diagnostic performance metrics sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) were assessed using histopathology as the gold standard. Given that histologic correlation was available in only 26.2% of cases, diagnostic performance estimates were interpreted with caution and may have been influenced by verification bias.
Results
Of the total cases, 10.2% (75/736) were insufficient/inadequate, 80.1% (589/736) benign, 3.0% (22/736) atypical, 2.0% (15/736) suspicious, and 4.7% (35/736) malignant. The ROM was 43.7% for insufficient, 39.7% for benign, 50.0% for atypical, 75.0% for suspicious, and 100% for malignant. Bronchial brush demonstrated the highest DA (81.3%), while BAL had low sensitivity (10.0%) despite high specificity (98.5%). EBUS-TBNA showed moderate sensitivity (50.0%) and lower specificity (55.6%).
Conclusion
The WHO Reporting System provides an effective framework for stratifying respiratory cytology samples. While categories such as malignant and suspicious showed high diagnostic reliability, false negatives in benign and inadequate categories highlight the need for integrated clinical and radiological assessment. Bronchial brush and wash emerged as the most diagnostically accurate specimen types. Further prospective studies are warranted to validate these findings across broader clinical settings.
{"title":"The New WHO Lung Cytopathology Reporting System in Practice: Diagnostic Performance and Risk of Malignancy in a Tertiary Care Setting","authors":"Shalini Bhalla, Mahak Lamba, Mamta Dwivedi, Shivanjali Raghuvanshi, Malti kumari Maurya, Madhu Kumar","doi":"10.1002/dc.70068","DOIUrl":"10.1002/dc.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Respiratory cytology plays a vital role in the early diagnosis of pulmonary diseases, particularly lung cancer, which remains a leading cause of cancer-related mortality worldwide. To enhance standardization and reduce inter-observer variability in lung cytology reporting, the World Health Organization (WHO), in collaboration with the IAC and IARC, introduced a new five-tiered reporting system for lung cytopathology in 2023. This study aims to retrospectively apply the WHO system to respiratory samples at a tertiary care center in India and evaluate diagnostic performance and risk of malignancy (ROM) for each category.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective observational study was conducted from June 2022 to May 2024, analyzing 736 respiratory cytology samples, including BAL, EBUS-TBNA, bronchial wash, bronchial brush, and sputum. Samples were reclassified using the WHO system, and 193 cases had histopathological correlation. ROM was calculated for each category, and diagnostic performance metrics sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) were assessed using histopathology as the gold standard. Given that histologic correlation was available in only 26.2% of cases, diagnostic performance estimates were interpreted with caution and may have been influenced by verification bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the total cases, 10.2% (75/736) were insufficient/inadequate, 80.1% (589/736) benign, 3.0% (22/736) atypical, 2.0% (15/736) suspicious, and 4.7% (35/736) malignant. The ROM was 43.7% for insufficient, 39.7% for benign, 50.0% for atypical, 75.0% for suspicious, and 100% for malignant. Bronchial brush demonstrated the highest DA (81.3%), while BAL had low sensitivity (10.0%) despite high specificity (98.5%). EBUS-TBNA showed moderate sensitivity (50.0%) and lower specificity (55.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The WHO Reporting System provides an effective framework for stratifying respiratory cytology samples. While categories such as malignant and suspicious showed high diagnostic reliability, false negatives in benign and inadequate categories highlight the need for integrated clinical and radiological assessment. Bronchial brush and wash emerged as the most diagnostically accurate specimen types. Further prospective studies are warranted to validate these findings across broader clinical settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"206-218"},"PeriodicalIF":1.0,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nebojša Mitrović, Nemanja Trifunović, Marija Nikolić, Damir Jašarović, Dejan Stevanović
Introduction
Cardiac amyloidosis is a restrictive cardiomyopathy caused by extracellular deposition of misfolded proteins. Abdominal fat pad fine-needle aspiration (FPFNA) has been described as a minimally invasive diagnostic tool for systemic and cardiac amyloidosis.
Methods
We present a step-by-step description of the aspiration technique, including sample handling, Congo red staining under polarized light, accompanied by illustrative images.
Conclusion
Abdominal fat pad FPFNA is a simple, inexpensive, and safe procedure. According to published data, it offers moderate to high sensitivity, especially in advanced disease, and can reduce the need for more invasive biopsies.
{"title":"Abdominal Fat Pad Fine-Needle Aspiration for the Diagnosis of Cardiac Amyloidosis: A Technical Note With Illustrative Images","authors":"Nebojša Mitrović, Nemanja Trifunović, Marija Nikolić, Damir Jašarović, Dejan Stevanović","doi":"10.1002/dc.70069","DOIUrl":"10.1002/dc.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cardiac amyloidosis is a restrictive cardiomyopathy caused by extracellular deposition of misfolded proteins. Abdominal fat pad fine-needle aspiration (FPFNA) has been described as a minimally invasive diagnostic tool for systemic and cardiac amyloidosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We present a step-by-step description of the aspiration technique, including sample handling, Congo red staining under polarized light, accompanied by illustrative images.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Abdominal fat pad FPFNA is a simple, inexpensive, and safe procedure. According to published data, it offers moderate to high sensitivity, especially in advanced disease, and can reduce the need for more invasive biopsies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"E72-E75"},"PeriodicalIF":1.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Folate receptor-⍺ (FR-⍺) is an attractive target for targeted therapy. Mirvetuximab soravtansine (MIRV) has been approved by the United States Food and Drug Administration (FDA) for treating adult patients with FR-⍺ positive, platinum-resistant epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. Therefore, identifying and detecting FR-⍺ has become an essential part of precision medicine. This study aimed to evaluate the feasibility of detecting FR-⍺ protein expression in serous cavity effusions using cell blocks (CBs) and compare the results with surgical pathology biopsy or resection specimens. Furthermore, we investigated potential variations in FR-⍺ expression pre- and post-chemotherapy.
Methods
Immunohistochemical (IHC) staining of FR-⍺ was performed on the serous cavity effusion specimens from 35 patients with epithelial ovarian cancer, along with matched surgical pathological (SP) biopsy or resection specimens, following the manufacturer's guidelines for IHC analysis.
Results
Positive staining was observed in 30 (85.7%) and 32 (91.4%) serous cavity effusion CB and tissue samples, respectively. A total of 31 (88.5%) tissue and 28 (80%) effusion CB samples exhibited moderate-to-strong FR-⍺ expression in at least 25% of tumor cells. A cutoff of 25% for FR-⍺ expression positivity was used to demonstrate high concordance (96.4%) between cytology CBs and tissue specimens. We recommend a cutoff of 75% viable tumor cells with moderate-to-strong membrane staining as “positive” in CBs for greater reliability, which aligns with FDA-approved criteria. A reasonable consistency was observed in FR-⍺ expression between the pre-treatment serous cavity effusion CB specimens and the new biopsy specimens obtained after multiline treatment.
Conclusion
We demonstrated that serous effusion CB specimens may be effective for FR-⍺ biomarker detection; FR-⍺ maintains stable expression pre- and post-chemotherapy, and patients can benefit from MIRV.
{"title":"Detecting FR-⍺ Expression Level in Cytology Effusion Specimens From Ovarian Cancer and Comparing It With Tissue Specimens","authors":"Yadan Ma, Xiaofei Yu, Xiaohong Duan, Siqian Huang, Sishi Bai, Baizhou Li","doi":"10.1002/dc.70067","DOIUrl":"10.1002/dc.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Folate receptor-⍺ (FR-⍺) is an attractive target for targeted therapy. Mirvetuximab soravtansine (MIRV) has been approved by the United States Food and Drug Administration (FDA) for treating adult patients with FR-⍺ positive, platinum-resistant epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. Therefore, identifying and detecting FR-⍺ has become an essential part of precision medicine. This study aimed to evaluate the feasibility of detecting FR-⍺ protein expression in serous cavity effusions using cell blocks (CBs) and compare the results with surgical pathology biopsy or resection specimens. Furthermore, we investigated potential variations in FR-⍺ expression pre- and post-chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Immunohistochemical (IHC) staining of FR-⍺ was performed on the serous cavity effusion specimens from 35 patients with epithelial ovarian cancer, along with matched surgical pathological (SP) biopsy or resection specimens, following the manufacturer's guidelines for IHC analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Positive staining was observed in 30 (85.7%) and 32 (91.4%) serous cavity effusion CB and tissue samples, respectively. A total of 31 (88.5%) tissue and 28 (80%) effusion CB samples exhibited moderate-to-strong FR-⍺ expression in at least 25% of tumor cells. A cutoff of 25% for FR-⍺ expression positivity was used to demonstrate high concordance (96.4%) between cytology CBs and tissue specimens. We recommend a cutoff of 75% viable tumor cells with moderate-to-strong membrane staining as “positive” in CBs for greater reliability, which aligns with FDA-approved criteria. A reasonable consistency was observed in FR-⍺ expression between the pre-treatment serous cavity effusion CB specimens and the new biopsy specimens obtained after multiline treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We demonstrated that serous effusion CB specimens may be effective for FR-⍺ biomarker detection; FR-⍺ maintains stable expression pre- and post-chemotherapy, and patients can benefit from MIRV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"197-205"},"PeriodicalIF":1.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12862507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Granular cell tumor (GCT) is a rare mesenchymal neoplasm that is believed to originate from Schwann-like mesenchymal cells. It affects more women than men with an F:M ratio of 5:4 and can involve various body sites such as peripheral soft tissues, trunk, and head and neck. Multiple lesions can be seen in up to 15% patients. Most of GCT are benign with indolent behavior. Rare cases show cytological atypia and considered histologically malignant; or show metastasis and considered clinically malignant. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is widely used nowadays for the diagnosis of epithelial malignancies of the gastrointestinal tract and pancreatobiliary tract. Its efficacy for submucosal and intramural mesenchymal lesions is focused primarily on gastrointestinal stromal tumors (GIST) because of their higher incidence compared with other mesenchymal lesions. Biliary tract GCT is rarely reported in the literature. Preoperative diagnosis of GCT has important therapeutic and prognostic value. Formulating such a diagnosis using cytologic smears alone is extremely challenging, but a definitive and accurate diagnosis is possible when cytomorphology is coupled with optimal cellularity and immunohistochemistry studies on the concurrent cellblock or tissue biopsy. Here we report the first case of biliary GCT diagnosed by EUS-FNA cytology and concurrent biopsy without surgical resection, which endorses the clinical utility of EUS-FNA cytology on evaluating biliary lesions and broaden our differential diagnosis of biliary neoplasms.
{"title":"Granular Cell Tumor of the Bile Duct: A Challenging Cytologic Diagnosis on Endoscopic Ultrasound-Guided Fine Needle Aspiration","authors":"Ujalla Sheikh, Lei Yan, Paolo Gattuso, Lin Cheng","doi":"10.1002/dc.70062","DOIUrl":"10.1002/dc.70062","url":null,"abstract":"<div>\u0000 \u0000 <p>Granular cell tumor (GCT) is a rare mesenchymal neoplasm that is believed to originate from Schwann-like mesenchymal cells. It affects more women than men with an F:M ratio of 5:4 and can involve various body sites such as peripheral soft tissues, trunk, and head and neck. Multiple lesions can be seen in up to 15% patients. Most of GCT are benign with indolent behavior. Rare cases show cytological atypia and considered histologically malignant; or show metastasis and considered clinically malignant. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is widely used nowadays for the diagnosis of epithelial malignancies of the gastrointestinal tract and pancreatobiliary tract. Its efficacy for submucosal and intramural mesenchymal lesions is focused primarily on gastrointestinal stromal tumors (GIST) because of their higher incidence compared with other mesenchymal lesions. Biliary tract GCT is rarely reported in the literature. Preoperative diagnosis of GCT has important therapeutic and prognostic value. Formulating such a diagnosis using cytologic smears alone is extremely challenging, but a definitive and accurate diagnosis is possible when cytomorphology is coupled with optimal cellularity and immunohistochemistry studies on the concurrent cellblock or tissue biopsy. Here we report the first case of biliary GCT diagnosed by EUS-FNA cytology and concurrent biopsy without surgical resection, which endorses the clinical utility of EUS-FNA cytology on evaluating biliary lesions and broaden our differential diagnosis of biliary neoplasms.</p>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"E67-E71"},"PeriodicalIF":1.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rosette-forming epithelioid osteosarcoma is an extremely rare type of osteosarcoma. This report describes a man in his early 50s with a destructive right iliac bone/acetabulum mass showing osseous destruction and extensive soft tissue involvement. Cytohistologic examination revealed osteosarcoma with epithelioid neoplastic cells arranged in rosettes. The neoplastic cells were immunoreactive for SATB2, TTF1, and CDX2. The osteoid was better appreciated in the H&E-stained materials. The cytohistological features, immunohistochemical profile, and differential diagnoses are discussed. Attention to details regarding the identification of osteoid in both cytology and histology materials is emphasized.
{"title":"Cytohistologic Diagnosis of Rosette-Forming Epithelioid Osteosarcoma","authors":"Brant G. Wang","doi":"10.1002/dc.70065","DOIUrl":"10.1002/dc.70065","url":null,"abstract":"<div>\u0000 \u0000 <p>Rosette-forming epithelioid osteosarcoma is an extremely rare type of osteosarcoma. This report describes a man in his early 50s with a destructive right iliac bone/acetabulum mass showing osseous destruction and extensive soft tissue involvement. Cytohistologic examination revealed osteosarcoma with epithelioid neoplastic cells arranged in rosettes. The neoplastic cells were immunoreactive for SATB2, TTF1, and CDX2. The osteoid was better appreciated in the H&E-stained materials. The cytohistological features, immunohistochemical profile, and differential diagnoses are discussed. Attention to details regarding the identification of osteoid in both cytology and histology materials is emphasized.</p>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"E63-E66"},"PeriodicalIF":1.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fine-needle aspiration cytology (FNAC) remains widely used for the evaluation of palpable breast lesions, particularly in resource-limited settings, though histopathology is the gold standard. The International Academy of Cytology (IAC) Yokohama System provides a standardized five-tier reporting framework with defined risk of malignancy (ROM). This study aimed to evaluate its diagnostic performance, reproducibility, and applicability in a tertiary care setting.
Materials and Methods
A total of 548 breast FNACs from 533 patients were reclassified both prospectively and retrospectively according to the IAC Yokohama categories. Histological correlation was available in 228 cases. Interobserver agreement was assessed among two senior cytopathologists and one junior pathologist using unweighted and weighted kappa statistics. Diagnostic performance was calculated against histology using three definitions of test positivity (Cat-5 only; Cat-4 & 5; Cat-3–5).
Results
A total of 548 FNACs from 533 patients were reclassified using the IAC Yokohama system: Cat-1 (36, 6.6%), Cat-2 (318, 58.0%), Cat-3 (14, 2.6%), Cat-4 (25, 4.6%), and Cat-5 (155, 28.3%). Histological correlation was available in 228 cases. The observed ROM was 50% for Cat-1, 7.9% for Cat-2, 45.5% for Cat-3, 93.8% for Cat-4, and 100% for Cat-5. Diagnostic accuracy improved with reclassification: in Group A (Cat-5 positive), sensitivity increased to 78.4% and specificity was 100%; in Group B (Cat-4 & 5 positive), sensitivity was 90.9% and specificity was 97.9%; and in Group C (Cat-3–5 positive), sensitivity reached 94.7% with a specificity of 89.6%. ROC analysis confirmed superior discrimination for the Yokohama system (AUC 0.94 vs. 0.88 for the original). Interobserver reproducibility was excellent, with weighted kappa values of 0.954 (P1 vs. P2), 0.942 (consensus vs. P3), and 0.939 (P2 vs. P3). Agreement was highest in benign and malignant categories and lowest in atypical and suspicious groups.
Conclusion
The IAC Yokohama System showed high diagnostic accuracy, excellent reproducibility, and reliable risk stratification. By reducing false negatives and minimizing equivocal reporting, it improved alignment with histology compared with the conventional descriptive system, supporting its routine use in breast cytology practice.
背景：细针穿刺细胞学（FNAC）仍然广泛用于评估可触及的乳房病变，特别是在资源有限的情况下，尽管组织病理学是金标准。国际细胞学学会（IAC）横滨系统提供了标准化的五层报告框架，定义了恶性肿瘤风险（ROM）。本研究旨在评估其在三级医疗机构的诊断性能、可重复性和适用性。材料和方法：533例患者548例乳腺FNACs，根据IAC横滨分类进行前瞻性和回顾性重新分类。228例有组织学相关性。两名高级细胞病理学家和一名初级病理学家使用未加权和加权kappa统计来评估观察者间的一致性。使用三种检测阳性定义（仅Cat-5； Cat-4和5；Cat-3-5）根据组织学计算诊断性能。结果：533例患者的548例FNACs使用IAC横滨系统重新分类：Cat-1(36例，6.6%),Cat-2(318例，58.0%),Cat-3(14例，2.6%),Cat-4（25例，4.6%）和Cat-5（155例，28.3%）。228例有组织学相关性。Cat-1的ROM为50%，Cat-2为7.9%，Cat-3为45.5%，Cat-4为93.8%，Cat-5为100%。随着重新分类，诊断准确率提高：在A组（Cat-5阳性），敏感性提高到78.4%，特异性为100%；B组（Cat-4和5阳性）敏感性为90.9%，特异性为97.9%；C组（Cat-3-5阳性）敏感性为94.7%，特异性为89.6%。ROC分析证实横滨系统的判别性较好（AUC为0.94，原始系统为0.88）。观察者间再现性极好，加权kappa值分别为0.954 （P1 vs. P2）、0.942（共识vs. P3）和0.939 （P2 vs. P3）。良性和恶性组的一致性最高，非典型和可疑组的一致性最低。结论：IAC横滨系统诊断准确率高，重现性好，风险分层可靠。通过减少假阴性和最大限度地减少模棱两可的报告，与传统的描述系统相比，它改善了与组织学的一致性，支持其在乳腺细胞学实践中的常规使用。
{"title":"Evaluation of Breast Lesions on Cytology Using International Academy of Cytology Yokohama Standardized Reporting System","authors":"Manish Jaiswal, Anurag Gupta, Tripti Verma, Pradyumn Singh, Rita Yadav, Akash Agarwal, Ashish Singhal, Nuzhat Husain, Shamrendra Narayan, Neha Singh","doi":"10.1002/dc.70064","DOIUrl":"10.1002/dc.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fine-needle aspiration cytology (FNAC) remains widely used for the evaluation of palpable breast lesions, particularly in resource-limited settings, though histopathology is the gold standard. The International Academy of Cytology (IAC) Yokohama System provides a standardized five-tier reporting framework with defined risk of malignancy (ROM). This study aimed to evaluate its diagnostic performance, reproducibility, and applicability in a tertiary care setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A total of 548 breast FNACs from 533 patients were reclassified both prospectively and retrospectively according to the IAC Yokohama categories. Histological correlation was available in 228 cases. Interobserver agreement was assessed among two senior cytopathologists and one junior pathologist using unweighted and weighted kappa statistics. Diagnostic performance was calculated against histology using three definitions of test positivity (Cat-5 only; Cat-4 & 5; Cat-3–5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 548 FNACs from 533 patients were reclassified using the IAC Yokohama system: Cat-1 (36, 6.6%), Cat-2 (318, 58.0%), Cat-3 (14, 2.6%), Cat-4 (25, 4.6%), and Cat-5 (155, 28.3%). Histological correlation was available in 228 cases. The observed ROM was 50% for Cat-1, 7.9% for Cat-2, 45.5% for Cat-3, 93.8% for Cat-4, and 100% for Cat-5. Diagnostic accuracy improved with reclassification: in Group A (Cat-5 positive), sensitivity increased to 78.4% and specificity was 100%; in Group B (Cat-4 & 5 positive), sensitivity was 90.9% and specificity was 97.9%; and in Group C (Cat-3–5 positive), sensitivity reached 94.7% with a specificity of 89.6%. ROC analysis confirmed superior discrimination for the Yokohama system (AUC 0.94 vs. 0.88 for the original). Interobserver reproducibility was excellent, with weighted kappa values of 0.954 (P1 vs. P2), 0.942 (consensus vs. P3), and 0.939 (P2 vs. P3). Agreement was highest in benign and malignant categories and lowest in atypical and suspicious groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The IAC Yokohama System showed high diagnostic accuracy, excellent reproducibility, and reliable risk stratification. By reducing false negatives and minimizing equivocal reporting, it improved alignment with histology compared with the conventional descriptive system, supporting its routine use in breast cytology practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"184-196"},"PeriodicalIF":1.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Asteroid bodies are rare cytoplasmic inclusions within multinucleated giant cells, most classically associated with sarcoidosis but also encountered in other granulomatous and reactive conditions. Their recognition in cytology is uncommon and diagnostically challenging. We present the case of a 30-year-old female with a post-traumatic forehead swelling in which fine needle aspiration cytology (FNAC) revealed numerous foreign body-type giant cells containing asteroid bodies. This case highlights the cytomorphological spectrum of asteroid bodies outside systemic sarcoidosis, their differential diagnoses, and their clinical relevance.
{"title":"Star in the Forehead","authors":"Ankur Singh, Priyanka Munjal, A. K. Verma","doi":"10.1002/dc.70060","DOIUrl":"10.1002/dc.70060","url":null,"abstract":"<div>\u0000 \u0000 <p>Asteroid bodies are rare cytoplasmic inclusions within multinucleated giant cells, most classically associated with sarcoidosis but also encountered in other granulomatous and reactive conditions. Their recognition in cytology is uncommon and diagnostically challenging. We present the case of a 30-year-old female with a post-traumatic forehead swelling in which fine needle aspiration cytology (FNAC) revealed numerous foreign body-type giant cells containing asteroid bodies. This case highlights the cytomorphological spectrum of asteroid bodies outside systemic sarcoidosis, their differential diagnoses, and their clinical relevance.</p>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 2","pages":"160-163"},"PeriodicalIF":1.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To describe the long-term clinical outcomes of women diagnosed with human papillomavirus type 31 (HPV 31) infection and to assess its potential implications for genotype-specific cervical cancer risk stratification in a real-world screening setting.
Methods
This retrospective cohort study analyzed 106,450 women screened for cervical cancer at the Afyonkarahisar Cancer Early Diagnosis, Screening, and Education Center (KETEM) between 2015 and 2025. Among 3313 HPV-positive women, 147 cases with confirmed HPV 31 infection and complete follow-up data were included. Clinical outcomes, cytology results, and histopathological findings were compared across three groups: isolated HPV 31, HPV 31 co-infected with HPV 16/18, and HPV 31 co-infected with other high-risk genotypes.
Results
Biopsies were performed in 66 women (44.9%) due to abnormal cytology or HPV 16/18 co-infection. CIN2+ lesions were detected in 15 patients (22.7% of those biopsied; 10.2% of the entire cohort). The CIN2+ detection rate was 6.0% in isolated HPV 31 infections and 44.4% in women co-infected with HPV 16/18 (p = 0.0006). Notably, 13.9% of cytology-negative women were diagnosed with CIN2+ on histopathology. Two invasive cancers occurred in women with isolated HPV 31 infection and negative cytology at baseline.
Conclusion
HPV 31 infection demonstrated measurable oncogenic potential, particularly in cytology-negative women and those with HPV 16/18 co-infection. While isolated HPV 31 positivity alone may not warrant immediate colposcopy, these findings support the need for genotype-specific risk stratification in cervical cancer screening. Further multicenter and prospective studies are required to confirm these results.
{"title":"Clinical Outcomes and Risk Implications of HPV 31 Infection: A 10-Year Retrospective Cohort Study","authors":"Cem Yagmur Ozdemir, Bahar Marangoz, Nagihan Ozdemir, Nayif Cicekli, Belgin Abacı, Dagistan Tolga Arioz","doi":"10.1002/dc.70061","DOIUrl":"10.1002/dc.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the long-term clinical outcomes of women diagnosed with human papillomavirus type 31 (HPV 31) infection and to assess its potential implications for genotype-specific cervical cancer risk stratification in a real-world screening setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed 106,450 women screened for cervical cancer at the Afyonkarahisar Cancer Early Diagnosis, Screening, and Education Center (KETEM) between 2015 and 2025. Among 3313 HPV-positive women, 147 cases with confirmed HPV 31 infection and complete follow-up data were included. Clinical outcomes, cytology results, and histopathological findings were compared across three groups: isolated HPV 31, HPV 31 co-infected with HPV 16/18, and HPV 31 co-infected with other high-risk genotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Biopsies were performed in 66 women (44.9%) due to abnormal cytology or HPV 16/18 co-infection. CIN2+ lesions were detected in 15 patients (22.7% of those biopsied; 10.2% of the entire cohort). The CIN2+ detection rate was 6.0% in isolated HPV 31 infections and 44.4% in women co-infected with HPV 16/18 (<i>p</i> = 0.0006). Notably, 13.9% of cytology-negative women were diagnosed with CIN2+ on histopathology. Two invasive cancers occurred in women with isolated HPV 31 infection and negative cytology at baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HPV 31 infection demonstrated measurable oncogenic potential, particularly in cytology-negative women and those with HPV 16/18 co-infection. While isolated HPV 31 positivity alone may not warrant immediate colposcopy, these findings support the need for genotype-specific risk stratification in cervical cancer screening. Further multicenter and prospective studies are required to confirm these results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":"54 3","pages":"167-172"},"PeriodicalIF":1.0,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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