Journal of the American Society of Cytopathology最新文献

Introduction: Recognition of lymph node involvement by small-cell lung carcinoma (SCLC) is challenging, especially during rapid onsite evaluation (ROSE). This distinction might carry clinical significance especially for staging and potential therapy.

Materials and methods: Cases with ROSE of lymph nodes for assessment of involvement by SCLC between 2020 and 2024 at our institution were reviewed. Adequacy evaluation results were correlated with the final diagnosis. Smears used during ROSE from cases with diagnostic discrepancies between ROSE and final diagnosis were retrieved for additional review. Interpretation accuracy was measured, and useful features for recognizing SCLC and possible contributing factors for misrecognition were studied.

Results: The majority of the cases show concordance between ROSE interpretation and the final review. Most discrepancies are due to under-recognition of scant SCLC cells from background lymphocytes or abundant necrosis. Rapid Papanicolaou-stained smears showed better sensitivity and specificity for recognizing SCLC cells than Diff-Quick stain during ROSE. Pathologists in practice for a longer period (>5 years) are more likely to accurately distinguish the carcinoma cells. Shorter time seems to have been spent onsite for evaluation of cases with under-recognized SCLC cells, but the association is not statistically significant.

Conclusions: Accurately recognizing lymph node involvement by SCLC during ROSE is important for timely diagnosis, triage, and management of cases. Several cytologic features should be utilized for accurately distinguishing SCLC cells from lymphocytes. Experience gained with practice increases diagnostic accuracy during ROSE, and rushing should be avoided. Knowledge of clinical impression and clear communication with clinicians should always be encouraged.

Introduction: Recent studies suggest that ultrasound-guided fine-needle aspiration biopsy (iFNAb) enhances diagnostic accuracy for palpable lesions. This study evaluates the efficacy of palpation-guided FNAb (pFNAb) performed at Unidade Local de Saúde de Coimbra, Portugal, compares findings to existing literature, and identifies lesions that could benefit from ultrasound guidance.

Materials and methods: A retrospective review of 278 pFNAb cases from 2021 to 2023 was conducted, collecting data on lesion characteristics, procedural details, and operator expertise. Diagnostic accuracy was determined through concordance with histopathology, flow cytometry, or clinical follow-up. Statistical analyses included Fisher's exact test, chi-square tests, and logistic regression. A Preferred Reporting Items for Systematic reviews and Meta-Analyses-guided literature review was also performed to contextualize findings.

Results: Diagnostic accuracy was achieved in 84% of pFNAb cases. Lesions less than 1 cm exhibited significantly lower diagnostic rates compared to larger lesions. Diagnostic accuracy improved with additional needle passes, reaching 87% with 3 attempts. Anatomical location significantly influenced outcomes, with scalp lesions having the lowest diagnostic rate (33%) compared to skin and soft tissue lesions (85.7%). Literature review findings corroborated the data, emphasizing the superior accuracy of iFNAb for smaller or anatomically challenging lesions.

Conclusions: pFNAb is effective for diagnosing most palpable lesions and provides a standard of care in settings without imaging resources. However, iFNAb is recommended for specific cases, such as small or scalp lesions, to enhance diagnostic accuracy. Tailoring biopsy approaches based on lesion characteristics can improve outcomes, reduce repeat procedures, and enhance patient care.

Introduction: Advancements in digital imaging technology for Papanicolaou test slides, combined with artificial intelligence are driving the development and adoption of innovative computer-assisted screening methods for cervical cancer within the cytology community. Our study aimed to assess the performance of the Hologic Genius Digital Diagnostic System (HGDDS) in the interpretation of low-grade squamous intraepithelial lesions (LSIL) in ThinPrep Papanicolaou slides.

Method: As part of a validation study performed with 890 ThinPrep Papanicolaou slides using the HGDDS, a subset of 146 LSIL cases were included in this study. Performance characteristics for the detection of cervical intraepithelial neoplasia (CIN) and interobserver variability among 3 cytopathologists were assessed.

Results: On evaluation of the consensus results of the 3 cytopathologists, of the 146 LSIL Papanicolaou cases, 60.3% were interpreted as LSIL with the HGDDS. The remainder were interpreted as ASCUS (26%), ASC-H (10.3%), HSIL (2.7%), and NILM (0.7%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting CIN1+ lesions in the ASCUS + category with the HGDDS were 100%, 25%, 97.9%, and 100%, respectively. The sensitivity, specificity, PPV, and NPV for the detection of CIN1+ lesions in the LSIL + category with the HGDDS were 74.7%, 75%, 99.1%, and 7.7%, respectively. Kendall's W coefficient was 0.792, indicating strong agreement among participating pathologists.

Conclusions: Our study demonstrated that ThinPrep Papanicolaou tests with LSIL could be interpreted with strong agreement among pathologists and with good performance indicators when utilizing the HGDDS.

The head and neck region encompasses a variety of complex, intricate structures that can give rise to a plethora of epithelial tumors. As novel diagnostic entities and ancillary tests emerge in surgical pathology, translating this expanding knowledge to cytology can be challenging. This review will summarize key developments in diagnosing virus-associated squamous cell carcinomas and salivary gland lesions by fine needle aspiration (FNA). Despite collective efforts to define optimal thresholds for p16 positivity in cytologic material, the performance of p16 remains suboptimal for FNA specimens, with a lack of consensus on the best cutoff. Forthcoming guidelines are expected to recommend HPV-specific assays as first-line testing in FNAs of metastatic nonkeratinizing SCC due to their superior performance in limited material. In salivary cytology, the Milan System for Reporting Salivary Gland Cytopathology recently entered its second edition, retaining the original diagnostic categories. The risks of malignancy for each category have been refined based on published data. While the diagnostic categories are now familiar, several categories warrant special attention to their nuances and pitfalls to improve diagnostic accuracy. Finally, general principles gleaned from advances in both virus-associated squamous cell carcinoma and salivary neoplasia are highlighted, equipping the practicing cytopathologist to approach everyday cases strategically and confidently.

Introduction: Human epidermal growth factor receptor 2 (HER2)-low breast cancer, defined by HER2 immunohistochemistry scores of 1+ or 2+ without gene amplification, represents a unique subgroup with emerging therapeutic implications. Limited data describe the behavior of HER2-low tumors, particularly in metastatic settings. This study evaluated the frequency of HER2-low expression, Ki-67 proliferation index, and survival outcomes across HER2 subtypes in metastatic breast carcinoma using cytology specimens.

Methods: A 3-year retrospective analysis identified 43 patients with metastatic breast carcinoma diagnosed via fine-needle aspiration or exfoliative cytology. HER2, ER, PR, and Ki-67 status were determined by immunohistochemistry, with equivocal HER2 cases assessed by in situ hybridization. Survival outcomes were estimated using the Kaplan-Meier method, with Cox regression identifying predictors of survival.

Results: Among 43 cases, 31 (70.5%) were HER2-low, 6 (13.6%) HER2-positive, and 6 (13.6%) HER2-zero. HER2 discordance between primary and metastatic lesions occurred in 19%, mainly involving transitions to HER2-low status. Hormone receptor positivity was more frequent in HER2-low tumors (71%) than HER2-zero tumors (33%) (P < 0.001). Mean Ki-67 was highest in HER2-low (45%) versus HER2-negative (34%) and HER2-positive (33%) cases (P = 0.549). Median survival was 13 months for HER2-low and 5 months for HER2-negative patients; survival differences were not significant (P = 0.225). Younger age (HR = 0.240, P = 0.048) and hormone receptor positivity (HR = 0.273, P = 0.011) were significant predictors of survival.

Conclusion: HER2-low expression is prevalent in metastatic breast carcinoma with a unique hormone receptor profile. Findings highlight the need for reassessment of HER2 status in metastatic settings, with potential therapeutic implications.