Chayanika Kala, Rajneesh Srivastava, Sanjay Kala, Lubna Khan, Neetu Purwar
Introduction
Fine Needle Aspiration Biopsy (FNAB) of the breast is a widely used diagnostic tool for detecting breast lesions, offering high sensitivity and positive predictive value. The International Academy of Cytology (IAC) established the Yokohama System in 2016 to standardise reporting of breast FNAB.
Objective
To categorise FNAB samples according to the IAC Yokohama System, assess the ROM for each category and evaluate the sensitivity, specificity and predictive values for malignancy diagnosis.
Methods
This prospective observational study involved predominantly younger adults with the majority presenting with a palpable breast mass. FNAB samples were collected, stained and examined microscopically. Categories were assigned according to the Yokohama System, and the results were compared with histopathological examination (HPE). Diagnostic metrics and ROM were calculated using statistical analysis.
Results
The study included 428 patients, with malignant cases comprising 49.5% of the samples, benign cases 43.5%, atypical cases 4.2%, suspicious for malignancy cases 1.9% and insufficient material 0.9%. The risk of malignancy (ROM) was 100% for malignant, 87.5% for suspicious for malignancy, 22.2% for atypical, 2.15% for benign and 25% for the insufficient category. Sensitivity, specificity and accuracy varied across groups, with group A, group B and group C showing accuracy at 92.99%, 97.66% and 95.3%, respectively.
Conclusion
The IAC Yokohama System effectively categorises breast FNAB samples, provides accurate diagnostic metrics for malignancy and aids clinical decision-making, particularly in resource-limited settings.
{"title":"Evaluating the Diagnostic Impact of the IAC Yokohama System for Breast Fine Needle Aspiration Biopsy Cytopathology: A Prospective Institutional Study","authors":"Chayanika Kala, Rajneesh Srivastava, Sanjay Kala, Lubna Khan, Neetu Purwar","doi":"10.1111/cyt.13499","DOIUrl":"10.1111/cyt.13499","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fine Needle Aspiration Biopsy (FNAB) of the breast is a widely used diagnostic tool for detecting breast lesions, offering high sensitivity and positive predictive value. The International Academy of Cytology (IAC) established the Yokohama System in 2016 to standardise reporting of breast FNAB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To categorise FNAB samples according to the IAC Yokohama System, assess the ROM for each category and evaluate the sensitivity, specificity and predictive values for malignancy diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective observational study involved predominantly younger adults with the majority presenting with a palpable breast mass. FNAB samples were collected, stained and examined microscopically. Categories were assigned according to the Yokohama System, and the results were compared with histopathological examination (HPE). Diagnostic metrics and ROM were calculated using statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 428 patients, with malignant cases comprising 49.5% of the samples, benign cases 43.5%, atypical cases 4.2%, suspicious for malignancy cases 1.9% and insufficient material 0.9%. The risk of malignancy (ROM) was 100% for malignant, 87.5% for suspicious for malignancy, 22.2% for atypical, 2.15% for benign and 25% for the insufficient category. Sensitivity, specificity and accuracy varied across groups, with group A, group B and group C showing accuracy at 92.99%, 97.66% and 95.3%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The IAC Yokohama System effectively categorises breast FNAB samples, provides accurate diagnostic metrics for malignancy and aids clinical decision-making, particularly in resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"491-497"},"PeriodicalIF":1.1,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010123","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}
Micronucleus (MN) and Nuclear Budding (NB) Have Been Used as an Important Stimulus for Nuclear Atypia in Revealing Chromosomal Damage and Cancer Risk. This Study Aims to Assess MN and NB as Nuclear Parameters and Explore Their Role in Differential Diagnosis of Thyroid FNA and “Bethesda System for Reporting Thyroid Cytology” (BSRTC).
Methods
The Study Included 350 Thyroid FNA Samples Categorised According to BSRTC. NB And MN Were Evaluated in 1000 Thyrocytes on FNA Slides. The Thyroidectomy Sections Were Divided Into Three Categories as ‘Malignant’, ‘Low-Risk’ and ‘Benign’.
Results
A Total of 350 Cases Were Classified as follows: 55 (15.71%) Benign, 159 (45.43%) Atypia of Undetermined Significance (AUS), 20 (5.71%) Follicular Neoplasm (FN), 48 (13.71%) Suspicious for Malignancy (SFM) and 68 (19.43%) Malignant. In comparison to all other cytopathologic diagnostic groups, the benign group had significantly lower levels of MN and NB (p < 0.001). The AUS group's MN and NB counts were significantly lower than those of the FN, SFM and malignant groups (MN for AUS-FN/SFM/M p < 0.001, NB for AUS-FN p = 0.01, NB for AUS-SFM/M p < 0.001, respectively). MN and NB counts were greater in the AUS group for cases with a malignant histopathologic diagnosis than for those with a benign histopathologic diagnosis (p < 0.001). MN and NB cut-off values > 5.50 and > 14.50, respectively, suggest high sensitivity and specificity of malignancy.
Conclusions
Increased Frequency of MN and NB closely associated with an increased risk of malignancy in thyroid FNA. Assessing MN and NB in thyroid FNA may help better stratify the risk in the AUS category.
{"title":"Micronucleus and Nuclear Budding Help to Identify Malignancy in Thyroid Fine Needle Aspiration Cytology","authors":"Nur Gizem Kocaoğlu Çelik, Ayşegül Aksoy Altınboğa, Tuba Dilay Kökenek Ünal","doi":"10.1111/cyt.13505","DOIUrl":"10.1111/cyt.13505","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Micronucleus (MN) and Nuclear Budding (NB) Have Been Used as an Important Stimulus for Nuclear Atypia in Revealing Chromosomal Damage and Cancer Risk. This Study Aims to Assess MN and NB as Nuclear Parameters and Explore Their Role in Differential Diagnosis of Thyroid FNA and “Bethesda System for Reporting Thyroid Cytology” (BSRTC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Study Included 350 Thyroid FNA Samples Categorised According to BSRTC. NB And MN Were Evaluated in 1000 Thyrocytes on FNA Slides. The Thyroidectomy Sections Were Divided Into Three Categories as ‘Malignant’, ‘Low-Risk’ and ‘Benign’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A Total of 350 Cases Were Classified as follows: 55 (15.71%) Benign, 159 (45.43%) Atypia of Undetermined Significance (AUS), 20 (5.71%) Follicular Neoplasm (FN), 48 (13.71%) Suspicious for Malignancy (SFM) and 68 (19.43%) Malignant. In comparison to all other cytopathologic diagnostic groups, the benign group had significantly lower levels of MN and NB (<i>p</i> < 0.001). The AUS group's MN and NB counts were significantly lower than those of the FN, SFM and malignant groups (MN for AUS-FN/SFM/M <i>p</i> < 0.001, NB for AUS-FN <i>p</i> = 0.01, NB for AUS-SFM/M <i>p</i> < 0.001, respectively). MN and NB counts were greater in the AUS group for cases with a malignant histopathologic diagnosis than for those with a benign histopathologic diagnosis (<i>p</i> < 0.001). MN and NB cut-off values > 5.50 and > 14.50, respectively, suggest high sensitivity and specificity of malignancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Increased Frequency of MN and NB closely associated with an increased risk of malignancy in thyroid FNA. Assessing MN and NB in thyroid FNA may help better stratify the risk in the AUS category.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"37 1","pages":"76-85"},"PeriodicalIF":1.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063001","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}
This enigma portal case highlights the cytological features of Primary cutaneous Rosai–Dorfman Disease, which is a breast cancer survivor. The classic morphological features, key diagnostic points and differentials are discussed.
In this report, the classical cytological features of primary cutaneous Rosai–Dorfman disease isare highlighted.
{"title":"Primary Cutaneous Rosai–Dorfman Disease in a Treated Case of Breast Carcinoma—Cytological Diagnostic Enigma","authors":"Sherrin Jacob, Balamurugan Thirunavukkarasu, Sudheer Kumar Arava, Rajinder Parshad","doi":"10.1111/cyt.13496","DOIUrl":"10.1111/cyt.13496","url":null,"abstract":"<p>This enigma portal case highlights the cytological features of Primary cutaneous Rosai–Dorfman Disease, which is a breast cancer survivor. The classic morphological features, key diagnostic points and differentials are discussed.</p><p>In this report, the classical cytological features of primary cutaneous Rosai–Dorfman disease isare highlighted.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"544-546"},"PeriodicalIF":1.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029738","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}
Large tumour cells with abundant eosinophilic cytoplasm, coarse chromatin and irregular nuclear shapes are typical cytological signs of fumarate hydratase-deficient renal cell carcinoma. CK7-negative/CA9-negative/PAX8-positive and AKR1B10-positive/2SC-positive/FH-deficient immunophenotypes may serve as important diagnostic markers.
{"title":"The Cytopathological Diagnosis of Fumarate Hydratase (FH)-Deficient Renal Cell Carcinoma in Two Patients With FH Gene Mutation","authors":"Xianglan Zhu, Kaixin Lei, Xiaoyu Liu, Xueying Su","doi":"10.1111/cyt.13504","DOIUrl":"10.1111/cyt.13504","url":null,"abstract":"<p>Large tumour cells with abundant eosinophilic cytoplasm, coarse chromatin and irregular nuclear shapes are typical cytological signs of fumarate hydratase-deficient renal cell carcinoma. CK7-negative/CA9-negative/PAX8-positive and AKR1B10-positive/2SC-positive/FH-deficient immunophenotypes may serve as important diagnostic markers.</p>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 4","pages":"418-422"},"PeriodicalIF":1.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049474","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}
<div> <section> <h3> Objective</h3> <p>Identifying aggressive variants of throid papillary carcinoma correctly is paramount, as their diagnosis requires more extensive surgical interventions. Numerous cytologic scoring systems have been proposed to distinguish non-aggressive from aggressive variants. Oncocytic morphology is characterised by cells with abundant granular cytoplasm resulting from mitochondrial accumulation. This feature is particularly prominent in specific PTC variants. Tall cell and hobnail variants are aggressive variants with oncocytic morphology. The present study aims to evaluate the cytomorphological features of 51 histologically confirmed papillary thyroid carcinoma (PTC) cases with oncocytic morphology and to identify cytological features that could facilitate the distinction between aggressive (tall cell and hobnail) and non-aggressive (oncocytic and Warthin-like) variants during the FNA stage, thereby enabling early detection of aggressive variants.</p> </section> <section> <h3> Methods</h3> <p>We retrospectively examined the cytological features of cases diagnosed with histologically confirmed aggressive variants with poor prognosis (tall cell and hobnail) and non-aggressive variants with good prognosis (oncocytic and Warthin-like), obtained from the pathology department of our hospital between 2014 and 2020.</p> </section> <section> <h3> Results</h3> <p>39 cases (76.5%) classified into the good prognosis group, which included oncocytic variant (O-PTC) (33 cases) and Warthin-like variant (WL-PTC) (6 cases). The poor prognosis group included 12 cases (23.5%), comprising hobnail variant (HN-PTC) (2 cases) and tall cell variant (TC-PTC) (10 cases). The swirl pattern was significantly more frequent in the poor prognosis group (83.3% vs. 43.6%, <i>p</i> = 0.022), with a sensitivity of 83.3% and specificity of 56.4%. The presence of nuclear grooves was observed in all cases of the poor prognosis group (100%) while in 61.5% of the good prognosis group (<i>p</i> = 0.011). This feature exhibited 100% sensitivity and 38.4% specificity. Concerning cytoplasmic volume, scant-medium amount cytoplasmic volume was significantly more common in the poor prognosis group (66.7% vs. 20.5%, <i>p</i> = 0.005), showing 66.7% sensitivity and 79.4% specificity, and yielding the highest accuracy rate (76.4%) among all characteristics.</p> </section> <section> <h3> Conclusions</h3> <p>Oncocytic morphology-based approaches may help identify poor prognosis variants and guide clinical decisions. In our study, cellular swirls, grooves and scant-medium cytoplasmic volume were the most significant cytological indicators for identifying po
目的：正确识别甲状腺乳头状癌的侵袭性变异是至关重要的，因为它们的诊断需要更广泛的手术干预。已经提出了许多细胞学评分系统来区分非侵袭性和侵袭性变异。嗜瘤细胞形态的特征是由于线粒体积聚而形成的细胞具有丰富的颗粒状细胞质。这个特性在特定的PTC变体中尤为突出。高细胞变异体和鞋钉变异体是侵袭性变异体，具有癌细胞形态。本研究旨在评估51例组织学证实的甲状腺乳头状癌（PTC）嗜瘤细胞形态的细胞形态学特征，并确定细胞学特征，以便在FNA阶段区分侵袭性（高细胞和鞋钉）和非侵袭性（嗜瘤细胞和wartin样）变异，从而能够早期发现侵袭性变异。方法：回顾性分析我院病毒科2014 - 2020年经组织学证实预后较差的侵袭性变异体（高细胞型和鞋钉型）和预后较好的非侵袭性变异体（嗜瘤细胞型和沃辛样）的细胞学特征。结果：39例（76.5%）归为预后良好组，其中嗜瘤细胞变异体（O-PTC） 33例，wartin样变异体（WL-PTC） 6例。预后不良组12例（23.5%），其中鞋钉变异（HN-PTC） 2例，高细胞变异（TC-PTC） 10例。不良预后组漩涡型发生率更高（83.3%比43.6%,p = 0.022），敏感性为83.3%，特异性为56.4%。预后不良组中核沟的存在率为100%，而预后良好组中核沟的存在率为61.5% （p = 0.011）。该特征的敏感性为100%，特异性为38.4%。在细胞质体积方面，中微量细胞质体积在预后不良组中更为常见（66.7% vs. 20.5%, p = 0.005），敏感性为66.7%，特异性为79.4%，准确率最高（76.4%）。结论：基于肿瘤细胞形态的方法可能有助于识别预后不良的变异并指导临床决策。在我们的研究中，细胞漩涡、沟槽和少量的细胞质体积是鉴别预后不良变异的最重要的细胞学指标。尽管先前强调细胞宽度/高度比和泡沫INCIs用于TC-PTC的诊断，但在我们的研究中，两组之间没有发现显着差异。
{"title":"Can Aggressive Papillary Thyroid Carcinoma Variants With Oncocytıc Morphology (Tall Cell and Hobnail Variants) be Detected Cytologically? Is the Differentiation as Straightforward as Reported?","authors":"Burcu Özcan, Merve Cin, Zeynep Ece Demirbaş","doi":"10.1111/cyt.13502","DOIUrl":"10.1111/cyt.13502","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Identifying aggressive variants of throid papillary carcinoma correctly is paramount, as their diagnosis requires more extensive surgical interventions. Numerous cytologic scoring systems have been proposed to distinguish non-aggressive from aggressive variants. Oncocytic morphology is characterised by cells with abundant granular cytoplasm resulting from mitochondrial accumulation. This feature is particularly prominent in specific PTC variants. Tall cell and hobnail variants are aggressive variants with oncocytic morphology. The present study aims to evaluate the cytomorphological features of 51 histologically confirmed papillary thyroid carcinoma (PTC) cases with oncocytic morphology and to identify cytological features that could facilitate the distinction between aggressive (tall cell and hobnail) and non-aggressive (oncocytic and Warthin-like) variants during the FNA stage, thereby enabling early detection of aggressive variants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively examined the cytological features of cases diagnosed with histologically confirmed aggressive variants with poor prognosis (tall cell and hobnail) and non-aggressive variants with good prognosis (oncocytic and Warthin-like), obtained from the pathology department of our hospital between 2014 and 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>39 cases (76.5%) classified into the good prognosis group, which included oncocytic variant (O-PTC) (33 cases) and Warthin-like variant (WL-PTC) (6 cases). The poor prognosis group included 12 cases (23.5%), comprising hobnail variant (HN-PTC) (2 cases) and tall cell variant (TC-PTC) (10 cases). The swirl pattern was significantly more frequent in the poor prognosis group (83.3% vs. 43.6%, <i>p</i> = 0.022), with a sensitivity of 83.3% and specificity of 56.4%. The presence of nuclear grooves was observed in all cases of the poor prognosis group (100%) while in 61.5% of the good prognosis group (<i>p</i> = 0.011). This feature exhibited 100% sensitivity and 38.4% specificity. Concerning cytoplasmic volume, scant-medium amount cytoplasmic volume was significantly more common in the poor prognosis group (66.7% vs. 20.5%, <i>p</i> = 0.005), showing 66.7% sensitivity and 79.4% specificity, and yielding the highest accuracy rate (76.4%) among all characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Oncocytic morphology-based approaches may help identify poor prognosis variants and guide clinical decisions. In our study, cellular swirls, grooves and scant-medium cytoplasmic volume were the most significant cytological indicators for identifying po","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"37 1","pages":"53-65"},"PeriodicalIF":1.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027747","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}
Caroline Bourque, Gianluca Savoia, Maxine Noik, Livia Florianova, Saruchi Bandargal, Sabrina Daniela da Silva, Richard Payne, Marc Philippe Pusztaszeri
Objectives
Thyroid nodules classified as atypia of undetermined significance (AUS) within the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) present a diagnostic challenge, with a risk of malignancy (ROM) of 5% to 50%. In 2017, TBSRTC introduced AUS subcategories to enhance ROM assessment. This study explores the correlation between AUS subclassification, molecular mutations, and surgical outcomes.
Methods
Retrospective analysis was performed of 114 AUS cases with molecular profiling by ThyroSeqV3 and surgical follow-up. AUS subcategories as defined by TBSRTC included: AUS-Architectural, AUS-Nuclear, AUS-Nuclear and Architectural, and AUS-Hürthle cell. Pathology diagnoses were categorised as benign, malignant, or borderline, including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).
Results
Of the 114 nodules, 32.5% were AUS-Architectural, 28.9% AUS-Nuclear and Architectural, 18.4% AUS-Nuclear, 19.3% AUS-Hürthle cell, and 0.9% AUS-Not Otherwise Specified. Papillary carcinoma, predominantly follicular variant, was the most common diagnosis (47.4%), followed by benign lesions (34.2%) and NIFTP (9.6%). RAS family mutations were the most prevalent molecular alteration (34.2%) followed by DICER1, EIF1AX, EXH1 mutations, CNA and GEP (29.8%). THADA fusions, PTEN, TSHR and BRAFK601E mutations were identified in 10.5% of cases, while high-risk mutations such as BRAF V600E, TERT, and TP53 were found in 8.8% of cases. AUS subcategories demonstrated distinct molecular profiles and were linked to varying surgical outcomes.
Conclusions
AUS subcategorization is associated with specific molecular profiles and surgical outcomes, supporting the subclassification of AUS cases per TBSRTC guidelines for improved risk stratification and clinical management. Further prospective studies with larger cohorts are necessary for validation.
目的：在Bethesda甲状腺细胞病理学报告系统（TBSRTC）中，甲状腺结节被分类为不确定意义的非典型性（AUS），其诊断具有挑战性，恶性肿瘤（ROM）的风险为5%至50%。2017年，TBSRTC引入了AUS子类别，以加强ROM评估。本研究探讨了AUS亚型、分子突变和手术结果之间的关系。方法：对114例AUS患者进行回顾性分析，采用ThyroSeqV3进行分子谱分析，并进行手术随访。由TBSRTC定义的AUS子类别包括：AUS-Architectural， AUS- nuclear, AUS- nuclear and Architectural，以及AUS- hrthle cell。病理诊断分为良性、恶性或交界性，包括具有乳头状样核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP）。结果：114例结节中，32.5%为auss -Architectural， 28.9%为auss - nuclear and Architectural， 18.4%为auss - nuclear， 19.3%为auss - h rthle细胞，0.9%为auss - other Specified。乳头状癌，主要是滤泡变异，是最常见的诊断（47.4%），其次是良性病变（34.2%）和NIFTP（9.6%）。RAS家族突变是最常见的分子改变（34.2%），其次是DICER1、EIF1AX、EXH1突变、CNA和GEP（29.8%）。在10.5%的病例中发现了ada融合、PTEN、TSHR和BRAFK601E突变，而在8.8%的病例中发现了BRAF V600E、TERT和TP53等高风险突变。AUS亚型表现出不同的分子特征，并与不同的手术结果有关。结论：AUS亚分类与特定的分子特征和手术结果相关，支持根据TBSRTC指南对AUS病例进行亚分类，以改善风险分层和临床管理。进一步的前瞻性研究需要更大的队列来验证。
{"title":"Malignancy Risk, Molecular Mutations, and Surgical Outcomes of Thyroid Nodules Classified as Atypia of Undetermined Significance in the Bethesda System: A Comprehensive Analysis","authors":"Caroline Bourque, Gianluca Savoia, Maxine Noik, Livia Florianova, Saruchi Bandargal, Sabrina Daniela da Silva, Richard Payne, Marc Philippe Pusztaszeri","doi":"10.1111/cyt.13503","DOIUrl":"10.1111/cyt.13503","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Thyroid nodules classified as atypia of undetermined significance (AUS) within the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) present a diagnostic challenge, with a risk of malignancy (ROM) of 5% to 50%. In 2017, TBSRTC introduced AUS subcategories to enhance ROM assessment. This study explores the correlation between AUS subclassification, molecular mutations, and surgical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective analysis was performed of 114 AUS cases with molecular profiling by ThyroSeqV3 and surgical follow-up. AUS subcategories as defined by TBSRTC included: AUS-Architectural, AUS-Nuclear, AUS-Nuclear and Architectural, and AUS-Hürthle cell. Pathology diagnoses were categorised as benign, malignant, or borderline, including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 114 nodules, 32.5% were AUS-Architectural, 28.9% AUS-Nuclear and Architectural, 18.4% AUS-Nuclear, 19.3% AUS-Hürthle cell, and 0.9% AUS-Not Otherwise Specified. Papillary carcinoma, predominantly follicular variant, was the most common diagnosis (47.4%), followed by benign lesions (34.2%) and NIFTP (9.6%). RAS family mutations were the most prevalent molecular alteration (34.2%) followed by <i>DICER1</i>, <i>EIF1AX</i>, <i>EXH1</i> mutations, CNA and GEP (29.8%). <i>THADA</i> fusions, <i>PTEN</i>, <i>TSHR</i> and <i>BRAFK601E</i> mutations were identified in 10.5% of cases, while high-risk mutations such as <i>BRAF V600E</i>, <i>TERT</i>, and <i>TP53</i> were found in 8.8% of cases. AUS subcategories demonstrated distinct molecular profiles and were linked to varying surgical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AUS subcategorization is associated with specific molecular profiles and surgical outcomes, supporting the subclassification of AUS cases per TBSRTC guidelines for improved risk stratification and clinical management. Further prospective studies with larger cohorts are necessary for validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"37 1","pages":"66-75"},"PeriodicalIF":1.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cyt.13503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997313","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}
There are numerous benign cellular changes that occur in the lung due to diverse underlying diseases that can be encountered in exfoliative samples and transbronchial and CT-guided samples. Entities such as bronchial cell hyperplasia, pneumocyte type II proliferation, repair, etc. should be recognised and diagnosed. Yet, many pathologists encounter difficulties in their interpretation and frequently either diagnose them as ‘Atypical’ resulting in more invasive procedures or misdiagnose them as ‘Malignant’ with drastic consequences to the patient. Other entities may be dismissed as benign lung elements, resulting in misclassification as non-diagnostic/non-representative, resulting in repeated or more invasive procedures. In this review, we will present an overview of many of these diagnostic pitfalls and mimickers and describe clues to their diagnosis and how to differentiate them from malignant conditions. As in all cytologic diagnoses, both false positive and false negative errors can occur and both types of errors can have grave consequences to patient management, resulting in increased unnecessary morbidity such as pneumonectomy and, at times, litigation.
{"title":"Benign Category in the WHO Reporting System for Lung Cytopathology: Diagnostic Difficulties and Differential Diagnosis","authors":"Claire W. Michael, Marianne Engels","doi":"10.1111/cyt.13497","DOIUrl":"10.1111/cyt.13497","url":null,"abstract":"<div>\u0000 \u0000 <p>There are numerous benign cellular changes that occur in the lung due to diverse underlying diseases that can be encountered in exfoliative samples and transbronchial and CT-guided samples. Entities such as bronchial cell hyperplasia, pneumocyte type II proliferation, repair, etc. should be recognised and diagnosed. Yet, many pathologists encounter difficulties in their interpretation and frequently either diagnose them as ‘Atypical’ resulting in more invasive procedures or misdiagnose them as ‘Malignant’ with drastic consequences to the patient. Other entities may be dismissed as benign lung elements, resulting in misclassification as non-diagnostic/non-representative, resulting in repeated or more invasive procedures. In this review, we will present an overview of many of these diagnostic pitfalls and mimickers and describe clues to their diagnosis and how to differentiate them from malignant conditions. As in all cytologic diagnoses, both false positive and false negative errors can occur and both types of errors can have grave consequences to patient management, resulting in increased unnecessary morbidity such as pneumonectomy and, at times, litigation.</p>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"443-457"},"PeriodicalIF":1.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046749","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}
Larissa Dias Assunção, Michelle Garcia Discacciati, Andressa Germano da Silva, Adriana Yoshida, Diama Bhadra Vale, Julio Cesar Teixeira
Introduction
Cervical cancer remains a significant global health concern, primarily associated with persistent infections by high-risk human papillomavirus (hr-HPV). As screening programmes evolve from traditional cytology to DNA-HPV testing, the need for a liquid medium that maintains the integrity of cervical samples for biomolecular analysis and cytology becomes critical.
Methods
This study evaluated the performance of the candidate liquid preservation medium (PM) Cytoliq for cervical samples intended for DNA-HPV testing and liquid-based cytology (LBC), in comparison with the reference PM, PreservCyt-ThinPrep. A total of 112 women aged 18–64 years underwent routine gynaecological examinations, with paired cervical samples preserved in both PM for HPV testing and genotyping (Cobas HPV test), and LBC. The study aimed for a sensitivity greater than 90% in detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+), moderate to high agreement in HPV testing results (Kappa index > 0.70) and adequate performance in LBC.
Results
The candidate PM exhibited non-inferior performance relative to the reference PM. DNA-HPV testing showed a 94.5% agreement rate (Kappa = 0.88) and a sensitivity of 92.9% for CIN2+ detection. Additionally, the candidate PM performed well in LBC smear production, with no significant differences in cytological diagnoses. The agreement in LBC diagnoses was 94.0% (Kappa = 0.79) with the ThinPrep processor and 91.8% (Kappa = 0.63) with the Cytoliq processor.
Conclusion
The Cytoliq PM demonstrated comparable efficacy to the reference for DNA-HPV testing and LBC, supporting its potential as an alternative preservation medium in cervical cancer screening programmes.
{"title":"Clinical Performance of a Liquid Preservation Medium for Cervicovaginal Samples in DNA-HPV Testing and Liquid-Based Cytology for Cervical Cancer Screening","authors":"Larissa Dias Assunção, Michelle Garcia Discacciati, Andressa Germano da Silva, Adriana Yoshida, Diama Bhadra Vale, Julio Cesar Teixeira","doi":"10.1111/cyt.13495","DOIUrl":"10.1111/cyt.13495","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cervical cancer remains a significant global health concern, primarily associated with persistent infections by high-risk human papillomavirus (hr-HPV). As screening programmes evolve from traditional cytology to DNA-HPV testing, the need for a liquid medium that maintains the integrity of cervical samples for biomolecular analysis and cytology becomes critical.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study evaluated the performance of the candidate liquid preservation medium (PM) Cytoliq for cervical samples intended for DNA-HPV testing and liquid-based cytology (LBC), in comparison with the reference PM, PreservCyt-ThinPrep. A total of 112 women aged 18–64 years underwent routine gynaecological examinations, with paired cervical samples preserved in both PM for HPV testing and genotyping (Cobas HPV test), and LBC. The study aimed for a sensitivity greater than 90% in detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+), moderate to high agreement in HPV testing results (Kappa index > 0.70) and adequate performance in LBC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The candidate PM exhibited non-inferior performance relative to the reference PM. DNA-HPV testing showed a 94.5% agreement rate (Kappa = 0.88) and a sensitivity of 92.9% for CIN2+ detection. Additionally, the candidate PM performed well in LBC smear production, with no significant differences in cytological diagnoses. The agreement in LBC diagnoses was 94.0% (Kappa = 0.79) with the ThinPrep processor and 91.8% (Kappa = 0.63) with the Cytoliq processor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Cytoliq PM demonstrated comparable efficacy to the reference for DNA-HPV testing and LBC, supporting its potential as an alternative preservation medium in cervical cancer screening programmes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 6","pages":"552-557"},"PeriodicalIF":1.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cyt.13495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054519","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}
Yi Xu, Xiao-Yu Nie, Qian Wang, Zhi-Hong Xian, Shu-Hui Zhang
The cytomorphology of malignant phyllodes tumour (MPT) in effusion specimens is rarely described. In this paper, the detailed cytopathological and immunohistochemical characteristics of metastatic MPT have been described in pleural effusion. Patients' medical history and the judicious utilisation of ancillary studies including cellblock and immunocytochemistry contribute to ensure precise cytological diagnoses.
The cytomorphology of malignant phyllodes tumour (MPT) in effusion specimens can be diagnostically challenging. The author presents detailed cytopathological and immunohistochemical characteristics of a case of metastatic MPT in pleural effusion.
{"title":"Cytomorphological and Immunohistochemical Features of Metastatic Malignant Phyllodes Tumour in Pleural Fluid: A Case Report With Literature Review","authors":"Yi Xu, Xiao-Yu Nie, Qian Wang, Zhi-Hong Xian, Shu-Hui Zhang","doi":"10.1111/cyt.13501","DOIUrl":"10.1111/cyt.13501","url":null,"abstract":"<p>The cytomorphology of malignant phyllodes tumour (MPT) in effusion specimens is rarely described. In this paper, the detailed cytopathological and immunohistochemical characteristics of metastatic MPT have been described in pleural effusion. Patients' medical history and the judicious utilisation of ancillary studies including cellblock and immunocytochemistry contribute to ensure precise cytological diagnoses.</p><p>The cytomorphology of malignant phyllodes tumour (MPT) in effusion specimens can be diagnostically challenging. The author presents detailed cytopathological and immunohistochemical characteristics of a case of metastatic MPT in pleural effusion.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 5","pages":"516-521"},"PeriodicalIF":1.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013613","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}
Villoglandular adenocarcinoma (VGA) of the cervix is a rare tumour with very few reports of cytological diagnosis on a cervical smear. Since the usual prognosis of VGA is more favourable than that of a conventional cervical adenocarcinoma, a pre-operative diagnosis is essential for appropriate therapeutic decisions. We report the clinical, cytological, and histopathological features of a case of VGA in an elderly woman. A 60-year-old female presented with postmenopausal bleeding and was found to have a hypertrophied cervix. Conventional smears from the cervix demonstrated features of atypical glandular cells with a villoglandular configuration. Endocervical cell nuclei were enlarged with overlapping, hyperchromasia and mild to moderate anisonucleosis. The cytological impression of villoglandular carcinoma was confirmed on subsequent hysterectomy and histopathology. Hence, cytopathologists need to be aware of the entity of villoglandular carcinoma of the cervix, its relatively bland nuclear features, and the diagnostic clues to allow for an accurate diagnosis on cervical smear. An accurate pre-operative diagnosis can assist the gynaecologists in arriving at appropriate therapeutic and prognostic decisions.
{"title":"Villoglandular Carcinoma of the Uterine Cervix: Clinic-Cytopathological-Histological Features of a Rare Case With Brief Review of the Literature","authors":"Neelam Sood, Ruchika Gupta, Sanjay Gupta","doi":"10.1111/cyt.13492","DOIUrl":"10.1111/cyt.13492","url":null,"abstract":"<div>\u0000 \u0000 <p>Villoglandular adenocarcinoma (VGA) of the cervix is a rare tumour with very few reports of cytological diagnosis on a cervical smear. Since the usual prognosis of VGA is more favourable than that of a conventional cervical adenocarcinoma, a pre-operative diagnosis is essential for appropriate therapeutic decisions. We report the clinical, cytological, and histopathological features of a case of VGA in an elderly woman. A 60-year-old female presented with postmenopausal bleeding and was found to have a hypertrophied cervix. Conventional smears from the cervix demonstrated features of atypical glandular cells with a villoglandular configuration. Endocervical cell nuclei were enlarged with overlapping, hyperchromasia and mild to moderate anisonucleosis. The cytological impression of villoglandular carcinoma was confirmed on subsequent hysterectomy and histopathology. Hence, cytopathologists need to be aware of the entity of villoglandular carcinoma of the cervix, its relatively bland nuclear features, and the diagnostic clues to allow for an accurate diagnosis on cervical smear. An accurate pre-operative diagnosis can assist the gynaecologists in arriving at appropriate therapeutic and prognostic decisions.</p>\u0000 </div>","PeriodicalId":55187,"journal":{"name":"Cytopathology","volume":"36 6","pages":"596-601"},"PeriodicalIF":1.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040647","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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