{"title":"Disappearing act: The US retreat on research funding is dimming the future of international cancer research: In this second of a three-part series on how new US policies and funding cuts are affecting cancer research, scientists warn that restrictive funding policies may turn off key partnerships.","authors":"Bryn Nelson, William Faquin","doi":"10.1002/cncy.70071","DOIUrl":"https://doi.org/10.1002/cncy.70071","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 2","pages":"e70071"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tarik M Elsheikh, Claire Sheen, Timothy Bell, Christine Booth, Erika E Doxtader, Fatima Hamadeh, Dawn Underwood, Linlin Yang, Rema Chaari
Background: Atypia of undetermined significance (AUS) is a subjective diagnosis with reported interinstitutional rates ranging from 1% to 20%. The Bethesda System for Reporting Thyroid Cytology (TBS) endorsed ≤10% as an achievable target; however, lowering AUS rates without informed, adjusted diagnostic thresholds can compromise the sensitivity of thyroid cytology. The authors conducted this study to identify quality-assurance measures that can assess individual pathologist's metrics compared with laboratory averages and published benchmarks and can provide feedback to pathologists on the causes of discrepancy.
Methods: AUS rates of 15 cytopathology-boarded pathologists were correlated with AUS:malignant ratios (AUS:M), histologic risks of malignancy (ROMs), and Afirma molecular-positive call rates (PCRs), and scatterplots were constructed. The distribution of pathologist TBS diagnostic categories was compared with laboratory averages and correlated with the above metrics.
Results: Pathologist AUS rates ranged from 7% to 44% (mean, 19%; 926 of 4801 cases). Average AUS:M and ROM rates were 7.0% and 68% (range, 3%-35% and 25%-87%), respectively. Regression analysis highlighted pathologists' metrics that were outliers. Evaluation of the distribution of individual pathologist's TBS diagnostic categories identified patterns/trends that explained deviations from laboratory averages, including patterns of significant overcalling of benign as AUS and downgrading diagnoses across multiple TBS categories.
Conclusions: Correlation of AUS, AUS:M, and ROM with molecular results, in addition to the distribution of pathologist TBS categories, offer a robust framework for quality assurance that illustrates deviations from target benchmarks, including shifts in interpretations from one TBS category to another. Giving feedback to pathologists regarding their practice patterns can help standardize diagnostic thresholds and meet designated target metrics.
{"title":"Molecular testing and other metrics in thyroid cytology as quality-assurance measures in evaluating variation among pathologists in the diagnosis of atypia of undetermined significance.","authors":"Tarik M Elsheikh, Claire Sheen, Timothy Bell, Christine Booth, Erika E Doxtader, Fatima Hamadeh, Dawn Underwood, Linlin Yang, Rema Chaari","doi":"10.1002/cncy.70074","DOIUrl":"10.1002/cncy.70074","url":null,"abstract":"<p><strong>Background: </strong>Atypia of undetermined significance (AUS) is a subjective diagnosis with reported interinstitutional rates ranging from 1% to 20%. The Bethesda System for Reporting Thyroid Cytology (TBS) endorsed ≤10% as an achievable target; however, lowering AUS rates without informed, adjusted diagnostic thresholds can compromise the sensitivity of thyroid cytology. The authors conducted this study to identify quality-assurance measures that can assess individual pathologist's metrics compared with laboratory averages and published benchmarks and can provide feedback to pathologists on the causes of discrepancy.</p><p><strong>Methods: </strong>AUS rates of 15 cytopathology-boarded pathologists were correlated with AUS:malignant ratios (AUS:M), histologic risks of malignancy (ROMs), and Afirma molecular-positive call rates (PCRs), and scatterplots were constructed. The distribution of pathologist TBS diagnostic categories was compared with laboratory averages and correlated with the above metrics.</p><p><strong>Results: </strong>Pathologist AUS rates ranged from 7% to 44% (mean, 19%; 926 of 4801 cases). Average AUS:M and ROM rates were 7.0% and 68% (range, 3%-35% and 25%-87%), respectively. Regression analysis highlighted pathologists' metrics that were outliers. Evaluation of the distribution of individual pathologist's TBS diagnostic categories identified patterns/trends that explained deviations from laboratory averages, including patterns of significant overcalling of benign as AUS and downgrading diagnoses across multiple TBS categories.</p><p><strong>Conclusions: </strong>Correlation of AUS, AUS:M, and ROM with molecular results, in addition to the distribution of pathologist TBS categories, offer a robust framework for quality assurance that illustrates deviations from target benchmarks, including shifts in interpretations from one TBS category to another. Giving feedback to pathologists regarding their practice patterns can help standardize diagnostic thresholds and meet designated target metrics.</p>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 2","pages":"e70074"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond the microscope: Solving pathology challenges in low and middle income countries requires a multifaceted and multidisciplinary approach.","authors":"Asteria H Kimambo, Edda A Vuhahula, Dianna L Ng","doi":"10.1002/cncy.70075","DOIUrl":"10.1002/cncy.70075","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 2","pages":"e70075"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to \"Fine-needle aspiration cytology reduces the frequency of surgeries for malignant salivary gland tumors\".","authors":"","doi":"10.1002/cncy.70080","DOIUrl":"10.1002/cncy.70080","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 2","pages":"e70080"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rúben Rodrigues Roque MSc, CFIAC, Irena Srebotnik Kirbiš PhD, Carla Sofia Castro Pinheiro CT(IAC), Rita Sattler Fagulha Martins CMIAC, Vanessa Sofia Tavares CMIAC, Saudade André MD, PhD, Ana Félix MD, PhD
Background
On-slide controls are essential for quality assurance in immunocytochemistry, yet their use in non–cell block cytology preparations remains a significant challenge. This study presents and evaluates a novel method for preparing on-slide controls from long-term prefixed cell suspensions, applicable to all types of cytology preparations.
Methods
A methodology for preparing on-slide controls is described in detail and comprehensively validated via three key evaluations: assessing antigen and cellular morphology stability in 17 suspensions over 29 months; conducting a retrospective review of immunocytochemistry records (2019–2024) to determine feasibility; and performing a tracer study to evaluate cell carryover risk.
Results
In the stability assessment, all 20 evaluated antigens and cellular morphologies remained well preserved in the stored control samples, with only transient partial loss of antigenicity observed on three of 149 slides. The method was successfully and reliably applied in 1904 immunocytochemistry tests (n = 48 primary antibodies), with a failure rate of 0.3% (95% CI, 0.1%–0.7%). The dedicated tracer study confirmed the complete absence of cell carryover or cross-contamination.
Conclusions
The described method offers a robust, practical, and adaptable solution for preparing on-slide controls applicable to all cytology preparations, including previously stained and mounted slides. Implementing this approach strengthens quality control for non–cell block cytology slides, enhances diagnostic reliability, and brings cytology practice closer to the quality standards established in immunohistochemistry.
{"title":"Validation of on-slide immunocytochemistry controls prepared from long-term preserved prefixed cell suspensions","authors":"Rúben Rodrigues Roque MSc, CFIAC, Irena Srebotnik Kirbiš PhD, Carla Sofia Castro Pinheiro CT(IAC), Rita Sattler Fagulha Martins CMIAC, Vanessa Sofia Tavares CMIAC, Saudade André MD, PhD, Ana Félix MD, PhD","doi":"10.1002/cncy.70072","DOIUrl":"https://doi.org/10.1002/cncy.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>On-slide controls are essential for quality assurance in immunocytochemistry, yet their use in non–cell block cytology preparations remains a significant challenge. This study presents and evaluates a novel method for preparing on-slide controls from long-term prefixed cell suspensions, applicable to all types of cytology preparations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A methodology for preparing on-slide controls is described in detail and comprehensively validated via three key evaluations: assessing antigen and cellular morphology stability in 17 suspensions over 29 months; conducting a retrospective review of immunocytochemistry records (2019–2024) to determine feasibility; and performing a tracer study to evaluate cell carryover risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the stability assessment, all 20 evaluated antigens and cellular morphologies remained well preserved in the stored control samples, with only transient partial loss of antigenicity observed on three of 149 slides. The method was successfully and reliably applied in 1904 immunocytochemistry tests (<i>n</i> = 48 primary antibodies), with a failure rate of 0.3% (95% CI, 0.1%–0.7%). The dedicated tracer study confirmed the complete absence of cell carryover or cross-contamination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The described method offers a robust, practical, and adaptable solution for preparing on-slide controls applicable to all cytology preparations, including previously stained and mounted slides. Implementing this approach strengthens quality control for non–cell block cytology slides, enhances diagnostic reliability, and brings cytology practice closer to the quality standards established in immunohistochemistry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 2","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In 2020, a <i>Cancer Cell</i> commentary by three immigrant scientists and naturalized Americans decried immigration policies under the first Trump administration that were “adversely affecting biomedical science.”<span><sup>1</sup></span> The policies, they stated, were at odds with the goal of beating cancer and with data that “overwhelmingly support the importance of immigrants for biomedical sciences and, in particular, cancer research.” Five years later, new travel, immigration, and funding policies by the second Trump administration have raised even deeper concerns that cancer research in the United States could be hobbled by the loss of highly skilled foreign researchers and the imposition of new barriers to international collaborations.</p><p>Gwen Nichols, MD, chief medical officer of the Leukemia and Lymphoma Society, says that the society’s goal is to support the very best research. “Oftentimes, that is a research team elsewhere in the world or a researcher working with folks in the US in a collaborative fashion,” she says. Blood cancers alone have been subdivided into 108 types, which underscores the complexity and need for international collaboration.</p><p>Amid that challenging backdrop, “I think we’re hitting the research workforce very hard,” Dr Nichols says. Some new immigration policies have been justified by the Trump administration as making research opportunities more equitable for scientists in the United States, “but they’ve cut the funding and they’ve cut grants!” she says. Beyond billions of dollars in cuts to National Institutes of Health grants, for instance, the administration proposed a 37% cut to the National Cancer Institute for fiscal year 2026.</p><p>At a talk during the ScienceWriters2025 conference in Chicago, Illinois, University of Massachusetts Amherst economist Ina Ganguli, PhD, presented data suggesting that immigration to the United States increases productivity for both foreign and US researchers, with a few caveats. The boost, she said, comes from the arrival of new knowledge and collaboration. The country, Dr Nichols says, needs to be honest about the fact that most laboratories are staffed by a mix of US and foreign researchers, and that foreign-born scientists have made major contributions to the nation’s science and to mentoring and developing the next generation of researchers.</p><p>Reflecting the current climate of apprehension, however, multiple researchers declined to comment for this story or agreed to do so only under the condition of anonymity, due to fear of reprisal or denied US entry. Among the causes for concern, several cancer researchers say that they have begun worrying whether they might be detained or deported at immigration checkpoints for relatively innocuous reasons, such as having political text messages on their phones.<span><sup>2</sup></span> In May 2025, the Trump administration threatened to revoke the visas of Chinese students before later relenting. The following month,
2020年，三位移民科学家和归化美国人在《癌细胞》上发表评论，谴责特朗普第一届政府的移民政策“对生物医学科学产生了不利影响”。他们表示，这些政策与战胜癌症的目标不符，也与“压倒性地支持移民对生物医学科学，尤其是癌症研究的重要性”的数据不符。五年后，特朗普第二届政府的新旅行、移民和资助政策引发了更深层次的担忧，即美国的癌症研究可能会因高技能外国研究人员的流失和国际合作的新障碍而陷入困境。Gwen Nichols医学博士是白血病和淋巴瘤协会的首席医疗官，她说协会的目标是支持最好的研究。她说：“通常情况下，这是一个世界其他地方的研究团队，或者是一个研究人员以合作的方式与美国人合作。”仅血癌就被细分为108种，这凸显了其复杂性和开展国际合作的必要性。在这种具有挑战性的背景下，“我认为我们对研究人员的打击非常大，”尼科尔斯博士说。特朗普政府认为，一些新的移民政策为美国科学家提供了更公平的研究机会，“但他们削减了资金和拨款！”她说。例如，除了削减美国国立卫生研究院（National Institutes of Health）数十亿美元的拨款外，政府还提议在2026财年削减美国国立癌症研究所（National Cancer Institute） 37%的经费。在伊利诺斯州芝加哥举行的科学作家2025年会议上，马萨诸塞大学阿默斯特分校的经济学家Ina Ganguli博士提出了一些数据，表明移民到美国可以提高外国和美国研究人员的生产力，但也有一些警告。她说，这种推动来自新知识和合作的到来。Nichols博士说，美国需要诚实地面对这样一个事实，即大多数实验室的工作人员都是由美国和外国研究人员组成的，而外国出生的科学家对美国的科学以及指导和培养下一代研究人员做出了重大贡献。然而，由于担心遭到报复或被拒绝进入美国，许多研究人员拒绝就这篇报道发表评论，或者只同意在匿名的条件下发表评论，这反映了当前的担忧气氛。在令人担忧的原因中，一些癌症研究人员说，他们开始担心，他们是否会因为相对无害的原因，比如手机上有政治短信，而在移民检查站被拘留或驱逐出境2025年5月，特朗普政府威胁要撤销中国学生的签证，后来才有所缓和。接下来的一个月，政府对来自其他12个国家的外国人实施了全面禁令，并对7个国家实施了部分禁令，声称目的是保护美国“免受外国恐怖分子和其他国家安全和公共安全威胁”。在这19个国家中，大多数国家的人口以穆斯林为主。除了这些禁令和撤销的威胁，尼科尔斯博士表示，复杂的美国签证程序长期以来一直对国际研究人员构成挑战。“现在更难了，虽然我们还没有看到这意味着什么，但它给人们在美国找工作的决定蒙上了一层阴影。”一位来自北非的研究人员专门研究肺癌和膀胱癌，曾在南美和美国两所知名医学院接受培训。他回忆起在特朗普第一任政府期间申请他的第一个J-1交流访问学者签证的“噩梦”。这位研究人员获得了全额资助的研究生奖学金，但在拿到签证的6个月里，他开始疯狂地寻找其他选择。他在2021年第二次申请J-1签证，并在2025年申请旅游签证，都没有遇到任何困难。然而，考虑到到美国进行与研究相关的旅行会带来额外的金钱、压力和时间，“我会优先考虑一个容易去的国家，”他说。现在，这意味着他所在的欧盟国家。一个特殊的会议或工作机会可能会说服他回到美国，“但考虑到目前签证和旅行的不确定性，我会保持谨慎，”他说。另一位驻欧洲的研究人员是一家从事癌症治疗的国际生物制药公司的首席科学官，他一直在处理来自忧心忡忡的研究人员的多次询问。她说，许多年轻的欧洲科学家正在重新考虑曾经被广泛认可的获得好职位的途径：在美国获得研究生学位或完成博士后研究。
{"title":"Coming apart: How US travel and immigration policies are fraying the future of cancer research","authors":"Bryn Nelson PhD, William Faquin MD, PhD","doi":"10.1002/cncy.70063","DOIUrl":"10.1002/cncy.70063","url":null,"abstract":"<p>In 2020, a <i>Cancer Cell</i> commentary by three immigrant scientists and naturalized Americans decried immigration policies under the first Trump administration that were “adversely affecting biomedical science.”<span><sup>1</sup></span> The policies, they stated, were at odds with the goal of beating cancer and with data that “overwhelmingly support the importance of immigrants for biomedical sciences and, in particular, cancer research.” Five years later, new travel, immigration, and funding policies by the second Trump administration have raised even deeper concerns that cancer research in the United States could be hobbled by the loss of highly skilled foreign researchers and the imposition of new barriers to international collaborations.</p><p>Gwen Nichols, MD, chief medical officer of the Leukemia and Lymphoma Society, says that the society’s goal is to support the very best research. “Oftentimes, that is a research team elsewhere in the world or a researcher working with folks in the US in a collaborative fashion,” she says. Blood cancers alone have been subdivided into 108 types, which underscores the complexity and need for international collaboration.</p><p>Amid that challenging backdrop, “I think we’re hitting the research workforce very hard,” Dr Nichols says. Some new immigration policies have been justified by the Trump administration as making research opportunities more equitable for scientists in the United States, “but they’ve cut the funding and they’ve cut grants!” she says. Beyond billions of dollars in cuts to National Institutes of Health grants, for instance, the administration proposed a 37% cut to the National Cancer Institute for fiscal year 2026.</p><p>At a talk during the ScienceWriters2025 conference in Chicago, Illinois, University of Massachusetts Amherst economist Ina Ganguli, PhD, presented data suggesting that immigration to the United States increases productivity for both foreign and US researchers, with a few caveats. The boost, she said, comes from the arrival of new knowledge and collaboration. The country, Dr Nichols says, needs to be honest about the fact that most laboratories are staffed by a mix of US and foreign researchers, and that foreign-born scientists have made major contributions to the nation’s science and to mentoring and developing the next generation of researchers.</p><p>Reflecting the current climate of apprehension, however, multiple researchers declined to comment for this story or agreed to do so only under the condition of anonymity, due to fear of reprisal or denied US entry. Among the causes for concern, several cancer researchers say that they have begun worrying whether they might be detained or deported at immigration checkpoints for relatively innocuous reasons, such as having political text messages on their phones.<span><sup>2</sup></span> In May 2025, the Trump administration threatened to revoke the visas of Chinese students before later relenting. The following month, ","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mauro Saieg MD, PhD, Pedro Piovesan Lago MD, Marc Philippe Pusztaszeri MD
<p>Generative artificial intelligence (AI) and large language models (LLMs) have rapidly entered the public and professional spotlight, raising important questions for fields like pathology for which human expertise has traditionally been indispensable.<span><sup>1</sup></span> Among these platforms, Chat Generative Pre-trained Transformer (ChatGPT) has attracted attention not only for its ability to generate fluent text but also, more recently, for its multimodal capability to process and interpret images.<span><sup>2</sup></span> It has been widely used for all purposes, from answering everyday trivial questions to even providing mental health support.<span><sup>3</sup></span> In cytopathology, where diagnostic judgment relies on a delicate balance of morphologic recognition, clinical context, and interpretive nuance, the idea that an AI could serve as an interpretive partner is both exciting and unsettling.</p><p>Most current AI efforts in pathology focus on computer vision systems, typically convolutional neural networks trained on large data sets of whole-slide images. These models excel at pattern recognition in highly standardized settings but are often rigid and task-specific.<span><sup>4</sup></span> By contrast, LLMs offer something novel: not only can they describe observed features, but they also attempt to synthesize them into a structured interpretation that mirrors how a human expert reasons. This duality has led to increasing exploration of their utility in medical image analysis, including radiologic, cytologic, and histologic images.<span><sup>5-9</sup></span> Yet, as emphasized by Pantanowitz and colleagues,<span><sup>10</sup></span> enthusiasm must be tempered by awareness of risks, including hallucinations, lack of validation, outdated knowledge, and ethical challenges such as sharing of data privacy into commercially available platforms without being compliant with laws such as the Health Insurance Portability and Accountability Act (HIPAA).</p><p>Thinking there might be a high potential from LLMs platforms to actually help us in everyday morphology recognition tasks, we tested an anecdotal modest experiment using 20 pairs of static thyroid fine-needle aspiration (FNA) images from the Papanicolaou Society of Cytopathology Atlas. Those images corresponded to a mix of benign and malignant examples, uploaded together with a copy of the latest version of The Bethesda System for Reporting Thyroid Cytopathology. We then asked ChatGPT-5 to assign a morphologic diagnosis for these images, as well as a Bethesda category and a brief description of the morphologic characteristics that lead to its diagnostic conclusion (Figure 1).<span><sup>11</sup></span> No metadata, such as patient's clinical information or nodules’ TI-RADS score, was provided in the prompt. If it answered with the same diagnosis and Bethesda classification of the Papanicolaou Society of Cytopathology Atlas, it was deemed correct. If either the diagnosis or classific
在偏远或服务不足的地区，人工智能产生的初步印象可以优先考虑紧急转诊的病例。虽然远非决定性的，但这种辅助作用可以在无法立即获得专家审查的情况下加速决策。当然，谨慎是必要的。正如潘塔诺维茨和其他人在《2023》中所展示的那样，即使在第五版中，幻觉和虚构的引用仍然是一个问题《美国细胞病理学学会杂志》的社论正确地强调，尽管完全禁止人工智能是不现实的，但迫切需要负责任的指导方针来管理其在细胞病理学写作、研究和可能的实践中的使用。细胞病理学以外的最新文献为理解法学硕士如何处理医学图像解释提供了有价值的背景。在放射学中，ChatGPT-4在纯文本考试问题上取得了很强的表现（约81%），但当包含图像时，其准确率急剧下降至约48%，这强调了即使在结构良好的考试环境中，视觉解释也面临挑战另一项独立的骨科断层摄影研究报告了38.4%的总体准确率，尽管内部一致，但经常出现不完整或捏造的答案在脑肿瘤放射学报告中，ChatGPT-4达到了与专业神经放射学家相当的诊断准确性在医学教育中，ChatGPT-4视觉模型显示出令人鼓舞的结果，在基于图像的美国医学许可考试（american medical Licensing exam）类型的问题中，包括皮肤学、心脏病学和胃肠病学，准确率高达89.5%，尽管在细微的情况下仍然存在错误病理特异性评估正在出现：组织病理学的早期研究表明，在选定的诊断挑战中，具有图像输入的ChatGPT-4可能接近住院医生水平的表现。这对执业病理学家意味着什么？我们的小系列——20个答案中有5个正确答案——几乎不足以支持临床应用，但它突显了我们面临的双重现实。一方面，这项技术还没有准备好取代训练有素的细胞病理学家的解释专业知识。另一方面，它可以从静态图像中生成结构化的、合理的形态学推理，这一事实是值得注意的，忽视这一发展可能会让位于外部力量，这些外部力量可能会在没有适当监督的情况下寻求在医学中实施人工智能。此外，ChatGPT，在其目前的商业形式中，从来没有训练过基于包含Bethesda系统所有类别的异构甲状腺图像的管理数据库进行细胞学解释。因此，期望从这样的模型中获得准确的诊断性能是不现实的。然而，如果大型语言模型的未来迭代-无论是ChatGPT， Gemini, Copilot， DeepSeek还是其他-在特定领域的数据集上进行专门的训练，并结合使用严格审查的病理内容的检索增强生成架构，它们实际上可以实现高水平的诊断准确性和可重复性。目的构建，病理意识llm可能因此演变成细胞学筛查和决策支持的强大工具。通过这种方式，未来可能会涉及微调llm与细胞病理学特异性数据集，与多模式数据流（放射学，分子学，临床）的集成，以及对大型，带注释的图像队列的严格验证。在这种情况下，人类与人工智能的合作研究将是关键：获得法学硕士的印象是否能提高病理学家的效率、准确性或信心？在人工智能的支持下，学员能更有效地学习吗？在将该技术集成到临床工作流程之前，必须系统地回答这些问题。伦理方面的考虑——包括问责制、透明度和公平获取——也必须在这一进程中保持核心地位。总之，生成式人工智能代表了细胞病理学中一股迷人的、颠覆性的力量。我们使用商业上可用的ChatGPT的经验证实了它的吸引力和局限性。未来的研究——利用更大的、病理特异性的、专业整理的数据集——将是培养法学硕士的必要条件，这些法学硕士有朝一日可以可靠地协助，甚至可能自主地执行细胞病理学的诊断任务。对于我们标题中提出的问题，我们到了吗？答案仍然是否定的。然而，这一旅程已经开始，我们的社会不能忽视这一旅程。作者声明无利益冲突。
{"title":"Generative artificial intelligence as an aid in interpreting thyroid FNA cytopathological images: Are we there yet?","authors":"Mauro Saieg MD, PhD, Pedro Piovesan Lago MD, Marc Philippe Pusztaszeri MD","doi":"10.1002/cncy.70069","DOIUrl":"10.1002/cncy.70069","url":null,"abstract":"<p>Generative artificial intelligence (AI) and large language models (LLMs) have rapidly entered the public and professional spotlight, raising important questions for fields like pathology for which human expertise has traditionally been indispensable.<span><sup>1</sup></span> Among these platforms, Chat Generative Pre-trained Transformer (ChatGPT) has attracted attention not only for its ability to generate fluent text but also, more recently, for its multimodal capability to process and interpret images.<span><sup>2</sup></span> It has been widely used for all purposes, from answering everyday trivial questions to even providing mental health support.<span><sup>3</sup></span> In cytopathology, where diagnostic judgment relies on a delicate balance of morphologic recognition, clinical context, and interpretive nuance, the idea that an AI could serve as an interpretive partner is both exciting and unsettling.</p><p>Most current AI efforts in pathology focus on computer vision systems, typically convolutional neural networks trained on large data sets of whole-slide images. These models excel at pattern recognition in highly standardized settings but are often rigid and task-specific.<span><sup>4</sup></span> By contrast, LLMs offer something novel: not only can they describe observed features, but they also attempt to synthesize them into a structured interpretation that mirrors how a human expert reasons. This duality has led to increasing exploration of their utility in medical image analysis, including radiologic, cytologic, and histologic images.<span><sup>5-9</sup></span> Yet, as emphasized by Pantanowitz and colleagues,<span><sup>10</sup></span> enthusiasm must be tempered by awareness of risks, including hallucinations, lack of validation, outdated knowledge, and ethical challenges such as sharing of data privacy into commercially available platforms without being compliant with laws such as the Health Insurance Portability and Accountability Act (HIPAA).</p><p>Thinking there might be a high potential from LLMs platforms to actually help us in everyday morphology recognition tasks, we tested an anecdotal modest experiment using 20 pairs of static thyroid fine-needle aspiration (FNA) images from the Papanicolaou Society of Cytopathology Atlas. Those images corresponded to a mix of benign and malignant examples, uploaded together with a copy of the latest version of The Bethesda System for Reporting Thyroid Cytopathology. We then asked ChatGPT-5 to assign a morphologic diagnosis for these images, as well as a Bethesda category and a brief description of the morphologic characteristics that lead to its diagnostic conclusion (Figure 1).<span><sup>11</sup></span> No metadata, such as patient's clinical information or nodules’ TI-RADS score, was provided in the prompt. If it answered with the same diagnosis and Bethesda classification of the Papanicolaou Society of Cytopathology Atlas, it was deemed correct. If either the diagnosis or classific","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mats Ehinger MD, PhD, Maria Calaminici MD, PhD, Immacolata Cozzolino MD, PhD, Pio Zeppa MD, PhD, Andrew S. Field MB, BS(Hons), FRCPA
The objective of the recently published World Health Organization Reporting System for Lymph Node, Spleen, and Thymus Cytopathology (WHO system) is to standardize the diagnostic approach to fine-needle aspiration biopsies of hematolymphoid tissues. By categorizing specimens into five diagnostic groups—inadequate/insufficient/nondiagnostic, benign, atypical, suspicious for malignancy, and malignant—the system provides a structured framework that enhances diagnostic clarity and facilitates communication between cytopathologists and clinicians. Each category is associated with a defined risk of malignancy, supporting informed clinical decision making regarding further diagnostic workup. Accurate categorization requires the integration of cytomorphologic features and clinical context, and final and specific diagnoses often require ancillary techniques such as flow cytometry, immunocytochemistry, in situ hybridization, and molecular diagnostics. To assist cytopathologists, especially those less familiar with hematolymphoid neoplasms, the WHO system incorporates a pattern-based diagnostic approach. Four cytopathologic patterns—mixed lymphoid cell; predominantly small/intermediate cell; predominantly large/pleomorphic/blastic cell; and single, very large, atypical cell—serve as guides to narrow down differential diagnoses. However, interpretation can be challenging because of overlapping features, variable inflammatory backgrounds, and limited sample material. This review provides a brief overview of the WHO system and its application to hematolymphoid proliferations, emphasizing the importance of clinical correlation and the use of relevant ancillary techniques. It then provides in-depth discussion of the pattern-based approach to diagnosing hematolymphoid neoplasms on cytopathology. It highlights the strengths and limitations of cytopathologic evaluation in hematolymphoid neoplasms and provides practical insights for applying the WHO system in routine practice.
{"title":"Practical implications of the World Health Organization Reporting System for Lymph Node, Spleen, and Thymus Cytopathology: Categories and ancillary testing for subtyping of hematolymphoid tumors on FNA biopsy cytopathology using a pattern-based approach","authors":"Mats Ehinger MD, PhD, Maria Calaminici MD, PhD, Immacolata Cozzolino MD, PhD, Pio Zeppa MD, PhD, Andrew S. Field MB, BS(Hons), FRCPA","doi":"10.1002/cncy.70066","DOIUrl":"10.1002/cncy.70066","url":null,"abstract":"<p>The objective of the recently published <i>World Health Organization Reporting System for Lymph Node, Spleen, and Thymus Cytopathology</i> (WHO system) is to standardize the diagnostic approach to fine-needle aspiration biopsies of hematolymphoid tissues. By categorizing specimens into five diagnostic groups—inadequate/insufficient/nondiagnostic, benign, atypical, suspicious for malignancy, and malignant—the system provides a structured framework that enhances diagnostic clarity and facilitates communication between cytopathologists and clinicians. Each category is associated with a defined risk of malignancy, supporting informed clinical decision making regarding further diagnostic workup. Accurate categorization requires the integration of cytomorphologic features and clinical context, and final and specific diagnoses often require ancillary techniques such as flow cytometry, immunocytochemistry, in situ hybridization, and molecular diagnostics. To assist cytopathologists, especially those less familiar with hematolymphoid neoplasms, the WHO system incorporates a pattern-based diagnostic approach. Four cytopathologic patterns—mixed lymphoid cell; predominantly small/intermediate cell; predominantly large/pleomorphic/blastic cell; and single, very large, atypical cell—serve as guides to narrow down differential diagnoses. However, interpretation can be challenging because of overlapping features, variable inflammatory backgrounds, and limited sample material. This review provides a brief overview of the WHO system and its application to hematolymphoid proliferations, emphasizing the importance of clinical correlation and the use of relevant ancillary techniques. It then provides in-depth discussion of the pattern-based approach to diagnosing hematolymphoid neoplasms on cytopathology. It highlights the strengths and limitations of cytopathologic evaluation in hematolymphoid neoplasms and provides practical insights for applying the WHO system in routine practice.</p>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji-Seon Jeong MD, PhD, Young Jun Choi MD, PhD, Jeong Hyun Lee MD, PhD, Jung Hwan Baek MD, PhD, Yu-Mi Lee MD, PhD, Tae-Yon Sung MD, PhD, Dong Eun Song MD, PhD
Background
Ultrasound-guided fine-needle aspiration (FNA) of various thyroid nodules often yields nondiagnostic results, which reveal a wide range of the risk of malignancy (ROM) and complicate patient management decisions. This ROM variability likely reflects selection bias, given that previous studies frequently excluded patients without histologic follow-up.
Methods
This retrospective cohort study included 1269 patients with nondiagnostic thyroid nodules from a total of 10,337 patients who underwent FNA at Asan Medical Center. The ROM was determined on the basis of pathologic findings after core needle biopsy (CNB) or resection.
Results
The median follow-up period after the initial FNA was 14.14 months (range, 0.03–145.81 months). Histologic follow-up was available for 361 patients (28.4%), with 49 patients (13.6%) having only surgical resection specimens, 252 patients (69.8%) having only CNB specimens, and 60 patients (16.6%) having both resection and CNB specimens. Sixty-four patients were diagnosed with malignancy on the basis of CNB or surgical resection. The ROM in this cohort ranged from 5.0% to 17.7%. The upper limit of the ROM (13.2%) at the 12-month follow-up in this study was the same as the mean ROM (13%) suggested in The Bethesda System for Reporting Thyroid Cytopathology as updated in 2023. Multivariate logistic regression revealed that younger age (p = .013), spiculated margins (p = .010), and hypoechogenicity (p = .001) were independently associated with malignancy.
Conclusions
This study aimed to reduce the overestimated upper limit of the ROM in nondiagnostic thyroid nodules, which was previously based solely on rare surgical follow-up results. Using CNB as an ancillary diagnostic tool can help to rapidly characterize initially nondiagnostic thyroid nodules and guide appropriate management.
{"title":"Reevaluation of malignancy risk in nondiagnostic thyroid nodules with long-term follow-up via surgical resection or core needle biopsy: A retrospective study","authors":"Ji-Seon Jeong MD, PhD, Young Jun Choi MD, PhD, Jeong Hyun Lee MD, PhD, Jung Hwan Baek MD, PhD, Yu-Mi Lee MD, PhD, Tae-Yon Sung MD, PhD, Dong Eun Song MD, PhD","doi":"10.1002/cncy.70068","DOIUrl":"10.1002/cncy.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ultrasound-guided fine-needle aspiration (FNA) of various thyroid nodules often yields nondiagnostic results, which reveal a wide range of the risk of malignancy (ROM) and complicate patient management decisions. This ROM variability likely reflects selection bias, given that previous studies frequently excluded patients without histologic follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included 1269 patients with nondiagnostic thyroid nodules from a total of 10,337 patients who underwent FNA at Asan Medical Center. The ROM was determined on the basis of pathologic findings after core needle biopsy (CNB) or resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median follow-up period after the initial FNA was 14.14 months (range, 0.03–145.81 months). Histologic follow-up was available for 361 patients (28.4%), with 49 patients (13.6%) having only surgical resection specimens, 252 patients (69.8%) having only CNB specimens, and 60 patients (16.6%) having both resection and CNB specimens. Sixty-four patients were diagnosed with malignancy on the basis of CNB or surgical resection. The ROM in this cohort ranged from 5.0% to 17.7%. The upper limit of the ROM (13.2%) at the 12-month follow-up in this study was the same as the mean ROM (13%) suggested in The Bethesda System for Reporting Thyroid Cytopathology as updated in 2023. Multivariate logistic regression revealed that younger age (<i>p</i> = .013), spiculated margins (<i>p</i> = .010), and hypoechogenicity (<i>p</i> = .001) were independently associated with malignancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study aimed to reduce the overestimated upper limit of the ROM in nondiagnostic thyroid nodules, which was previously based solely on rare surgical follow-up results. Using CNB as an ancillary diagnostic tool can help to rapidly characterize initially nondiagnostic thyroid nodules and guide appropriate management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marcel Mayer MD, Sofia Kourou MD, Marwan Alfarra MD, Charlotte Laatz, Kevin Hansen MD, Julia Esser MD, Hans Nikolaus Caspar Eckel MD, Kathrin Möllenhoff MD, Lena Hieggelke MD, Marianne Engels MD, Christoph Arolt MD, Alexander Quaas MD, Philipp Wolber MD, Louis Jansen MD, Lisa Nachtsheim MD, Jens Peter Klussmann MD, Sami Shabli MD
Background
Salivary gland tumors are rare and heterogeneous head and neck neoplasms. Preoperative distinction between benign and malignant lesions is challenging because imaging is often insufficient. Fine-needle aspiration cytology (FNAC) combined with the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides standardized risk stratification and diagnostic guidance; however, its influence on surgical frequency remains insufficiently characterized.
Methods
This retrospective single-center study included patients with histologically confirmed malignant tumors within the major salivary glands with preoperative FNAC and surgery. The association between MSRSGC category and number of surgeries was evaluated using χ2 tests and multivariate Poisson regression.
Results
Overall, 157 patients were included. Those with high-to-intermediate-risk MSRSGC categories (two surgeries: 22.3% vs. one surgery: 77.7%) required significantly fewer surgeries than those with low-risk/nondiagnostic FNAC (two surgeries: 54.2%/53.3% vs. one surgery: 45.8%/46.7%, p < .001). A high-to-intermediate risk compared to a nondiagnostic FNAC results was an independent predictor for fewer surgeries in multivariate analysis (incidence rate ratio, 0.875; 95% confidence interval, 0.773–0.990; p = .034). True–positive results were most frequent in squamous cell carcinoma, whereas acinic cell and mucoepidermoid carcinomas were often misclassified.
Conclusions
The use of the MSRSGC enables reliable preoperative risk stratification of malignant salivary gland tumors. High-to-intermediate-risk categories (Milan III/IVb/V/VI) were associated with a lower likelihood of multiple surgeries. True–positive FNAC results were most frequent in squamous cell carcinoma and metastatic melanoma, whereas acinic cell, mucoepidermoid, and salivary duct carcinomas were prone to misclassification. Structured FNAC reporting improves diagnostic accuracy and informs personalized surgical planning, reducing interventions and optimizing management.
{"title":"Fine-needle aspiration cytology reduces the frequency of surgeries for malignant salivary gland tumors","authors":"Marcel Mayer MD, Sofia Kourou MD, Marwan Alfarra MD, Charlotte Laatz, Kevin Hansen MD, Julia Esser MD, Hans Nikolaus Caspar Eckel MD, Kathrin Möllenhoff MD, Lena Hieggelke MD, Marianne Engels MD, Christoph Arolt MD, Alexander Quaas MD, Philipp Wolber MD, Louis Jansen MD, Lisa Nachtsheim MD, Jens Peter Klussmann MD, Sami Shabli MD","doi":"10.1002/cncy.70070","DOIUrl":"10.1002/cncy.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Salivary gland tumors are rare and heterogeneous head and neck neoplasms. Preoperative distinction between benign and malignant lesions is challenging because imaging is often insufficient. Fine-needle aspiration cytology (FNAC) combined with the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides standardized risk stratification and diagnostic guidance; however, its influence on surgical frequency remains insufficiently characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center study included patients with histologically confirmed malignant tumors within the major salivary glands with preoperative FNAC and surgery. The association between MSRSGC category and number of surgeries was evaluated using χ<sup>2</sup> tests and multivariate Poisson regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 157 patients were included. Those with high-to-intermediate-risk MSRSGC categories (two surgeries: 22.3% vs. one surgery: 77.7%) required significantly fewer surgeries than those with low-risk/nondiagnostic FNAC (two surgeries: 54.2%/53.3% vs. one surgery: 45.8%/46.7%, <i>p</i> < .001). A high-to-intermediate risk compared to a nondiagnostic FNAC results was an independent predictor for fewer surgeries in multivariate analysis (incidence rate ratio, 0.875; 95% confidence interval, 0.773–0.990; <i>p</i> = .034). True–positive results were most frequent in squamous cell carcinoma, whereas acinic cell and mucoepidermoid carcinomas were often misclassified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of the MSRSGC enables reliable preoperative risk stratification of malignant salivary gland tumors. High-to-intermediate-risk categories (Milan III/IVb/V/VI) were associated with a lower likelihood of multiple surgeries. True–positive FNAC results were most frequent in squamous cell carcinoma and metastatic melanoma, whereas acinic cell, mucoepidermoid, and salivary duct carcinomas were prone to misclassification. Structured FNAC reporting improves diagnostic accuracy and informs personalized surgical planning, reducing interventions and optimizing management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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