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}
Renal mass biopsy (RMB) cytology is increasingly used for the pretreatment evaluation of renal masses. Cytopathologic classification of RMB specimens facilitates communication with clinicians and provides valuable risk stratification to guide management decisions. This study evaluated the risk of malignancy (ROM) associated with RMB cytology in renal oncocytic neoplasms (ONs).
Design
The renal neoplasms with oncocytic features were reclassified per the 5th edition of the WHO Classification of Tumors. RMB cases were assigned to six diagnostic categories: 1) nondiagnostic (ND), 2) benign, 3) low risk oncocytic neoplasm (LRON), 4) atypical, 5) suspicious for malignancy (SFM), and 6) malignant.
Results
In total, 198 RMB cases with oncocytic features were identified, comprising oncocytoma (111 [56%]), chromophobe renal cell carcinoma (RCC) (55 [28%]), LRON (10 [5%]), hybrid oncocytic neoplasm (8 [4%]), low-grade oncocytic tumor (7 [4%]), papillary RCC (6 [3%]), and eosinophilic vacuolated tumor (1 [1%]). The overall ROM for ONs was 35%. ROMs by category were ND (29%), benign (2%), LRON (30%), atypical (100%), SFM (50%), and malignant (100%). Post-RMB resection was more frequently used for malignant (36 of 57 [63%]), SFM (1 of 2 [50%]), and ND (4 of 7 [57%]), whereas active surveillance was more frequently employed for benign ON (100 of 111 [90%]) and LRON (12 of 20 [60%]). Cryoablation was used in 9% (18 of 198) of ONs.
Conclusions
This study defines ROMs across cytologic categories of ONs to stratify the risks and underscores the valuable role of RMB. These findings provide a framework for clinicians to make informed decisions based on cytologic classification and associated ROM.
{"title":"Risk of malignancy of cytologic categories and post-biopsy clinical management of renal oncocytic neoplasms","authors":"Xiaoqi Lin MD, PhD","doi":"10.1002/cncy.70064","DOIUrl":"10.1002/cncy.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Renal mass biopsy (RMB) cytology is increasingly used for the pretreatment evaluation of renal masses. Cytopathologic classification of RMB specimens facilitates communication with clinicians and provides valuable risk stratification to guide management decisions. This study evaluated the risk of malignancy (ROM) associated with RMB cytology in renal oncocytic neoplasms (ONs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The renal neoplasms with oncocytic features were reclassified per the 5th edition of the WHO Classification of Tumors. RMB cases were assigned to six diagnostic categories: 1) nondiagnostic (ND), 2) benign, 3) low risk oncocytic neoplasm (LRON), 4) atypical, 5) suspicious for malignancy (SFM), and 6) malignant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 198 RMB cases with oncocytic features were identified, comprising oncocytoma (111 [56%]), chromophobe renal cell carcinoma (RCC) (55 [28%]), LRON (10 [5%]), hybrid oncocytic neoplasm (8 [4%]), low-grade oncocytic tumor (7 [4%]), papillary RCC (6 [3%]), and eosinophilic vacuolated tumor (1 [1%]). The overall ROM for ONs was 35%. ROMs by category were ND (29%), benign (2%), LRON (30%), atypical (100%), SFM (50%), and malignant (100%). Post-RMB resection was more frequently used for malignant (36 of 57 [63%]), SFM (1 of 2 [50%]), and ND (4 of 7 [57%]), whereas active surveillance was more frequently employed for benign ON (100 of 111 [90%]) and LRON (12 of 20 [60%]). Cryoablation was used in 9% (18 of 198) of ONs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study defines ROMs across cytologic categories of ONs to stratify the risks and underscores the valuable role of RMB. These findings provide a framework for clinicians to make informed decisions based on cytologic classification and associated ROM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762320","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}
Vincenzo Fiorentino MD, Walter Giordano MSc, Cristina Pizzimenti MD, PhD, Valeria Zuccalà MD, PhD, Antonio Ieni MD, PhD, Clelia Molinario MSc, Salvatore Cannavò MD, Alfredo Campennì MD, Pietro Tralongo MD, Maurizio Martini MD, PhD, Giuseppe Giuffrè MD, Luigi Maria Larocca MD, Guido Fadda MD, Esther Diana Rossi MD, PhD
Background
Molecular testing is increasingly used to improve preoperative risk assessment of thyroid nodules, especially those with indeterminate cytology. This study evaluated the performance of the Myriapod next-generation sequencing (NGS) DNA-only cancer panel in fine-needle aspiration cytology thyroid samples, correlating findings with postsurgical diagnoses.
Methods
A retrospective analysis was performed on fine-needle aspiration cytology specimens from 74 thyroid nodules in the TIR3A, TIR3B, TIR4, and TIR5 categories according to the Italian Consensus for the Classification and Reporting of Thyroid Cytology. DNA from these samples, obtained from residual liquid-based cytology material, was analyzed with the Myriapod NGS panel, targeting 16 genes implicated in thyroid cancer. All patients underwent surgery, allowing for histopathologic correlation.
Results
The residual liquid-based cytology material yielded adequate DNA for molecular testing in 89.2% of the nodules. All TIR3A (low-risk intermediate) nodules were histologically benign, whereas 50% of TIR3B (high-risk intermediate) nodules were malignant; mutations were identified only in the malignant nodules. In the TIR4 category (suspicious for malignancy), BRAF V600E was the most frequent mutation in malignant nodules. Both TIR5 (malignant) nodules were papillary thyroid carcinomas with a BRAF V600E mutation. The molecular test demonstrated 100% sensitivity, 95.5% specificity, 91.7% positive predictive value, and 100% negative predictive value for samples that were adequate for molecular testing. An intention-to-diagnose analysis that included samples inadequate for molecular testing was also performed, yielding 84.6% sensitivity, 87.5% specificity, 91.7% positive predictive value, and 84% negative predictive value.
Conclusions
The Myriapod NGS panel aids in the preoperative assessment of thyroid nodules. Its high negative predictive value may help avoid unnecessary surgery, whereas the detection of specific mutations strongly correlates with malignancy, thus informing surgical planning.
{"title":"Molecular profiling of thyroid nodules on cytologic samples: Findings from an Italian multi-institutional cohort","authors":"Vincenzo Fiorentino MD, Walter Giordano MSc, Cristina Pizzimenti MD, PhD, Valeria Zuccalà MD, PhD, Antonio Ieni MD, PhD, Clelia Molinario MSc, Salvatore Cannavò MD, Alfredo Campennì MD, Pietro Tralongo MD, Maurizio Martini MD, PhD, Giuseppe Giuffrè MD, Luigi Maria Larocca MD, Guido Fadda MD, Esther Diana Rossi MD, PhD","doi":"10.1002/cncy.70065","DOIUrl":"https://doi.org/10.1002/cncy.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Molecular testing is increasingly used to improve preoperative risk assessment of thyroid nodules, especially those with indeterminate cytology. This study evaluated the performance of the Myriapod next-generation sequencing (NGS) DNA-only cancer panel in fine-needle aspiration cytology thyroid samples, correlating findings with postsurgical diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on fine-needle aspiration cytology specimens from 74 thyroid nodules in the TIR3A, TIR3B, TIR4, and TIR5 categories according to the Italian Consensus for the Classification and Reporting of Thyroid Cytology. DNA from these samples, obtained from residual liquid-based cytology material, was analyzed with the Myriapod NGS panel, targeting 16 genes implicated in thyroid cancer. All patients underwent surgery, allowing for histopathologic correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The residual liquid-based cytology material yielded adequate DNA for molecular testing in 89.2% of the nodules. All TIR3A (low-risk intermediate) nodules were histologically benign, whereas 50% of TIR3B (high-risk intermediate) nodules were malignant; mutations were identified only in the malignant nodules. In the TIR4 category (suspicious for malignancy), <i>BRAF</i> V600E was the most frequent mutation in malignant nodules. Both TIR5 (malignant) nodules were papillary thyroid carcinomas with a <i>BRAF</i> V600E mutation. The molecular test demonstrated 100% sensitivity, 95.5% specificity, 91.7% positive predictive value, and 100% negative predictive value for samples that were adequate for molecular testing. An intention-to-diagnose analysis that included samples inadequate for molecular testing was also performed, yielding 84.6% sensitivity, 87.5% specificity, 91.7% positive predictive value, and 84% negative predictive value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Myriapod NGS panel aids in the preoperative assessment of thyroid nodules. Its high negative predictive value may help avoid unnecessary surgery, whereas the detection of specific mutations strongly correlates with malignancy, thus informing surgical planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"134 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145719378","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}
<p>Every year in the United States, physicians perform approximately 1 million prostate biopsies designed to detect the most common malignancy in men after skin cancer. Biomedical researchers have long sought a biopsy technique that offers the ideal but elusive combination of a highly accurate prostate cancer diagnosis with minimal discomfort and a low risk of complications.</p><p>Since the 1980s, the technique of choice has been a transrectal approach with ultrasound guidance; a more recent magnetic resonance imaging (MRI)–ultrasound fusion has improved the technique by combining an MRI scan with real-time ultrasound imaging. Even so, questions have persisted about the method’s accuracy, while patients remain at risk for infections and sepsis even with a standard course of prophylactic antibiotics.</p><p>Over the past few years, a transperineal approach that instead samples prostate tissue through the skin of the perineum between the scrotum and the anus has reemerged as a biopsy alternative. Ironically, transperineal biopsy was the method of choice in the 1920s, in large part because of physicians’ concerns that fecal contamination rendered the transrectal approach unsafe.<span><sup>1</sup></span></p><p>The arrival of ultrasound and antibiotics and the ease and convenience of the transrectal approach reversed the trend. Several recent studies, however, have added new data on infection rates and accuracy that advocates argue should prompt a reestablishment of transperineal biopsies as the field’s gold standard. The case for change, however, has been clouded by mixed results and caveats that suggest prostate biopsies still have plenty of rough edges to refine.</p><p>In part because of concerns over an uptick in post–transrectal biopsy infection rates and the rise of antibiotic-resistant pathogens, European medical guidelines now favor transperineal biopsies. Physicians in the United States have proceeded more cautiously. Jim Hu, MD, a professor of urologic oncology at Weill Cornell Medicine in New York, estimates that the latter technique accounts for only 10% of all prostate biopsies.</p><p>Dr Hu was the principal investigator of a randomized clinical trial dubbed PREVENT that he hopes will add momentum to the shift toward a transperineal approach. The study, published in September 2024, reported no infections among 382 men undergoing an in-office transperineal biopsy but six infections among 370 men undergoing an in-office transrectal biopsy (for an infection rate of 1.6%).<span><sup>2</sup></span></p><p>Because transperineal biopsy is a percutaneous procedure, patients in that arm received a local anesthetic to numb the skin but no prophylactic antibiotics. “With the transrectal biopsy, we used targeted prophylaxis, which is the most rigorous form of prophylaxis,” Dr Hu says.</p><p>Most trials use augmented prophylaxis, in which patients receive one or more antibiotics added to a fluoroquinolone-based regimen. “We actually did a rectal culture
{"title":"A new push to revive transperineal prostate biopsies","authors":"Bryn Nelson PhD, William Faquin MD, PhD","doi":"10.1002/cncy.70059","DOIUrl":"10.1002/cncy.70059","url":null,"abstract":"<p>Every year in the United States, physicians perform approximately 1 million prostate biopsies designed to detect the most common malignancy in men after skin cancer. Biomedical researchers have long sought a biopsy technique that offers the ideal but elusive combination of a highly accurate prostate cancer diagnosis with minimal discomfort and a low risk of complications.</p><p>Since the 1980s, the technique of choice has been a transrectal approach with ultrasound guidance; a more recent magnetic resonance imaging (MRI)–ultrasound fusion has improved the technique by combining an MRI scan with real-time ultrasound imaging. Even so, questions have persisted about the method’s accuracy, while patients remain at risk for infections and sepsis even with a standard course of prophylactic antibiotics.</p><p>Over the past few years, a transperineal approach that instead samples prostate tissue through the skin of the perineum between the scrotum and the anus has reemerged as a biopsy alternative. Ironically, transperineal biopsy was the method of choice in the 1920s, in large part because of physicians’ concerns that fecal contamination rendered the transrectal approach unsafe.<span><sup>1</sup></span></p><p>The arrival of ultrasound and antibiotics and the ease and convenience of the transrectal approach reversed the trend. Several recent studies, however, have added new data on infection rates and accuracy that advocates argue should prompt a reestablishment of transperineal biopsies as the field’s gold standard. The case for change, however, has been clouded by mixed results and caveats that suggest prostate biopsies still have plenty of rough edges to refine.</p><p>In part because of concerns over an uptick in post–transrectal biopsy infection rates and the rise of antibiotic-resistant pathogens, European medical guidelines now favor transperineal biopsies. Physicians in the United States have proceeded more cautiously. Jim Hu, MD, a professor of urologic oncology at Weill Cornell Medicine in New York, estimates that the latter technique accounts for only 10% of all prostate biopsies.</p><p>Dr Hu was the principal investigator of a randomized clinical trial dubbed PREVENT that he hopes will add momentum to the shift toward a transperineal approach. The study, published in September 2024, reported no infections among 382 men undergoing an in-office transperineal biopsy but six infections among 370 men undergoing an in-office transrectal biopsy (for an infection rate of 1.6%).<span><sup>2</sup></span></p><p>Because transperineal biopsy is a percutaneous procedure, patients in that arm received a local anesthetic to numb the skin but no prophylactic antibiotics. “With the transrectal biopsy, we used targeted prophylaxis, which is the most rigorous form of prophylaxis,” Dr Hu says.</p><p>Most trials use augmented prophylaxis, in which patients receive one or more antibiotics added to a fluoroquinolone-based regimen. “We actually did a rectal culture","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"133 12","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653611","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":"Evolving standards in salivary gland cytopathology: The Milan and World Health Organization reporting systems","authors":"Marc P. Pusztaszeri MD, Zubair W. Baloch MD, PhD","doi":"10.1002/cncy.70062","DOIUrl":"10.1002/cncy.70062","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"133 12","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585834","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}
The high cost of professional-quality microscopes for pathology labs can create a barrier to the availability of diagnostic services, especially in resource-constrained settings. Low-cost portable microscopes (LCPMs) are popular for recreational use and widely available. To our knowledge, they have not been evaluated for use in rapid on-site evaluation (ROSE). The aim of this study was to identify which LCPMs have the potential for clinical use.
Methods
In this investigation, five LCPMs were evaluated by 18 pathology professionals to determine the adequacy of fine-needle aspiration (FNA) biopsy readings using patient-generated material. Participants were surveyed to systematically assess preferred and undesirable characteristics of LCPMs and to provide feedback on their use.
Results
Most expressed that though LCPMs were not a comparable replacement for standard microscopes, they were a better option than nothing and could be helpful in instances with highly cellular and relatively flat slide preparations. Most participants believed that LCPMs could be used for ROSE in resource-limited environments.
Conclusions
Pathology professional evaluated LCPMs on simulated fine-needle aspiration biopsy smear slides. The feedback they provided in this study suggests that LCPMs may be a feasible alternative to standard microscopes for ROSE in resource-limited settings.
{"title":"The feasibility of low-cost portable microscopes as an alternative to standard microscopes for rapid on-site evaluation of FNA","authors":"Mishaal Gardezi BS, Mahtab Fakhari MD, Diane Libert MD, Ronit Dey BS, Theodore Phan, Traci Shiu BS, Adebola M. Adeniyi MD, Cheyenne Martin BS, Breeana Snowball BS, MS, Alarice C. Lowe MD","doi":"10.1002/cncy.70061","DOIUrl":"10.1002/cncy.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The high cost of professional-quality microscopes for pathology labs can create a barrier to the availability of diagnostic services, especially in resource-constrained settings. Low-cost portable microscopes (LCPMs) are popular for recreational use and widely available. To our knowledge, they have not been evaluated for use in rapid on-site evaluation (ROSE). The aim of this study was to identify which LCPMs have the potential for clinical use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this investigation, five LCPMs were evaluated by 18 pathology professionals to determine the adequacy of fine-needle aspiration (FNA) biopsy readings using patient-generated material. Participants were surveyed to systematically assess preferred and undesirable characteristics of LCPMs and to provide feedback on their use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most expressed that though LCPMs were not a comparable replacement for standard microscopes, they were a better option than nothing and could be helpful in instances with highly cellular and relatively flat slide preparations. Most participants believed that LCPMs could be used for ROSE in resource-limited environments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pathology professional evaluated LCPMs on simulated fine-needle aspiration biopsy smear slides. The feedback they provided in this study suggests that LCPMs may be a feasible alternative to standard microscopes for ROSE in resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"133 12","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548500","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}
High-quality RNA is essential for accurate molecular testing. This study evaluates the impact of cytological preparation techniques (May–Grünwald–Giemsa [MGG], Papanicolaou [PAP], Diff-Quik, and air-dried) on RNA quality in smear slides.
Methods
A total of 182 smears were prepared from fresh surgical specimens of 26 patients using seven different techniques. RNA was isolated, reverse-transcribed, and analyzed using quantitative polymerase chain reaction (qPCR). RNA quality was assessed using ΔCt (ΔCt = 45 – Ct, cycle threshold), where higher ΔCt indicates better RNA quality.
Results
RNA quality, measured by ΔCt, showed clear differences (p < .001) in-between preparation methods, whereas RNA concentration did not differ significantly among smear types (p = .07). MGG-stained smears (both film- and coverslip-mounted) demonstrated the highest and most consistent ΔCt values. PAP-stained smears yielded the lowest ΔCt values, indicating the poorest RNA quality. Air-dried unstained smears showed highly variable ΔCt values and frequent amplification failures. Diff-Quik preparations had intermediate performance. Mounting method (film vs. coverslip) did not significantly affect RNA quality.
Conclusion
Among cytology smear techniques, MGG provided the best RNA preservation, PAP the worst, and air-dried slides yielded inconsistent results. These findings highlight the critical role of smear preparation in preserving RNA for molecular testing, especially RNA-based next-generation sequencing.
{"title":"The impact of cytological preparation techniques on RNA quality: A comparative study on smear samples","authors":"Cisel Aydin Mericoz MD, Gulsum Caylak, Elif Sevin Sanioglu, Zeynep Seçil Satilmis BA, Ayse Humeyra Dur Karasayar MD, MSc, Ibrahim Kulac MD","doi":"10.1002/cncy.70060","DOIUrl":"https://doi.org/10.1002/cncy.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-quality RNA is essential for accurate molecular testing. This study evaluates the impact of cytological preparation techniques (May–Grünwald–Giemsa [MGG], Papanicolaou [PAP], Diff-Quik, and air-dried) on RNA quality in smear slides.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 182 smears were prepared from fresh surgical specimens of 26 patients using seven different techniques. RNA was isolated, reverse-transcribed, and analyzed using quantitative polymerase chain reaction (qPCR). RNA quality was assessed using ΔCt (ΔCt = 45 – Ct, cycle threshold), where higher ΔCt indicates better RNA quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>RNA quality, measured by ΔCt, showed clear differences (<i>p</i> < .001) in-between preparation methods, whereas RNA concentration did not differ significantly among smear types (<i>p</i> = .07). MGG-stained smears (both film- and coverslip-mounted) demonstrated the highest and most consistent ΔCt values. PAP-stained smears yielded the lowest ΔCt values, indicating the poorest RNA quality. Air-dried unstained smears showed highly variable ΔCt values and frequent amplification failures. Diff-Quik preparations had intermediate performance. Mounting method (film vs. coverslip) did not significantly affect RNA quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among cytology smear techniques, MGG provided the best RNA preservation, PAP the worst, and air-dried slides yielded inconsistent results. These findings highlight the critical role of smear preparation in preserving RNA for molecular testing, especially RNA-based next-generation sequencing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"133 12","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145486677","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}
<p>It is a common constituent of walls, flooring, furniture, carpet adhesives, and tobacco smoke. Many women use it daily in lotions, conditioners, and other personal care products. Some salon workers have been exposed to high doses through hair straighteners, whereas pathologists regularly encounter it as a tissue fixative and embalming agent.</p><p>Unlike the per- and polyfluoroalkyl substances (PFAS) “forever chemicals” and microplastics more recently linked to health risks, formaldehyde can occur naturally; at higher levels, however, it has been deemed a toxic substance and chemical irritant for decades. In 2006, the International Agency for Research on Cancer concluded that “sufficient evidence” existed to designate formaldehyde as a group 1 carcinogen.<span><sup>1</sup></span> Data from animal and human studies have linked it most strongly to cancers of the upper aerodigestive tract, sinuses, and nasal cavity.</p><p>Nevertheless, recent research suggests that the known hazard is still an intentional and ubiquitous component of homes and workplaces across the United States. Nicholas Shapiro, DPhil, an associate professor of biology and society at the University of California, Los Angeles, says that one of the biggest exposure routes is the off-gassing of engineered wood, for which formaldehyde makes an effective binder. As a derivative of natural gas, formaldehyde also is cheap to produce in bulk.</p><p>“We’re heavily reliant on it for our cost of living,” he says. “It’s essentially a chemical that’s too big to fail.” In his new book, <i>Homesick</i>, Dr Shapiro details the toxic legacy of the more than 120,000 trailers distributed by the Federal Emergency Management Agency in the aftermath of Hurricane Katrina in 2005. Among the stew of toxic chemicals contaminating the trailers, formaldehyde in the trailers’ wood laminates was by far the most abundant.</p><p>The danger extends far beyond mobile homes, however. In a 2024 study, researchers calculated that a typical residential building in the United States contained 207 g of embedded formaldehyde on average; safely venting that amount requires up to 4 years.<span><sup>2</sup></span> Avoiding the chemical in housing altogether, the researchers concluded, could prevent roughly 645 cancer cases every year.</p><p>Dr Shapiro says that he likes to remind people that air is the dominant mode of exchange between the human body and the wider environment. “I think people associate the word ‘formaldehyde’ with their seventh-grade biology class where they dissected a frog, and they haven’t really thought about it since then,” he says, “even though 9 out of 10 breaths that they’re taking are in these indoor spaces that are chemically conditioned most prominently by that chemical.”</p><p>Formaldehyde is a strong respiratory and skin irritant that can cause coughing, throat irritation, asthma-like symptoms, headaches, and rashes. In his research, Dr Shapiro has collected samples and stories of more “surre
它是墙壁、地板、家具、地毯粘合剂和烟草烟雾的常见成分。许多女性每天在乳液、护发素和其他个人护理产品中使用它。一些沙龙工作人员通过直发器接触到高剂量的甲醛，而病理学家则经常将其作为组织固定剂和防腐剂。与全氟烷基和多氟烷基物质（PFAS）“永远的化学品”以及最近与健康风险联系在一起的微塑料不同，甲醛可以自然产生；然而，在更高的水平上，几十年来它一直被认为是一种有毒物质和化学刺激物。2006年，国际癌症研究机构（International Agency for Research on Cancer）得出结论，有“足够的证据”将甲醛列为1类致癌物来自动物和人类研究的数据表明，它与上气消化道、鼻窦和鼻腔的癌症联系最为密切。然而，最近的研究表明，在美国，这种已知的危害仍然是家庭和工作场所中故意和无处不在的组成部分。尼古拉斯·夏皮罗博士是加州大学洛杉矶分校的生物学和社会学副教授，他说，最大的暴露途径之一是工程木材的废气，甲醛是有效的粘合剂。作为天然气的衍生物，甲醛的批量生产成本也很低。他说：“我们的生活成本严重依赖它。”“它本质上是一种大到不能倒的化学物质。”在他的新书《思乡》中，夏皮罗博士详细描述了联邦紧急事务管理局在2005年卡特里娜飓风过后分发的12万多辆拖车的有毒遗产。在污染拖车的有毒化学物质中，拖车的木层压板中的甲醛含量最高。然而，危险远远超出了移动房屋。在2024年的一项研究中，研究人员计算出，美国一栋典型的住宅建筑平均含有207g的甲醛；安全排放这些气体需要长达4年的时间研究人员得出结论，完全避免在住房中使用这种化学物质，每年可以预防大约645例癌症病例。夏皮罗博士说，他喜欢提醒人们，空气是人体与更广阔环境之间主要的交换方式。“我认为人们把‘甲醛’这个词和他们七年级的生物课联系在一起，当时他们解剖了一只青蛙，从那以后他们就没有真正想过这个问题，”他说，“尽管他们呼吸的10次中有9次是在这些室内空间里，这些空间的化学条件最明显地受到这种化学物质的影响。”甲醛是一种强烈的呼吸和皮肤刺激物，可引起咳嗽、喉咙刺激、哮喘样症状、头痛和皮疹。在他的研究中，夏皮罗博士收集了可能与高暴露有关的更多“超现实症状”的样本和故事：例如，一个工业卫生学家经常做噩梦，而一个警察再也尝不出食物的味道。一些人反复流鼻血，而另一些人则患有慢性腹泻。更令人不安的是，许多人每天都在不知情的情况下使用甲醛。最近的另一项研究追踪了居住在洛杉矶的70名黑人和拉丁裔女性使用的个人护理产品，如乳液、洗发水和护发素。研究人员发现，超过一半的女性使用含有甲醛释放剂的产品，甲醛释放剂是为了延长产品的保质期而添加的。总的来说，使用甲醛防腐剂的产品相对较少，但这些产品往往很受欢迎。主要作者罗宾·多德森博士是马萨诸塞州牛顿市寂静之春研究所的一名暴露科学家，他说：“它们存在于身体乳液和许多护发产品等常见产品中，因为它们每天都在使用，所以它变得更加令人担忧。”多德森博士说，向消费者传达信息仍然是一项挑战，特别是因为甲醛释放剂往往有长而复杂的名称，如二唑烷酰脲，这掩盖了它们作为抗菌防腐剂的真正功能。她说：“人们并不明显它们实际上会释放甲醛，但这正是它们被放入产品中的原因。”“这对消费者来说是压倒性的。”对病理学家来说，意大利的一项研究为实验室中职业性接触福尔马林提供了令人不安的新线索。研究发现，在培养的外周血淋巴细胞中，暴露于甲醛的病理学家的姐妹染色单体交换频率明显高于对照组，这是一种与癌症相关的基因毒性形式。然而，在可预见的未来，甲醛可能仍然是一种不可避免的罪恶。 “毫无疑问，10%的中性缓冲福尔马林将继续用作组织病理学实验室的固定剂，”加州奥克兰Alameda卫生系统实验室医学和病理学系主任Harris Goodman医学博士说。“我不认为它会消失。”美国病理学家学会（CAP）加利福尼亚中部海岸分部专员古德曼博士指出，甲醛溶液易于操作，并且作为组织固定剂效果良好。此外，他说，“成百上千”的细胞病理学测试已经在福尔马林固定材料上得到了验证和验证。夏皮罗博士回忆说，他听过很多关于科学家的故事，他们曾经定期用嘴吸甲醛。联邦职业安全与健康管理局（OSHA）和CAP现在都有标准要求适当的个人防护设备和监督，以帮助减少职业接触化学品。在某些情况下，CAP在自己的标准中反映了OSHA的要求。在家庭中，减少多种接触途径可能要困难得多。多德森博士说，建议消费者通过比较购物来降低自己的风险是不现实的，尤其是在缺乏明确标签的情况下。她说：“这不是简单地通过购物来解决问题的。”“我确实认为，在这种情况下，当消费者真的处于亏损状态时，老实说，需要有一种监管方法。”然而，普遍的方法是高度分散的，联邦政府在解决甲醛暴露方面几乎没有进展，少数州通过限制和标签要求提供了零敲碎打的解决方案。尽管一些联邦法案规定了建筑材料中的甲醛含量，夏皮罗博士说，这些法案规定的是工程木材等商品，而不是房屋制造商或他们的最终产品。“我们没有对人们的房屋进行基于健康的评估。我们不会从一个已建成的房屋中提取样本，然后看它是否处于健康水平。我们在产品进入房屋建造之前就对其进行了监管，结果，我们仍然有有毒的房屋，”他说。事实上，ProPublica在2024年对美国家庭内部的风险进行的一项调查显示，除了引发哮喘、流产和生育问题外，这种化学物质“比空气中任何其他化学物质导致的癌症病例都多”“这种化学物质维系着我们的家园。它是一种粘合剂，将工程木材结合在一起，补贴我们的生活成本，它也是生物学上解开我们的一部分，”夏皮罗博士说。多德森博士说，要想有意义地减少暴露，提高消费者意识的多层次策略，加上更多的联邦或州“监管杠杆”，可能是必要的。夏皮罗博士补充说，尽管该国的住宅建筑基础设施在很大程度上是分散的，但人造住宅行业的集中性质可能使其成为基于健康的监管的一个有吸引力的初始目标，特别是如果这些监管是基于检测室内空气质量的。他说，这些“小步骤”可以与更大的预防措施结合起来，比如替代房屋建筑。夏皮罗博士说，归根结底，这是为了“提高我们花了最多钱、花了最多时间的地方的安全性”。
{"title":"The heavy health costs of a chemical “that’s too big to fail”","authors":"Bryn Nelson PhD, William Faquin MD, PhD","doi":"10.1002/cncy.70053","DOIUrl":"10.1002/cncy.70053","url":null,"abstract":"<p>It is a common constituent of walls, flooring, furniture, carpet adhesives, and tobacco smoke. Many women use it daily in lotions, conditioners, and other personal care products. Some salon workers have been exposed to high doses through hair straighteners, whereas pathologists regularly encounter it as a tissue fixative and embalming agent.</p><p>Unlike the per- and polyfluoroalkyl substances (PFAS) “forever chemicals” and microplastics more recently linked to health risks, formaldehyde can occur naturally; at higher levels, however, it has been deemed a toxic substance and chemical irritant for decades. In 2006, the International Agency for Research on Cancer concluded that “sufficient evidence” existed to designate formaldehyde as a group 1 carcinogen.<span><sup>1</sup></span> Data from animal and human studies have linked it most strongly to cancers of the upper aerodigestive tract, sinuses, and nasal cavity.</p><p>Nevertheless, recent research suggests that the known hazard is still an intentional and ubiquitous component of homes and workplaces across the United States. Nicholas Shapiro, DPhil, an associate professor of biology and society at the University of California, Los Angeles, says that one of the biggest exposure routes is the off-gassing of engineered wood, for which formaldehyde makes an effective binder. As a derivative of natural gas, formaldehyde also is cheap to produce in bulk.</p><p>“We’re heavily reliant on it for our cost of living,” he says. “It’s essentially a chemical that’s too big to fail.” In his new book, <i>Homesick</i>, Dr Shapiro details the toxic legacy of the more than 120,000 trailers distributed by the Federal Emergency Management Agency in the aftermath of Hurricane Katrina in 2005. Among the stew of toxic chemicals contaminating the trailers, formaldehyde in the trailers’ wood laminates was by far the most abundant.</p><p>The danger extends far beyond mobile homes, however. In a 2024 study, researchers calculated that a typical residential building in the United States contained 207 g of embedded formaldehyde on average; safely venting that amount requires up to 4 years.<span><sup>2</sup></span> Avoiding the chemical in housing altogether, the researchers concluded, could prevent roughly 645 cancer cases every year.</p><p>Dr Shapiro says that he likes to remind people that air is the dominant mode of exchange between the human body and the wider environment. “I think people associate the word ‘formaldehyde’ with their seventh-grade biology class where they dissected a frog, and they haven’t really thought about it since then,” he says, “even though 9 out of 10 breaths that they’re taking are in these indoor spaces that are chemically conditioned most prominently by that chemical.”</p><p>Formaldehyde is a strong respiratory and skin irritant that can cause coughing, throat irritation, asthma-like symptoms, headaches, and rashes. In his research, Dr Shapiro has collected samples and stories of more “surre","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"133 11","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437350","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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