{"title":"Spotlight: Rising stars in cytology","authors":"Bonnie Choy MD","doi":"10.1002/cncy.22891","DOIUrl":"10.1002/cncy.22891","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 11","pages":"673-674"},"PeriodicalIF":2.6,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888543","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}
Kaitlyn R. Muscarella MD, Paul T. Eberts MD, Laura D. Craig-Owens MD, Elizabeth Kean Groark MD, Dustin R. Osborne PhD, Teresa Osborne RT(R)(VI), Gregg Tracy BSN, Cristopher D. Stephens MD, Laurentia M. Nodit MD
{"title":"Mucinous-appearing contamination of serous effusions by sodium carboxymethyl cellulose from suction canister lids","authors":"Kaitlyn R. Muscarella MD, Paul T. Eberts MD, Laura D. Craig-Owens MD, Elizabeth Kean Groark MD, Dustin R. Osborne PhD, Teresa Osborne RT(R)(VI), Gregg Tracy BSN, Cristopher D. Stephens MD, Laurentia M. Nodit MD","doi":"10.1002/cncy.22892","DOIUrl":"10.1002/cncy.22892","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"133 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888542","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 third edition of The Bethesda System (TBS) subclassifies the atypia of undetermined significance (AUS) category on the basis of the presence of nuclear atypia (AUS-Nuclear). This approach is supported by studies showing significant differences in the risk of malignancy (ROM) between AUS-Nuclear and those without (AUS-Other). Although aspirates of follicular neoplasms (FNs) are characterized by marked architectural atypia, TBS recognizes the infrequent occurrence of FNs with mild nuclear atypia (FN-Nuclear). Furthermore, limited studies have shown significant differences in ROM between FN-Nuclear and those without (FN-Other). This study explored potential differences in ROM, molecular-derived risk of malignancy (MDROM), and molecular alterations between FN-Nuclear and FN-Other.
Methods
A retrospective database search identified 93 FN aspirates. Cytology slides, molecular reports, and histologic follow-ups were reviewed. Both groups' benign call rate (BCR), positive call rate (PCR), MDROM, and ROM were computed and compared.
Results
Eighty-six percent of aspirates (80 of 93) comprised FN-Other, whereas 14% (13 of 93) were FN-Nuclear. The BCR and PCR for FN-Other were 51% and 49%, respectively. In contrast, they were 23% and 77% for FN-Nuclear, respectively. The MDROM significantly differed between FN-Other (30%) and FN-Nuclear (56%) (p < .05). HRAS mutation was the most common molecular alteration in FN-Nuclear, whereas mutations in NRAS/KRAS and copy number alterations were more common in FN-Other. The ROM1/ROM2 in FN-Other and FN-Nuclear were 16%/31% and 54%/88%, respectively.
Conclusions
These results reveal that FN-Nuclear exhibits significantly higher MDROM and ROM than FN-Other, which provides support for a subclassification scheme for FNs based on the presence of nuclear atypia.
{"title":"Follicular neoplasms with nuclear atypia versus other types of atypia: Should follicular neoplasms be stratified according to the presence of nuclear atypia?","authors":"Youley Tjendra MD, Yiqin Zuo MD, PhD, Jaylou M. Velez Torres MD","doi":"10.1002/cncy.22889","DOIUrl":"10.1002/cncy.22889","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The third edition of The Bethesda System (TBS) subclassifies the atypia of undetermined significance (AUS) category on the basis of the presence of nuclear atypia (AUS-Nuclear). This approach is supported by studies showing significant differences in the risk of malignancy (ROM) between AUS-Nuclear and those without (AUS-Other). Although aspirates of follicular neoplasms (FNs) are characterized by marked architectural atypia, TBS recognizes the infrequent occurrence of FNs with mild nuclear atypia (FN-Nuclear). Furthermore, limited studies have shown significant differences in ROM between FN-Nuclear and those without (FN-Other). This study explored potential differences in ROM, molecular-derived risk of malignancy (MDROM), and molecular alterations between FN-Nuclear and FN-Other.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective database search identified 93 FN aspirates. Cytology slides, molecular reports, and histologic follow-ups were reviewed. Both groups' benign call rate (BCR), positive call rate (PCR), MDROM, and ROM were computed and compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-six percent of aspirates (80 of 93) comprised FN-Other, whereas 14% (13 of 93) were FN-Nuclear. The BCR and PCR for FN-Other were 51% and 49%, respectively. In contrast, they were 23% and 77% for FN-Nuclear, respectively. The MDROM significantly differed between FN-Other (30%) and FN-Nuclear (56%) (<i>p</i> < .05). <i>HRAS</i> mutation was the most common molecular alteration in FN-Nuclear, whereas mutations in <i>NRAS</i>/<i>KRAS</i> and copy number alterations were more common in FN-Other. The ROM1/ROM2 in FN-Other and FN-Nuclear were 16%/31% and 54%/88%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results reveal that FN-Nuclear exhibits significantly higher MDROM and ROM than FN-Other, which provides support for a subclassification scheme for FNs based on the presence of nuclear atypia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 11","pages":"707-713"},"PeriodicalIF":2.6,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22889","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888541","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>For Vera Gorbunova, PhD, professor of biology and medicine at the University of Rochester in New York, the moment of serendipity initially seemed like a nuisance. Dr Gorbunova’s laboratory studies why certain animals, such as the extremely long-lived, hairless, and so-ugly-they’re-cute subterranean dwellers known as naked mole-rats, are extraordinarily resistant to cancer. The unusual rodents from eastern Africa have a eusocial colony structure reminiscent of honeybees and can live more than 40 years in captivity, roughly 10-fold longer than mice.</p><p>As part of its research, Dr Gorbunova’s laboratory grew naked mole-rat fibroblast cells, which make and secrete collagen and other components of the framework for connective tissues. Graduate students noticed that the cells also were secreting a viscous substance into the cell culture dish. The substance was so thick and gooey that it clogged the vacuum pump used to suck up the growing medium from the dishes. “When people complained about it, we all thought, ‘Well, there must be something interesting,’” Dr Gorbunova recalls.</p><p>After initial tests suggested that the viscous substance was not an overabundant protein, a Google search hinted at hyaluronic acid, a natural lubricant and cushion for skin and other sensitive body parts in humans and other animals. Sure enough, confirmatory tests revealed that the secretions were a very long form of hyaluronic acid made by the <i>HAS2</i> gene.<span><sup>1</sup></span></p><p>From additional experiments, the laboratory found that this version of hyaluronic acid binds to a specific cell receptor and appears to trigger an anticancer response by arresting cell growth and division. “Basically, when there is a lot of high-molecular weight hyaluronic acid in the tissue, it reduces cell proliferation and it also slows down premalignant hyperplastic cells,” Dr Gorbunova says. In transgenic mice, the introduced <i>HAS2</i> gene granted the animals more longevity and resistance to both spontaneous and induced tumors.<span><sup>2</sup></span> “They didn’t become completely resistant like naked mole-rats, which means there are additional mechanisms that are different in the mole-rat, but the incidence was reduced significantly,” she says.</p><p>From an evolutionary perspective, Dr Gorbunova doubts that anticancer activity was the original purpose of the naked mole-rats’ hyaluronic acid production. In a wide range of other tunnel-dwelling species, the researchers recently reported that all produced the same high-molecular-weight compound.<span><sup>3</sup></span> “What we proposed is that it really becomes upregulated with adaptation to subterranean life,” she says. One possibility is that because underground animals are constantly rubbing against tunnel walls, the acid helps to reinforce their skin.</p><p>When the laboratory ramped up hyaluronic acid production in mice, the animals likewise acquired “very stretchy, elastic skin,” she says. “But then once it’s ov
{"title":"Exposing the naked truth about how mole-rats evade cancer","authors":"Bryn Nelson PhD, William Faquin MD, PhD","doi":"10.1002/cncy.22887","DOIUrl":"10.1002/cncy.22887","url":null,"abstract":"<p>For Vera Gorbunova, PhD, professor of biology and medicine at the University of Rochester in New York, the moment of serendipity initially seemed like a nuisance. Dr Gorbunova’s laboratory studies why certain animals, such as the extremely long-lived, hairless, and so-ugly-they’re-cute subterranean dwellers known as naked mole-rats, are extraordinarily resistant to cancer. The unusual rodents from eastern Africa have a eusocial colony structure reminiscent of honeybees and can live more than 40 years in captivity, roughly 10-fold longer than mice.</p><p>As part of its research, Dr Gorbunova’s laboratory grew naked mole-rat fibroblast cells, which make and secrete collagen and other components of the framework for connective tissues. Graduate students noticed that the cells also were secreting a viscous substance into the cell culture dish. The substance was so thick and gooey that it clogged the vacuum pump used to suck up the growing medium from the dishes. “When people complained about it, we all thought, ‘Well, there must be something interesting,’” Dr Gorbunova recalls.</p><p>After initial tests suggested that the viscous substance was not an overabundant protein, a Google search hinted at hyaluronic acid, a natural lubricant and cushion for skin and other sensitive body parts in humans and other animals. Sure enough, confirmatory tests revealed that the secretions were a very long form of hyaluronic acid made by the <i>HAS2</i> gene.<span><sup>1</sup></span></p><p>From additional experiments, the laboratory found that this version of hyaluronic acid binds to a specific cell receptor and appears to trigger an anticancer response by arresting cell growth and division. “Basically, when there is a lot of high-molecular weight hyaluronic acid in the tissue, it reduces cell proliferation and it also slows down premalignant hyperplastic cells,” Dr Gorbunova says. In transgenic mice, the introduced <i>HAS2</i> gene granted the animals more longevity and resistance to both spontaneous and induced tumors.<span><sup>2</sup></span> “They didn’t become completely resistant like naked mole-rats, which means there are additional mechanisms that are different in the mole-rat, but the incidence was reduced significantly,” she says.</p><p>From an evolutionary perspective, Dr Gorbunova doubts that anticancer activity was the original purpose of the naked mole-rats’ hyaluronic acid production. In a wide range of other tunnel-dwelling species, the researchers recently reported that all produced the same high-molecular-weight compound.<span><sup>3</sup></span> “What we proposed is that it really becomes upregulated with adaptation to subterranean life,” she says. One possibility is that because underground animals are constantly rubbing against tunnel walls, the acid helps to reinforce their skin.</p><p>When the laboratory ramped up hyaluronic acid production in mice, the animals likewise acquired “very stretchy, elastic skin,” she says. “But then once it’s ov","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 8","pages":"463-464"},"PeriodicalIF":2.6,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874177","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}
A standardized reporting system for bone and soft tissue tumor cytopathology has not yet been established. The objective of this study was to explore the potential utility of a classification modified from the Milan System for Salivary Gland Cytopathology and compared it with the upcoming World Health Organization (WHO) system for fine-needle aspiration of soft tissue lesions.
Methods
The authors reviewed 285 cytology cases of bone/joint (n = 173) and soft tissue (n = 112) lesions, scoring each within diagnostic categories. The results were compared with histologic diagnoses and the risk of malignancy (ROM) for each category, and diagnostic reliability was analyzed.
Results
All 285 cases were successfully classified into one of the following categories: nondiagnostic (6.3%), non-neoplastic (11.9%), atypia of uncertain significance (11.9%), benign neoplasm (5.6%), bone and soft tissue neoplasm of uncertain malignant potential (25.3%), suspicious for malignancy (1.4%), and malignant (37.5%). The ROM was 44.4% (eight of /18 cases) in nondiagnostic, 0% (zero of 34 cases) in non-neoplastic, 32.4% (11 of 34 cases) in atypia of uncertain significance, 0% (zero of 16 cases) in benign neoplasm, 16.7% (12 of 72 cases) in bone and soft tissue neoplasm of uncertain malignant potential, 75.0% (three of four cases) in suspicious for malignancy, and 100% (107 of 107 cases) in malignant categories. Using the WHO system, the proportion and ROM of the benign category (non-neoplastic and benign neoplasm) was 17.5% and 0%, respectively. Among benign and malignant lesions, the diagnostic accuracy, sensitivity, and specificity for detecting malignancy were 99.4%, 100%, and 98.0%, respectively.
Conclusions
The modified Milan system as well as the WHO system may be a useful cytopathologic classification tool for both bone and soft tissue lesions.
背景：骨与软组织肿瘤细胞病理学的标准化报告系统尚未建立。本研究的目的是探索从米兰唾液腺细胞病理学系统修改而来的分类方法的潜在效用，并将其与世界卫生组织（WHO）即将推出的软组织病变细针穿刺系统进行比较：作者回顾了285例骨/关节（173例）和软组织（112例）病变的细胞学病例，在诊断类别内对每个病例进行评分。将结果与组织学诊断和每个类别的恶性肿瘤风险（ROM）进行了比较，并分析了诊断的可靠性：所有 285 个病例均被成功归入以下类别之一：无诊断性（6.3%）、非肿瘤性（11.9%）、意义不明的不典型性（11.9%）、良性肿瘤（5.6%）、恶性可能性不明的骨与软组织肿瘤（25.3%）、恶性可疑（1.4%）和恶性（37.5%）。ROM中，44.4%（18例中的8例）为非诊断性，0%（34例中的0例）为非肿瘤性，32.4%（34例中的11例）为意义不明的不典型性，0%（16例中的0例）为良性肿瘤，16.7%（72例中的12例）为恶性程度不确定的骨与软组织肿瘤，75.0%（4例中的3例）为恶性可疑，100%（107例中的107例）为恶性肿瘤。根据世界卫生组织的系统，良性类别（非肿瘤和良性肿瘤）的比例和 ROM 分别为 17.5%和 0%。在良性和恶性病变中，检测恶性肿瘤的诊断准确性、敏感性和特异性分别为 99.4%、100% 和 98.0%：结论：改良米兰系统和世界卫生组织系统可能是骨和软组织病变的有用细胞病理学分类工具。
{"title":"Reappraisal of bone and soft tissue cytopathology classification using the modified Milan system","authors":"Masaki Naka CT, PhD, Hidetaka Yamamoto MD, PhD, Kenichi Kohashi MD, PhD, Takeshi Iwasaki MD, PhD, Taro Mori MD, PhD, Miwako Nogami CT, Fumihiko Ookubo CT, Kayoko Higuchi MD, PhD, Toru Motoi MD, PhD, Yoshinao Oda MD, PhD","doi":"10.1002/cncy.22888","DOIUrl":"10.1002/cncy.22888","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A standardized reporting system for bone and soft tissue tumor cytopathology has not yet been established. The objective of this study was to explore the potential utility of a classification modified from the Milan System for Salivary Gland Cytopathology and compared it with the upcoming World Health Organization (WHO) system for fine-needle aspiration of soft tissue lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The authors reviewed 285 cytology cases of bone/joint (<i>n</i> = 173) and soft tissue (<i>n</i> = 112) lesions, scoring each within diagnostic categories. The results were compared with histologic diagnoses and the risk of malignancy (ROM) for each category, and diagnostic reliability was analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All 285 cases were successfully classified into one of the following categories: nondiagnostic (6.3%), non-neoplastic (11.9%), atypia of uncertain significance (11.9%), benign neoplasm (5.6%), bone and soft tissue neoplasm of uncertain malignant potential (25.3%), suspicious for malignancy (1.4%), and malignant (37.5%). The ROM was 44.4% (eight of /18 cases) in nondiagnostic, 0% (zero of 34 cases) in non-neoplastic, 32.4% (11 of 34 cases) in atypia of uncertain significance, 0% (zero of 16 cases) in benign neoplasm, 16.7% (12 of 72 cases) in bone and soft tissue neoplasm of uncertain malignant potential, 75.0% (three of four cases) in suspicious for malignancy, and 100% (107 of 107 cases) in malignant categories. Using the WHO system, the proportion and ROM of the benign category (non-neoplastic and benign neoplasm) was 17.5% and 0%, respectively. Among benign and malignant lesions, the diagnostic accuracy, sensitivity, and specificity for detecting malignancy were 99.4%, 100%, and 98.0%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The modified Milan system as well as the WHO system may be a useful cytopathologic classification tool for both bone and soft tissue lesions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 11","pages":"696-706"},"PeriodicalIF":2.6,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792016","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}
Rachelle P. Mendoza MD, Emily Symes MD, Peng Wang MD, PhD, Cole Miller MS, Stephanie C. Thompson MD, Tatjana Antic MD, Anna Biernacka MD, PhD
Background
Spindle cell carcinoid tumor (SCCT) is a rare variant of lung carcinoid tumor consisting predominantly or exclusively of spindle cells. To the authors' knowledge, this is the first study to date investigating the molecular characteristics of SCCTs.
Methods
Eighty-five carcinoid tumors initially diagnosed by fine-needle aspiration over a period of 10 years were reviewed. The final diagnostic classification was based on resection specimens. Six SCCTs were identified and characterized based on cytomorphology, and immunohistochemical and molecular features.
Results
Most patients with SCCT were Caucasian (100.0%), women (83.3%), asymptomatic (66.7%), and nonsmokers (83.3%). The median age at diagnosis was 78.0 years (range, 58.2–80.3 years). A higher proportion of patients who had SCCT were diagnosed with distant metastasis. The smears were cellular and demonstrated clean backgrounds without necrosis or mitotic activity. SCCTs comprised of bipolar-to-elongated cells with finely granular chromatin, inconspicuous nucleoli, scant cytoplasm, and minimal atypia or pleomorphism. The tumor cells sometimes appeared boomerang-shaped and might mimic granulomas or blood vessels. SCCTs showed strong expression for pan-cytokeratin, synaptophysin, chromogranin, and CD56, with weak TTF-1 and a very low Ki-67 proliferation index. All SCCTs had low tumor mutational burden and were microsatellite-stable. One case showed multiple whole-gene losses in chromosome 11, whereas another harbored duplication in ARID1A. Two cases demonstrated gains in chromosomes 17, one of which also showed gains in chromosome 18. None had a single nucleotide mutation.
Conclusions
SCCT is a rare subset of lung carcinoid tumors. These tumors harbor unique cytologic, prognostic, and molecular features that may have significant diagnostic and clinical implications.
{"title":"Cytomorphologic and molecular characterization of spindle cell carcinoid tumors of the lung","authors":"Rachelle P. Mendoza MD, Emily Symes MD, Peng Wang MD, PhD, Cole Miller MS, Stephanie C. Thompson MD, Tatjana Antic MD, Anna Biernacka MD, PhD","doi":"10.1002/cncy.22886","DOIUrl":"10.1002/cncy.22886","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Spindle cell carcinoid tumor (SCCT) is a rare variant of lung carcinoid tumor consisting predominantly or exclusively of spindle cells. To the authors' knowledge, this is the first study to date investigating the molecular characteristics of SCCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty-five carcinoid tumors initially diagnosed by fine-needle aspiration over a period of 10 years were reviewed. The final diagnostic classification was based on resection specimens. Six SCCTs were identified and characterized based on cytomorphology, and immunohistochemical and molecular features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most patients with SCCT were Caucasian (100.0%), women (83.3%), asymptomatic (66.7%), and nonsmokers (83.3%). The median age at diagnosis was 78.0 years (range, 58.2–80.3 years). A higher proportion of patients who had SCCT were diagnosed with distant metastasis. The smears were cellular and demonstrated clean backgrounds without necrosis or mitotic activity. SCCTs comprised of bipolar-to-elongated cells with finely granular chromatin, inconspicuous nucleoli, scant cytoplasm, and minimal atypia or pleomorphism. The tumor cells sometimes appeared <i>boomerang-shaped</i> and might mimic granulomas or blood vessels. SCCTs showed strong expression for pan-cytokeratin, synaptophysin, chromogranin, and CD56, with weak TTF-1 and a very low Ki-67 proliferation index. All SCCTs had low tumor mutational burden and were microsatellite-stable. One case showed multiple whole-gene losses in chromosome 11, whereas another harbored duplication in <i>ARID1A</i>. Two cases demonstrated gains in chromosomes 17, one of which also showed gains in chromosome 18. None had a single nucleotide mutation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SCCT is a rare subset of lung carcinoid tumors. These tumors harbor unique cytologic, prognostic, and molecular features that may have significant diagnostic and clinical implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 10","pages":"656-665"},"PeriodicalIF":2.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22886","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723188","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":"Thyroid nodules and cancer: The search for certainty","authors":"Pamela Hartzband MD","doi":"10.1002/cncy.22882","DOIUrl":"10.1002/cncy.22882","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 12","pages":"738-740"},"PeriodicalIF":2.6,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603311","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}
Henri Lagerstam BMed, Erkka Tommola MD, Saara Kares MSc, Ivana Kholová MD, PhD, MIAC
Background
The objective of this study was to evaluate the diagnostic performance of the category atypia of undetermined significance (AUS) at the authors' institution based on the Milan System for Reporting Salivary Gland Cytopathology.
Methods
All AUS cases diagnosed at Fimlab Laboratories between January 1, 2018, and December 31, 2022, were included. Histologic verifications were checked until May 31, 2023. The upper-bound and lower-bound risk of malignancy and risk of neoplasm were calculated. The timelines between the pathology laboratory workflow and patient management were also calculated.
Results
From 1157 fine-needle aspirations (FNAs), 162 (14.0%) AUS cases were diagnosed in 146 patients, with an average ± standard deviation age of 66.1 ± 14.9 years. There was variation in the AUS percentages, with higher values during the coronavirus disease 2019 pandemic years (15% and 17.5% in 2020 and 2021, respectively). Seventy-five cases (46.3%) had histologic follow-up: 16 were malignant neoplasms, and 36 were benign neoplasms. The upper and the lower bounds of the-risk of malignancy and risk of neoplasm were 21.3% and 69.3% and 9.9% and 32.1%, respectively. The average time from the first FNA with an AUS diagnosis to surgical resection ranged from 6 to 682 days, and the time to the first repeat FNA ranged from 10 to 691 days.
Conclusions
The results indicated higher percentages of AUS cases compared with the reference value, which may be attributed to the impact of the coronavirus disease 2019 pandemic. The risk of malignancy calculated in this study was closer to the reference value from the first edition of the Milan System for Reporting Salivary Gland Cytopathology compared with the second edition.
{"title":"The Milan system atypia of undetermined significance: 5-year performance data","authors":"Henri Lagerstam BMed, Erkka Tommola MD, Saara Kares MSc, Ivana Kholová MD, PhD, MIAC","doi":"10.1002/cncy.22883","DOIUrl":"10.1002/cncy.22883","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The objective of this study was to evaluate the diagnostic performance of the category <i>atypia of undetermined significance</i> (AUS) at the authors' institution based on the Milan System for Reporting Salivary Gland Cytopathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All AUS cases diagnosed at Fimlab Laboratories between January 1, 2018, and December 31, 2022, were included. Histologic verifications were checked until May 31, 2023. The upper-bound and lower-bound risk of malignancy and risk of neoplasm were calculated. The timelines between the pathology laboratory workflow and patient management were also calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1157 fine-needle aspirations (FNAs), 162 (14.0%) AUS cases were diagnosed in 146 patients, with an average ± standard deviation age of 66.1 ± 14.9 years. There was variation in the AUS percentages, with higher values during the coronavirus disease 2019 pandemic years (15% and 17.5% in 2020 and 2021, respectively). Seventy-five cases (46.3%) had histologic follow-up: 16 were malignant neoplasms, and 36 were benign neoplasms. The upper and the lower bounds of the-risk of malignancy and risk of neoplasm were 21.3% and 69.3% and 9.9% and 32.1%, respectively. The average time from the first FNA with an AUS diagnosis to surgical resection ranged from 6 to 682 days, and the time to the first repeat FNA ranged from 10 to 691 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results indicated higher percentages of AUS cases compared with the reference value, which may be attributed to the impact of the coronavirus disease 2019 pandemic. The risk of malignancy calculated in this study was closer to the reference value from the first edition of the Milan System for Reporting Salivary Gland Cytopathology compared with the second edition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 10","pages":"646-655"},"PeriodicalIF":2.6,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603310","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}
This study evaluated the diagnostic effectiveness of the AIxURO platform, an artificial intelligence–based tool, to support urine cytology for bladder cancer management, which typically requires experienced cytopathologists and substantial diagnosis time.
Methods
One cytopathologist and two cytotechnologists reviewed 116 urine cytology slides and corresponding whole-slide images (WSIs) from urology patients. They used three diagnostic modalities: microscopy, WSI review, and AIxURO, per The Paris System for Reporting Urinary Cytology (TPS) criteria. Performance metrics, including TPS-guided and binary diagnosis, inter- and intraobserver agreement, and screening time, were compared across all methods and reviewers.
Results
AIxURO improved diagnostic accuracy by increasing sensitivity (from 25.0%–30.6% to 63.9%), positive predictive value (PPV; from 21.6%–24.3% to 31.1%), and negative predictive value (NPV; from 91.3%–91.6% to 95.3%) for atypical urothelial cell (AUC) cases. For suspicious for high-grade urothelial carcinoma (SHGUC) cases, it improved sensitivity (from 15.2%–27.3% to 33.3%), PPV (from 31.3%–47.4% to 61.1%), and NPV (from 91.6%–92.7% to 93.3%). Binary diagnoses exhibited an improvement in sensitivity (from 77.8%–82.2% to 90.0%) and NPV (from 91.7%–93.4% to 95.8%). Interobserver agreement across all methods showed moderate consistency (κ = 0.57–0.61), with the cytopathologist demonstrating higher intraobserver agreement than the two cytotechnologists across the methods (κ = 0.75–0.88). AIxURO significantly reduced screening time by 52.3%–83.2% from microscopy and 43.6%–86.7% from WSI review across all reviewers. Screening-positive (AUC+) cases required more time than negative cases across all methods and reviewers.
Conclusions
AIxURO demonstrates the potential to improve both sensitivity and efficiency in bladder cancer diagnostics via urine cytology. Its integration into the cytopathological screening workflow could markedly decrease screening times, which would improve overall diagnostic processes.
{"title":"Evaluating artificial intelligence–enhanced digital urine cytology for bladder cancer diagnosis","authors":"Tien-Jen Liu, Wen-Chi Yang, Shin-Min Huang, Wei-Lei Yang, Hsing-Ju Wu, Hui Wen Ho, Shih-Wen Hsu, Cheng-Hung Yeh, Ming-Yu Lin, Yi-Ting Hwang, Pei-Yi Chu MD, PhD","doi":"10.1002/cncy.22884","DOIUrl":"10.1002/cncy.22884","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study evaluated the diagnostic effectiveness of the AIxURO platform, an artificial intelligence–based tool, to support urine cytology for bladder cancer management, which typically requires experienced cytopathologists and substantial diagnosis time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One cytopathologist and two cytotechnologists reviewed 116 urine cytology slides and corresponding whole-slide images (WSIs) from urology patients. They used three diagnostic modalities: microscopy, WSI review, and AIxURO, per The Paris System for Reporting Urinary Cytology (TPS) criteria. Performance metrics, including TPS-guided and binary diagnosis, inter- and intraobserver agreement, and screening time, were compared across all methods and reviewers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AIxURO improved diagnostic accuracy by increasing sensitivity (from 25.0%–30.6% to 63.9%), positive predictive value (PPV; from 21.6%–24.3% to 31.1%), and negative predictive value (NPV; from 91.3%–91.6% to 95.3%) for atypical urothelial cell (AUC) cases. For suspicious for high-grade urothelial carcinoma (SHGUC) cases, it improved sensitivity (from 15.2%–27.3% to 33.3%), PPV (from 31.3%–47.4% to 61.1%), and NPV (from 91.6%–92.7% to 93.3%). Binary diagnoses exhibited an improvement in sensitivity (from 77.8%–82.2% to 90.0%) and NPV (from 91.7%–93.4% to 95.8%). Interobserver agreement across all methods showed moderate consistency (κ = 0.57–0.61), with the cytopathologist demonstrating higher intraobserver agreement than the two cytotechnologists across the methods (κ = 0.75–0.88). AIxURO significantly reduced screening time by 52.3%–83.2% from microscopy and 43.6%–86.7% from WSI review across all reviewers. Screening-positive (AUC+) cases required more time than negative cases across all methods and reviewers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AIxURO demonstrates the potential to improve both sensitivity and efficiency in bladder cancer diagnostics via urine cytology. Its integration into the cytopathological screening workflow could markedly decrease screening times, which would improve overall diagnostic processes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 11","pages":"686-695"},"PeriodicalIF":2.6,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22884","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603309","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>Every year, roughly 1500–2000 women in the United States are diagnosed with a rare set of ovarian cancers known as granulosa cell tumors (GCTs), which carry a high risk of recurrence. Another 1300 individuals are diagnosed with adenoid cystic carcinomas (ACCs), which arise primarily in the salivary glands, commonly invade nerves, and metastasize to distant sites such as the lungs in approximately half of all cases.</p><p>Both cancers are rare enough that patients often struggled to connect with others facing the same malignancy until social media platforms such as Facebook helped them to connect through patient support groups. Such groups, in turn, have become critical resources for research efforts seeking to better understand the diseases and improve patient outcomes.</p><p>Amid the spate of recent warnings about the dangers of social media, including rampant misinformation, online groups have become the main vehicle for connecting patients and families affected by rare diseases. Physicians now regularly recommend Facebook groups to their patients, says Meghan Halley, PhD, MPH, a senior research scholar at the Stanford Center for Biomedical Ethics in Palo Alto, California. “It’s often the largest gathering of any patients with a particular very rare disease that’s available,” she says. “The extent to which the rare disease community has leveraged social media to identify other patients, share information, and provide social support is one of the few bastions of really good news in the social media space.”</p><p>Researchers have made good use of the space as well. In collaboration with the Granulosa Cell Tumor Survivor Sisters Facebook group, for example, a recent study based on an online survey of 743 patients revealed that 30% of respondents had recurrent disease, with one third of those recurrences occurring within 5 years of diagnosis.<span><sup>1</sup></span> The study represented one of the largest surveys yet of GCT patients’ treatment experiences. “Using naturally forming consumer groups may assist with developing the evidence base for care and supporting those living with GCT ovarian cancer,” the authors concluded.</p><p>Bioethicists such as Dr Halley, however, also have urged caution when relying on social media for bolstering research efforts. In a review of 120 social media–aided studies on rare noncancer diseases, she and her colleagues found that more than half relied exclusively on surveys, and the patient demographics, when reported, skewed toward female and White participants. “Despite its potential benefits in rare disease research, the use of social media is still methodologically limited, and the participants reached may not be representative of the rare disease population by gender, race, age, or rare disease type,” wrote the researchers.<span><sup>2</sup></span></p><p>Rare cancers are tracked, in part, through the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. Classification, thou
{"title":"The power and pitfalls of using social media to study rare cancers","authors":"Bryn Nelson PhD, William Faquin MD, PhD","doi":"10.1002/cncy.22879","DOIUrl":"10.1002/cncy.22879","url":null,"abstract":"<p>Every year, roughly 1500–2000 women in the United States are diagnosed with a rare set of ovarian cancers known as granulosa cell tumors (GCTs), which carry a high risk of recurrence. Another 1300 individuals are diagnosed with adenoid cystic carcinomas (ACCs), which arise primarily in the salivary glands, commonly invade nerves, and metastasize to distant sites such as the lungs in approximately half of all cases.</p><p>Both cancers are rare enough that patients often struggled to connect with others facing the same malignancy until social media platforms such as Facebook helped them to connect through patient support groups. Such groups, in turn, have become critical resources for research efforts seeking to better understand the diseases and improve patient outcomes.</p><p>Amid the spate of recent warnings about the dangers of social media, including rampant misinformation, online groups have become the main vehicle for connecting patients and families affected by rare diseases. Physicians now regularly recommend Facebook groups to their patients, says Meghan Halley, PhD, MPH, a senior research scholar at the Stanford Center for Biomedical Ethics in Palo Alto, California. “It’s often the largest gathering of any patients with a particular very rare disease that’s available,” she says. “The extent to which the rare disease community has leveraged social media to identify other patients, share information, and provide social support is one of the few bastions of really good news in the social media space.”</p><p>Researchers have made good use of the space as well. In collaboration with the Granulosa Cell Tumor Survivor Sisters Facebook group, for example, a recent study based on an online survey of 743 patients revealed that 30% of respondents had recurrent disease, with one third of those recurrences occurring within 5 years of diagnosis.<span><sup>1</sup></span> The study represented one of the largest surveys yet of GCT patients’ treatment experiences. “Using naturally forming consumer groups may assist with developing the evidence base for care and supporting those living with GCT ovarian cancer,” the authors concluded.</p><p>Bioethicists such as Dr Halley, however, also have urged caution when relying on social media for bolstering research efforts. In a review of 120 social media–aided studies on rare noncancer diseases, she and her colleagues found that more than half relied exclusively on surveys, and the patient demographics, when reported, skewed toward female and White participants. “Despite its potential benefits in rare disease research, the use of social media is still methodologically limited, and the participants reached may not be representative of the rare disease population by gender, race, age, or rare disease type,” wrote the researchers.<span><sup>2</sup></span></p><p>Rare cancers are tracked, in part, through the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. Classification, thou","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 7","pages":"391-392"},"PeriodicalIF":2.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22879","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466334","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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