The incidence of renal tumors has steadily increased over the past decade. In this study, the authors performed a systematic review and analysis of the literature on renal fine-needle aspiration (FNA) to determine its performance and explore whether a standardized classification system can be used for reporting renal FNA cytology.
Methods
A systematic search of published articles on renal FNA was conducted. The data on FNA and histologic diagnosis were extracted and categorized, and the risk of malignancy was calculated. Different scenarios were used to estimate FNA performance statistics.
Results
Of the 3766 potentially relevant studies, 23 met the inclusion criteria of the study. The 2231 FNA cases included were re-categorized according to the classification system, rendering 142 (6.36%) nondiagnostic, 270 (12.1%) nonneoplastic, 271 (12.14%) benign neoplasm, 65 (2.91%) renal neoplasm with unknown malignant potential, oncocytic type, 25 (1.12%) atypia of undetermined significance, 60 (2.68%) suspicious for malignancy, and 1398 (62.66%) malignant FNA diagnoses. The risk of malignancy in these cases was 65.4%, 18.1%, 16.6%, 16.9%, 60%, 73.3%, and 96.9%, respectively. According to the classification system, the study indicated that the accuracy of renal FNA was between 91% and 95%, the sensitivity was 90.9%–96.7%, and the specificity was 82%–92% in different scenarios.
Conclusions
There is a need for a standardized reporting in renal cytology that will improve the sensitivity and accuracy of renal cytology, reduce the rate of indeterminate diagnoses, and alter the management strategies of renal lesions. Based on the available literature, a new reporting system is proposed, including categories with an associated risk of malignancy.
{"title":"A systematic review on performance characteristics of FNA of renal lesions: It is time for a standardized classification system","authors":"Kübra Katipoglu MD, Irem Kilic MD, Olcay Kurtulan MD, Yasemin Akdas PhD, MPH, Güliz A. Barkan MD","doi":"10.1002/cncy.22826","DOIUrl":"10.1002/cncy.22826","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The incidence of renal tumors has steadily increased over the past decade. In this study, the authors performed a systematic review and analysis of the literature on renal fine-needle aspiration (FNA) to determine its performance and explore whether a standardized classification system can be used for reporting renal FNA cytology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of published articles on <i>renal FNA</i> was conducted. The data on FNA and histologic diagnosis were extracted and categorized, and the risk of malignancy was calculated. Different scenarios were used to estimate FNA performance statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 3766 potentially relevant studies, 23 met the inclusion criteria of the study. The 2231 FNA cases included were re-categorized according to the classification system, rendering 142 (6.36%) <i>nondiagnostic</i>, 270 (12.1%) <i>nonneoplastic</i>, 271 (12.14%) <i>benign neoplasm</i>, 65 (2.91%) <i>renal neoplasm with unknown malignant potential, oncocytic type</i>, 25 (1.12%) <i>atypia of undetermined significance</i>, 60 (2.68%) <i>suspicious for malignancy</i>, and 1398 (62.66%) <i>malignant</i> FNA diagnoses. The risk of malignancy in these cases was 65.4%, 18.1%, 16.6%, 16.9%, 60%, 73.3%, and 96.9%, respectively. According to the classification system, the study indicated that the accuracy of renal FNA was between 91% and 95%, the sensitivity was 90.9%–96.7%, and the specificity was 82%–92% in different scenarios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is a need for a standardized reporting in renal cytology that will improve the sensitivity and accuracy of renal cytology, reduce the rate of indeterminate diagnoses, and alter the management strategies of renal lesions. Based on the available literature, a new reporting system is proposed, including categories with an associated risk of malignancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 8","pages":"510-524"},"PeriodicalIF":2.6,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875950","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}
Tieying Hou MD, PhD, Katrina Collins MD, Guohua Liang MD, PhD, Sheila E. Segura MD, Thomas M. Ulbright MD, Hector Mesa MD, PhD, Harvey M. Cramer MD
Background
Metastatic germ cell tumors (GCTs) involving body cavity effusions and cerebrospinal fluid (CSF) are rare. Diagnosis is challenging because of limited morphological and clinicopathological information in the literature.
Methods
A database search of our institution from 1990 to 2024 identified 27 cases of metastatic GCTs, comprising five pediatric and 22 adolescent and adult patients, in serous cavities or the CSF, including peritoneal (15), pleural (nine), CSF (two), and pericardial (one) fluid.
Results
The most common primary site was the testis (n = 10), followed by the ovaries (n = 7), mediastinum (n = 4), retroperitoneum (n = 3), pineal gland (n = 2), and sacrum/coccyx (n = 1). The primary tumors in 14 patients were mixed GCTs (six with a seminoma component), followed by immature teratomas (six), yolk sac tumors (three), embryonal carcinomas (two), pure seminomas (one), and postpubertal teratomas (one). The median interval between primary tumor diagnosis and diagnosis of fluid positivity was 7 months (range: 0–134 months). In nine cases, the malignant fluid was diagnosed simultaneously with or within 1 month of the primary tumor. GCT subtyping was performed on 23 of the 27 cytological specimens. Twenty-four patients (89%) also had metastases to other sites. Thirteen patients died of the disease (48%), with a median survival time of 4 months.
Conclusions
Metastatic GCTs in serous effusions and CSF are often associated with disseminated disease and poor prognosis. Subtyping can be performed by cytomorphology combined with immunohistochemistry.
{"title":"Metastatic germ cell tumors in serous cavities and cerebrospinal fluid: A single-center experience","authors":"Tieying Hou MD, PhD, Katrina Collins MD, Guohua Liang MD, PhD, Sheila E. Segura MD, Thomas M. Ulbright MD, Hector Mesa MD, PhD, Harvey M. Cramer MD","doi":"10.1002/cncy.22827","DOIUrl":"10.1002/cncy.22827","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metastatic germ cell tumors (GCTs) involving body cavity effusions and cerebrospinal fluid (CSF) are rare. Diagnosis is challenging because of limited morphological and clinicopathological information in the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A database search of our institution from 1990 to 2024 identified 27 cases of metastatic GCTs, comprising five pediatric and 22 adolescent and adult patients, in serous cavities or the CSF, including peritoneal (15), pleural (nine), CSF (two), and pericardial (one) fluid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The most common primary site was the testis (<i>n</i> = 10), followed by the ovaries (<i>n</i> = 7), mediastinum (<i>n</i> = 4), retroperitoneum (<i>n</i> = 3), pineal gland (<i>n</i> = 2), and sacrum/coccyx (<i>n</i> = 1). The primary tumors in 14 patients were mixed GCTs (six with a seminoma component), followed by immature teratomas (six), yolk sac tumors (three), embryonal carcinomas (two), pure seminomas (one), and postpubertal teratomas (one). The median interval between primary tumor diagnosis and diagnosis of fluid positivity was 7 months (range: 0–134 months). In nine cases, the malignant fluid was diagnosed simultaneously with or within 1 month of the primary tumor. GCT subtyping was performed on 23 of the 27 cytological specimens. Twenty-four patients (89%) also had metastases to other sites. Thirteen patients died of the disease (48%), with a median survival time of 4 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Metastatic GCTs in serous effusions and CSF are often associated with disseminated disease and poor prognosis. Subtyping can be performed by cytomorphology combined with immunohistochemistry.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 9","pages":"549-555"},"PeriodicalIF":2.6,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22827","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859874","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}
Barbara A. Centeno MD, Mauro Saieg MD, PhD, Momin T. Siddiqui MD, Miguel Perez-Machado MD, PhD, Lester J. Layfield MD, Birgit Weynand, Michelle D. Reid MD, Edward B. Stelow MD, Maria D. Lozano MD, PhD, Noriyoshi Fukushima MD, PhD, Ian A. Cree, Ravi Mehrotra MD, Fernando C. Schmitt MD, PhD, Andrew S. Field MBBS (Hons), Martha B. Pitman MD
The recently published WHO Reporting System for Pancreaticobiliary Cytopathology (World Health Organization [WHO] System) is an international approach to the standardized reporting of pancreaticobiliary cytopathology, updating the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSC System). Significant changes were made to the categorization of benign neoplasms, intraductal neoplasms, mucinous cystic neoplasms, and malignant neoplasms considered low grade. Benign neoplasms, such as serous cystadenoma, categorized as Neoplastic: benign in the PSC system, are categorized as Benign/negative for malignancy in the WHO system. Pancreatic neuroendocrine tumor, solid-pseudopapillary neoplasm, and gastrointestinal stromal tumor, categorized as Neoplastic: other in the PSC system, are categorized as Malignant in the WHO System in accord with their classification in the 5th edition WHO Classification of Digestive System Tumours (2019). The two new categories of Pancreaticobiliary Neoplasm Low-risk/grade and Pancreaticobiliary Neoplasm High-risk/grade are mostly limited to intraductal neoplasms and mucinous cystic neoplasms. Low-risk/grade lesions are mucinous cysts, with or without low-grade epithelial atypia. High-risk/grade lesions contain neoplastic epithelium with high-grade epithelial atypia. Correlation with clinical, imaging, and ancillary studies remains a key tenet. The sections for each entity are written to highlight key cytopathological features and cytopathological differential diagnoses with the pathologist working in low resource setting in mind. Each section also includes the most pertinent ancillary studies useful for the differential diagnosis. Sample reports are provided for each category. Finally, the book provides a separate section with risk of malignancy and management recommendations for each category to facilitate decision-making for clinicians.
最近出版的《世界卫生组织胰胆细胞病理学报告系统》（WHO Reporting System for Pancreaticobiliary Cytopathology）（世界卫生组织[WHO]系统）是胰胆细胞病理学标准化报告的国际方法，更新了帕氏细胞病理学协会的胰胆细胞病理学报告系统（PSC System）。该系统对良性肿瘤、导管内肿瘤、粘液性囊肿和低级别恶性肿瘤的分类做出了重大修改。良性肿瘤，如浆液性囊腺瘤，在 PSC 系统中被归类为 "肿瘤性：良性"，但在世卫组织系统中被归类为 "良性/恶性阴性"。胰腺神经内分泌肿瘤、实性假乳头状瘤和胃肠道间质瘤在PSC系统中归类为 "肿瘤性：其他"，在世卫组织系统中则归类为 "恶性"，与第五版《世卫组织消化系统肿瘤分类》（2019年）中的分类一致。胰胆管肿瘤低危/分级和胰胆管肿瘤高危/分级这两个新类别主要限于导管内肿瘤和粘液性囊肿。低危/分级病变为粘液性囊肿，伴有或不伴有低度上皮不典型性。高危/高级别病变含有肿瘤上皮，上皮不典型性高。与临床、影像学和辅助检查的相关性仍然是关键原则。每个实体的章节都突出了关键的细胞病理学特征和细胞病理学鉴别诊断，并考虑到了在低资源环境中工作的病理学家。每个部分还包括对鉴别诊断最有用的相关辅助研究。每个类别都提供了报告样本。最后，本书还提供了一个单独的部分，介绍恶性肿瘤的风险和每个类别的处理建议，以方便临床医生做出决策。
{"title":"The World Health Organization Reporting System for Pancreaticobiliary Cytopathology: Overview and Summary","authors":"Barbara A. Centeno MD, Mauro Saieg MD, PhD, Momin T. Siddiqui MD, Miguel Perez-Machado MD, PhD, Lester J. Layfield MD, Birgit Weynand, Michelle D. Reid MD, Edward B. Stelow MD, Maria D. Lozano MD, PhD, Noriyoshi Fukushima MD, PhD, Ian A. Cree, Ravi Mehrotra MD, Fernando C. Schmitt MD, PhD, Andrew S. Field MBBS (Hons), Martha B. Pitman MD","doi":"10.1002/cncy.22806","DOIUrl":"10.1002/cncy.22806","url":null,"abstract":"<p>The recently published <i>WHO Reporting System for Pancreaticobiliary Cytopathology</i> (World Health Organization [WHO] System) is an international approach to the standardized reporting of pancreaticobiliary cytopathology, updating the <i>Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology</i> (PSC System). Significant changes were made to the categorization of benign neoplasms, intraductal neoplasms, mucinous cystic neoplasms, and malignant neoplasms considered low grade. Benign neoplasms, such as serous cystadenoma, categorized as Neoplastic: benign in the PSC system, are categorized as Benign/negative for malignancy in the WHO system. Pancreatic neuroendocrine tumor, solid-pseudopapillary neoplasm, and gastrointestinal stromal tumor, categorized as Neoplastic: other in the PSC system, are categorized as Malignant in the WHO System in accord with their classification in the 5th edition WHO Classification of Digestive System Tumours (2019). The two new categories of Pancreaticobiliary Neoplasm Low-risk/grade and Pancreaticobiliary Neoplasm High-risk/grade are mostly limited to intraductal neoplasms and mucinous cystic neoplasms. Low-risk/grade lesions are mucinous cysts, with or without low-grade epithelial atypia. High-risk/grade lesions contain neoplastic epithelium with high-grade epithelial atypia. Correlation with clinical, imaging, and ancillary studies remains a key tenet. The sections for each entity are written to highlight key cytopathological features and cytopathological differential diagnoses with the pathologist working in low resource setting in mind. Each section also includes the most pertinent ancillary studies useful for the differential diagnosis. Sample reports are provided for each category. Finally, the book provides a separate section with risk of malignancy and management recommendations for each category to facilitate decision-making for clinicians.</p>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 7","pages":"396-418"},"PeriodicalIF":2.6,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862090","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>After a natural disaster, the danger is far from over for residents with health concerns, whether cancer or other conditions. An extreme event may disrupt access to shelter, food, and water while also destroying medications, health supplies, roads, and health care facilities. Because power and telecommunications are often knocked out, telehealth can be difficult or impossible.</p><p>Extreme events are not new hazards. With a hotter planet fueling stronger and more unpredictable storms, flooding, wildfires, and heatwaves, however, researchers are having to rethink how they approach disaster preparedness and response and risk communication for increasingly vulnerable communities. “The same people who are at risk of flooding also may live in a fenceline community where the flooding could cause the redistribution of chemical contaminants that could also impact their health,” says Jennifer Horney, PhD, a professor of epidemiology at the University of Delaware in Newark.</p><p>That dual risk was laid bare by the 2017 flooding of the heavily industrialized Houston Ship Canal and surrounding neighborhoods by Hurricane Harvey, says Dr Horney, a core faculty member of the University of Delaware’s Disaster Research Center. Access, safety concerns, and other pressure points can likewise be magnified by extreme events. “If you have housing that’s not safe or a lack of transportation, those things are really important in non-disaster times to your health, but they’re really, <i>really</i> important in disaster times,” Dr Horney says.</p><p>For patients with cancer, the need for specialized care can compound the threat. “When you think about it in the context of access to care and extreme weather events disrupting that access, access to cancer care is really critical,” says Eva Rawlings Parker, MD, assistant professor of dermatology at Vanderbilt University Medical Center in Nashville, Tennessee. “It’s one thing if you miss your routine physical and can reschedule that. It’s quite another thing if you miss your chemotherapy infusion: It can have much more significant consequences.”</p><p>A 2019 study led by researchers at the American Cancer Society found that hurricane disasters were associated with worse overall survival for patients with locally advanced non–small cell lung cancer who were undergoing daily radiotherapy.<span><sup>1</sup></span> The longer the disaster declaration was, the worse their survival was, for disasters lasting up to a month. Because even short radiotherapy delays can decrease lung cancer survival rates, the authors recommended that disaster mitigation planning include strategies for identifying at-risk patients with cancer, arranging for their transfer to other treatment centers, and eliminating out-of-network insurance charges.</p><p>The growing urgency to develop contingency plans could be aided by lessons learned from vulnerable facilities and populations, notes Leticia Nogueira, PhD, MPH, scientific director of health service
{"title":"Climate change is threatening access to cancer care","authors":"Bryn Nelson PhD, William Faquin MD, PhD","doi":"10.1002/cncy.22828","DOIUrl":"https://doi.org/10.1002/cncy.22828","url":null,"abstract":"<p>After a natural disaster, the danger is far from over for residents with health concerns, whether cancer or other conditions. An extreme event may disrupt access to shelter, food, and water while also destroying medications, health supplies, roads, and health care facilities. Because power and telecommunications are often knocked out, telehealth can be difficult or impossible.</p><p>Extreme events are not new hazards. With a hotter planet fueling stronger and more unpredictable storms, flooding, wildfires, and heatwaves, however, researchers are having to rethink how they approach disaster preparedness and response and risk communication for increasingly vulnerable communities. “The same people who are at risk of flooding also may live in a fenceline community where the flooding could cause the redistribution of chemical contaminants that could also impact their health,” says Jennifer Horney, PhD, a professor of epidemiology at the University of Delaware in Newark.</p><p>That dual risk was laid bare by the 2017 flooding of the heavily industrialized Houston Ship Canal and surrounding neighborhoods by Hurricane Harvey, says Dr Horney, a core faculty member of the University of Delaware’s Disaster Research Center. Access, safety concerns, and other pressure points can likewise be magnified by extreme events. “If you have housing that’s not safe or a lack of transportation, those things are really important in non-disaster times to your health, but they’re really, <i>really</i> important in disaster times,” Dr Horney says.</p><p>For patients with cancer, the need for specialized care can compound the threat. “When you think about it in the context of access to care and extreme weather events disrupting that access, access to cancer care is really critical,” says Eva Rawlings Parker, MD, assistant professor of dermatology at Vanderbilt University Medical Center in Nashville, Tennessee. “It’s one thing if you miss your routine physical and can reschedule that. It’s quite another thing if you miss your chemotherapy infusion: It can have much more significant consequences.”</p><p>A 2019 study led by researchers at the American Cancer Society found that hurricane disasters were associated with worse overall survival for patients with locally advanced non–small cell lung cancer who were undergoing daily radiotherapy.<span><sup>1</sup></span> The longer the disaster declaration was, the worse their survival was, for disasters lasting up to a month. Because even short radiotherapy delays can decrease lung cancer survival rates, the authors recommended that disaster mitigation planning include strategies for identifying at-risk patients with cancer, arranging for their transfer to other treatment centers, and eliminating out-of-network insurance charges.</p><p>The growing urgency to develop contingency plans could be aided by lessons learned from vulnerable facilities and populations, notes Leticia Nogueira, PhD, MPH, scientific director of health service","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 5","pages":"266-267"},"PeriodicalIF":3.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140817269","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":"Is molecular testing of salivary gland FNA specimens ready for prime time?","authors":"Marc P. Pusztaszeri MD","doi":"10.1002/cncy.22825","DOIUrl":"10.1002/cncy.22825","url":null,"abstract":"","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 7","pages":"393-395"},"PeriodicalIF":2.6,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140810875","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}
This study conducts the first meta-analysis to assess the aggregated risk of malignancy associated with each category of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) for reporting serous effusion cytology, while also evaluating diagnostic accuracy. PubMed/MEDLINE and Embase were systematically searched using the keywords “(pleural, peritoneal, and pericardial effusions) AND (serous effusion cytology) OR (International System for Reporting Serous Fluid Cytopathology)”. Articles underwent risk of bias assessment using the QUADAS-2 tool. After excluding inadequate samples, a meta-analysis determined sensitivity and specificity for different cutoff points, including "atypical considered positive," "suspicious of malignancy considered positive," and "malignant considered positive." Summary receiver operating characteristic curves assessed diagnostic accuracy, and the diagnostic odds ratio was pooled. Sixteen retrospective cross-sectional studies, totaling 19,128 cases, were included. Sensitivity and specificity for the “atypical and higher risk categories” considered positive were 77% (95% confidence interval [CI], 68%–84%) and 95% (95% CI, 93%–97%) respectively. For the “suspicious for malignancy and higher risk categories” considered positive, sensitivity and specificity were 57% (95% CI, 49%–65%) and 100% (95% CI, 99%–100%) respectively. Sensitivity and specificity for the “malignant” category considered positive for malignancy were 70% (95% CI, 60%–77%) and 99% (95% CI, 98%–99%), respectively. The pooled area under the curve ranged from 85% to 89.5% for each cutoff. This meta-analysis underscores the ISRSFC's accuracy in reporting serous fluid cytology. It emphasizes the diagnostic importance of the "suspicious" and "malignant" categories in identifying malignancy, and the role of the "benign" category in ruling out malignancy.
{"title":"Diagnostic accuracy of International System for Reporting Serous Fluid Cytopathology: A systematic review and meta-analysis in malignancy diagnosis","authors":"Sana Ahuja MD, Rhea Ahuja MD, Shivam Pandey PhD, Sufian Zaheer MD","doi":"10.1002/cncy.22822","DOIUrl":"10.1002/cncy.22822","url":null,"abstract":"<p>This study conducts the first meta-analysis to assess the aggregated risk of malignancy associated with each category of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) for reporting serous effusion cytology, while also evaluating diagnostic accuracy. PubMed/MEDLINE and Embase were systematically searched using the keywords “(pleural, peritoneal, and pericardial effusions) AND (serous effusion cytology) OR (International System for Reporting Serous Fluid Cytopathology)”. Articles underwent risk of bias assessment using the QUADAS-2 tool. After excluding inadequate samples, a meta-analysis determined sensitivity and specificity for different cutoff points, including \"atypical considered positive,\" \"suspicious of malignancy considered positive,\" and \"malignant considered positive.\" Summary receiver operating characteristic curves assessed diagnostic accuracy, and the diagnostic odds ratio was pooled. Sixteen retrospective cross-sectional studies, totaling 19,128 cases, were included. Sensitivity and specificity for the “atypical and higher risk categories” considered positive were 77% (95% confidence interval [CI], 68%–84%) and 95% (95% CI, 93%–97%) respectively. For the “suspicious for malignancy and higher risk categories” considered positive, sensitivity and specificity were 57% (95% CI, 49%–65%) and 100% (95% CI, 99%–100%) respectively. Sensitivity and specificity for the “malignant” category considered positive for malignancy were 70% (95% CI, 60%–77%) and 99% (95% CI, 98%–99%), respectively. The pooled area under the curve ranged from 85% to 89.5% for each cutoff. This meta-analysis underscores the ISRSFC's accuracy in reporting serous fluid cytology. It emphasizes the diagnostic importance of the \"suspicious\" and \"malignant\" categories in identifying malignancy, and the role of the \"benign\" category in ruling out malignancy.</p>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 10","pages":"609-620"},"PeriodicalIF":2.6,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140570096","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}
Atypical squamous cells (ASC) in urine cytology are rarely found, and their clinical significance is not well studied. Previous studies were limited by a small number of cases and a lack of objective grading of ASC and/or their correlation with accompanying urothelial cell abnormality (UCA).
Methods
The institutional database was searched over 10 years for urine cytology reports containing ASC or from patients who had a concurrent diagnoses of high-grade (HG) urothelial carcinoma with squamous differentiation or squamous carcinoma. ASC were defined as keratinized squamous cells and were subcategorized as reactive, koilocytosis, low-grade (LG) atypia, and HG atypia. Correlations with age, sex, specimen type, accompanying UCA, number of ASC, and the risk of HG malignancy (ROHM) were assessed.
Results
ASC were present in 0.15% of all urine specimens (123 of 81,018). Slides and clinical follow-up were available on 91 patients (median age, 71 years). LG and HG squamous atypia had ROHMs of 70% and 92%, respectively. ASC not accompanied and accompanied by UCA had ROHMs of 37% and 94%, respectively. Most malignancies (34 of 67; 51%) showed rare ASC in urine. Reactive changes and koilocytosis had 0% ROHM.
Conclusions
ASC in urine cytology is a significant finding and is associated with a high ROHM. In the absence of accompanying UCA, LG squamous atypia had a lower ROHM than HG atypia. In the presence of UCA, LG and HG squamous atypia had ROHMs of over 90%. These findings suggest that ASC and their grade of atypia should be noted in the cytology report, and clinicians should be made aware of their clinical significance.
{"title":"Atypical squamous cells in urine cytology are associated with a significant risk of high-grade malignancy","authors":"Linh Ho MD, Tarik M. Elsheikh MD","doi":"10.1002/cncy.22816","DOIUrl":"10.1002/cncy.22816","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atypical squamous cells (ASC) in urine cytology are rarely found, and their clinical significance is not well studied. Previous studies were limited by a small number of cases and a lack of objective grading of ASC and/or their correlation with accompanying urothelial cell abnormality (UCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The institutional database was searched over 10 years for urine cytology reports containing ASC or from patients who had a concurrent diagnoses of high-grade (HG) urothelial carcinoma with squamous differentiation or squamous carcinoma. ASC were defined as keratinized squamous cells and were subcategorized as reactive, koilocytosis, low-grade (LG) atypia, and HG atypia. Correlations with age, sex, specimen type, accompanying UCA, number of ASC, and the risk of HG malignancy (ROHM) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ASC were present in 0.15% of all urine specimens (123 of 81,018). Slides and clinical follow-up were available on 91 patients (median age, 71 years). LG and HG squamous atypia had ROHMs of 70% and 92%, respectively. ASC not accompanied and accompanied by UCA had ROHMs of 37% and 94%, respectively. Most malignancies (34 of 67; 51%) showed rare ASC in urine. Reactive changes and koilocytosis had 0% ROHM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ASC in urine cytology is a significant finding and is associated with a high ROHM. In the absence of accompanying UCA, LG squamous atypia had a lower ROHM than HG atypia. In the presence of UCA, LG and HG squamous atypia had ROHMs of over 90%. These findings suggest that ASC and their grade of atypia should be noted in the cytology report, and clinicians should be made aware of their clinical significance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 8","pages":"499-509"},"PeriodicalIF":2.6,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22816","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140570008","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}
Henri Lagerstam BMed, David Kalfert MD, PhD, Zahra Maleki MD, MIAC, Ivana Kholová MD, PhD, MIAC
Background
The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is widely accepted and endorsed by professional societies. Although several studies focusing on the MSRSGC have been published, few have been prospective studies. The objective of this study was to evaluate the effectiveness of the MSRSGC in cytopathology practice.
Methods
A comprehensive literature search was conducted to identify all prospective studies on the MSRSGC. The risk of malignancy (ROM), risk of neoplasm, and diagnostic accuracy for each diagnostic category were calculated. Data were tabulated in Microsoft Excel, and analyses were performed with the Open Meta-Analyst program.
Results
Seven prospective and seven retrospective studies were identified. The total number of fine-needle aspirations (FNAs) was 1587 in the prospective studies and 1764 in the retrospective studies. The ROM values for the nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories in prospective versus retrospective studies were 21.0% versus 26.6%, 9.4% versus 8.1%, 34.9% versus 39.6%, 2.4% versus 2.1%, 36.6% versus 31.2%, 86.0% versus 66.0%, and 97.0% versus 96.7%, respectively. Sensitivities, specificities, and diagnostic odds ratios were 83.1% (95% confidence interval [CI], 71.1%–90.8%) versus 89.1% (95% CI, 83.6%–92.9%), 98.4% (95% CI, 96.6%–99.3%) versus 94.9% (95% CI, 91.9%–96.9%), and 310.7 (95% CI, 121.2–796.6) versus 218.8 (95% CI, 107.3–438.1).
Conclusions
This meta-analysis indicated that the MSRSGC works well in FNA cytopathology practice and improves diagnostic accuracy in all diagnostic categories. The ROMs of prospective studies were in concordance with the MSRSGC reference values.
{"title":"How the Milan System for Reporting Salivary Gland Cytopathology works in cytopathology practice: Meta-analysis of prospective studies and comparison with retrospective studies","authors":"Henri Lagerstam BMed, David Kalfert MD, PhD, Zahra Maleki MD, MIAC, Ivana Kholová MD, PhD, MIAC","doi":"10.1002/cncy.22815","DOIUrl":"10.1002/cncy.22815","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is widely accepted and endorsed by professional societies. Although several studies focusing on the MSRSGC have been published, few have been prospective studies. The objective of this study was to evaluate the effectiveness of the MSRSGC in cytopathology practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted to identify all prospective studies on the MSRSGC. The risk of malignancy (ROM), risk of neoplasm, and diagnostic accuracy for each diagnostic category were calculated. Data were tabulated in Microsoft Excel, and analyses were performed with the Open Meta-Analyst program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven prospective and seven retrospective studies were identified. The total number of fine-needle aspirations (FNAs) was 1587 in the prospective studies and 1764 in the retrospective studies. The ROM values for the nondiagnostic, nonneoplastic, atypia of undetermined significance, benign neoplasm, salivary gland neoplasm of uncertain malignant potential, suspicious for malignancy, and malignant categories in prospective versus retrospective studies were 21.0% versus 26.6%, 9.4% versus 8.1%, 34.9% versus 39.6%, 2.4% versus 2.1%, 36.6% versus 31.2%, 86.0% versus 66.0%, and 97.0% versus 96.7%, respectively. Sensitivities, specificities, and diagnostic odds ratios were 83.1% (95% confidence interval [CI], 71.1%–90.8%) versus 89.1% (95% CI, 83.6%–92.9%), 98.4% (95% CI, 96.6%–99.3%) versus 94.9% (95% CI, 91.9%–96.9%), and 310.7 (95% CI, 121.2–796.6) versus 218.8 (95% CI, 107.3–438.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This meta-analysis indicated that the MSRSGC works well in FNA cytopathology practice and improves diagnostic accuracy in all diagnostic categories. The ROMs of prospective studies were in concordance with the MSRSGC reference values.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 7","pages":"447-457"},"PeriodicalIF":2.6,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140570000","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}
The atypia of undetermined significance (AUS) category is heterogeneous, leading to variations in its use. To prevent excessive usage, the AUS rate should be ≤10%. Although this recommendation aims to maintain diagnostic quality, it lacks supporting data. The AUS:Malignant (AUS:M) ratio has been proposed as a metric tool to evaluate AUS use. Furthermore, integrating ThyroSeq v3 (TSV3) positive call rate (PCR) and the molecular-derived risk of malignancy (MDROM) have been put forward as performance improvement tools. The authors reviewed their AUS:M ratios, TSV3 PCR, MDROM, and ROM.
Methods
Thyroid aspirates evaluated in the laboratory (from August 2022 to September 2023) by seven cytopathologists (CPs) were identified. AUS:M ratio, MDROM, ROM, and TSV3 PCR results for the laboratory and each CP were recorded and analyzed.
Results
A total of 2248 aspirates were identified (462 AUS and 80 malignant). The AUS:M ratio for the laboratory was 5.8 (CPs range, 2.8 to 7.3). The TSV3 PCR for the laboratory was 23% (CPs range, 11% to 41%). The MDROM for the laboratory was 19% (CPs range, 9% to 31%), whereas the ROM was 36% (CPs range, 29% to 50%). Linear regression analysis of AUS:M ratio versus TSV3 PCR and MDROM demonstrated a moderate positive correlation but a weak negative correlation to the ROM. Deviations from established targets were attributed to multiple factors.
Conclusion
The findings of this study underscore the importance of using a combination of metrics to evaluate diagnostic practices. By dissecting the practice patterns of each CP, the authors can measure different aspects of their performance and provide individualized feedback.
{"title":"Exploring the atypia of undetermined significance: Malignant ratio, ThyroSeq v3 positive call rate, molecular-derived risk of malignancy, and risk of malignancy as possible quality metric tools in thyroid cytology","authors":"Jaylou M. Velez Torres MD, Porshya M. Curnow CT, ASCP, Youley Tjendra MD, Merce Jorda MD, Carmen Gomez Fernandez MD, Monica Garcia Buitrago MD, Yiqin Zuo MD, Roberto Ruiz Cordero MD","doi":"10.1002/cncy.22820","DOIUrl":"10.1002/cncy.22820","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The atypia of undetermined significance (AUS) category is heterogeneous, leading to variations in its use. To prevent excessive usage, the AUS rate should be ≤10%. Although this recommendation aims to maintain diagnostic quality, it lacks supporting data. The AUS:Malignant (AUS:M) ratio has been proposed as a metric tool to evaluate AUS use. Furthermore, integrating ThyroSeq v3 (TSV3) positive call rate (PCR) and the molecular-derived risk of malignancy (MDROM) have been put forward as performance improvement tools. The authors reviewed their AUS:M ratios, TSV3 PCR, MDROM, and ROM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thyroid aspirates evaluated in the laboratory (from August 2022 to September 2023) by seven cytopathologists (CPs) were identified. AUS:M ratio, MDROM, ROM, and TSV3 PCR results for the laboratory and each CP were recorded and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2248 aspirates were identified (462 AUS and 80 malignant). The AUS:M ratio for the laboratory was 5.8 (CPs range, 2.8 to 7.3). The TSV3 PCR for the laboratory was 23% (CPs range, 11% to 41%). The MDROM for the laboratory was 19% (CPs range, 9% to 31%), whereas the ROM was 36% (CPs range, 29% to 50%). Linear regression analysis of AUS:M ratio versus TSV3 PCR and MDROM demonstrated a moderate positive correlation but a weak negative correlation to the ROM. Deviations from established targets were attributed to multiple factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings of this study underscore the importance of using a combination of metrics to evaluate diagnostic practices. By dissecting the practice patterns of each CP, the authors can measure different aspects of their performance and provide individualized feedback.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 8","pages":"491-498"},"PeriodicalIF":2.6,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22820","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602952","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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