Cancer Cytopathology最新文献

Because of many factors, the landscape of cervical cancer prevention is again at a pivot point within the United States. Primary human papillomavirus (HPV) screening has been recommended as the preferred testing method by the American Cancer Society since 2020. Although primary HPV testing provides high negative predictive value in screening, women who screen positive for HPV need triage using methods that have an optimal balance between sensitivity for precancer and the number of colposcopies required for detection. The triage test ideally should maximize specificity while also reassuring patients who test negative, although it should be acknowledged that no screening or triage test can entirely exclude disease in a screen-positive patient. While cervical cytology (the Papanicolaou test) triage of primary HPV screen-positive patients is currently recommended by most screening strategies, additional triage tests, specifically extended HPV genotyping and combined p16/Ki-67 dual-stain immunocytochemistry, are now approved by the US Food and Drug Administration and incorporated into cervical cancer screening and management guidelines. Incorporating these triage methods into practice should be achieved by using appropriate validation/verification and implementation steps and, in the case of dual-stain immunocytochemistry, appropriate cytologist/cytopathologist training. The US Food and Drug Administration approval of vaginal self-collection in May 2024 is another significant advance for increasing access to screening. These samples can only be tested using primary HPV screening platforms, and guidance for management has been endorsed by the ASCCP's enduring guidelines process. This review discusses issues that warrant consideration before implementation and provides practical guidance for the incorporation of self-collected specimens and extended genotyping/dual-stain tests into the workflow of the cytopathology laboratory.

Physicians have long observed that patients who have cancer and are also malnourished are more likely to die. Beyond making treatments less effective and more toxic, malnutrition can reduce a patient’s functional abilities and quality of life while increasing the risk of complications. For many decades, however, the surprisingly common and largely unresolved phenomenon of malnutrition in patients with cancer was seen as an inevitability.

Jann Arends, MD, a gastroenterologist, hematologist, and medical oncologist at the University of Freiburg in Germany, says that weight loss and emaciation were once taken for granted as a standard feature of intractable cancers. “Most cancers would not respond to even aggressive anticancer treatments, and weight loss was seen as a harbinger of death and not as a condition requiring supportive care,” Dr Arends says.

That mindset further solidified, he says, when clinical trials testing routine artificial nutrition (delivered via feeding tubes or intravenous lines) yielded no discernable benefits for patients but higher complication rates than oral feeding. In response, the American Society for Parenteral and Enteral Nutrition recommended not using artificial nutrition to treat patients with cancer and thus furthered what Dr Arends calls “nutritional nihilism in an age of only rare oncological success.”

As cancer treatment successes have multiplied during the past 15 years, however, more research has helped to change recommendations, refine the benefits and limitations of nutritional care in patients, and provide better estimates of just how common malnutrition can be.

One eye-opening 2014 study of approximately 1900 patients with cancer in 154 hospitals throughout France found that 39% were malnourished, including more than 60% of patients diagnosed with pancreatic, esophageal, or stomach cancer.¹

Although malnutrition rates tend to be higher in hospitalized patients, the condition also is common even in newly diagnosed patients. In 2017, the Prevalence of Malnutrition in Oncology study in Italy sought to get a better view of the nutritional status of adult patients at their first visit to a medical oncology center after being diagnosed with a solid tumor.² Conducted at 22 centers across the country, the observational study enrolled nearly 2000 patients. Oncologists used several scales, including the Mini Nutritional Assessment, to assess the patients for signs of nutritional impairment.

Collectively, they found that 51% of the patients had a nutritional impairment, 9% were overtly malnourished, and 43% were at risk for malnutrition. More than 40% had anorexia, or an abnormal loss of appetite, while 64% had lost weight during the previous 6 months. The results, the authors asserted, supported a “call to action” for oncologists to be more aware of the significant risk of malnutrition, even in patients with nonmetastatic cancer, a