Cancer Cytopathology最新文献

After decades of aggressive cancer treatments, multiple studies have forced a reckoning of overtreatment for low-risk prostate, cervical, breast, and other cancers. Some studies of patients with low-risk prostate cancer managed by active surveillance, for example, have reported 10-year prostate cancer-specific survival rates of nearly 100%. A 2015 study, by contrast, found that of roughly 3000 men who had a life expectancy of less than 10 years and were diagnosed with low-risk prostate cancer, 67% had been overtreated.¹ In addition to averting the harm of increased treatment-related genitourinary and gastrointestinal toxicity, the authors wrote that “the ability to avoid treating the 80% of men with lowgrade disease who will never die of prostate cancer would save $1.32 billion per year nationally.”

Just as costly preventive care can lead to potential undertreatment and poor patient outcomes by undermining screening access and follow-up, overtreatment without clear evidence of benefits can contribute to avoidable harms and unnecessary costs for the US health care system.

The studies documenting continued overtreatment, however, raise important questions about whether such care is necessarily inappropriate in all cases and whether researchers have the tools needed to make that distinction. Researchers who spoke with CytoSource said that the decision-making often comes down to subjective judgment calls based in part on incomplete medical records, a lack of reliable risk stratification, limited high-quality imaging, conflicting guidelines, and strong patient preference. “This is the art of medicine, which is not very scientific,” says Sylvia L. Asa, MD, PhD, a professor of pathology at Case Western Reserve University in Cleveland, Ohio. “We’re not there yet.”

The ongoing controversy over how best to manage low-risk thyroid cancer offers one cautionary tale about the difficulty of finding the right balance. Dr Asa, for example, has found small incidental cancers in up to 24% of patients’ surgically resected thyroid glands. “They are very common,” she says. “They are readily accessible. People have palpation of their neck, we find something, they do an ultrasound, what we find clinically is probably completely irrelevant, but a small incidental cancer is identified and then panic ensues.”

On the basis of a diagnosis of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), patients routinely underwent total thyroidectomy and received radioactive iodine as treatments. The treatments can offer clear benefits to patients with aggressive cancers but not to patients with low-risk disease, and neither intervention is risk-free. “The problem I worry about is that this is a disease of young people,” Dr Asa says. “We’re giving radiation to young people, many of whom are still planning to have a family and we say it’s safe, but let’s just say if it were my daughter or my son, I really w

The use of standardized reporting systems for non-gynecologic cytopathology has made enormous gains in popularity during the past decade, including for thyroid fine-needle aspiration, urine cytology, serous effusions, pancreas, lymph nodes, lung, and more. In February 2018, the first edition Atlas of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was published. The MSRSGC defines six diagnostic fine-needle aspiration categories encompassing the spectrum of non-neoplastic, benign, and malignant lesions of the salivary glands. The goal of the MSRSGC is to combine each diagnostic category with a defined risk of malignancy and a specific clinical and/or surgical management algorithm. Since its initial publication in 2018, more than 200 studies and commentaries have been published confirming the role of the MSRSGC. The second edition of the MSRSGC, published in July 2023, includes refined risks of malignancy based on systematic reviews and meta-analyses, a new chapter summarizing the use of salivary gland imaging, new advances in ancillary testing, and updates in nomenclature.

Biopsy of benign and low-risk tumors of the kidney can be grouped into three distinct categories with different levels of risk, and the suggested diagnoses of these tumors should be tailored to their respective category.