Process improvement in thyroid fine needle aspiration: Standardizing number of smears for enhanced adequacy and diagnosis.

Fine-needle aspiration (FNA) is a safe, cost-effective diagnostic procedure used in the evaluation of thyroid nodules. The number of thyroid FNAs has dramatically increased over the past few years. In the absence of standardized procedures regarding the number of needle passes needed for diagnosis and the lack of clarity on the use of conventional smears (CS) versus liquid-based preparations (LBP), the demand of thyroid FNAs has led to increased workload on cytology laboratories, which can negatively affect patient safety.

Is Fragmentation of Prostate Core Biopsies Inevitable? A Quality Improvement Initiative.

Context.—: Core biopsies are standard of care for diagnosis and surveillance of prostate cancer. Fragmentation makes numeric assessment of cancer challenging and increases risk of inaccurate staging with direct implications on management.

Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology.

Context.—: The Paris System for Reporting Urinary Cytology has been disseminated since its inception in 2013; however, the daily practice patterns of urinary tract cytopathology are not well known.

Objective.

High grade squamous intraepithelial lesion on high-risk HPV negative patients: Why we still need the Pap test.

Background: Cervical cancer is caused by high-risk human papillomavirus (hrHPV). Though screening Pap test (PT) has reduced cancer mortality by detecting precursor lesions, there is now a move toward replacing screening PT with hrHPV testing. The aims of this study were to determine hrHPV negative rate in high grade squamous intraepithelial lesion (HSIL) PT in high-risk patients and correlate with histopathology; and to review the hrHPV negative HSIL PT.

Touch imprint (TI) cytology of needle core biopsies (NCB) in pathology laboratories: A practice survey of participants in the College of American Pathologists (CAP) Non Gynecologic Cytopathology (NGC) Education Program.

Background: Intra-procedural assessment of touch imprint (TI) cytology from needle core biopsies (NCB) is used to ensure sample adequacy and to provide immediate diagnosis in various settings. We aimed to survey laboratories for current practices on the use of cytology with NCB.

Methods: A voluntary supplemental questionnaire including questions on demographics, personnel involved, sites, accessioning, and reporting was sent with the College of American Pathologists (CAP) 2015 Non gynecologic Cytopathology Education Program to survey practices of cytologic assessment of NCB.

Twelve tips for the introduction of emotional intelligence in medical education.

Emotional intelligence (EI) is the ability to recognize, understand, and manage emotions in yourself and in others. EI has long been recognized as a critical component for individual and organizational success within the business realm, and there is emerging evidence that enhancing EI is equally important in the medical setting. EI can improve interpersonal communications, enable constructive conflict resolution, and promote a culture of professionalism.

Indeterminate diagnoses in EUS-guided FNA of the pancreas: analysis of cytologist and clinician perceptions, cytologic features, and clinical outcomes.

Introduction: Indeterminate "atypical" or "suspicious for malignancy" diagnoses in the evaluation of pancreatic fine-needle aspiration (FNA) specimens can present challenges in the clinical management of patients with pancreatic masses. A main goal of this study was to identify, via survey, potential differences in perception between cytologists and clinicians with regard to the implications of, and factors contributing to, indeterminate diagnoses. We also evaluated clinical practice at our institution as it relates to such diagnoses and identified clinicopathologic features associated with indeterminate diagnoses, which allowed for correlation with survey results.

For diagnosis of liver masses, fine-needle aspiration versus needle core biopsy: which is better?

Introduction: Both fine needle aspiration (FNA) and needle core biopsy (NCB) are widely accepted methods for obtaining diagnostic material. There is variability in how different institutions use these techniques in assessing liver masses. The aim of this study is to compare the diagnostic accuracy and tissue quality between FNA and NCB, and create a cost-effective algorithm for evaluating liver masses.

Reproducibility of atypia of undetermined significance/follicular lesion of undetermined significance category using the bethesda system for reporting thyroid cytology when reviewing slides from different institutions: A study of interobserver variability among cytopathologists.

Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) offers a six-tiered diagnostic scheme for thyroid Fine Needle Aspiration (FNA): Benign, Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS), suspicious for follicular neoplasm, suspicious for malignancy, malignant, and unsatisfactory with an aim to standardize diagnostic criteria. Reported rate of AUS/FLUS category in the literature has varied from 3% to 20.5%.

Improving Adequacy of Small Biopsy and Fine-Needle Aspiration Specimens for Molecular Testing by Next-Generation Sequencing in Patients With Lung Cancer: A Quality Improvement Study at Dartmouth-Hitchcock Medical Center.

Context: - At our medical center, cytopathologists perform rapid on-site evaluation for specimen adequacy of fine-needle aspiration and touch imprint of needle core biopsy lung cancer samples. Two years ago the molecular diagnostics laboratory at our institution changed to next-generation sequencing using the Ion Torrent PGM and the 50-gene AmpliSeq Cancer Hotspot Panel v2 for analyzing mutations in a 50-gene cancer hot spot panel. This was associated with a dramatic fall in adequacy rate (68%).

A case of S-100 negative melanoma: A diagnostic pitfall in the workup of a poorly differentiated metastatic tumor of unknown origin.

When confronted with a metastatic poorly differentiated tumor of unknown origin, the initial workup includes the standard panel of immunostains to rule out carcinoma, sarcoma, lymphoma, and the greatest mimicker in pathology - malignant melanoma. Although not specific, the S-100 protein is expressed in over 95% of malignant melanomas. Herein, we present a case of multiorgan metastatic malignancy with a dominant hilar and mediastinal mass in a current smoker; clinically, highly suggestive of widespread primary lung cancer.

Genomic characterization of patient-derived xenograft models established from fine needle aspirate biopsies of a primary pancreatic ductal adenocarcinoma and from patient-matched metastatic sites.

N-of-1 trials target actionable mutations, yet such approaches do not test genomically-informed therapies in patient tumor models prior to patient treatment. To address this, we developed patient-derived xenograft (PDX) models from fine needle aspiration (FNA) biopsies (FNA-PDX) obtained from primary pancreatic ductal adenocarcinoma (PDAC) at the time of diagnosis. Here, we characterize PDX models established from one primary and two metastatic sites of one patient.

An analysis of human papillomavirus testing and endocervical component on pap tests: A pilot study using the Roche Cobas(®) assay.

Introduction: HPV is known to have a predilection for infecting the transformation zone (TZ). Endocervical cells (EC) on a Pap test (PT) indicate that the cervical TZ has been sampled. Earlier repeat testing of women lacking EC is of little value in further detecting disease, thus a sample without EC is not necessarily inadequate.

Trends in Cervical Cytology Screening and Reporting Practices: Results From the College of American Pathologists 2011 PAP Education Supplemental Questionnaire.

Context: The College of American Pathologists periodically surveys laboratories to determine changes in cytopathology practices. We report the results of a 2011 gynecologic cytology survey.

Objective: To provide a cross-sectional survey of gynecologic cytology practices in 2010.

Glioblastoma multiforme with epithelial differentiation: a potential diagnostic pitfall in cerebrospinal fluid cytology.

Cerebrospinal fluid (CSF) cytology provides valuable diagnostic and prognostic information for diseases of the central nervous system (CNS) and remains the gold standard for the detection of neoplastic meningitis. Metastatic involvement of the CSF by non-CNS neoplasms far surpasses that of primary brain tumors, although conventional glioblastoma multiforme (GBM) can occasionally be identified in the CSF. GBM with epithelial differentiation is an uncommon variant that may contain features such as adenoid structures, signet ring cells, or squamous metaplasia.

Pancreatic fine-needle aspiration cytopathology: an analysis of the CAP NGC program for pancreatic FNA 2003-2011.

Introduction: The College of American Pathologists monitors quality in cytologic analysis in its nongynecologic cytology sample program. We report the performance of participating laboratories in pancreatic fine-needle aspiration sample analysis.

Materials And Methods: We evaluated 23,079 responses to 392 pancreatic fine-needle aspiration slide challenges that were collected between January 6, 2003 and December 31, 2011.

Nongynecologic cytology practice patterns: a survey of participants in the College of American Pathologists interlaboratory comparison program in nongynecologic cytopathology.

Context: Nongynecologic cytology (NGC) practices are expected to expand relative to gynecologic cytology. The College of American Pathologists attempts to track practice patterns in NGC using a self-reported questionnaire.

Objective: To analyze self-reported laboratory staffing and practices from a 2010 survey relating to NGC specimens, stains, preparation, procedures, and ancillary testing.

Immunohistochemistry practices of cytopathology laboratories: a survey of participants in the College of American Pathologists Nongynecologic Cytopathology Education Program.

Context: Immunohistochemistry (IHC) is important for cytology but poses special challenges because preanalytic conditions may differ from the conditions of IHC-positive controls.

Objective: To broadly survey cytology laboratories to quantify preanalytic platforms for cytology IHC and identify problems with particular platforms or antigens. To discover how validation guidelines for HER2 testing have affected cytology.

Implementation of telecytology for immediate assessment of endoscopic ultrasound-guided fine-needle aspirations compared to conventional on-site evaluation: analysis of 240 consecutive cases.

Objective: To evaluate the implementation of telecytology in an academic cytology service for immediate assessment of endoscopic ultrasound (EUS) and endobronchoscopic ultrasound (EBUS) fine-needle aspiration (FNA).

Study Design: Telecytology was evaluated over a 10-month period. Using an Olympus BX41(®) microscope and an Olympus DP72(®) camera with Olympus cellSens(®) software, real-time dynamic images of air-dried Diff-Quik(®)-stained smears were transmitted by a cytopathology fellow or cytotechnologist using a secure internet connection.

Cytomorphologic features of advanced lung adenocarcinomas tested for EGFR and KRAS mutations: a retrospective review of 50 cases.

Associations between bronchioloalveolar carcinoma (BAC), mucinous differentiation, and epidermal growth factor receptor (EGFR) and KRAS mutations have been previously reported in studies of surgical specimens. We present the cytomorphology of lung adenocarcinomas, including metastases that were diagnosed by cytologic methods and the relationship to both EGFR and KRAS mutational status. We retrospectively reviewed the clinical and cytomorphologic features of 50 lung adenocarcinomas that were tested for both EGFR and KRAS mutations.

Quality improvement by standardization of procurement and processing of thyroid fine-needle aspirates in the absence of on-site cytological evaluation.

Background: Thyroid nodules are relatively common and are routinely evaluated by fine-needle aspiration cytology, usually performed by clinicians. We noticed qualitative and/or quantitative variability in samples submitted to the cytopathology laboratory from clinicians, for example, the number of glass slides submitted (2-25) and air-dried smears versus alcohol-fixed slides, with variability in specimen adequacy and interpretability. The objective of this study was to standardize the preanalytic variables to determine if there is an improvement in the specimen quality.

Patient misidentification in Papanicolaou tests: a systems-based approach to reducing errors.

Context: Patient safety is of prime concern in every laboratory. Double labeling of glass slides is performed in many cytology laboratories where handwritten patient information on the frosted portion of the glass is overlaid with paper labels (sometimes containing bar codes). The cytotechnologists match this information by turning slides over.

Histopathological features of the terminal ileum in lymphocytic and collagenous colitis: a study of 32 cases and review of literature.

Biopsy specimens from the terminal ileum of 32 patients with the histopathological diagnosis of lymphocytic colitis or collagenous colitis and 11 control individuals were evaluated for the presence or absence of ileal mucosal abnormalities and for the number of intraepithelial lymphocytes, assessed by immunohistochemical stains for the pan T-cell marker, CD3. We found that the mean CD3 counts in patients with lymphocytic/collagenous colitis were significantly higher than those in the control group. Seven of 14 patients with collagenous colitis and 14 of 18 patients with lymphocytic colitis revealed an increase in intraepithelial T lymphocytes when compared with the control group (P =.