Selective screening for nongynecologic cytology specimens: modifying the screening process for improved efficiency and practice.

Nongynecologic (NG) cytology cases usually generate multiple slides. In cases showing overtly malignant or neoplastic cells, the cytotechnologist (CT) may not need to screen all slides. We test the hypothesis that selective screening of a subset of slides by the CT is as effective as "routine screening" of all slides. The selective screening process (SSP) was performed by having the cytotechnologist (CT) screen and mark overtly malignant or neoplastic cells on up to three slides. Cases requiring more slides to be screened were not included in SSP. For each SSP case, the total slide count, number of slides screened, final diagnosis, and cytologic-histologic correlation (CHC) data were collected over 10 months and compared to the data from routinely screened cases. SSP was performed on 191 cases during a 10-month period. An average of 1.9 slides per case was screened by the cytotechnologist using the SSP. The average number of unscreened slides passed to the pathologist was 6.3 per case. On average, SSP resulted in 83.6 min of CT's time saved per day. Quality control by CHC demonstrated no false-positive cases in either the SSP or "routinely screened" groups. The diagnostic accuracy of the specific cytology diagnoses was 98% by SSP and 100% by "routine screening." SSP provides a mechanism for the cytotechnologist to "screen" fewer slides and pass the cases to the pathologist more efficiently without compromising overall patient care.

Fine needle aspiration biopsy of renal mucinous tubular and spindle cell carcinoma: report of two cases.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare renal tumor. Here we report two cases of MTSCC which were initially evaluated by fine needle aspiration biopsy (FNAB) and followed by surgical resection of the tumors. The cytomorphologic features of MTSCC were characterized by aggregates of relatively uniform, predominantly oval to spindle cells intermixed with abundant metachromatic myxoid matrix. Only rare epithelioid tumor cells with vacuolated cytoplasm were present. Immunohistochemically, the tumor cells were positive for CK7, CK19, CD10, vimentin, E-cadherin, alpha-methyl CoA racemase, and negative for CK903 and CK20. EMA and carbonic anhydrase IX immunoreactivity was seen in one of the two cases. Multiple chromosomal losses involving chromosomes 1, 2, 17 and likely chromosome 7 were revealed by fluorescence in situ hybridization (FISH). These cytomorphologic, immunophenotypic, and cytogenetic features were helpful for including this entity in the differential diagnosis of renal cell carcinomas.