Resident training in interventional pathology: Ultrasound-guided fine-needle aspiration and rapid on site evaluation-5 years of teaching experience in a single university hospital.

INTRODUCTION: Despite the established role of the interventional pathologist, their diagnostic performance is difficult to establish. At least in Spain training of pathology residents in ultrasound-guided interventional procedures for specimen collection is limited or absent in most institutions. We present our teaching experience in the instruction of ultrasound-guided fine-needle aspiration (FNA) to pathology residents in a tertiary-level hospital. MATERIALS AND METHODS: The training of pathology residents who rotated through the interventional unit of the pathology department and the application of ultrasound-guided FNA and rapid on-site evaluation (U-ROSE) was documented over 5 years. The training period was broken down into learning phases and included the number of ultrasound-guided FNA performed, anatomical location, and their diagnostic performance, among other aspects. RESULTS: Nineteen (19) pathology residents were trained in U-ROSE, and performed a total of 4003 procedures, with a mean of 211 per resident. In 53% of cases only one pass was required for an adequated sample. The specimen was diagnostic in more than 97% of cases. The most frequently sampled anatomical sites were the thyroid gland (n = 2347), followed by lymph node (n = 667), soft tissues (n = 663) and salivary glands (n = 322). CONCLUSION: The results support the training programme followed by pathology residents in learning U-ROSE, which is essential to lay the foundations for the future interventional pathologist.

Proposal for a standardized methodology for performing endobronchial ultrasound-guided mediastinal cryobiopsy: a four-step approach.

Endobronchial ultrasound (EBUS)-guided mediastinal cryobiopsy is a novel technique that increases the accuracy of diagnosing most pathologies that affect the mediastinum. Although EBUS-guided transbronchial needle aspiration (EBUS-TBNA) is the first choice in the diagnosis of mediastinal pathology, mediastinal cryobiopsy offers a larger and higher quality biopsy with minimal artifacts and no crushing when compared to conventional cytological samples obtained through EBUS-TBNA. It is particularly valuable in pathologies where EBUS-TBNA has diagnostic limitations, such as lymphoproliferative diseases, benign granulomatous conditions like sarcoidosis and silicosis, some rare infectious processes, metastases from rare non-pulmonary tumors, and in advanced stages of non-small cell lung cancer (NSCLC) where immunohistochemistry and molecular analysis are essential for personalized treatment. Therefore, mediastinal cryobiopsy seems to play a crucial role in these challenging scenarios. However, there is ongoing debate in the field of interventional pulmonology regarding the best approach for obtaining a mediastinal cryobiopsy. Some interventional pulmonologists use a high-frequency needle knife to create an incision in the tracheobronchial wall adjacent to the mediastinal lesion before inserting the cryoprobe, while others use a needle to create a pathway to the target area. There are also variations in the use of endoscopic or ultrasound imaging for guidance. In this article, we aim to review the current literature on different methods of performing mediastinal cryobiopsy and share our own clinical experience and methodology in a systematic way for its implementation in a safe, fast, and effective way.

Biopsy of Intrapulmonary Lesions in Lungs with Atelectasis and Pleural Effusion / Biopsia de lesiones intrapulmonares en pulmones con atelectasia y derrame pleural

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Systematized protocol for interventional pathology reports. Pathology report paradigm for pathologist-performed Ultrasound Guided Fine Needle Aspiration (USFNA) and Ultrasound Guided Core Needle Biopsy (USCNB) / Protocolo sistematizado para informes de patología intervencionista. Informe de anatomía patológica para punción-aspiración con aguja fina con ecografía (EcoPAAF) y biopsia con aguja gruesa con ecografía (EcoBAG)

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Silicosis en trabajadores con conglomerados artificiales de cuarzo / Silicosis in Artificial Quartz Conglomerate Workers

Introducción: La silicosis es una enfermedad crónica progresiva producida por la inhalación de sílice cristalina. La mayoría de los casos aparecen en trabajadores de minería de interior y extracción de piedra natural (pizarra, granito). Ante la progresiva aparición de nuevos casos de silicosis en trabajadores con conglomerados artificiales de cuarzo (CAC), se planteó un estudio que tuvo como objetivo analizar las características de la silicosis producida por un nuevo agente en España. Métodos: El estudio consistió en una serie de 96 casos diagnosticados de silicosis según criterios internacionales durante el periodo comprendido entre 2010 y 2017. Se analizaron las características clínicas, radiológicas, funcionales y patológicas. Resultados: La edad media fue de 45 años, el 55% con silicosis simple y el 45% con silicosis complicada. En 10 pacientes se diagnosticó silicosis acelerada, con una media de 33 años de edad. El tiempo medio de exposición a los conglomerados fue de 15 años y en un 77% no se utilizaban medidas de protección adecuadas. La mitad de los pacientes estaban asintomáticos y presentaban diferentes formas clásicas en la radiografía de tórax y tomografía computarizada de alta resolución de tórax, así como imágenes de vidrio deslustrado. No se observaron alteraciones en la función pulmonar. Conclusiones: La silicosis en los trabajadores con CAC se observa en personas jóvenes, en activo, en un considerable porcentaje de forma acelerada, con escasos síntomas y sin alteración funcional. Las medidas de protección son escasas. Es importante conocer estas características para el diagnóstico precoz y las necesarias medidas preventivas

Introduction: Silicosis is a chronic progressive disease caused by inhalation of crystalline silica. Most cases develop in underground mine workers and in subjects involved in the extraction of natural stone (slate and granite). In view of the progressive emergence of new cases of silicosis in artificial quartz conglomerate workers, we performed a study to analyze the characteristics of silicosis produced by this new agent in Spain. Methods: The study consisted of a series of 96 cases of silicosis diagnosed according to international criteria during the period 2010-2017. We analyzed clinical, radiological, pathological and functional characteristics. Results: Mean age of participants was 45 years; 55% had simple silicosis and 45% had complicated silicosis. Ten patients were diagnosed with accelerated silicosis, with a mean age of 33 years. Mean time of exposure to conglomerates was 15 years, and 77% had not used appropriate protection measures. Half of the patients were asymptomatic and presented different classic forms on chest X-ray and chest high-resolution computed tomography, along with ground-glass images. No lung function changes were recorded. Conclusions: Silicosis in artificial quartz conglomerate workers occurs in a young, actively employed population, a considerable percentage of whom present an accelerated form. They have few symptoms and no functional limitations. Protection measures are scarce. It is important to characterize these features to provide early diagnosis and implement the necessary preventive measures

El patólogo intervencionista. Punción aspiración con aguja fina «ecoguiada» realizada por citopatólogo. Una realidad en España / The interventional pathologist. Ultrasound guided fine needle aspiration performed by cytopathologists. Now a reality in Spain

Introducción. El desarrollo y perfeccionamiento de la ecografía a partir de los setenta supuso un gran avance en el ámbito de la punción aspiración con aguja fina (PAAF), posibilitando localizar lesiones no palpables y minimizar complicaciones. El uso de PAAF ecoguiada trajo como consecuencia que dicha técnica se desplazara por motivos logísticos de los servicios de anatomía patológica a los servicios de radiología. El «alejamiento del patólogo» trajo como consecuencia numerosos inconvenientes. Con la finalidad de recuperar el territorio perdido y optimizar el procedimiento se inició una experiencia pionera —y hasta donde sabemos única España— en el Servicio de Anatomía Patológica del Hospital Universitario Central de Asturias (HUCA) con la PAAF ecoguiada realizada por citopatólogo. Método. Se cuantificaron todas las PAAF realizadas en el HUCA desde el 1 de julio de 2015 hasta el 30 de junio de 2016. Se procedió a clasificarlas dependiendo de si fueron PAAF ecoguiadas realizadas por patólogo o PAAF no realizada por patólogo, teniendo como principal criterio si fueron valorables o insuficientes. Resultados. Casi la mitad de las PAAF efectuadas fueron realizadas por citopatólogo (923). Las PAAF ecoguiadas realizadas por patólogo superaron en rendimiento diagnóstico a las PAAF no realizadas por patólogo. En todas las localizaciones anatómicas comprables, la PAAF ecoguiada realizada por patólogo tuvo un menor porcentaje de muestras insuficientes (4,33%) en comparación con la PAAF no realizada por patólogo (12,05%). Conclusión. El citopatólogo adecuadamente adiestrado es capaz de realiza PAAF ecoguiada con excelentes resultados. Los buenos resultados obtenidos han traído como consecuencia el aumento progresivo del número de PAAF solicitadas para llevar a cabo en el Servicio de Anatomía Patológica (AU)

Introduction. The development and improvement of ultrasound from the seventies has caused a breakthrough in fine needle aspiration (FNA), allowing the location of non-palpable lesions and minimizing complications. For logistic reasons, ultrasound-guided-FNA (US-FNA) is carried out in the department of radiology. However, the distance from the pathologist has many disadvantages. In order to correct this and thus optimize the procedure, the Department of Pathology at the University Hospital of Asturias (Hospital Universitario Central de Asturias [HUCA]) has initiated, for the first time in Spain, the Ultrasound-Guided-FNA Performed by Cytopathologists programme. We present our experience so far. Method. FNA performed at HUCA were quantified from July 1st 2015 to June 30th 2016. FNA were classified as US-FNA-cytopathologists or US-FNA-without cytopathologists. Criteria of sufficient and insufficient samples were taken into account. Results. Almost half of the FNA were made by cytopathologists (923). The performance of US-FNA-cytopathologists was better than US-FNA-without cytopathologists. US-FNA-cytopathologists had a lower percentage of inadequate samples (4.33%) compared to FNA carried out by non cytopathologists (12.05%). Conclusion. Adequately trained cytopathologists can perform US-FNA with excellent results. Our positive experience has resulted in an increase in the number of requests for FNA to be carried out in the Department of Pathology (AU)