Intraoperative Sentinel Node Fine-Needle Aspiration Biopsy as a Substitute for Whole Sentinel Node Excisional Biopsy in Breast Cancer Patients. Initial Report.

INTRODUCTION: Sentinel Node Biopsy (SNB) is the choice procedure for axillary staging in Breast Cancer. Following the ACOSOG Z11 trial, axillary dissection is advised only in patients with more than 2 positive SNs. We aimed at exploring palpation-guided, intraoperative fine-needle aspiration biopsy of the SN as a replacement for whole SN excision in node-negative BC patients to minimize side-effects. PATIENTS AND METHODS: We included 80 patients with BC undergoing SNB between December 2020 and May 2022. After identification of the SN, the breast surgeon performed SN-FNAB. Results were compared with definitive pathological assessment. ResultsDiagnostic yield was 80%, including a "learning curve." 58 of 64 patients with suitable samples tested negative. In this group, the Negative Predictive Value was 77.6% (IC 64.7%-87.5 %). If micro metastasis is disregarded, the NPV would increase to 86.2% (IC 74.6%-93.9%). If we accept the Z11 criterion for axillary dissection, the NPV would rise to 100%. Six patients had a positive SN-FNAB. They were all confirmed as having macro metastatic-positive SNs at the final pathological assessment, and 3 of them also displayed extra nodal extension (ENE). CONCLUSION: We believe that intraoperative SN-FNAB is highly accurate for swiftly depicting both low axillary tumor burden/negative cases, in whom axillary dissection is to be omitted, as well as high axillary tumor burden cases.

Developing indicators for quality assurance in cytopathology. Catalan Society of Cytopathology.

BACKGROUND: Quality control in cytology must be established through reliable and easily measurable indicators. METHODS: From the Catalan Society of Cytopathology a group of experts has been established to write a document with 13 indicators that cover the entire cytological process, based on its Cytopathology Quality Guide. It has been elaborated through guides and documents with scientific evidence and DELPHI methodology in order to reach a structured consensus on the opinions of a group of experts. RESULTS: Thirteen indicators, covering all the cytologic process are expressed in worksheets specifying all their characteristics. CONCLUSION: This document allows the control of all stages of the cytological process.

Diagnostic performance of the bronchial aspirate collected before and after the bronchial biopsy in patients with pulmonary neoplasia with endobronchial lesion. / Rendimiento diagnóstico del broncoaspirado recogido antes y después de la biopsia bronquial en pacientes con neoplasia pulmonar y lesión endobronquial.

BACKGROUND AND OBJECTIVES: In patients with lung cancer (LC) and endobronchial lesion, the optimal sequence for collecting bronchial aspirate, before (BASpre) or after the biopsy (BASpost) is not yet established. The aim of this study was to compare the diagnostic performance of BASpre with BASpost. MATERIALS AND METHODS: Retrospective study of patients with LC and endobronchial lesion undergoing bronchoscopy with bronchial biopsy and BASpre and BASpost samples. The diagnostic performance of both techniques was calculated. RESULTS: A total of 144 patients were included. BASpre was diagnostic in 24 (16.7%) cases and BASpost in 33 (22.9%) (Chi-squared P<0.009). The number of cases in which it was the only diagnostic method was identical: Two for BASpre and two cases for BASpost. CONCLUSIONS: In patients with LC and endobronchial lesion, BASpost is diagnosed in a higher percentage of cases than BASpre. This difference does not affect the overall diagnostic performance of bronchoscopy as the number of times in which either is the only diagnostic procedure is identical.

Concordance Between Rapid On-Site Evaluation and Final Cytologic Diagnosis in Patients Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Non-Small Cell Lung Cancer Staging.

OBJECTIVES: In patients with lung cancer undergoing mediastinal staging through endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), decisions are based on rapid on-site evaluation (ROSE) findings. We aimed to analyze the concordance rate between ROSE diagnosis and final diagnosis. METHODS: A prospective study was carried out in patients undergoing EBUS-TBNA for lung cancer staging. Diagnosis concordance was defined as cases where lymph nodes (LNs) presented the same diagnosis in ROSE and final diagnosis. Determinants of concordance were analyzed. RESULTS: Sixty-four patients were included and 637 LNs sampled. ROSE diagnosis was concordant with final diagnosis in 612 (96.1%) LNs and nonconcordant in 25 (3.9%). Differences in the concordance rate were found between pathologists, ROSE diagnoses, presence of cell block, number of passes, and number of slides. The staging status was changed between ROSE and the final diagnosis in three (4.6%) patients. CONCLUSIONS: ROSE diagnosis has a high concordance with the final diagnosis.

Nodal size ranking as a predictor of mediastinal involvement in clinical early-stage non-small cell lung cancer.

In non-small cell lung cancer (NSCLC) patients, the recommended minimum requirement for an endoscopy-based mediastinal staging procedure is sampling the largest lymph node (LN) in right and left inferior paratracheal, and subcarinal stations. We aimed to analyze the percentage of cases where the largest LN in each mediastinal station was malignant in a cohort of NSCLC patients with mediastinal metastases diagnosed in the lymphadenectomy specimen. Furthermore, we investigated the sensitivity of a preoperative staging procedure in a hypothetical scenario where only the largest LN of each station would have been sampled.Prospective data of patients with mediastinal nodal metastases diagnosed in the lymphadenectomy specimens were retrospectively analyzed. The long-axis diameter of the maximal cut surface of all LNs was measured on hematoxylin and eosin-stained sections.Seven hundred seventy five patients underwent operation and 49 (6%) with mediastinal nodal disease were included. A total of 713 LNs were resected and 119 were involved. Sixty seven nodal stations revealed malignant LNs: in these, the largest LN was malignant in 39 (58%). In a "per patient" analysis, a preoperative staging procedure that sampled only the largest LN would have attained a sensitivity of 0.67; and if the largest and the second largest were sampled, sensitivity would be 0.87.In patients with NSCLC, nodal size ranking is not reliable enough to predict malignancy. In clinical practice, regardless of the preoperative staging method, systematic thorough sampling of all visible LNs is to be recommended over selective random samplings.

Underscreened Women Remain Overrepresented in the Pool of Cervical Cancer Cases in Spain: A Need to Rethink the Screening Interventions.

OBJECTIVE: Audit of women with invasive cervical cancer (CC) is critical for quality control within screening activities. We analysed the screening history in the 10 years preceding the study entry in women with and without CC during 2000-2011. METHODS: 323 women with CC from six pathology departments in Catalonia (Spain) and 23,782 women with negative cytology were compared. Age, previous history of cytologies, and histological type and FIGO stage were collected from the pathology registries. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%). RESULTS: History of cytology was registered in 26.2% of CC cases and in 78% of the control women (P < 0.0001) and its frequency decreased with increasing age. Compared to women with squamous cell carcinoma, adenocarcinoma cases were significantly more likely to have a cytology within the 3-year interval preceding cancer diagnosis (OR = 2.6 CI 95%: 1.2-5.6) and to have normal cytology results in previous screenings (OR = 2.4 CI 95%: 1.2-4.5). FIGO II-IV cases were more common among older women (older than 60 years). CONCLUSIONS: Absence of prior screening history was extremely common among CC cases compared to controls. Organized actions to reduce underscreened women and use of highly sensitive HPV-based tests could be important to reduce CC burden.

Rendimiento diagnóstico del broncoaspirado recogido antes y después de la biopsia bronquial en pacientes con neoplasia pulmonar y lesión endobronquial / Diagnostic performance of the bronchial aspirate collected before and after the bronchial biopsy in patients with pulmonary neoplasia with endobronchial lesion

Antecedentes y objetivos: En pacientes con cáncer de pulmón (CP) y lesión endobronquial, la secuencia óptima de recogida del broncoaspirado, previamente (BASpre) o posteriormente a la biopsia (BASpost) aún no está establecida. El objetivo de este estudio fue comparar el rendimiento diagnóstico del BASpre con el BASpost. Materiales y métodos: Estudio retrospectivo que incluyó pacientes con CP y lesión endobronquial sometidos a una broncoscopia con biopsia bronquial y muestras de BASpre y de BASpost. Se calculó el rendimiento diagnóstico de ambas técnicas. Resultados: Se incluyeron 144 pacientes. El BASpre fue diagnóstico en 24 (16,7%) casos y el BASpost en 33 (22,9%) (prueba de Chi-cuadrado p<0,009). El número de casos en que resultaron el único método diagnóstico fue idéntico: 2 para el BASpre y 2 casos para el BASpost. Conclusiones: En pacientes con CP y lesión endobronquial, el BASpost aporta material diagnóstico en un porcentaje de casos mayor que el BASpre. No obstante, esta diferencia no es clínicamente relevante ya que no influye en el rendimiento diagnóstico global de la broncoscopia

Background and objectives: In patients with lung cancer (LC) and endobronchial lesion, the optimal sequence for collecting bronchial aspirate, before (BASpre) or after the biopsy (BASpost) is not yet established. The aim of this study was to compare the diagnostic performance of BASpre with BASpost. Materials and methods: Retrospective study of patients with LC and endobronchial lesion undergoing bronchoscopy with bronchial biopsy and BASpre and BASpost samples. The diagnostic performance of both techniques was calculated. Results: A total of 144 patients were included. BASpre was diagnostic in 24 (16.7%) cases and BASpost in 33 (22.9%) (Chi-squared P<0.009). The number of cases in which it was the only diagnostic method was identical: Two for BASpre and two cases for BASpost. Conclusions: In patients with LC and endobronchial lesion, BASpost is diagnosed in a higher percentage of cases than BASpre. This difference does not affect the overall diagnostic performance of bronchoscopy as the number of times in which either is the only diagnostic procedure is identical

Historia de cribado en mujeres con cáncer infiltrante de cuello uterino / Screening history in women with infiltrating uterine cancer

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