Thyroid fine-needle aspiration cytology: performance data of neoplastic and malignant cases as identified from 1558 responses in the ASCP Non-GYN Assessment program thyroid fine-needle performance data.

BACKGROUND: Fine-needle aspiration of the thyroid is a common procedure, with an established role in reducing unnecessary thyroid surgery and identifying neoplasms and malignancies. METHODS: The study evaluated 1558 responses in the American Society for Clinical Pathology (ASCP) Non-GYN Assessment program of aspirates of thyroid neoplasms and malignancies and placed them into the following groups: group A (target or correct interpretation), group B (incorrect interpretation as a benign thyroid nodule), group C (incorrect interpretation malignant aspirate as thyroid neoplasm), and group D (malignant diagnosis with incorrect interpretation). In clinical practice, responses in groups A, C, and D would lead to surgical excision, whereas responses in group B would not. RESULTS: Of a total of 1558 responses, 78.5% of the responses were in group A, 8.5% in group B, 3.75% in group C, and 9.25% in group D. By individual diagnosis, the group rates were 86.5%, 0%, 11%, and 2.5% for anaplastic thyroid carcinoma; 83%, 5.5%, 4.25%, and 7.25% for papillary thyroid carcinoma; 79%, 7%, 6%, and 8% for medullary thyroid carcinoma; 83.5% 6.75%, 0%, and 9.75% for Hürthle cell neoplasm; and 61%, 22%, 0%, and 17% for follicular neoplasm in groups A, B, C, and D respectively. CONCLUSIONS: Fine-needle aspiration was effective in diagnosing thyroid neoplasms and malignancies and in separating thyroid nodules into surgical and nonsurgical categories. Data from a large group of cytology professionals showed good performance; however, there is room for improvement, especially in making specific diagnoses. In particular, follicular neoplasm and follicular variant of papillary thyroid carcinoma were challenging diagnoses for participants.

Cytology workforce study: a report of current practices and trends in New York State.

A survey was conducted among 130 New York State (NYS) registered cytology laboratories to better understand current and future changes in the practice of cytology, changes in the cytotechnologist (CT) scope of practice, and the future need for CTs. A 51.5% (67/130) response rate was obtained. Trends for gynecologic case volume varied across facility types. Nongynecologic volume is growing primarily in hospitals and large medical center laboratories and private laboratories; the fine-needle aspiration volume is growing in hospital and large medical center laboratories. One third of responding laboratories anticipate a continued demand for CTs within the next 3 years owing to impending retirements. Few laboratories also report the gradual adoption of molecular testing with CTs directly involved. Because 60% (3/5) of NYS CT training programs have closed since 2008, the 2 remaining programs are a valuable key staffing resource for CTs. Continued viability of these programs is essential to provide the necessary training and staffing of NYS laboratories for cytopathology practice.

Fine needle aspiration of metastatic adult granulosa cell tumor of the ovary: a case report.

BACKGROUND: Granulosa cell tumors (GCTs) of the ovary are low grade ovarian malignancies with a predilection for late recurrences in the pelvic cavity and occasionally distant metastases. Fine needle aspiration (FNA) can be used to detect such recurrences accurately based on unique cytologic and immunohistochemical features. CASE: A 5-cm, retrocaval mass at the level of the kidneys was detected in a 63-year-old woman who had a diagnosis of adult GCT (AGCT) of the ovary 18 years earlier and a local recurrence 5 years prior to this admission. The FNA of the retrocaval mass displayed small tumor cells with scant cytoplasm arranged in small aggregates and isolated cells. Coffee bean-like longitudinal nuclear grooves and microfollicular structures with amorphous material resembling Call-Exner bodies were not readily identified. Cytohistologic correlation with the patient's previous biopsies and positive immunohistochemical staining reaction with estrogen receptor, progesterone receptor and inhibin confirmed the recurrence of AGCT, thus avoiding unnecessary surgical interventions for diagnostic purposes. CONCLUSION: For accurate interpretation of cytologic findings of recurrent GCT, proper clinical history, cytohistologic correlation with prior biopsies and a positive immunohistochemical reaction with inhibin are of vital importance.

Fine needle aspiration cytology of ALK1(-), CD30+ anaplastic large cell lymphoma post renal transplantation: a case report and literature review.

Post transplant lymphoproliferative disorders (PTLD) complicates the course of 0.3 to 3% of renal transplant patients receiving immunosuppression. Epstein-Barr virus (EBV) related non-Hodgkin's lymphomas of B-cell type is more common than those of T-cell origin. CD30 positive Anaplastic Large Cell Lymphoma (ALCL) is a Non-Hodgkin's lymphoma (B or T cell type) that accounts for a small percentage of PTLD's. ALCL of T-cell type are a spectrum of disease ranging from primary cutaneous to systemic nodal ALCL. The systemic nodal ALCL is further subdivided into anaplastic lymphoma kinase-1 (ALK-1) positive or negative. ALK-1 protein is a gene fusion product of translocation (2;5) and carries prognostic implications. We present an unusual manifestation of ALK-1 negative CD30 positive ALCL in a post renal transplant patient in FNA cytology with all supportive adjuvant studies and differential diagnoses and review the cytology literature on this topic.

Impact of New York State's new licensure regulations for laboratory professionals on staffing of clinical laboratories.

Licensing of laboratory professionals has been a controversial issue for the individuals working in these professions for many years. In New York State (NYS), licensing of laboratory professionals has been debated for over three decades and did not become law until 2005. The NYS licensure law stipulates specific educational requirements that include course work as well as curricular content areas. In addition to these educational requirements, the licensure law stipulates successful completion of a certification examination for new licensure applicants. To determine if the new legislation in NYS has had a demonstrable impact on the ability to recruit qualified laboratory professionals, a survey tool was developed to gather baseline data for a longitudinal study on the same topic. A 20 item survey along with a letter of explanation and a self addressed return envelope was distributed by mail to managers and/or supervisors of laboratories in 150 hospitals that ranged in size from small community hospitals to large medical centers across the state of New York. Questions were created addressing each of the following categories: day to day laboratory staffing, increased cost of recruiting to the facility after licensure law, impact on ability to cross train and staff evenings and weekends, and impact on patient care. It is apparent from the survey results that the employers have already started experiencing difficulty to staff certain laboratory vacancies especially for Clinical Laboratory Technologists (CLT) and fear that this trend might continue over the years not only pertaining to CLT but also to other laboratory vacancies such as Histotechnologists-Histotechnicians and Cytotechnologists. The impact of the NYS licensure law on staffing, facility costs, patient care, and laboratory professionals are discussed.

Presentation of endometriosis of the cervix in cervical smear: a case report and review of literature.

Endometriosis of the cervix is considered a rare lesion with a predilection in women with a previous history of cervical trauma, such as biopsy, conization, or laser vaporization. Description of endometriosis of the cervix in cytological literature is equally rare with most of the published reports dealing with the role of fine-needle aspiration in diagnosis and how the atypia in cases with cervical endometriosis poses differential diagnosis for other premalignant and malignant endocervical lesions. We present here a case depicting endometriosis of the cervix in a cervical/endocervical smear from a 48-year-old female with intermenstrual spotting. The purpose of this article is 2-fold: to report a case of endometriosis of the cervix in exfoliative cytology and to review pertinent cytological literature. In this article, cytological and histological presentation of cervical endometriosis is described, and the importance of considering cervical endometriosis in the differential diagnosis when dealing with endometrial shedding that is not part of the normal physiology in a cycling woman is emphasized.