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. OBJECTIVE.­: To determine factors responsible for fragmentation at our institution. DESIGN.­: Prostate core biopsies performed at 2 hospital sites during 1 week were prospectively identified. Biopsies were received in multipart formalin jars, either mounted on a nonadherent dressing pad (Telfa, Medtronic Inc) or freely suspended, and grossed by experienced pathologists' assistants. Fragmentation was defined as the difference between number of cores sent by the clinician and number of cores counted by the pathologist on microscopy. RESULTS.­: Forty-six cases (15 benign; 31 malignant) with 535 specimen jars were identified of which 309 of 535 (57.8%) had >1 biopsy core per jar; 230 of 535 (43%) were received mounted on Telfa and 185 of 535 (34.6%) had histologic evidence of adenocarcinoma. Overall fragmentation rate was 157 of 535 (29.3%). Lowest fragmentation rate was seen when 1 core was submitted per jar regardless of mounting method (31 of 226; 14% for single versus 126 of 309; 41% for >1 per jar; P < .001). For 1 Telfa-mounted core, rate of fragmentation was 5 of 18 (27.8%) versus 26 of 203 (12.8%) when unmounted (P = .24). Significant increase in fragmentation of Telfa-mounted cores was seen when there were 3 per jar (32 of 70; 46% mounted fragmented versus 9 of 47; 19% unmounted fragmented specimens; P = .01). CONCLUSIONS.­: Submission of >1 biopsy core per jar and use of Telfa for mounting are associated with increased fragmentation. We recommend limiting submission to 1 core per jar and avoid mounting on Telfa pads.

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.­: To assess urinary tract cytopathology practice patterns across a variety of pathology laboratories to aid in the implementation and future update of the Paris System for Reporting Urinary Cytology. DESIGN.­: A questionnaire was designed to gather information about urinary tract cytopathology practices and mailed in July 2014 to 2116 laboratories participating in the College of American Pathologists interlaboratory comparison program. The participating laboratories' answers were summarized. RESULTS.­: Of the 879 of 2116 laboratories (41%) that participated, 745 (84.8%) reported processing urinary tract specimens in house. The laboratories reported processing various specimen types: voided urine, 735 of 738 (99.6%); bladder washing/barbotage, 639 of 738 (86.6%); and catheterized urine specimens, 653 of 738 (88.5%). Some laboratories used multiple preparation methods, but the most commonly used preparation techniques for urinary tract specimens were ThinPrep (57.4%) and Cytospin (45.5%). Eighty-eight of 197 laboratories (44.7%) reported preparing a cell block, but with a low frequency. Adequacy criteria were used by 295 of 707 laboratories (41.7%) for voided urine, and 244 of 707 (34.5%) assessed adequacy for bladder washing/barbotage. More than 95% of the laboratories reported the use of general categories: negative, atypical, suspicious, and positive. Polyomavirus was classified as negative in 408 of 642 laboratories (63.6%) and atypical in 189 of 642 (29.4%). One hundred twenty-eight of 708 laboratories (18.1%) performed ancillary testing, and of these, 102 of 122 (83.6%) reported performing UroVysion. CONCLUSIONS.­: Most laboratories use the ThinPrep method followed by the Cytospin technique; therefore, the criteria published in The Paris System for Reporting Urinary Cytology, based mostly on ThinPrep and SurePath, should be validated for Cytospin, and relevant information should be included in the revised edition of The Paris System for Reporting Urinary Cytology.

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. RESULTS: Among 844 respondents, 403 (48%) performed cytologic assessment of NCB. Common body sites included lung (94%; 368/392), liver (87%; 340/ 392), and lymph nodes/spleen (77%; 303/392). Most of the time, a pathologist was present on-site 75% (295/393) for adequacy assessment which was usually verbally reported to the provider performing the procedure. Specimens were prepared by cytotechnologists (50%; 193 of 388) or pathologists (45%; 176 of 388) by touching the core to the slide (50%; 196 of 390) and rolling the core on the slide (45%; 177/390). Among the respondents, 19% said that cytotechnologists independently performed immediate assessment of TI of NCB. Most laboratories (69%; 264/384) evaluated air-dried slides with a modified Giemsa stain and rendered one TI/NCB combined report (87%, 334/385). CONCLUSIONS: This is the first survey performed specifically to determine the practice of adequacy assessment of TI of NCB. Cytotechnologists are generally not performing adequacy assessment of TI without pathologist oversight. A single report is usually issued which includes the adequacy assessment as a part of the final report.

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. As healthcare becomes increasingly team-based, proficiency in EI will be required to build consensus among multidisciplinary stakeholders, and effect change in attitudes and behaviors that result in improved patient safety and clinical outcomes. Based on the existing literature and the authors' experiences, these 12 tips provide practical suggestions on how to introduce EI into a medical curriculum. These tips have broad applicability, and can be implemented in courses on topics such as professionalism, leadership development, empathy, patient safety, or wellness.

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. METHOD: LIS was searched (January 2015-June 2016) for HSIL PT results. Patient chart was reviewed for age, hrHPV co-testing result including genotyping (Aptima® ), and histopathology follow-up (f/u) which was compared between hrHPV-positive and hrHPV-negative groups. hrHPV-negative HSIL PT slides were re-evaluated for concordance with original interpretation. Student t test was used for data analysis. RESULTS: There were 230 patients with HSIL PT who had hrHPV co-testing and 199/230 had histopathological f/u. Majority (210/230, 91.3%) were hrHPV positive, and 20 (8.7%) were hrHPV negative. HrHPV negative HSIL was significantly more common in older women (mean age 49.3 years) compared with hrHPV-positive HSIL (mean age 40.7 years) (P = .0015). The most frequently detected genotype was HPV16 (40%). F/u was CIN2/3 in 145/181 (80%) hrHPV-positive HSIL (includes nine squamous cell carcinoma) and 6/16 (37.5%) hrHPV-negative HSIL. CONCLUSION: Although the risk of CIN2/3 and carcinoma was higher in hrHPV-positive patients, possibility of hrHPV-negative dysplastic lesions should be considered in older women as 6 of 16 (37.5%) of these women had CIN2/3 and/or carcinoma which would have been missed without the PT.

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. MATERIALS AND METHODS: A database search was performed to detect all liver FNA cases and their corresponding NCB between January 2014 and August 2016. A retrospective chart review was performed to gather pertinent clinicopathologic information. RESULTS: Seventy-seven FNA and 68 corresponding NCB were reviewed from 74 patients. Diagnoses in the 74 patients included 36 hepatocellular carcinomas (HCC), 29 metastatic malignancies (MET), 5 poorly differentiated carcinomas (PDC), 2 cholangiocarcinomas (CHO), and 2 benign lesions (BEN). More immunohistochemical (IHC) studies (P < 0.05) were performed on NCB tissues than FNA tissues in HCC (mean, 2.1 versus 0.8), MET (2.5 versus 0.5), and PDC groups (11.2 versus 0.2). The false negative rate (FNR) of NCB was lower (P < 0.05) than that of FNA in the HCC group; and FNR of NCB was higher (P < 0.05) than that of FNA in the MET group. CONCLUSIONS: For HCC, NCB usually has better tissue quality and diagnostic accuracy than FNA; for metastatic lesions in the liver, FNA has better diagnostic accuracy than NCB, although NCB can provide more tissue for ancillary testing and has better diagnostic quality. Appropriate diagnostic method is important for improving diagnostic accuracy and saving medical resources.

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. MATERIALS AND METHODS: Online surveys were sent to cytologists and clinicians to gather information on the respondents' experiences with pancreatic endoscopic ultrasound-guided FNA and their perceptions about the indeterminate diagnostic categories. Cytological specimens and patient medical records were reviewed to collect data on specimen acquisition, cytological features, tumor characteristics, and patient management. RESULTS: Survey responses revealed that cytologists and clinicians held similar perceptions of the clinical impact of the indeterminate categories but had dissimilar ideas on the factors contributing to these diagnoses. Statistically significant associations were identified between indeterminate diagnoses and the following variables: number of passes performed; adequacy on rapid on-site evaluation; repeat FNA procedures; lesions with cystic changes; and well-differentiated tumor cytomorphology. CONCLUSIONS: Awareness of the perceptions of cytologists and clinicians about, as well as the clinical features and cytologic variables associated with, "indeterminate" cases has the potential to improve patient care.

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%. METHODS: The aim of this study was to assess interobserver variability among cytopathologists to assess reproducibility of the AUS/FLUS category. Seven cytopathologists brought FNA cases (a mixture of atypical and non-atypical FNA diagnosis) diagnosed using TBSRTC from their respective institutions which were reviewed and diagnosed by the participants. The analysis assessed interobserver variability among 7 cytopathologists and determined characteristics on the slides which were associated with concordance to the institutional diagnosis. RESULTS: Seventy eight of 125 (62.4%) benign cases were classified as benign by the reviewers and 26 (21%) were called AUS/FLUS on review. A third of the AUS/FLUS cases were called benign on review and 28.2% were classified as suspicious for neoplasia/malignancy. Roughly a third each of the suspicious for follicular neoplasm/suspicious for malignancy cases were classified as AUS/FLUS. DISCUSSION: When pathologists from different institutions shared their slides, concordance was high for specimens with adequate cellularity and those that were clearly benign but thresholds varied for the other indeterminate categories. Most definite categorization of the AUS/FLUS category was seen on review. Diagn. Cytopathol. 2017;45:399-405. © 2017 Wiley Periodicals, Inc.

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%). OBJECTIVE: - To improve the adequacy rate to at least 90% for molecular testing using next-generation sequencing for all specimens collected by rapid on-site evaluation by the cytology laboratory. DESIGN: - After baseline data on adequacy rate of cytology specimens with rapid on-site evaluation for molecular testing had been collected, 2 changes were implemented. Change 1 concentrated all the material in one block but did not produce desired results; change 2, in addition, faced the block only once with unstained slides cut up front for molecular testing. Data were collected in an Excel spreadsheet and adequacy rate was assessed. RESULTS: - Following process changes 1 and 2 we reached our goal of at least 90% adequacy rate for molecular testing by next-generation sequencing on samples collected by rapid on-site evaluation including computed tomography-guided needle core biopsies (94%; 17 of 18) and fine-needle aspiration samples (94%; 30 of 32). CONCLUSION: - This study focused on factors that are controllable in a pathology department and on maximizing use of scant tissue. Optimizing the adequacy of the specimen available for molecular tests avoids the need for a second procedure to obtain additional tissue.

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. This case was eventually classified as malignant melanoma, despite a significant diagnostic challenge due to lack of prior history, unusual cytomorphology, and S-100 protein negativity. A battery of immunostains was performed and the addition of other melanocytic-associated markers confirmed the melanocytic lineage of the neoplasm. This case highlights the pitfalls in the differential diagnosis of a metastatic tumor of unknown origin by fine needle aspiration cytology due to the significant morphologic overlap of poorly differentiated malignancies. We emphasize that, albeit rare, malignant melanomas can be completely negative for S-100 protein and the use of additional melanocytic-associated markers in the differential workup maybe critical in arriving promptly at a proper diagnosis. We also briefly discuss other currently available immunohistochemical markers that can assist in the identification of the S-100 negative melanoma.

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. We identified an activating KRAS G12R mutation among other mutations in these models. In explant cells derived from these PDX tumor models with a KRAS G12R mutation, treatment with inhibitors of CDKs (including CDK9) reduced phosphorylation of a marker of CDK9 activity (phospho-RNAPII CTD Ser2/5) and reduced viability/growth of explant cells derived from PDAC PDX models. Similarly, a CDK inhibitor reduced phospho-RNAPII CTD Ser2/5, increased apoptosis, and inhibited tumor growth in FNA-PDX and patient-matched metastatic-PDX models. In summary, PDX models can be constructed from FNA biopsies of PDAC which in turn can enable genomic characterization and identification of potential therapies.

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. Both HPV testing and PT can be performed using a single sample; however, few studies have investigated the relationship between HPV results and TZ sampling. MATERIALS AND METHODS: Specimens were collected following the ThinPrep(®) liquid-based PT protocol. The Roche Cobas(®) HPV test was performed on post-aliquot samples. Data was collected retrospectively on 500 patients: 250 consecutive cases of EC- and 250 of EC+ on PT. To maintain uniformity, we included only cases diagnosed as negative (NILM). We compared HPV test results within each category. As a positive control, five consecutive cases each of LSIL and HSIL were also reviewed. RESULTS: Of NILM cases, 11 of 250 EC+ cases and 14 of 250 EC- cases were positive for hrHPV. HPV 16 was present in 5 of 11 EC + cases and in 1 of 14 EC- cases. Of LSIL cases, 1 of 5 EC+ cases was positive for hrHPV, and 2 of 5 EC- cases were positive for hrHPV. Of HSIL cases, 5 of 5 EC+ cases were hrHPV+. In the time period studied, only one case of EC- HSIL was found, which was positive for hrHPV. DISCUSSION: Although our study did not prove a significant correlation between HPV testing results and EC on PT, more EC+ PTs were positive for HPV16 compared to EC- PTs. The absence of EC on PT does not appear to warrant re-testing for HPV infection, though larger studies are required to determine the significance of low HPV 16 in PT without EC. Diagn. Cytopathol. 2016;44:280-282. © 2016 Wiley Periodicals, Inc.

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. DESIGN: In 2011, a survey was sent to 1604 laboratories participating in the College of American Pathologists gynecologic cytology interlaboratory comparison education program and proficiency testing programs requesting data from 2010 on the following topics: terminology/reporting, cytotechnologist workload, quality assurance, reagents, and ancillary testing. RESULTS: Six hundred and twenty-five laboratories (39%) replied to the survey. The nonstandard use of "low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion" is used by most laboratories to report the presence of low-grade squamous intraepithelial lesion with possibility of high-grade squamous intraepithelial lesion. Most laboratories also report the presence or absence of cells from the transformation zone. Most respondents do not limit cytotechnologist screening workload during the work shift. Only about one-third of laboratories (188 of 582; 32%) use image-assisted screening devices. Rapid prescreening as a quality assurance measure is used by only 3.5% (21 of 594) of the laboratories. When used for screening, most laboratories use the imager for retrospective review of slides to detect human locator and interpretive errors. Most laboratories receive both liquid-based cytology samples (mainly ThinPrep, Hologic, Marlborough, Massachusetts) and conventional Papanicolaou tests. Expiration dates of liquid-based cytology test vials are not usually recorded. CONCLUSIONS: The field of gynecologic cytology is evolving rapidly. These survey results offer a snapshot of national 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. Herein, we present a case of GBM with epithelial differentiation to highlight a potential diagnostic pitfall in CSF cytology. A 55-year-old man presented with neurological symptoms and a 6.4 cm left temporal lobe cystic mass. Primary resection revealed GBM with focal epithelial differentiation confirmed by cytokeratin, epithelial membrane antigen, and glial fibrillary acidic protein immunohistochemical studies. Four months following primary resection, the patient developed severe headache for which a lumbar puncture with CSF cytologic evaluation was performed. The cytospin preparation showed numerous malignant epithelioid cells with high nuclear-cytoplasmic ratio and prominent cytoplasmic vacuoles resembling metastatic carcinoma. However, the lesional cells were cytomorphologically identical to the epithelial component present in the patient's recently diagnosed GBM. This case illustrates the potential for GBM with epithelial differentiation to closely mimic metastatic carcinoma from a non-CNS site in CSF cytology, which expands the differential diagnosis and emphasizes the necessity of clinical correlation.

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. The analysis examined concordance to the reference diagnosis as well as performance of conventional Papanicolaou smears, Romanowsky smears, CytoSpin and ThinPrep preparations. A nonlinear mixed model was fit with 3 factors: reference diagnosis, reader type, and preparation type. RESULTS: Overall concordance rate was 93.2%, 94.8% for ductal adenocarcinoma, and 96.2% for interpretation of malignancy in cases of neuroendocrine tumors. There was no difference in performance between pathologists and cytotechnologists. In negative/benign preparations, there was a 76.3% concordance to the reference diagnosis. There was 89.2% sensitivity for diagnosis of malignancy when adenocarcinoma was present and 72.8% specificity for a benign non-neoplastic diagnosis with a tendency to overcall and demonstrate insecurity by providing a number of incorrect diagnoses for benign entities. Sensitivity of an exact diagnosis of neuroendocrine lesion when a neuroendocrine tumor is present was 79%. Concordance for diagnosis of mucinous cystic neoplasm without cytologic atypia was problematic at 46.4% with participants yielding an erroneous interpretation of adenocarcinoma one-third of the time. CONCLUSIONS: Participants performed well in recognizing adenocarcinoma, but they overcalled negative samples. Findings can provide focus for education and suggest that efforts be directed at benign pancreatic samples, neuroendocrine cytomorphology, and mucinous neoplasms.

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. DESIGN: The "NGC 2010 Demographics and Supplemental Questionnaire: Current Nongynecologic Practices in Cytopathology Laboratories" was mailed to 2059 laboratories. RESULTS: Survey response rate was 51% (1048 of 2059), predominantly from voluntary, nonprofit hospitals, where NGC samples were reviewed in nontraining settings by pathologists without American Board of Pathology Added Qualification in Cytopathology. Cytotechnologists reviewed NGC cases in 67.4% (675 of 1002) of laboratories. The annual mean and median volumes of NGC cases were 1927 and 858, respectively. Laboratories used more than one method to process NGCs; cell-blocks were most frequently used (930 of 1029; 90.4%) and were created with centrifugation to pellet (538 of 961; 56%). Direct smears were second in preparation frequency; discrete staining was preferred to batch staining. Nongynecologic cytology was used for molecular studies in 34.9% (350 of 1002) of laboratories, most commonly for fluorescent in situ hybridization of urine specimens. Flow cytometric immunophenotyping was performed by 55.9% (554 of 991) and immunohistochemistry by 91.9% (911 of 991) of the responding laboratories. Most laboratories (911 of 993; 91.7%) report specimen completion in 2 or fewer days. Cytohistologic correlation was performed by 71.6% (722 of 1008) of the laboratories both concurrently and retrospectively. CONCLUSION: The various parameters examined in the 2010 survey provide a benchmark for future efforts in quality assurance and process improvement in NGC.

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. DESIGN: A voluntary survey of cytology IHC practices was sent to 1899 cytology laboratories participating in the College of American Pathologists Nongynecologic Cytopathology Education Program in the fall of 2009. RESULTS: A total of 818 laboratories (43%) responded to the survey by April 2010. Three hundred fourty-five of 791 respondents (44%) performed IHC on cytology specimens. Seventeen different fixation and processing platforms prior to antibody reaction were reported. A total of 59.2% of laboratories reported differences between the platforms for cytology specimens and positive controls, but most (155 of 184; 84%) did not alter antibody dilutions or antigen retrieval for cytology IHC. When asked to name 2 antibodies for which staining conditions differed between cytology and surgical samples, there were 18 responses listing 14 antibodies. A total of 30.6% of laboratories performing IHC offered HER2 testing before publication of the 2007 College of American Pathologists/American Society of Clinical Oncologists guidelines, compared with 33.6% afterward, with increased performance of testing by reference laboratories. Three laboratories validated a nonformalin HER2 platform. CONCLUSIONS: The platforms for cytology IHC and positive controls differ for most laboratories, yet conditions are uncommonly adjusted for cytology specimens. Except for the unsuitability of air-dried smears for HER2 testing, the survey did not reveal evidence of systematic problems with any antibody or platform.

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. Cytomorphologic features evaluated included cell size, architectural pattern, nucleoli, intranuclear cytoplasmic inclusions (INCI), mucin, necrosis, squamoid features, lymphocytic response, and histologic features of BAC differentiation. DNA was extracted from a paraffin-embedded cell block or frozen needle core fragments. Exon 19 deletions and the L858R mutation in exon 21 of EGFR were detected using PCR followed by capillary electrophoresis for fragment sizing. KRAS mutational analysis was performed by real-time PCR using a set of seven different Taqman(r) allelic discrimination assays to detect six mutations in codon 12 and one mutation in codon 13. Six cases (12%) showed EGFR mutations, 12 (24%) showed KRAS mutations, and 38 (62%) contained neither EGFR nor KRAS mutations. The majority of patients had stage IV disease (78%); 20 samples (40%) were from metastatic sites. The presence of prominent INCI (P = 0.036), papillary fragments (P = 0.041), and histologic features of BAC on paraffin block (P = 0.039) correlated with the presence of EGFR mutations. The presence of necrosis (P = 0.030), squamoid features (P = 0.048), and poorly differentiated tumors (P = 0.025) were more likely to be identified in the KRAS positive group.

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. The cytopathologists remotely accessed the real-time images on a computer in their office and rendered immediate assessments. Mean procedure times, and preliminary and final diagnoses were compared between telecytology and conventional on-site evaluation. RESULTS: Two hundred and forty consecutive EUS-FNA and EBUS-FNA procedures with immediate assessments were performed during the evaluation period, of which 158 (66%) utilized telecytology and 82 (34%) did not utilize telecytology. The mean procedure time required for cytotechnologists and cytology fellows was 1.1 h for both conventional on-site and telecytology evaluations. The mean procedure time for cytopathologists was 0.74 h for conventional on-site evaluations and 0.2 h for telecytology. CONCLUSIONS: Incorporation of telecytology for immediate assessment of EUS-FNA increased cytopathologist efficiency.