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An abstract of the article "Preoperative Diagnosis of Pancreatic Mucinous Cystic Neoplasms: A Correlation of Cytologic Features, Mucin Stain Results and Cyst fluid CEA Levels with Surgical Follow Up," by Melissa C. Bowman, Stephen P. Gmitro, Charles V. Biscotti, R. Matthew Walsh and Jennifer A. Brainard is presented.

An abstract of the article "Trichomonal Infection and Associated Squamous Cell Abnormalities," by Nancy J. Ray, Stephen Baker, Gary W. Procop, and Jennifer A. Brainard is presented.

An abstract of the article "Cytologic Diagnoses and HPV Test Results in Endocervical Glandular Neoplasms," by Julie A. Shorie, Debbie A. Sabo, Charles V. Biscotti and Jennifer A. Brainard is presented.

An abstract of the article "Clinical Significance of Non-Diagnostic Molecular Changes Detected by UroVysion FISH in Urine from Patients Under Surveillance for Recurrent Urothelial Carcinoma," by David B. Litt, Sandra E. Dolar, Brian Wells, Carvel Nguyen, J. Stephen Jones and Jennifer A. Brainard is presented.

An abstract of the article "Utility of MonoPrep® Slides in the Evaluation of Fine Needle Aspirate Specimens: A Direct to Vial Comparison with the ThinPrep® Method," by Dawn L. Underwood, Julie Shorie, Matthew Howard, David Cohen, Melinda Kral, Jennifer A. Brainard, and Christine N. Booth is presented.

An abstract of the article "Expression Pattern of HPV L1 Capsid Protein in PAP Tests: A Potential Biomarker in Risk Assessment for High Grade SIL Lesion," by Thomas Scheidemantel, Kelly Simmerman, Sandy Dolar, Jennifer Brainard, Raymond Tub, Ralf Hilfrich, and Bin Yang is presented.

Although primary vaginal cancer is uncommon, representing 1-2% of all female genital malignancies, metastatic disease to the vagina is not. Most cases represent metastases from other pelvic organs or the colon. We present the second case in the literature of a pancreatic adenocarcinoma metastasizing exclusively to the vagina. [Copyright &y& Elsevier]

Purpose: Perianal Paget's disease is a rare intraepithelial adenocarcinoma of the perianal skin and the second most common localization of extramammary Paget's disease. This study was designed to evaluate long-term outcomes in patients with perianal Paget's disease. Methods: We identified patients who were treated for perianal Paget's disease between 1981 and 2013. Patient demographics, family history, associated malignancies, treatments, histopathological features, need for re-operations, and long-term outcomes were documented. Results: Our study cohort consisted of 15 male and 10 female patients with a median age of 67 (40-83) years. Four patients had concurrent anorectal adenocarcinoma (two anal canal, two rectal) when perianal Paget's disease was diagnosed. Index operations performed were wide local excision (14 patients), local excision (five patients), abdominoperineal resection (four patients), and radiotherapy (two patients). Five patients developed invasive carcinoma (three anal canal, one vulvar, one perianal squamous cell carcinoma) during a median follow-up time of 60 (3-299) months. Thirteen patients were re-operated. Fifteen patients had a reconstructive procedure following excision. Overall survival was similar between the patients who were treated with wide local excision and local excision regardless of surgical margin status at index excision ( P = 0.75). Conclusions: Since there is a risk for developing invasive carcinoma in the anal canal and perineum in patients with perianal Paget's disease, close follow-up is needed after R0 or R1 excision. Physicians should be aware of the risk of cancers associated with perianal Paget's disease and should rule out them during management. [ABSTRACT FROM AUTHOR]

The majority of breast diseases result from lesions of the ductal epithelium. Mammary ductoscopy allows for visualization of intraductal abnormalities, and ductoscopic lavage provides thousands of cells for analysis. We reviewed our experience of 89 cases of patients with pathologic nipple discharge (PND) undergoing ductoscopy-directed duct excision and collection of ductal washings. Patients undergoing ductoscopy-directed duct excision with ductal washings had an 88% abnormal pathology rate. Most abnormalities were benign (71% papillomas), but the atypia rate for this group was 62%. The combination of visualization and pathologic analysis of washings provided the highest predictive value for the diagnosis of papilloma. Cellular yields for this technique were excellent with most specimens yielding >5,000 epithelial cells per high powered field and with evaluable ductal cells in 82% of specimens. Mammary ductoscopy offers the advantage of a high lesion localization rates with intraoperative guidance. The most accurate tool was the combination of ductal washings and ductoscopic visualization, but preoperative use of these techniques is not helpful in most cases. Greater than 90% of patients with PND are found to have a lesion on pathologic examination when using this technique for directed duct excision. Of interest, ductal washings obtained from symptomatic patients with benign diseases are often atypical. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer screening guidelines for women aged ≥30 years allow for co-testing or primary cytology testing. Our objective was to determine the test characteristics and costs associated with Cytology, HPV and Co-testing screening strategies.Main Methods: Retrospective cohort study of women undergoing cervical cancer screening with both cytology and HPV (Hybrid Capture 2) testing from 2004 to 2010 in an integrated health system. The electronic health record was used to identify women aged ≥30 years who had co-testing. Unsatisfactory or unavailable test results and incorrectly ordered tests were excluded. The main outcome was biopsy-proven cervical intraepithelial neoplasia grade 3 or higher (CIN3+).Key Results: The final cohort consisted of 99,549 women. Subjects were mostly white (78.4 %), married (70.7 %), never smokers (61.3 %) and with private insurance (86.1 %). Overall, 5121 (5.1 %) tested positive for HPV and 6115 (6.1 %) had cytology ≥ ASCUS; 1681 had both and underwent colposcopy and 310 (0.3 %) had CIN3+. Sensitivity for CIN3+ was 91.9 % for Primary Cytology, 99.4 % for Co-testing, and 94.8 % for Primary HPV; specificity was 97.3 % for Co-testing and Primary Cytology and 97.9 % for Primary HPV. Over a 3-year screening interval, Primary HPV detected more cases of CIN3+ and was less expensive than Primary Cytology. Co-testing detected 14 more cases of CIN3+ than Primary HPV, but required an additional 100,277 cytology tests and 566 colposcopies at an added cost of $2.38 million, or $170,096 per additional case detected.Conclusions: Primary HPV was more effective and less expensive than Primary Cytology. Primary HPV screening appears to represent a cost-effective alternative to Co-testing. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective of this study was to compare the histological characteristics of pathological specimens of excised midurethral sling mesh and surrounding vaginal tissue in patients who presented preoperatively with pain and/or exposure of mesh to patients who underwent mesh excision for voiding dysfunction without pain and/or erosion. Methods: This is a retrospective case-control study of women who underwent excision of midurethral sling mesh between 2008 and 2013. Three groups were identified: (1) voiding dysfunction without pain or exposure (control group), (2) pain and/or mesh exposure, and (3) voiding dysfunction with pain and/or mesh exposure. All original pathological specimens were rereviewed by one pathologist blinded to indication for excision and the previous pathology report. Degree of inflammation and fibrosis were recorded based on a 4-point scale along with the presence of giant cell reaction. Results: A total of 130 subjects met inclusion criteria: 60 (46.2 %) with voiding dysfunction only, 21 (16.2 %) with pain/erosion, and 49 (37.7 %) with both pain/exposure and voiding dysfunction. The voiding dysfunction only group was found to have significantly higher levels of inflammation, median grade 2 (1-3), compared to the other two groups with a p value of 0.007. There were no statistical differences in fibrosis and giant cell reaction between the three groups. Conclusions: Midurethral sling mesh excised for voiding dysfunction demonstrates elevated levels of inflammation compared to mesh that is excised for pain and/or exposure. The vaginal tissue fibrosis and giant cell reaction are similar in patients who undergo mesh excision for voiding dysfunction and pain, and/or mesh exposure. [ABSTRACT FROM AUTHOR]

Objective The management of atypical cells on endoscopic retrograde brush cytology ( ERBC) in patients with indeterminate biliary stricture is unclear. This study aimed to investigate the detection of cancer (pancreatic and biliary carcinoma) in patients with atypical cells on ERBC and the factors predicting it. Methods From a prospectively maintained cytology database in a tertiary care center, patients with indeterminate biliary stricture and atypical cells on ERBC from 1996 to 2012 were studied. The date of the initial ERBC with atypical cells was identified as time zero. The primary outcome was to study the incidences and Kaplan- Meier estimates for detecting cancer. Results In all, 104 patients with 182.8 person-years of follow-up were identified. In 38 (36.5%) patients cancer was detected (19 cholangiocarcinoma, 15 pancreatic cancer, three ampullary cancer and one gallbladder carcinoma) over a mean follow-up of 4.4 months. On Cox regression analysis, the presence of clinical jaundice (hazard ratio [ HR] 4.08, 95% CI 1.41-11.8), active alcohol consumption ( HR 7.33, 95% CI 1.85-29.1) and elevated carbohydrate antigen 19-9 ( CA19-9) level (>33 U/mL) ( HR 8.42, 95% CI 1.75-40.6) at the time of ERBC were associated with increased risk for the detection of cancer. Detection of cancer was more common during the first 6 months of follow-up than at any time period thereafter. Conclusion Elevated CA19-9 level, the presence of clinical jaundice and current alcohol consumption are associated with increased detection of cancer in patients with indeterminate biliary stricture and atypical cells on ERBC. [ABSTRACT FROM AUTHOR]

Objectives: To determine the outcomes for patients with nondiagnostic fluorescence in situ hybridization (FISH) (ie, <4 gains of chromosomes 3, 7, or 17 in ≤3 cells). FISH detects urothelial carcinoma and is especially beneficial in patients with negative or atypical urine cytology findings. A positive result is defined as a gain of ≥2 chromosomes (3, 7, or 17) in 4 cells, isolated loss of 9p21 in 12 cells, or isolated gains of only 1 chromosome in ≥10% of cells. Most FISH-positive patients will develop recurrent urothelial carcinoma within 1 year. Methods: We compared the data from 149 patients with a nondiagnostic FISH result and ≥30 months of follow-up with the data from patients with a negative FISH result from the same period. The time to conversion to a positive FISH result or the development of a bladder tumor was recorded. Results: Patients with nondiagnostic FISH results had significantly greater rates of progression to positive FISH findings or the development of a bladder tumor than did patients with negative FISH findings. Most progression occurred within 1 year. Patients with nondiagnostic FISH results and concurrent negative cytology and cystoscopy had a very low risk of developing recurrent disease, similar to that found with truly negative FISH results. Conclusions: Nondiagnostic FISH results are related to a greater risk of progression to positive FISH results and tumor recurrence than those with negative FISH findings. However, after controlling for negative cytologic and cystoscopic status, a nondiagnostic FISH result does not appear to be an independent predictor of disease recurrence, and aggressive investigation is not warranted. [Copyright &y& Elsevier]

Introduction: Sclerosing pneumocytoma (SP) is a rare benign tumor and a potential diagnostic pitfall. Our aim was to review the cytologic features of our surgically diagnosed SP cases including the clinical, immunohistochemical and available molecular findings., Materials and Methods: A computerized search from 2013 to 2020 for surgical cases with corresponding cytology specimens diagnosed as SP was performed. The clinical data, cytology, and surgical specimens were collated for analysis., Results: Six cytology specimens were collected. All were female (mean age = 35). Three have incidental lung nodules and three with cough. Cytologic findings showed variable architectural pattern (papillary, solid, singly scattered, acinar/rosette-like) and cellular heterogeneity (surface, stromal, epithelioid, plasmacytoid cells). Atypia was identified in 4/6 cases. The original cytology diagnoses were negative = 1, SP = 2 and adenocarcinoma = 3. The latter diagnoses were amended to SP after review of the surgical specimens. The three false positive cases on review have cytologic features mimicking adenocarcinoma. Immunohistochemical stains showed tumor cells (surface and stromal) were positive for TTF-1, and EMA with only the surface cells positive for pancytokeratin and Napsin A. Though two cases sent for molecular testing were negative for AKT1 or CTNNB1 exon 3 mutation, our panel did not evaluate AKT1 exon 4., Conclusions: SP is a diagnostic pitfall with 50% initially misdiagnosed as adenocarcinoma. Integrating the clinical/radiologic findings, cytologic features, and performance of immunohistochemistry on cell block are helpful in avoiding misdiagnosis. Molecular testing for recurrent mutations, if present, could be helpful for diagnosis and possible therapy options. However, routinely used molecular testing may not always capture relevant molecular markers for SP., (© 2024 The Author(s). Diagnostic Cytopathology published by Wiley Periodicals LLC.)

This report highlights information and outcomes from the November 2022 ASC/IAC joint Cytology Education Symposium, an annual conference organized by the Cytology Programs Review Committee. The manuscript provides information on shared educational opportunities and practices for cytology students and other learners in anatomic pathology, discusses recruitment strategies for schools of cytology, conveys teaching resources, introduces perspectives on virtual microscopy and online learning, and transmits information about wellness of students in schools of cytology., (Copyright © 2023 John Wiley & Sons Limited and American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Objectives: Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use-associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Prevention guidelines. The aim of this study was to determine the specificity of ORO staining in BAL specimens with disease states other than EVALI., Methods: Consecutive BAL specimens (October-December 2019) were stained with ORO. The lipid-laden macrophage index (LLMI) was calculated for each case., Results: We studied BAL samples from 50 patients. Indications for BAL were surveillance bronchoscopy for lung transplantation (27/50), suspected infection (12/50), sarcoidosis/suspected sarcoidosis (3/50), nodules or ground-glass opacities (3/50), hemoptysis (2/50), asthma or eosinophilic pneumonia (2/50), and idiopathic pulmonary fibrosis (1/50). ORO staining was seen in BAL fluid macrophages in 45 of 50 cases (focal in 18, moderate in 23, diffuse in 4); LLMI ranged from 0 to 218. Using a threshold of LLMI of 85 or higher as positive, ORO was positive in 7 of 50 (14%) cases (range, 85-218)., Conclusions: ORO staining in BAL fluid macrophages is not specific for EVALI. Even when an LLMI of 85 or higher is used as a threshold for positivity, ORO positivity occurs in a significant subset of non-vaping-related cases., (© The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Papanicolaou test quality metrics include the ASC rate, ASC:SIL ratio, and ASC HPV+ rate. What a laboratory should do when metrics show a worrisome trend is not well defined. In 2015, our laboratory noted a worrisome trend in our quality metrics and decided to implement a systemic education program in 2016; we monitored the effectiveness of our program., Methods: An educational intervention was designed for March/April 2016. Cytotechnologist education consisted of: group meeting on March 10 to discuss metrics, lecture, and written materials on ASC-US criteria, a quiz on challenging ASC-US cases, encouragement to seek consultation, and each cytotechnologist received quarterly individual metrics. The cytopathologist education consisted of: group meeting on April 16 to discuss metrics, encouragement to bring borderline cases to consensus conference, and each faculty received quarterly individual metrics. The ASC rate, ASC:SIL ratio, and ASC HPV+ rate was collected for the institution and each individual faculty in 2016 for January to March (pre-interventions, Q1), April to June (post-interventions, Q2), and July to September (post-interventions, Q3). ASC-H was included in the calculation of ASC %, ASC:SIL, and ASC HPV+ rates., Results: There was a substantial decline in the lab ASC rate and ASC:SIL ratio, and the ASC HPV+ rate increased. Individual faculty changes in ASC:SIL ratio and ASC HPV+ rate also improved., Conclusions: In our institution, an educational program has been very effective in improving Papanicolaou test metrics. It is helpful to perform re-education at all levels within the department., (Copyright © 2021 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Background: The incidence of anal carcinoma has risen in recent decades. Exfoliative cytology screening of selected high risk patients is performed in many centers. Unsatisfactory cytology results are frustrating to patients, clinicians, and laboratorians. The aim of this study is to ascertain outcomes of patients with non-diagnostic anal cytology., Methods: A retrospective review of anal cytology testing performed at the Cleveland Clinic between 01/01/2001 and 12/31/2015 was performed. All cases were received as liquid-based samples and processed as ThinPreps (Hologic, Marlborough, MA). Co-testing for HR-HPV DNA was performed using Hybrid Capture 2® (Qiagen, Germantown, MD) in the majority of patients., Results: Of 1,276 ThinPrep anal cytology samples, 130 (10%) were deemed unsatisfactory. 77% of patients were HIV positive. 85% were males. Of the unsatisfactory cases, 116 (89%) were co-tested for HR-HPV DNA. Of those, 40 patients (34%) had a simultaneous positive HR-HPV DNA. Adequate follow up cytology within a one year and a two year period revealed that 18/130 (14%) and 26/130 (20%) of patients had ASC or SIL respectively. Histologic follow-up within one and two years showed 3 patients (2%) and 8 patients (6%) with HSIL or worse., Conclusions: High risk patients with unsatisfactory anal cytology are not "negative". At least one-third proved to be concomitantly HR-HPV DNA positive with one-fifth showing subsequent cytologic squamous abnormalities and with more than 5% being diagnosed with a high grade intraepithelial lesion within two years. Prompt repeat cytology and/or HR-HPV DNA is recommended for high risk patients with non-diagnostic cytology., (© 2017 Wiley Periodicals, Inc.)

Background: The detection of mutated epidermal growth factor receptor (EGFR) in non-small cell lung cancer (NSCLC) with residual cell pellets derived from liquid-based cytology (LBC) samples (eg, endoscopic ultrasound-guided fine-needle aspiration) has been validated with allele-specific polymerase chain reaction. The aim of this study was to validate next-generation sequencing (NGS) technology for detecting gene mutations with residual cell pellets from LBC., Methods: Archived DNA extracted from LBC samples of adenocarcinoma stored in PreservCyt with a known EGFR mutation status was retrieved. Genomic DNA was multiplex-amplified and enriched with Ion AmpliSeq Cancer Hotspot Panel v2 chemistry and the OneTouch 2 instrument; this was followed by semiconductor sequencing on the Ion Personal Genome Machine platform. The mutation hotspots of 6 NSCLC-related genes (BRAF, EGFR, ERBB2, KRAS, MET, and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit α [PIK3CA]) were analyzed with NextGENe and Torrent Suite bioinformatics tools., Results: The commonly identified EGFR sequence changes, including 4 L858R mutations, 3 exon 19 deletions, and 1 exon 20 insertion, were in 100% concordance between the assay platforms. Less common NSCLC variants were also found in the mutation hotspots of ERBB2, KRAS, MET, and PIK3CA genes., Conclusions: NSCLC mutation analysis using NGS can be successfully performed on residual cell pellets derived from LBC samples. This approach allows the simultaneous examination of multiple mutation hotspots in a timely manner to improve patient care. Cancer Cytopathol 2017;125:178-187. © 2016 American Cancer Society., (© 2017 American Cancer Society.)

Introduction: Lung transplantation (LTx) is performed for end-stage lung diseases that would be otherwise fatal. Pulmonary allograft recipients are a unique patient population as they are at high risk for malignancy and infectious complications due to the need for immunosuppression. Endobronchial ultrasonography (EBUS)-guided fine-needle aspiration (FNA) is a minimally invasive technique for evaluating abnormalities of the mediastinum/lungs. To our knowledge, this report is the first in the literature addressing targeted EBUS-FNA biopsies in patients who have undergone LTx., Material and Methods: During 5 years from May 1, 2009 to May 1, 2014, 582 patients underwent LTx at the Cleveland Clinic. A review of records indicated that 14 of these patients later underwent EBUS-FNA. Demographic and diagnostic parameters were recorded., Results: A total of 14 patients (mean age 64 years) underwent EBUS-FNA after LTx. The mean interval between LTx and EBUS-FNA was 15 months. EBUS-FNA yielded cytologic material diagnostic of malignancy in 10 patients (71%) with one-half of those cases being squamous carcinomas., Conclusions: EBUS-FNA is a useful diagnostic modality in lung allograft recipients and is of value in confirming and staging thoracic malignancies in this population. Carcinoma subtyping is feasible by EBUS-FNA, and performance of ancillary studies to confirm clonality in post-transplant lymphoproliferative disorders is possible., (Copyright © 2015 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Introduction: Squamous intraepithelial lesions (SIL) and squamous cell carcinomas (SCC) can rarely be detected in endometrial sampling. We reviewed all cases of SIL and SCC detected solely on endometrial biopsies and curettings to determine their significance and whether these findings were detected on prior or concurrent Papanicolaou (Pap) test., Materials and Methods: Endometrial samples with detached fragments of SIL and SCC over a 13-year period were reviewed, along with prior and/or concurrent Pap tests, human papillomavirus status, and subsequent pathology results. Cases with concurrent cervical or endocervical sampling that showed SIL or SCC were excluded., Results: Fifty patients had endometrial biopsies and/or curettings with SIL or SCC. Thirty-six patients (72%) had concurrent or previous Pap tests within 1 year prior to the endometrial sampling. The Pap test was negative for intraepithelial lesion or malignancy in 44% of patients (16/36) and atypical squamous cells of undetermined significance in 22% of patients (8/36). The source of the SIL and SCC in endometrial sampling was cervical SIL in 18 patients, cervical SCC in 14 patients, endometrioid carcinomas in 3 patients, metastatic carcinoma in 1 patient, and not definitively identified in 14 patients., Conclusions: The majority of SIL and SCC in endometrial samples are from the cervix. Prior and concurrent Pap tests were often negative for intraepithelial lesion or malignancy in patients with SIL and SCC detected by endometrial samples. This suggests that SIL and SCC detected on endometrial sampling may detect a subset of cervical SIL/SCC that are more proximal in the endocervical canal and are not sampled with conventional Pap tests., (Copyright © 2015 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Introduction: Breast carcinoma (BC) metastatic to the intrathoracic cavity is difficult to diagnose due to low sensitivity of current immunohistochemical (IHC) stains. Mammaglobin, gross cystic disease fluid protein-15 (GCDFP-15), and estrogen receptor (ER) immunomarkers show variable results. GATA3 is a recently described marker for detecting urothelial and breast cancers. Our goal is to test the utility of GATA3 in cell blocks from thoracic cytology specimens., Materials and Methods: We retrieved cases of BC that metastasized to the thoracic cavity from January 1, 2005 to September 30, 2013. IHC was performed on the cell blocks for the presence of GATA3, ER, GCDFP-15, and mammaglobin. Stains were scored quantitatively and qualitatively., Results: Fifty cases of metastatic BC found in pleural effusions and endobronchial ultrasound-guided fine-needle aspirates were identified in 48 patients. Thirty-four cases had sufficient material for IHC (19 pleural effusions, 15 endobronchial ultrasound-guided fine-needle aspirates). GATA3 showed strong nuclear positivity in 31 of 34 cases (91.2%). ER (25 of 34, 73.5%), mammaglobin (23 of 34, 67.6%) and GCDFP-15 (11 of 34, 32.6%) were positive in fewer cases. GATA3 and ER were concordant in 26 of 34 cases (76.5%) (24 ER/GATA3-positive, 2 ER/GATA3-negative). Discordant results were found in 8 of 34 cases (23.5%). Of these, GATA3 was positive and ER was negative in 7 cases. GATA3 was negative and ER was positive in 1 case., Conclusions: GATA3 is more sensitive than ER, mammaglobin, or GCDFP-15 in detecting metastatic BC in cytologic specimens. GATA3 may be positive when ER is negative. In cytologic specimens with limited diagnostic material, GATA3 may be used as a first-line marker in a limited IHC panel to support metastatic BC., (Copyright © 2015 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Introduction: We review endobronchial ultrasound-guided fine-needle aspirate samples and investigate cases with discrepancies between rapid on-site evaluation (ROSE) and final diagnosis in patients with bronchogenic carcinoma., Materials and Methods: Endobronchial ultrasound-guided fine-needle aspirates from 2009 to 2010 were studied. On-site adequacy assessments were compared with final diagnoses. Concordant diagnoses showed agreement between ROSE interpretation and final diagnosis. If the initial interpretation differed from the final diagnosis, the case was discordant. Slides from discordant aspirates were reviewed. Discordant results were categorized as sampling error or interpretive/screening error at ROSE., Results: A total of 340 endobronchial ultrasound-guided procedures were performed in 335 patients (168 men, 167 women, median age 65 years). Diagnostic discrepancies between ROSE and final diagnoses occurred in 65 aspirates (11%) from 51 patients with carcinoma. Of the 65 discrepant cases, 52 (83%) were subsequently called positive for carcinoma. Rescreening of slides in 47 available cases with a final positive diagnosis showed insufficient tumor for diagnosis in 28 of 47 cases (60%). The remaining 19 of 47 cases (40%) were classified as interpretive/screening errors at ROSE. Most errors occurred in aspirates called atypical or atypical suspicious, which upon rescreening were considered diagnostic (16 aspirates, 84%)., Conclusions: Initial and final diagnoses were concordant in 89% of aspirates from patients with carcinoma. All aspirates that were positive at ROSE were concordant. In discordant cases, all aspirates deemed "atypical suspicious for malignancy" and 86% of aspirates deemed "atypical cells" on ROSE had a final diagnosis of carcinoma. The majority of discordant cases with a positive final diagnosis were due to sampling (60%)., (Copyright © 2014 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Introduction: High-risk human papilloma virus (hrHPV)-associated head and neck (HN) squamous cell carcinomas (SCCs) have important differences from non-hrHPV-related HNSCCs. A highly sensitive and specific test for HPV in cytology fine-needle aspirations (FNAs) would be useful, as it has the potential to alter therapy., Materials and Methods: Patients with an HN FNA diagnosed as SCC or suspicious for SCC were included. Hybrid Capture 2 (HC2) was performed on residual rinse material and chromogenic in situ hybridization (CISH) for hrHPV was performed on the cell block. HC2-positive samples were genotyped for HPV types 16, 18, and 45. "Gold standard" p16 and CISH testing was performed on histologic material from the primary tumor. Tumors concordantly positive for p16 and CISH were considered hrHPV-positive, concordantly negative were considered hrHPV-negative, and discordant results were considered hrHPV-equivocal., Results: A total of 96 FNAs from 95 patients were included. Surgical material was available in 80 patients. Of those, 29 patients (36%) were positive for hrHPV by "gold standard" testing, and 3 patients (4%) had equivocal results. HC2 was 72% sensitive and 100% specific for hrHPV. Sixty percent of HC2-positive aspirate samples were positive for HPV16. CISH was 61% sensitive and 79% specific for hrHPV. HC2 had a significantly better sensitivity and specificity than did CISH on paired sample analysis (P < .05)., Conclusions: HC2 is a highly sensitive and specific assay for the detection of hrHPV in HN FNA samples. This new application of a familiar, widely available testing method has the potential to be clinically useful in the management of patients with HNSCC., (Copyright © 2014 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Purpose: Little is known about prognostic factors and treatment outcomes in young patients with anaplastic thyroid cancer (ATC). The goal of this study is to define the clinical features of this subgroup., Material and Methods: Patients age 55 or younger with either ATC or well-differentiated thyroid cancer (WDTC) with anaplastic changes were identified using electronic medical record at the Cleveland Clinic. The same number of patients older than 55 was randomly selected to serve as control. Progression-free survival (PFS), overall survival time (OST) and cause-specific mortality (CSM) were measured against age, tumor histology, extent of disease, and treatment modalities., Results: Twelve patients age 55 or younger were identified. The median age was 51 years. Four patients had WDTC with anaplastic components--mixed tumor group (MTG). Their median PFS, OST, and CSM at 24 months were 21.5 months, 51 months, and 25%, respectively. For the other 8 patients who had pure ATC, their median PFS, OST, and CSM were 3.5 months, 6 months, and 100%, respectively. Patients in the MTG had better survival compared to the pure ATC and control group in terms of PFS (p = 0.0047 and p = 0.0053), OST (p = 0.0028 and p = 0.0029) and the CSM at 24 months (p = 0.0339 and p = 0.0096). In the pure ATC group, patients with positive cervical lymph node and distant metastases had similar overall survival outcomes (6 vs. 8 months, p = 0.4995)., Conclusion: Prognostic factors favoring survival in young patients with ATC include ATC arising within WDTC. Once full anaplastic transformation occurs, age was not a significant factor in survival., (© 2013 Elsevier Inc. All rights reserved.)