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* Context.--Pathologists routinely assess Ki67 immunohistochemistry to grade gastrointestinal and pancreatic neuroendocrine tumors. Unfortunately, manual counts of the Ki67 index are very time consuming and eyeball estimation has been criticized as unreliable. Manual Ki67 counts performed by cytotechnologists could potentially save pathologist time and improve accuracy.Objective.--To assess the concordance between manual Ki67 index counts performed by cytotechnologists versus eyeball estimates and manual Ki67 counts by pathologists.Design.--One Ki67 immunohistochemical stain was retrieved from each of 18 archived gastrointestinal or pancreatic neuroendocrine tumor resections. We compared pathologists' Ki67 eyeball estimates on glass slides and printed color images with manual counts performed by 3 cytotechnologists and gold standard manual Ki67 index counts by 3 pathologists.Results.--Tumor grade agreement between pathologist image eyeball estimate and gold standard pathologist manual count was fair ([kappa] = 0.31; 95% CI, 0.030-0.60). In 9 of 20 cases (45%), the mean pathologist eyeball estimate was 1 grade higher than the mean pathologist manual count. There was almost perfect agreement in classifying tumor grade between the mean cytotechnologist manual count and the mean pathologist manual count ([kappa] = 0.910; 95% CI, 0.697-1.00). In 20 cases, there was only 1 grade disagreement between the 2 methods. Eyeball estimation by pathologists required less than 1 minute, whereas manual counts by pathologists required a mean of 17 minutes per case.Conclusions.--Eyeball estimation of the Ki67 index has a high rate of tumor grade misclassification compared with manual counting. Cytotechnologist manual counts are accurate and save pathologist time.(Arch Pathol Lab Med. 2018;142:402-407; doi: 10.5858/arpa.2017-0203-OA), Neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas are uncommon neoplasms with marked heterogeneity in clinical behavior. (1,2) Ki67 immunohistochemistry has emerged as an important prognostic indicator and is [...]

Objective: At our institution, cell blocks (CBs) are routinely produced for all body fluid samples, lung fine needle aspirations (FNAs), non-salivary gland and non-thyroid head and neck FNAs, and endoscopic ultrasound-guided (EUS) FNAs that have undergone rapid on-site evaluation (ROSE). For all remaining FNA specimens, CBs are generated only if requested by the pathologist. A recent inhouse trial evaluated the impact of routine CBs for all non-parotid and non-thyroid head and neck FNAs and revealed fewer false negative diagnoses with this approach. The aim of this study is to further evaluate the utility of routine CB preparation for other FNA specimen types. Method(s): This prospective study compared pre and post-CB diagnoses of FNAs obtained from lymph nodes, salivary glands, soft tissue lesions, EUS FNAs with and without ROSE, and other miscellaneous sites excluding thyroid and breast FNAs. Cell blocks were automatically generated for these FNA specimens over a period of four consecutive months. The pre and post cell-block diagnoses were compared and any potential impacts on diagnoses were recorded. Data and results: A total of 116 FNA specimens were included in the study. In 22 (18.9%) of these cases, the CB provided additional information that contributed to the final diagnosis. Parotid lesion FNAs were the most frequently associated with contributory CB material. In 9 of 38 parotid FNAs reviewed (23.7%), the CBs contained architectural features and/or confirmed lesional cell type allowing for a more definitive diagnosis. Conclusions: The findings support routine generation of CBs for some specimen types, particularly parotid lesion FNAs. [ABSTRACT FROM AUTHOR]