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Background Neurotrophic tyrosine kinase receptor (NTRK) rearrangement has been reported in a subset of papillary thyroid carcinoma (PTC) cases. Little is known about the cytomorphologic features of NTRK-rearranged PTC. Methods We report an institutional series of 13 fine needle aspiration (FNA) specimens of NTRK-rearranged PTC with a predominantly indeterminate cytology diagnosis. NTRK3 or NTRK1 rearrangements were detected on FNA or surgical specimens by next-generation sequencing. Results The 13 patients had a median age of 18 years; 10 patients were female and 3 patients were male. In 10 (77%) cases, cytology was indeterminate, and histopathologic follow-up was predominantly the follicular variant of PTC (n = 8 [62%]), mostly infiltrative subtype. Of 12 FNA specimens available for review, a predominant loosely cohesive group pattern was the most commonly encountered architectural pattern (n = 5 [41%]), followed by single cell (n = 3 [25%]), thick cord (n = 2 [17%]), and microfollicular pattern (n = 2 [17%]). Background lymphocytic thyroiditis was observed in 9 cases. At the cellular level, the cytoplasm was moderate and granular, occasionally vacuolated. Classic PTC nuclear features (eg, nuclear enlargement, elongation, grooves, and nuclear membrane irregularity) were present but were often focal and subtle. Chromatin was often granular. Intranuclear pseudoinclusions were absent or rare. Conclusion Our study demonstrates that most cases of NTRK rearrangement lack classic PTC cytomorphologic characteristics. Loosely cohesive groups and single cells with granular, sometimes vacuolated cytoplasm and subtle nuclear features are often seen on FNA specimens. Recognizing these characteristics may be helpful to preoperatively prompt molecular testing, including NTRK rearrangement analysis.

Diffuse malignant mesothelioma (MM) is an incurable tumour of the serosal membranes, which is often caused by exposure to asbestos and commonly diagnosed at advanced stage. Malignant mesothelioma in situ (MMIS) is now included as diagnostic category by the World Health Organization (WHO). However, our international survey of 34 pulmonary pathologists with an interest in MM diagnosis highlights inconsistency regarding how the diagnosis is being made by experts, despite published guidelines. Whilst the WHO restricts the diagnosis to surgical samples, the very concept has implication for cytological diagnosis, which is already regarded as controversial in itself by some. MMIS is currently only applicable as precursor to MM with an epithelioid component, and raises the possibility for different molecular pathways for different histological MM subtypes. The clinical implications of MMIS at this stage are uncertain, but aggressive therapies are being initiated in some instances. Based on the results of the survey we here present a critical appraisal of the concept, its clinical and conceptual implications and provide practice suggestions for diagnosis. A low threshold for ancillary testing is suggested. The designations of 'malignant mesothelioma, cannot exclude MMIS' or 'atypical mesothelial proliferation with molecular indicators of malignancy, so-called MMIS' could be used on cytology samples, adding 'no evidence of invasion in sample provided' for surgical samples. Clinical and radiological correlation are integral to diagnosis and best done at multidisciplinary meetings. Finally, collaborative studies are required to improve our understanding of MMIS. ispartof: PATHOLOGY vol:53 issue:4 pages:446-453 ispartof: location:England status: published

ObjectiveHuman papilloma virus (HPV) detection and genotyping are increasingly used in clinical risk assessment. We aimed to analyze HPV genotyping performance in risk stratification among cytology diagnosis categories.MethodsBetween January 1, 2015 and December 31, 2016, 4562 cases with cytology–HPV co-testing and biopsy follow-up were identified. HPV tests were performed on Cobas (n=3959) or Aptima (n=603) platforms. Of the biopsies, 669 demonstrated high-grade squamous intraepithelial lesions or worse.ResultsPooled high-risk HPV testing had high overall sensitivity (97%) but low specificity (20%) and positive predictive value (20%) for biopsy-confirmed high-grade squamous intraepithelial lesions or worse. HPV16/18 genotyping had considerably improved specificity (81%) and positive predictve value (35%) in predicting high-grade squamous intraepithelial lesions or worse, especially in atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion categories. Significantly more biopsy-confirmed high-grade squamous intraepithelial lesions or worse were detected by Aptima than Cobas testing, as measured by HPV16/18 (48% vs 33%, pConclusionsHPV genotyping was sensitive for biopsy-confirmed high-grade squamous intraepithelial lesions or worse in all cytologic categories, and is particularly valuable in risk evaluation for women with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions. The triaging role was greatly diminished in high-risk lesions (atypical glandular cells, atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions) due to low specificity and positive predictive value. Aptima performance in risk management was superior to Cobas, with significantly higher positive predictive value for biopsy-confirmed high-grade squamous intraepithelial lesions or worse. Our results highlight the importance of careful data interpretation from studies using different HPV testing methods and the need to incorporate HPV E6/E7-mRNA testing into management guidelines.

Background The Milan System for Reporting Salivary Gland Cytopathology (Milan System) has previously shown its diagnostic utility by categorizing the seven cytology findings in salivary gland lesions. However, there has been lack of study about the risk of high-grade malignancy in the cytology diagnosis based on the Milan System. Thus, we tried to identify the diagnostic ability of the Milan System for high-grade malignancy and to suggest an improved diagnostic approach for preoperative estimation of high-grade malignancy using the Milan System. Methods A total of 413 patients with parotid gland tumors, who had undergone surgical resection from 2011 to 2015 were included in the present study retrospectively. Cytopathology was reclassified according to the Milan System by two independent reviewers. The outcomes were risk of malignancy and risk of high-grade malignancy. The diagnostic performance of the Milan System category [Malignant] for detecting high-grade malignancy was calculated. Results The risk of malignancy was 83.3% and 100% in the Milan System categories [Suspicious for Malignancy] and [Malignant], respectively. Meanwhile, the risk of high-grade malignancy was 16.7% and 55.9% in these two categories. Disease-free survival of patients with high-grade malignancy was significantly worse than those with low- and intermediate-grade malignancy. Union combining the Milan System category [Malignant] with the presence of nodal metastasis suggested high-grade malignancy with an acceptable diagnostic sensitivity (0.889-0.963) and negative predictive value (0.900-0.966). Conclusions The Milan System category [Malignant] with the presence of nodal metastasis suggested parotid gland tumors as high-grade malignancy in a pretreatment setting.

Two-thirds of neuroendocrine neoplasms arising in the human body originate from the gastrointestinal system or pancreas. Gastroenteropancreatic neuroendocrine neoplasms are heterogeneous, comprising both well differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The clinical presentation, molecular characteristics, and behavior are distinct for NETs and NECs. Fine-needle aspiration is an important modality for the primary diagnosis and staging of these neoplasms and can provide information of prognostic and therapeutic significance. Our evolving understanding of neuroendocrine neoplasm biology has led to several iterations of classification. In this review, new concepts and issues most relevant to cytology diagnosis of gastroenteropancreatic neuroendocrine neoplasms are discussed, such as newer detection methods that aid in diagnosis and staging, recent changes in World Health Organization classification, practical issues related to grading these neoplasms on cytology, guidelines for diagnostic reporting, and panels of immunohistochemical stains for the diagnosis of metastasis. The current understanding of genetic and epigenetic events related to tumor development and potential applications for cytology also are presented as they relate to prognostication and recent therapeutic advances.

Background: Supravital staining is the staining of living tissue removed from the body, but before cessation of the chemical life of the cells. Objective: The present study has been undertaken with the aim of to assess adequacy of material during FNAC, study the cytomorphological features and rapid diagnosis by wet smears. Also, to evaluate the diagnostic capability of supravital stain applied over the tissue obtained by FNAC of various organs and aspirated body fluids. Material and Method: In present study 100 fine needle aspiration of various tissue and organ were examined for cytological evaluation. FNAC were done in the Out Patients and In patients of several departments of Gajara Raja Medical College. Out of 100 cases 33 from lymphnode, 19 from soft tissue swelling, 13- from breast lump, 13 from thyroid, 04 from parotid swelling, 14 from the body fluid and 04 miscellaneous. Result:Out of 100 cases 93 cases (93%) were diagnosed correctly and discrepancy of 7 cases found in cytological diagnosis by toluidine blue and H&E stain. Out of 48 non-neoplastic cases 45 diagnosed correctly with the overall accuracy of 93.75% andout of 52 neoplastic cases 48 were diagnosed correctly with the accuracy of 92.30%. Discussion:The advantage of this technique is that cells are seen in living natural condition without any artefact caused by fixation, air dry or cutting.

Introduction:FNAC is a simple, quick, inexpensive and minimally invasive technique for early diagnosis of palpable lesions in Head and neck. It is usually performed in outpatient department with nearly no complications. Objectives:To evaluate the role of FNAC and its utility in the diagnosis of palpable head and neck masses. To study the spectrum of head and neck lesions and its correlation with age, sex, and frequency of occurrence and its categorization into various groups. Methods:A study was conducted over a period of one year and two months by pathology department, SMS hospitals and Dr. M.K.Shah Medical College, Ahmedabad. Total 130 cases of Head and neck lesions were included during the study period. All patients coming from OPD’S of different departmentspresented with head and neck swellingwere included in the study. Result:Out of 130 cases, 59(45%) were male, 71(55%) were female. Head and neck swelling was most common in the age group of 21-30 years (25.3%).Highest number of FNAC was done from lymph node followed by Thyroid gland and Salivary gland respectively. Lymph node swelling were the most common 81(62%), followed by thyroid 28(22%), skin/subcutaneous 12(9%), salivary gland 09(07%). Conclusion:The accuracy of cytology diagnosis is very high if the requisition forms are accompanied with all relevant clinical history along with proper laboratory information. FNAC could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.

BACKGROUND Urinary tract cytology (UTC) specimens diagnosed using high-risk indeterminate categories such as "atypical urothelial cells, cannot exclude high-grade urothelial carcinoma" (AUC-H) or "suspicious for high-grade urothelial carcinoma" (SHGUC) have a high rate of detection of high-grade urothelial carcinoma on subsequent biopsy. Although urologists are familiar with such terminology, it is unclear whether patients receive appropriate follow-up when UTC is ordered by nonurologists. In the current study, the authors investigated whether the use of AUC-H versus SHGUC altered patient management among nonurologists. METHODS Specimens signed out as AUC-H or SHGUC were identified from the archives of the study institution, which included periods of time before the use of the standardized Johns Hopkins Hospital template, during use of the Johns Hopkins Hospital template, and after institution of The Paris System for Reporting Urinary Cytology. RESULTS Approximately one-half of the specimens diagnosed as AUC-H were not investigated further when ordered by nonurologists. Patients with specimens diagnosed as AUC-H received fewer subsequent biopsies (14% vs 53%; P

Background: Lytic lesions of bone are easier to aspirate and fine needle aspiration cytology aids in an earlier diagnosis. The findings are correlated with radiological findings and subsequent histopathological diagnosis. Sensitivity, specificity, positive and negative predictive value of fine needle aspiration cytology of lytic lesions of bone evaluated.Methods: It was a descriptive study for 2 years. All types of lytic lesions of bone were aspirated with fine needle along with radiological assistance. The cytological diagnosis was correlated with histo pathological diagnosis.Results: A total number of 84 cases were studied with histopathological follow up in 51 cases. FNAC diagnosis was correct in 34 cases. In 8 cases, cytology diagnosis was malignant neoplasm, but correct typing was not possible. In 9 cases cytological diagnosis were inconclusive due to inadequate material. Sensitivity of the test was 70.83%, specificity was 50.12%, positive predictive value was 97.14%, negative predictive value was 6.67% and overall accuracy was 70 .01%.Conclusions: The role of FNAC in diagnosis of bone lesions is both promising and challenging. Because of simplicity, low morbidity and economical benefits, FNAC should be the first step in the diagnosis of bone lesions.

At our institution, almost all thyroid fine-needle aspiration (FNA) procedures are performed by either Endocrinology or Radiology personnel. In this study, we compared the cytology and molecular adequacy rates of these 2 thyroid FNA practices, which differ on several aspects of specimen procurement.All thyroid FNA specimens from Endocrinology and Radiology practices between September 2008 and December 2016 were included. Over this time frame, the molecular testing modality transitioned from polymerase chain reaction (PCR)-based (7-gene panel era) to next generation sequencing (NGS)-based (ThyroSeq era). In measuring cytology adequacy, the Bethesda System unsatisfactory rate was determined. Molecular adequacy was categorized as Optimal, Limited Thyroid Epithelial Cells, Limited Nucleic Acids, or Failed. These parameters were compared for the 2 practices.The study cohorts comprised 5810 specimens from Endocrinology and 4597 from Radiology. More Endocrinology specimens were satisfactory for cytology diagnosis than those from Radiology (94.7% versus 90.0%, P0.001). For molecular adequacy, fewer Endocrinology specimens were optimal than specimens from Radiology for both the 7-gene panel era (76.2% versus 82.9%, P0.001) and the ThyroSeq era (88.1% versus 91.9%, P = 0.049).The 2 thyroid FNA practices varied inversely in their adequacy rates for cytology and molecular testing. Had one practice been superior for both cytology and molecular adequacy, a recommendation for the method of choice would have been straightforward. However, our results show that optimization of FNA practice for the current practice of thyroid cytology requires further investigation due to the complex nature of specimen procurement.

BACKGROUND Fine-needle aspiration (FNA) is an important tool for the diagnosis of infectious disease. FNA material should be appropriately submitted for cultures when indicated by preliminary findings. Correlation of cytologic diagnoses with culture results are important quality assurance tools. The current study reviewed 14 years of FNA-culture correlation. METHODS FNA cytology-culture correlation records from the years 1996 through 2007 and 2010 through 2011 were retrieved from electronic databases compiled for histology and culture correlation. Correlation was limited to those cases for which material was submitted for culture from the FNA sample. Culture results were retrieved from the laboratory or hospital information system. RESULTS Correlative data included 770 cases. Cytology, culture, or both were positive for microbes in 416 of 770 samples (54%), excluding cultured bacterial skin contaminants. Among the 204 bacteria cases, 93 (46%) were identified by cytology and culture, 92 (45%) were identified by culture only, and 19 (9%) were identified by cytology only. Among the 16 cases of Actinomycetales, 8 (50%) were identified by cytology and culture, 5 (31%) were identified by culture only, and 3 (19%) were identified by cytology only. Of the 129 cases of mycobacteria, 63 (49%) were identified by cytology and culture, 44 (34%) were identified by culture only, and 22 (17%) were identified by cytology only. Among the 67 cases of fungi, 34 (51%) were identified by cytology only, with 15 of these 34 cases being fungal hyphae; 25 cases (37%) were identified by cytology and culture, with a 100% concordance between the cytology diagnosis and culture result; and 8 cases (12%) were identified by culture only. CONCLUSIONS FNA cytology-culture correlation is a valuable tool with which to assess the efficacy and limitations of the direct diagnosis of infectious agents, and to identify types of infections that may be negative on culture but positive on cytology diagnosis. Cancer (Cancer Cytopathol) 2015. © 2015 American Cancer Society.

Cervical cancer is the fourth most common neoplasia in women and the infection with human papilloma virus (HPV) is its necessary cause. Screening methods, currently based on cytology and HPV DNA tests, display low specificity/sensitivity, reducing the efficacy of cervical cancer screening programs. Herein, molecular signatures of cervical cytologic specimens revealed by liquid chromatography-mass spectrometry (LC-MS), were tested in their ability to provide a metabolomic screening for cervical cancer. These molecules were tested whether they could clinically differentiate insignificant HPV infections from precancerous lesions. For that, high-grade squamous intraepithelial lesions (HSIL)-related metabolites were compared to those of no cervical lesions in women with and without HPV infection. Samples were collected from women diagnosed with normal cervix (N = 40) and from those detected with HSIL from cytology and colposcopy (N = 40). Liquid-based cytology diagnosis, DNA HPV-detection test, and LC-MS analysis were carried out for all the samples. The same sample, in a customized collection medium, could be used for all the diagnostic techniques employed here. The metabolomic profile of cervical cancer provided by LC-MS was found to indicate unique molecular signatures for HSIL, being two ceramides and a sphingosine metabolite. These molecules occurred independently of women's HPV status and could be related to the pre-neoplastic phenotype. Statistical models based on such findings could correctly discriminate and classify HSIL and no cervical lesion women. The results showcase the potential of LC-MS as an emerging technology for clinical use in cervical cancer screening, although further validation with a larger sample set is still necessary.

Introduction Traditionally at our institution, smears with or without liquid-based cytology (LBC) and core biopsies (CBs) have been obtained by radiologists performing image-guided fine-needle aspiration biopsies (FNABs) of deep organs. Since 2015, however, there has been a shift to providing cytology with samples for LBC only when obtaining CBs. The impression among our institution's cytologists is that LBC alone is less often adequate for diagnosis compared with smears and LBC together. We examined a series of kidney FNABs pre- and post-"LBC only" to evaluate this impression. Materials and methods With institutional review board approval, we compared all kidney FNABs from 2012 to those from 2015. We recorded the type(s) of cytology preparation(s), the number of cytology slides, the cytology diagnosis, the concurrent CB diagnosis, and whether there was a subsequent excision and the excision diagnosis. We examined cytology and CB slides as needed. Results In 2012, 105 patients underwent 111 kidney biopsies, 109 with smears made. In 2015, 58 patients underwent 62 kidney biopsies, 7 with smears made. In 2012, there were 13 (12%) nondiagnostic (ND) cytology cases and 19 (17%) cases where the cytology and CB diagnoses were discrepant. By comparison, in 2015, there were 20 (32%) ND cytology cases and 21 (33%) discrepant cases. Conclusions There were more cytology slides per case and fewer ND diagnoses in 2012 compared with 2015 (12% versus 32%, respectively, P = 0.001). Concordance was also better in 2012 (83% versus 67%, P = 0.015). We believe that our metrics would improve if we returned to the procedures followed in 2012.

Introduction The Paris System for Reporting Urinary Cytology (TPS) currently includes a volume recommendation for voided urine specimens of 30 mL based on observations of performance with BD SurePath preparation system. Given that many labs use the Hologic ThinPrep methods for voided urines, an analysis of data acquired with this system is undertaken in this study. Materials and methods We identified a total of 744 voided urine specimens. All specimens were processed fresh by ThinPrep at a large academic center that had incorporated a tiered urine cytology reporting template prior to TPS. To determine the optimum binary cutoff thresholds for voided urine volume, the fraction of high-risk cytologic diagnoses—suspicious for high-grade urothelial carcinoma (SHGUC) or worse—was compared below and above various volumes cutpoints. Results The cytology diagnosis was inadequate in 1.5%, negative for high-grade urothelial carcinoma in 64%, atypical urothelial cells in 14.2% SHGUC in 6.6%, high-grade urothelial carcinoma (HGUC) in 11.3%, low-grade urothelial neoplasm in 1.9%, and other malignancies in 0.5%. High-risk cytology was diagnosed in 19.1% of specimens ≥25 mL and in 13.5% of specimens P = 0.090). Volume of ≥25 mL was associated with the optimum cutoff for diagnosing SHGUC or HGUC. Conclusions A specimen volume of ≥25 mL is associated with higher rates of diagnosis of HGUC or SHGUC in voided urine specimens processed by ThinPrep. This is similar to the 30 mL cutoff determined for SurePath preparation that was incorporated into TPS and may provide helpful information for ThinPrep labs that are in the process of adopting TPS.

AIM: To describe the characteristics of patients with pleural effusion (PE) treated in a General hospital in the last four years. METHODE: We included all patients who underwent diagnostic thoracentesis from 1 January 2010 until 31 December 2013 at our center. Chart review was performed to obtain baseline characteristics, clinical diagnosis and mortality. RESULTS: 728 patients were included. Causes of PE: 213 (29%) infectious non-TB, 189 (26%) congestive heart failure (CHF), 157 (21%) malignant, TB 23 (3%), other diagnosis 15%; in 30 patients (4%) PE was considered idiopathic. We obtained a positive bacteriological culture only in 80 (37%) of the infectious PE. Among the malignant PE, pleural fluid cytology was positive in 91 patients (58%). In patients with CHF, 46.5% had protein in pleural fluid (PF) > 2.5 g/L, and in the 39% of the 103 patients who had LDH measured it was higher than 200U/L. In patients with infectious PE, 23% had PF protein CONCLUSIONS: 1. Pleural effusion is associated with high mortality; 2. In infectious non-TB pleural effusions the germ is isolated only in 1/3 of the cases; 3. In malignant PE, cytology diagnosis contributes in less than 60% of cases requiring the implementation of other diagnostic procedures; 4. Determination of isolated proteins and LDH in pleural fluid is not useful to discriminate between transudates and exudates PE, given the high false positive in patients with CHF.

Aims An approach to the process of undertaking cytopathology diagnosis for medical students and those who operate with cytology specimens is presented. Material and Methods This simple mnemonic (ABCDE) can be used as a memory aid determining the order in which cells or tissue fragments should be evaluated. When receiving a slide for diagnosis and prior to examining it under the microscope we need to make sure that it is correctly labelled and prepared (Correct) and we also need to know or gather all available information concerning the patient (A, Available Information). Once under the microscope, we check the type of cells and the adequacy of specimen (B, Body & Being Adequate). Next, by taking into consideration the cellular morphology and potentially by performing ancillary studies we proceed to answer if the cells are neoplastic or not (C, Cancer). We then either form a differential diagnosis list or we end up with our final diagnosis (D, Differential diagnosis or Diagnosis), which is followed by the writing of the report (E, Exhibit). Results These sequential steps (Correct ABCDE) followed as an ad hoc procedure by most pathologists, are important in order to achieve a complete and clear diagnosis and report, which is intended to support optimal clinical practice. Conclusions This ABCDE concept is a generic standard approach which is not limited to specific specimens and can help improve both cytopathology diagnoses and the quality of the final cytopathology reports., Diagnostic Pathology, 2015

Ultrasound (US) followed by USG-FNA is paramount for the evaluation of thyroid nodules. This chapter covers the US of normal thyroid gland, thyroid gland anomalies, and thyroid nodules including US features that prompt FNA cytology correlation. USG-FNA techniques for sampling thyroid nodules and specimen handling are also included. The FNA cytology diagnosis of benign, atypical, and malignant conditions described is based on the Bethesda System for Reporting Thyroid Cytopathology nomenclature. Cytologic features, molecular profile, immunocytochemistry, and US features of the various entities are described. Ancillary tests in atypical or undetermined follicular lesions and molecular markers and their therapeutic implications are also described at the end of the chapter. Numerous cytology and US figures complement the text.

Thyroid cytology is a widely used, cost effective outpatient procedure, which can be easily utilized in resource limited peripheral hospitals, available for preoperative assessment of thyroid nodules. We conducted the following study to analyze thyroid cytology reporting in three peripheral hospitals in Sri Lanka to assess their diagnostic utility, identify the associated problems and make recommendations for further improvement. This was a retrospective study performed on 300 thyroid cytology cases with a histological diagnosis. Thyroid cytology was reported according to BTA/RCP guidelines. Of the cytology diagnosis categories 72.7% were Thy 2, 22.3% were Thy 3, 4.7% were Thy 4 and 0.3% were Thy 5 lesions. Malignancy detection rate for each category were 2.3% for Thy 1, 13.4% for Thy 2, 64.3% for Thy 3 and 100% for Thy 4. The test had a 66.7% sensitivity, 97.7% specificity, 66.8% positive predictive value and 97.7% negative predictive value in diagnosing a malignancy. These parameters are comparable with the published parameters. However, the sensitivity of the test in the three hospitals showed significant variability. Concerted use of clinical and ultrasound findings in the interpretation of smears and multidisciplinary team meetings to discuss equivocal cases can be used to improve the diagnostic utility of thyroid cytology in these hospitals. Furthermore, performance of regular internal audits for each institution to identify problems is important since the study has shown variations in diagnostic parameters in different hospitals.

Mature B- and T-cell lymphomas are increasingly being associated with specific genetic alterations; characterization of these changes can sometimes be crucial to both diagnosis and prognosis. Molecular testing encompasses florescence in situ hybridization (FISH) and polymerase chain reaction (PCR)-based assays, as well as classical cytogenetics. FISH and PCR-based assays can be performed on cytology material without the need for advanced planning for testing with fresh tissue. As many lymphoproliferations are amenable to fine needle aspiration diagnosis, it is important for the cytopathologist to be aware of what testing is feasible in these (sometimes limited) specimens. Here, we review pertinent genetic changes in mature B- and T-cell lymphomas with a focus on those that may be encountered more commonly in cytology specimens. Diagn. Cytopathol. 2012;40:542–555. © 2012 Wiley Periodicals, Inc.

We report the cytological features of two cases of chondromyxoid fibroma (CMF) confirmed by histopathology examination. First case was a 40-year-old male who presented with a foot swelling, and the second case was a 16-year-old male with a lesion at the angle of jaw. A fine needle aspiration cytology (FNAC) was performed in both the cases. In first case, a correct diagnosis of CMF could be offered on FNAC. In the second case, though the cytology diagnosis was a sarcoma considering the cytological, radiological and clinical features, the histopathological examination confirmed the same to be a CMF. The cases are being discussed to highlight the usefulness of FNAC to diagnose these uncommon benign bone lesions and the potential pitfalls in the cytological diagnosis of chondroid lesions. Diagn. Cytopathol. 2013;41:904–908. © 2012 Wiley Periodicals, Inc.

Cilj rada je ustanoviti vrijednost citološke analize bioptičkog uzorka sluznice jednjaka, uzetoga prilikom endoskopske pretrage i usporediti je s patohistološkom analizom istoga u dijagnosticiranju malignih tumora sluznice jednjaka. U razdoblju od dvije godine,endoskopskom pretragom jednjaka, prilikom koje su uzeti uzorci za citologiju i patohistologiju, obradili smo 86 bolesnika u kirurškoj ambulanti. Materijal smo uzeli s 1-3 mjesta na sluznici jednjaka i od svakog uzorka učinjen je otisak za citološku analizu, te potom poslan na patohistologiju. Od ukupno 86 bolesnika, citološka i patohistološka dijagnoza podudarale su se kod njih 76 (88,3%). Negativnih na karcinom bilo je 31 (36,0%), a pozitivnih 45 (52,3%). Od 45 bolesnika pozitivnih u obje analize, samo su četiri bolesnika bila citološki pozitivna, a karcinom je patohistološki dokazan tek u drugoj, ponovljenoj pretrazi i biopsiji. U jednoga citološki pozitivnog i patohistološki negativnog bolesnika, karcinom je dokazan na operativnim patohistološkim uzorcima. Patohistološka analiza bila je pozitivna u 50 bolesnika: 45 njih bilo je citološki pozitivno, dok su tri bila citološki suspektna na karcinom, a dvoje bolesnika imalo je citološki nalaz izražene atipije na stanicama sluznice jednjaka. U ocjeni histoloških tipova karcinoma, citologija i patohistologija poklapale su se u 39 od 45 pozitivnih bolesnika (86,6%): 24 karcinoma pločastih stanica, 11 adenokarcinoma, dok su 4 bila ocijenjena samo kao karcinomi. Citološka analiza otiska bioptičkog uzorka sluznice jednjaka pokazala je visoku dijagnostičku točnost u dijagnozi karcinoma jednjaka. U ocjeni histološkog tipa karcinoma pločastih stanica, citološka i patohistološka dijagnoza podudarale su se u 96% slučajeva. Najviša osjetljivost dobiva se kombiniranjem citološke i patohistološke metode. Pozitivan citološki nalaz, uz negativan patohistološki, zahtijeva ponavljanje pretrage uzimanjem bioptičkog uzorka za obje analize., The aim of this study was to investigate the role of imprint cytology as a diagnostic tool, either alone or combined with histopathology, of oesophageal biopsy specimens. A two - year study of endoscopic cytology and histopathology was carried out on 86 patients suspected of having a malignant oesophageal lesion. Patients were biopsied on one to three locations and imprint cytology preparation was made for each biopsy specimen and then sent to histopathology. In 76 of 86 patients (88.3%) cytology and histopathology diagnosis were the same: 31 (36.0%) were negative and 45 (57.0%) were positive. Of 45 positive patients, a false-negative histopathology diagnosis was given in only four patients. Repeated biopsy confirmed the first positive cytology diagnosis. In one cytology positive and histopathology negative patient, carcinoma was diagnosed on surgical pathology. Of 50 histopathology positive patients, 45 were cytology positive, 3 were cytology suspected and 2 had severe cytology atypia. In tumor types evaluation, cytology and histopathology diagnosis were the same in 39 of 45 positive patients (86.6%): 24 were squamous cell carcinomas, 11 were adenocarcinomas while 4 were only carcinomas. Imprint cytology demonstrated high diagnostic accuracy in the diagnosis of malignant oesophageal tumors. Cytology and histopathology showed high correlation (96%) in the diagnosis of histologic type of squamous cell carcinoma. The cytology and histopathology techniques remain complementary and both should be utilized for maximum diagnostic efficiency. Positive cytology and negative histopathology diagnosis require repeated biopsy.

Most primary malignant epithelial neoplasms and many benign lesions of the breast possess such characteristic cytologic features that they can be diagnosed with certainty by needle aspiration. Because inadequate sampling may result in a false-negative cytology diagnosis, the time-tested rule is that a negative cytologic diagnosis is not definitive unless it is fully supported by negative clinical and mammographic findings.

Detailed root cause analysis to determine causes of pulmonary cytology errors has not been used to design specific practice changes. We performed root cause analysis of all false-negative bronchial brushing and washing specimen errors (n = 32) detected by the cytologic-histologic correlation process in 2002. Medical records and all slides were reviewed. Based on the correlation process, 10 errors were interpretive, 16 sampling, and 6 combined interpretive/sampling. Root cause analysis showed that the lesion was not accessible in 8 cases and tumor was readily identified on the slides in only 1 case. In 11 cases, the malignant cells were few and not recognized, and in 13 cases, obscuring artifacts (eg, cellular crushing and air drying) limited interpretation. Sampling issues had a major role in the misdiagnosis in 31 cases (97%), and recommendations for error reduction include immediate interpretation and the use of transmucosal fine-needle aspiration.

Objective . To determine the diagnostic correlation between referral cytology, initial biopsies and colposcopic impression in patients assessed in a provincial cytology screening program. Methods . A retrospective review of the computerized cytology screening database for British Columbia (BC), to identify all patients having their first colposcopy between 1986 and 2000 in 24 participating clinics constituted the study population. 84,244 patient records were identified for analysis. Colposcopies were performed mainly by 37 general gynecologists as part of a province-wide colposcopy program. Correlation of cytology, colposcopic impression and directed biopsies was performed. Results . The colposcopic impression correlated with the referral cytology within one degree in over 90% of cases. Colposcopists felt cytology underestimated disease in 1.5% and overestimated disease in 8.3%. Cytology–histology correlation within one degree occurred in 82%. Cytology underestimated the result of the biopsies in 2.3% and appeared to overestimate disease in 16.1% of patients. Patients with HSIL cytology had corresponding lesions in 77%, with a further 4.9% having LSIL disease. The predictive accuracy of colposcopy increased with advancing severity of disease expected. As the degree of cytological abnormality worsened, the predictive accuracy of colposcopic diagnosis increased. Conclusions . Both cytology and colposcopy have high sensitivity but low to moderate specificity. Colposcopy is most accurate in identifying high-grade diseases. Colposcopic impression correlates closely with the cytology diagnosis and combining the two produces optimum results.

The thyroid aspiration cytology diagnosis already has merits in the aspects of accuracy and economy. However, when it is indeterminate cytology, it decreases the accuracy of diagnosis and causes confusion, so other methods need to be added together for diagnosis before surgery or diagnostic surgery needs to be performed, which take more time and money. Therefore, each diagnostic procedure will be divided into three steps and examined the points for improvements and limits by discussing each step’s problem. First, it is the problem of lesion itself. It is difficult to diagnose even with tissue sample. Second, it is the problem of cytopathologists’ reading experiences. Third, it is the problem of sampling procedure. As for the second and third problems, they require training from each field for improvement. For the first problem, immunohistochemical stain could be carried out if possible for help and make diagnosis by taking clinical findings into account; however, considering the fact that it is difficult to diagnose even with tissue sample due to the characteristic of lesion, the limit can only be admitted that accurate diagnosis is difficult from only cytological diagnosis.

e19028 Background: Clinical observation of next-generation photodynamic therapy (NGPDT) for advanced non-small cell lung cancer (NSCLC). Methods: Through pathology or cytology diagnosis, 66 cases of advanced non-small cell lung cancer patients were selected and randomly divided into two groups. The Next Generation Photodynamic Therapy (NGPDT) group had 32 patients. Photosensitizer was administered on a dosage of 2 mg per kilogram of body weight, wherein two-thirds via ultrasonic atomization inhalation and one-third via oral intake. After the irradiation target(s) were determined, optical fiber for laser treatment purposes was guided into lung tumor(s) via interstitial procedure, percutaneous puncture under precious laser navigation, irradiation light intensity was 200 J/cm2, irradiation power was 1,000 mw, activation was then started and lasted for eight to ten minutes, laser irradiation into tumor was two to five centimeters in length, irradiation could be performed phase by phase (sub-paragraph treatment) based on tumor size or irradiations could be performed repeatedly. While in the mean time in the chemotherapy/radiotherapy group (external beam radiotherapy + whole body chemotherapy) 34 cases were observed, 15 MV X ray radiation therapy irradiation field covers primary lung tumor lesion(s) and mediastinal lymphatic drainage area, dosage was 65-70 Gy, on every first day in a week of radiotherapy, 20 mg cisplatin was administered via intravenous application. Results: In the NGPDT group and simultaneous radiotherapy/chemotherapy group, one and two years survival rate were 93.75%, 70.60% and 68.75, 32.35% respectively (P

this difference was not statistically significant and the risk of detecting CIN 2+ after a diagnosis of ASC-H in women older than 50 was sufficiently high to clinically warrant referral to colposcopy. HPV testing was performed at the request of the clinician in 127 (25.1%) of all ASC-H cases, with 83 cases (65.4%) testing positive for HPV. When subcategorized by age, 70.4% of 98 women age 50 and younger were HPV-positive, while this proportion in the 29 women above 50 years of age was 48.3%. Although this percentage was significantly lower as confirmed by chi-square testing (p