Dorothy L. Rosenthal

Detection of breast cancer cells in ductal lavage fluid by methylation-specific PCR

If detected early, breast cancer is curable. We tested cells collected from the breast ducts by methylation-specific PCR (MSP). Methylated alleles of Cyclin D2, RAR-beta, and Twist genes were frequently detected in fluid from mammary ducts containing endoscopically visualised carcinomas (17 cases of 20), and ductal carcinoma in situ (two of seven), but rarely in ductal lavage fluid from healthy ducts (five of 45). Two of the women with healthy mammograms whose ductal lavage fluid contained methylated markers and cytologically abnormal cells were subsequently diagnosed with breast cancer. Carrying out MSP in these fluid samples may provide a sensitive and powerful addition to mammographic screening for early detection of breast cancer.

Telecytologic diagnosis of breast fine needle aspiration biopsies. Intraobserver concordance.

OBJECTIVEnTo determine the intraobserver concordance between telecytologic and glass slide diagnosis of breast fine needle aspirates.nnnSTUDY DESIGNnTwenty-five cases, originally received in consultation, were each examined by three cytopathologists. An average of seven compressed digital images per case were presented, together with a brief clinical history, using the http protocol and an internet browser.nnnRESULTSnAgreement between the telecytologic and glass slide diagnosis ranged from 80% to 96%. Nevertheless, two cases that had been unequivocally diagnosed as malignant based upon video images were considered to be benign by the same pathologist when reviewing the glass slides. Both diagnostic confidence and self-concordance were higher for one pathologist having significant previous video microscopy experience.nnnCONCLUSIONnAlthough intraobserver concordance between telecytologic and glass slide diagnoses of breast fine needle aspirates is high, refinement of existing criteria for diagnosis of malignancy, taking account of the particular limitations associated with telecytologic diagnosis, may be prudent prior to widespread use of telecytology for fine needle aspiration evaluation.

Adequacy in voided urine cytology specimens: The role of volume and a repeat void upon predictive values for high‐grade urothelial carcinoma

Adequacy assessment is one of the most controversial and overlooked components in the daily practice of cytopathology, because it is generally determined from limited samples. Because voided urine varies widely in terms of its volume and cellularity, there is little consensus about the proper role for these variables in assessing specimen adequacy. In this study, the authors explored the role of volume in voided urine specimens to determine whether it plays a role in determining adequacy for the detection of high‐grade urothelial carcinoma.

Improved risk stratification for patients with high-grade urothelial carcinoma following application of the Paris System for Reporting Urinary Cytology

The Paris System for Reporting Urinary Cytology (TPS) requires 4 cytomorphologic criteria for a definitive diagnosis of high‐grade urothelial carcinoma (HGUC) in urinary tract cytology (UTC) specimens: an elevated nuclear‐to‐cytoplasmic (N/C) ratio (at or above 0.7), markedly atypical nuclear borders, moderate to severe hyperchromasia, and coarse chromatin. However, malignant UTC specimens often contain degenerative changes, and this limits the number of malignant cells meeting all 4 TPS cytomorphologic criteria.

Should the BK polyomavirus cytopathic effect be best classified as atypical or benign in urine cytology specimens

According to The Paris System for Reporting Urinary Cytology (TPS), the category of atypical urothelial cells (AUC) should not be applied to specimens in which cellular changes can be entirely attributed to the polyoma (BK) virus cytopathic effect (CPE). Until recently, cases with BK CPE at The Johns Hopkins Hospital were categorized as atypical urothelial cells of uncertain significance (AUC‐US), which is equivalent to the TPS AUC category. This study was performed to determine how significantly the rate of AUC‐US specimens would decrease if specimens with only BK CPE were classified as benign.

The cytomorphological features of low-grade urothelial neoplasms vary by specimen type

Urinary tract (UT) cytology has been used successfully to diagnose high‐grade urothelial carcinoma but is reported to have poor sensitivity for low‐grade urothelial neoplasms (LGUNs). However, the literature has shown that LGUN may be associated with atypical findings in UT specimens. The authors determined which features were most commonly observed, and whether the method of specimen procurement had an effect.

When words matter: A "suspicious" urinary tract cytology diagnosis improves patient follow-up among nonurologists

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.

Upper urinary tract washings outperform voided urine specimens to detect upper tract high‐grade urothelial carcinoma

Cytological examination of voided urine (VU) can reliably diagnose high‐grade urothelial carcinoma (HGUC) of the lower urinary tract, but its value in the diagnosis of upper tract HGUC (UTHGUC) is less well‐established. To clarify the utility of VU in the setting of UTHGUC, we examined urinary specimens from patients with UTHGUC on follow‐up surgical pathology.

A 20-year and 46,000-specimen journey to Paris reveals the influence of reporting systems and passive peer feedback on pathologist practice patterns: A 20-Year Journey to Paris

An important goal of The Paris System for Reporting Urinary Cytology (TPS) is to reduce unnecessary atypical diagnoses given to urinary tract cytology (UTC) specimens. Since implementation of TPS at the study institution in 2016, the institutional atypical rate has declined only slightly. The authors speculated that TPS might not have had an immediate impact because several faculty members were involved in TPS committees and because TPS contains elements that already had been integrated into institutional practice. To identify factors contributing to alterations in the institutional atypical rate, the authors examined their practice over the last 22 years.

Performance of ovarian cyst fluid fine-needle aspiration cytology

Although ovarian fine‐needle aspiration (FNA) cytology is not commonly used as a primary modality of diagnosis for patients with ovarian lesions, many ovarian cysts are aspirated intraoperatively and occasionally for diagnostic purposes. Therefore, the ability to interpret these specimens remains critical. Previous studies have suggested a high specificity but low sensitivity as a limitation. The objective of the current study was to further explore the use and performance of ovarian cyst FNA for diagnosing malignancy at the study institution.