Edmund S. Cibas

Indications for thyroid FNA and pre-FNA requirements: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference†‡

The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine‐Needle Aspiration (FNA) State of the Science Conference on October 22–23, 2007 in Bethesda, MD. The 2‐day meeting was accompanied by a permanent informational website and several on‐line discussions between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes the indications for performing an FNA of a nodule discovered by physical examination or an imaging study; the indications for using ultrasound versus palpation for guidance when performing a thyroid FNA; the issues surrounding informed consent for thyroid FNA; and the information required on a requisition form that accompanies a thyroid FNA specimen. (http://thyroidfna.cancer.gov/pages/info/agenda/) Diagn. Cytopathol. 2008;36:390–399.

Diagnosing lymphoproliferative disorders involving the cerebrospinal fluid : Increased sensitivity using flow cytometric analysis

Flow cytometric immunophenotypic analysis (FCA) can be performed to evaluate lymphoid cells in cerebrospinal fluid (CSF). We compared this method with conventional cytologic diagnosis to determine its utility. A retrospective comparison of 35 consecutive CSF flow cytometry results with the corresponding cytologic diagnoses was undertaken. Twenty‐five of 35 CSFs (71%) were successfully analyzed by flow cytometry. The 10 samples which could not be analyzed were either too old (greater than 3 days) or had an insufficient number of cells. A total of 9 lymphomas was detected: 4 by both flow cytometry and cytology; 2 by cytology alone; and 3 by flow cytometry alone. This represents a 50% increase in the detection of lymphoproliferative disorders in CSF by a combination of flow cytometry and cytology vs. cytology alone. Furthermore, in 3 cases with follow‐up where the cytologic diagnosis was “atypical cells of undetermined significance” and the flow cytometric findings were negative for malignancy, the clinical course confirmed a benign pleocytosis in all three. We conclude that flow cytometric analysis markedly improves sensitivity when used in combination with cytology in the evaluation of lymphoid cells in CSF. Diagn. Cytopathol. 2000;23:369–374.

Cytologic diagnosis of gastrointestinal stromal tumor with emphasis on the differential diagnosis with leiomyosarcoma.

Gastrointestinal stromal tumor (GIST) has only recently been distinguished histologically and immunochemically from morphologically similar neoplasms of the abdomen.

Reducing or eliminating use of the category of atypical squamous cells of undetermined significance decreases the diagnostic accuracy of the Papanicolaou smear

The diagnosis of “atypical squamous cells of undetermined significance” (ASCUS) is controversial, not only for the clinical utility of its subcategories (favor reactive vs. favor dysplasia), but for its very existence as an expression of uncertainty. In the current study, the authors investigated the impact of reducing and eliminating this category on the sensitivity and predictive values for detecting squamous intraepithelial lesions (SILs).

The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion

Cervical cytologic specimens that show a low‐grade squamous intraepithelial lesion (LSIL) occasionally contain a few cells that are suspicious for, but not diagnostic of, a high‐grade squamous intraepithelial lesion (HSIL). In such cases, a diagnosis of LSIL cannot exclude HSIL is rendered. The objective of the current study was to assess the positive predictive value (PPV) for HSIL in follow‐up cervical biopsies for these cases.

ASC/SIL ratio for cytotechnologists: A survey of its utility in clinical practice

The atypical squamous cell to squamous intraepithelial lesion (ASC/SIL) ratio for cytotechnologists (CTs) may correlate with screening sensitivity in some laboratory settings. Whether this ratio can be applied to other laboratory settings is not known. We conducted a survey of nine cytology laboratories and correlated the ASC/SIL ratio of individual CTs with other laboratory characteristics.

Angiomatoid fibrous histiocytoma a series of five cytologic cases with literature review and emphasis on diagnostic pitfalls

Angiomatoid fibrous histiocytoma (AFH) is an uncommon and mostly indolent soft tissue neoplasm, which usually occurs in the subcutaneous tissue of the extremities in children and young adults. Although the histologic features of AFH are well established, reports of its cytomorphology are very limited. This report characterizes the cytomorphologic features of five cases of AFH, with correlation to clinical, histology, and cytogenetic findings.

Automation in cytology: a survey conducted by the New Technology Task Force, Papanicolaou Society of Cytopathology.

Despite the overwhelming interest in the development of several computer based technologies in the last several years, the role of automation in cytology has remained controversial. The potential of these technologies in the reduction of false negative results in pap smears is well recognized. However, there is still remarkable confusion as how to incorporate automation in the routine practice of cytology. This prompted the New Technology Task Force of the George Papanicolaou Society of Cytopathology to design a survey to seek the opinion of those engaged in cervicovaginal cytology screening regarding the value of automation in cytology.

Distinguishing benign from malignant mesothelial cells in effusions by Glut-1, EMA, and Desmin expression: an evidence-based approach.

Distinguishing malignant mesothelioma (MM) from reactive mesothelial hyperplasia (RM) may be difficult in effusions. This study tested the hypothesis that immunocytochemistry (IC) in effusion cell blocks (CB) can distinguish MM from RM and that the results may be applied to individual specimens. External validation of a risk score (RS) model associating sensitivity and specificity was applied to an external set of MM and RM specimens from a separate institution.