Manon Auger

Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic-histologic correlation.

Fine‐needle aspiration (FNA) cytology of axillary lymph nodes is a simple, minimally invasive technique that can be used to improve preoperative determination of the status of the axillary lymph nodes in patients with breast cancer, thereby serving as a tool with which to triage patients for sentinel versus full lymph node dissection procedures. The aim of the current study was to determine the sensitivity and specificity of FNA cytology to detect metastatic breast carcinoma in axillary lymph nodes.

Is the performance of urinary cytology as high as reported historically? A contemporary analysis in the detection and surveillance of bladder cancer

OBJECTIVES The goal of this study was to evaluate sensitivity and specificity of urine cytology during a contemporary period at our institution in comparison with historical analysis and other reported urinary biomarkers. MATERIALS AND METHODS Data from 1,114 consecutive patients corresponding to 3,251 specimens (2,979 cytologic and 272 histologic specimens) between January 2006 and July 2006 were retrieved. Subsequent cytologic and surgical specimen reports were examined with a minimum 2-year follow-up period. Collected parameters included the date of collection, reason for urinary evaluation, type of specimen, and tumor grade. Atypical diagnosis was considered negative. RESULTS On cytologic examination, 71% of specimens were benign, 23% atypical, and 6% suspicious or positive for urothelial carcinoma. Reason for collection was surveillance in 61% and new symptoms in 28%. Depending on the tumor grade, sensitivity results ranged from 10% for low-grade to 51% for high-grade tumors. Importantly, specificity of urine cytology ranged from 83% to 88% (depending on the type of urine collection and type of clinical presentation). Anticipatory positive rate was 44% after a median time of 15 months. Specificity of other reported urinary markers ranges from 40% to 90%. CONCLUSION Our institutions experience with regard to specificity of urine cytology is lower than reported historically. Whether this is a consequence of heterogeneous study designs and parameters is open to debate. As the anticipatory positive rate was high, close surveillance remains recommended in patients with positive urine cytology and negative workup. Other institutions are encouraged to evaluate whether there remains a significant advantage for urine cytology over other urinary marker assays within their own clinical setting.

Atypical Squamous Cells of Undetermined Significance

OBJECTIVE: To evaluate the significance of atypical squamous cells of undetermined significance (ASCUS) by correlating the histologic findings following a diagnosis of ASCUS on a cervical cytologic smear. STUDY DESIGN: Eighty-four smears that had been called ASCUS over a five-month period and that had corresponding histologic material were reviewed independently. Only 52 of the 84 cases on which a consensus was reached were retained for the current study. RESULTS : The breakdown of the follow-up histologic diagnoses was as follows: 28 cases (54%) were negative (without squamous intraepithelial lesions [SIL]); 22 cases (42%) showed SILs, of which 14 (27%) were low grade, 5 (10%) were high grade and 3 (5%) had SILs that could not be further classified because of fragmentation of the endocervical curettings. Finally, two cases (4%) proved to be invasive cervical carcinoma on histology despite smears that were satisfactory and not limited by the quantity or quality of material; in these the discrepancy was attributed to sampling error. CONCLUSION: Patients whose cervical cytologic smears fall into the category of ASCUS may, on follow-up, exhibit a wide spectrum of findings, ranging from no pathologic abnormality to frequent SIL and even to invasive carcinoma in rare instances. A diagnosis of ASCUS on smears warrants careful follow-up and investigation.

Rapid prescreening of papanicolaou smears : A practical and efficient quality control strategy

Efficient quality control (QC) is essential to ensure high sensitivity of Papanicolaou (Pap) smears. For this purpose, rescreening of 10% random negative smears is ineffective. Rapid rescreening (RR) of all negative Pap smears is more practical and has received widespread acceptance, especially in Europe, although its sensitivity is difficult to monitor and its retrospective nature may influence the vigilance of the screeners. The method of rapid prescreening (RPS) overcomes these drawbacks because rapid review of Pap smears occurs before routine full screening.

Differentiating cytological features of bronchioloalveolar carcinoma from adenocarcinoma of the lung in fine-needle aspirations: A statistical analysis of 27 cases

Bronchioloalveolar carcinoma (BAC) is an uncommon type of lung carcinoma that is important to distinguish from adenocarcinoma (adenoCA) because of its different biological behavior. Although the features of BAC have often been described in cytological material other than fine‐needle aspirations (FNA), they have rarely been detailed in FNA specimens. We undertook to delineate the differentiating cytological features of 13 cases of BAC (7 of the nonsecretory type and 6 of the secretory type) and of 14 cases of bronchogenic adenoCA in FNA material, looking at 17 cytological criteria and using statistical analysis. When statistically analyzed with chi‐square and Pearsons correlation, only 3 of the 17 features were found to be good discriminants for distinguishing nonsecretory BAC (NS‐BAC) from adenoCA: prominence of monolayered tumor sheets, fine chromatin pattern, and mild cellular pleomorphism correlated significantly with NS‐BAC. On the other hand, only the prominence of nuclear grooves and the abundance of extracellular mucin correlated significantly with secretory BAC (S‐BAC) when compared to adenoCA. When using a logistic regression analysis, NS‐BAC and S‐BAC were best discriminated from adenoCA by the prominence of monolayered tumor sheets and by the abundance of extracellular mucin, respectively. We conclude that, in most instances, it is possible to make an accurate diagnosis of BAC and to distinguish it from adenoCA of the lung in FNA material. Diagn. Cytopathol. 16:253–257, 1997.

Correlation of cytotechnologists' parameters with their performance in rapid prescreening of papanicolaou smears

Efficient quality control is essential to ensure high sensitivity of Papanicolaou (Pap) smears. For this purpose, rescreening of 10% random negative smears is increasingly felt to be ineffective. Rapid rescreening (RR) of all negative Pap smears is more practical and has received widespread acceptance, especially in Europe, although its sensitivity is difficult to monitor and its retrospective nature may influence the vigilance of the screeners. The method of rapid prescreening (RPS) overcomes these drawbacks because rapid review of Pap smears precedes full screening.

The bethesda system for reporting thyroid cytopathology: Proposed modifications and updates for the second edition from an international panel

The Bethesda System for Reporting Thyroid Cytology (TBSRTC) was proposed in 2007 at the National Cancer Institute Thyroid Fine Needle Aspiration State of the Art and Science » Conference held in Bethesda, Maryland. The aim was to address the inconsistent and sometimes confusing reporting terminologies used for thyroid FNA throughout the world. The TBSRTC consists of 6 diagnostic categories, each associated with an implied risk of malignancy that translates directly into a clinical management algorithm. Since the publication of the TBSRTC cytology Atlas in January 2010, considerable experience has been gained regarding its application in cytology practice, clinical impact, and limitations. In conjunction with the International Academy of Cytology (IAC), an international panel composed of sixteen cytopathologists and an endocrinologist with special interest in thyroid cytology, including several co-authors of the 2010 TBSRTC Atlas, was created to: 1) analyze the current worldwide impact of TBSRTC, 2) report on the current state of TBSRTC based upon a review of the published literature, and 3) provide possible recommendations for a future update of TBSRTC. Herein, we summarize the panels deliberations and key recommendations that our panel hopes will be useful during the preparation of the second edition of TBSRTC.

Impact of Implementing the Paris System for Reporting Urine Cytology in the Performance of Urine Cytology: A Correlative Study of 124 Cases.

OBJECTIVES We assessed the performance of urine cytology using the Paris System for Reporting Urine Cytology (PSRUC) in comparison to our current system. METHODS In total, 124 specimens with histologic correlation were reviewed and assigned to the PSRUC categories: benign, atypical urothelial cells (AUCs), suspicious for high-grade urothelial carcinoma (SHGUC), and high-grade urothelial carcinoma (HGUC). Original cytological diagnoses were recorded. RESULTS Fewer cases were given an AUC diagnosis using the PSRUC in comparison to the original diagnoses (26% vs 39%), while the association of AUCs with subsequent HGUC increased from 33% to 53% with the PSRUC. Using the PSRUC resulted in a higher number of low-grade carcinomas assigned to the benign (40%) rather than the AUC (22%) category. The performance of SHGUC/HGUC diagnoses was similar in both systems (predictive value = 94%). CONCLUSIONS The PSRUC seems to improve the performance of urine cytology by limiting the AUC category to cases that are more strongly associated with HGUC.

Measuring the significance of workload on performance of cytotechnologists in gynecologic cytology: a study using rapid prescreening.

Workload is extensively regulated and often used as a measure of quality in gynecologic cytology. Whether workload correlates with the sensitivity of screening in gynecologic cytology is not known.

Improvement in the Routine Screening Performance of Cytotechnologists Over Time

Documenting the performance of gynecologic screening in actual practice settings is difficult to achieve. In the current study, the screening performance of 11 individual cytotechnologists as well as that of the overall laboratory over 2 consecutive time periods was examined using the rapid prescreening (RPS) method.