Mary K. Sidawy

Fine‐needle aspiration of thyroid nodules

The purpose of this study was to evaluate the results of thyroid fine‐needle aspiration (FNA) and to determine the reasons for the discrepancies between the cytologic and histologic diagnoses.

Interobserver variability in the classification of proliferative breast lesions by fine-needle aspiration: results of the Papanicolaou Society of Cytopathology Study.

This study evaluates the applicability of the published cytologic criteria in the categorization of proliferative breast lesions by assessing the diagnostic accuracy and interobserver reproducibility of a panel of experts. Twelve breast fine‐needle aspiration (FNA) specimens of biopsy‐proven nonproliferative breast lesion (NPL) (1 case), proliferative lesions without atypia (PL) (7 cases), proliferative lesion with atypia (PLA) (1 case), and low‐nuclear grade ductal carcinoma in situ (DCIS) (3 cases) were selected. Six FNAs were Papanicolaou (PAP) and 6 were Diff‐Quik‐stained (DQ). Six expert cytopathologists classified the smears using a summary of published criteria as a guideline. All 6 participants rendered the same cytologic diagnosis in 2/12 (16%) cases. The agreement among the 6 raters was low (Kappa = 0.35). Cytohistologic correlation was achieved in 26/72 (36%) FNA diagnoses. The correlation of the PAP‐stained cases was better than the DQ: 17/36 (47%) PAP and 9/36 (25%) DQ correlated. Improving the correlation was achieved by amalgamation of NPL and PL into “low risk” and PLA and DCIS into “high risk” categories: 47/72 (65%) FNA diagnoses then correlated with histology [29/36 (81%) PAP and 18/36 (50%) DQ]. We conclude that the cytologic criteria of proliferative breast lesions need to be further defined and assessed. Consideration should be given to minimizing the number of diagnostic categories and adopting a terminology that has a direct effect on patient management. Diagn. Cytopathol. 1998;18:150–165.

Changing trends in breast fine-needle aspiration: Results of the Papanicolaou society of cytopathology survey

Following the NCI‐sponsored consensus conference on fine‐needle aspiration of the breast, the Criteria and Nomenclature Task Force of the Papanicolaou Society of Cytopathology undertook a survey to assess the status of these issues and recommendations among practicing cytopathologists. The survey was designed to assess the impact of the changing trends in the diagnosis of breast lesions on cytopathology laboratories. It also intended to assess the impact of the recommendations of the consensus conference concerning the inclusion of a statement in breast FNA reports recommending the use of the triple test, the use of the proposed diagnostic terminology, and to evaluate criteria for specimen adequacy in breast FNAs used in different institutions. The results of this survey indicate the impact of an increasing use of core biopsies on the number of breast FNAs performed over the last several years. The recently recommended diagnostic terminology for breast FNA has quickly gained wide acceptance, as has the fundamental concept of the triple test. The issue of specimen adequacy, however, remains controversial, with some laboratories utilizing quantitative criteria, while the majority do not. Diagn. Cytopathol. 2000;22:126–130.

Atypical glandular cells of undetermined significance

The clinical significance of atypical glandular cells of undetermined significance (AGUS) remains poorly understood, and patient management is not standardized. The authors evaluated the rate, qualification, and follow‐up (FU) findings of AGUS patients.

The stability of estrogen and progesterone receptor expression on breast carcinoma cells stored as preservCyt suspensions and as thinPrep slides

Analysis of estrogen receptor (ER) and progesterone receptor (PR) status is an important ancillary test in the evaluation of positive breast fine‐needle aspirates. This study compares the detection of ER and PR in breast carcinoma cells suspended in PreservCyt with that achieved with stored ThinPrep slides (TP).

Evaluation of the 10% rescreen of negative gynecologic smears as a quality assurance measure.

The CLIA 88 regulations require the laboratory to review at least 10% of the gynecologic cases interpreted as negative that are examined by each cytotechnologist. The review must include negative cases selected at random and from patients identified as a high risk group. To evaluate the validity of this regulation, we reviewed the results of the 10% rescreen over a 24‐mo period. The rescreening by pathologists detected epithelial abnormalities in 4/2,124 negative cases (0.18%). Subsequently, biopsy‐proven squamous intraepithelial lesions were found in all four cases. Three different cytotechnologists were responsible for the four false‐negative interpretations. Our results show that 10% rescreen of negative smears may detect a few false‐negative cases. However, it is a time‐consuming and inefficient mean to evaluate the performance of cytotechnologists. Quality control in gynecologic cytopathology is essential, but it is equally important that laboratories concentrate their resources and energy on methods proven to be effective. Diagn Cytopathol 1996;14:84–86.

Can nonproliferative breast disease and proliferative breast disease without atypia be Distinguished by fine-needle aspiration cytology?†

Cytologic criteria reported to be helpful in the distinction of proliferative breast disease without atypia (PBD) from nonproliferative breast disease (NPBD) have not been rigorously tested.

Reactive cellular change

The aim of this study was to evaluate the rate of squamous intraepithelial lesions (SIL) in women with reactive cellular change (RCC) cervical smears and compare the results with a control group with within normal limit (WNL) smears.

Evaluation of the 5-year review of negative cervical smears in patients with high grade squamous intraepithelial lesions

Federal regulations require laboratories to re‐examine negative cervical smears from the 5 yr preceding a diagnosis of high‐grade squamous intraepithelial lesion (HSIL) or carcinoma. To assess the value of this regulation as a quality assurance measure, we evaluated the previous cervical smears from 47 patients with a diagnosis of HSIL rendered during a 9‐mo period. Fifteen patients had a total of 24 previous smears initially reported as squamous intraepithelial lesions (SIL). The remaining 32 patients had a total of 58 smears that carried a diagnosis lesser than SIL. Upon re‐screening 22/58 (38%) smears, from 16 patients, were upgraded to SIL (8 low grade, 14 high grade). Underdiagnosed SIL was detected in seven (44%) patients with the 1‐yr review, 12 (75%) with the 2‐yr review, 15 (94%) with the 3‐yr review, and 16 (100%) with the 5‐yr review. The authors conclude that the negative smear review is a beneficial quality assurance and teaching method that may lead to quality improvement. A 3‐yr retrospective review is effective and detects 94% of the undercalls. Diagn Cytopathol 1996;15:7–11.