Ruth L. Katz

Urinary nuclear matrix protein 22 (NMP22): A diagnostic adjunct to urine cytologic examination for the detection of recurrent transitional-cell carcinoma of the bladder

This study compares urine nuclear matrix protein 22 (NMP22) immunoassay and conventional urine cytologic examination for detecting recurrent transitional‐cell carcinoma (TCC) of the urinary bladder. One hundred twenty‐eight urine specimens from 107 patients with a history of TCC of the urinary bladder were studied. NMP22 immunoassay and conventional cytologic examination were performed on each specimen. The NMP22 and cytology results were then compared with the results of subsequent cystoscopies/surgical biopsies performed over a 6‐mo follow‐up period. The sensitivity of urine cytologic study for predicting recurrent TCC was 60%, while the sensitivity of NMP22 assay was 47%. When both NMP22 assay results and the cytologic interpretation were positive for TCC, the positive predictive value of the combined tests was 74%. When both tests showed negative results, the negative predictive power was 81%. Our findings suggest that urine NMP22 assay may represent a useful diagnostic adjunct to conventional urine cytologic examination for the detection of recurrent TCC of the urinary bladder. Diagn. Cytopathol. 1999;20:285–290.

DNA Image Analysis Combined with Routine Cytology Improves Diagnostic Sensitivity of Common Bile Duct Brushing

Cytologic evaluation of common bile duct brushings has a low sensitivity for diagnosing malignancy because of scant cellularity, poor cellular preservation, or sampling errors occur. The aim of this study was to evaluate whether cytology combined with image analysis improves the diagnostic accuracy of bile duct brushing in comparison with cytology alone.

Comparison of molecular abnormalities in bronchial brushings and tumor touch preparations: Potential use of fluorescence in situ hybridization to identify predictive markers in early-stage lung carcinomas

Preneoplastic lung lesions and early‐stage lung carcinomas are associated with molecular abnormalities. The authors performed a pilot study to evaluate the use of DNA fluorescence in situ hybridization (FISH) probes to ascertain whether these biomarkers can predict nonsmall cell lung carcinoma (NSCLC).

Modern approach to lymphoma diagnosis by fine-needle aspiration: restoring respect to a valuable procedure.

I t is estimated that for the year 2005, there will be 63,740 patients in the U.S. newly diagnosed with lymphoma, while patients who develop a disease recurrence may represent 30% of this figure. Many of the enlarged lymph nodes associated with lymphoma are superficial whereas a significant percentage of patients will present with bulky lymphadenopathy at deep-seated sites, such as the retroperitoneum or mediastinum. In either setting, it is estimated that approximately 20% of these patients will be subjected to fine-needle aspiration (FNA) in an attempt to establish a pathologic diagnosis using a minimally invasive approach. However, for FNA biopsy to become established as a first-line procedure, it must be perceived by the oncology community as yielding accurate and diagnostically useful information on which to base therapy. Currently, this procedure is controversial, and was the subject of a negative article in a widely read oncology journal that reported a retrospective series of FNAs performed by multiple practitioners in a community setting in which there was no uniform approach to the classification of lymphoma according to an accepted system. Furthermore, although the diagnostic accuracy improved significantly when immunophenotyping was performed, ancillary studies were performed in fewer than half of the cases. Although many studies performed in academic centers around the globe have reported high diagnostic accuracy of FNAs for lymphoma when coupled with ancillary studies, these studies are not usually published in oncology journals. Furthermore, it also is unfortunate that the hematopathology community at large does not support the practice of FNA, preferring to obtain core needle biopsies or whole lymph nodes whenever possible. How can cytopathologists who have undergone formal training in FNA of lymphoma change this mindset? Exporting a contemporary approach to the diagnosis of lymphoma by FNA from the ivory tower of academia to a community setting requires receptive pathologists who are willing to make a specific cytologic diagnosis in the context of a clinically relevant lymphoma classification, such as that of the World Health Organization. Cytomorphology in conjunction with immunophenotyping, proliferation studies, and the grading of lymphomas when appropri429 CANCER CYTOPATHOLOGY

Blastic variant of mantle-cell lymphoma: Cytomorphologic, immunocytochemical, and molecular genetic features of tissue obtained by fine-needle aspiration biopsy

Mantle‐cell lymphoma (MCL) is a rare type of non‐Hodgkins lymphoma that has a moderately aggressive clinical course, generally between that of low‐grade and of intermediate‐grade lymphomas. However, a small subset of MCLs, the so‐called “blastic” variant, exhibits a poor prognosis and an aggressive clinical course. We describe a case of blastic MCL that occurred in a 64‐yr‐old man and that was diagnosed and accurately subclassified as blastic MCL on the basis of a fine‐needle aspiration (FNA) biopsy. The aspirate smears showed a monotonous population of intermediate‐sized lymphocytes with irregular nuclear contours, finely dispersed nuclear chromatin, and inconspicuous nucleoli. Material was obtained by FNA for ancillary studies (immunocytochemical stains, flow cytometry, cytogenetics, image analysis, and molecular studies) that supported the diagnosis of blastic MCL. Surgical biopsy confirmed the diagnosis. These findings underscore the utility of FNA in diagnosing lymphomas, particularly when the cytomorphologic examination is combined with appropriate ancillary studies. Diagn. Cytopathol. 1998;19:59–62.

Cytologic features of renal medullary carcinoma: A study of three cases

Renal medullary carcinoma is a rare tumor that is most common in young black men with sickle cell disease or trait. Patients often present with advanced disease at the time of diagnosis, and their prognosis is poor, even with aggressive therapy. The clinical and pathologic features of renal medullary carcinoma have been described in several articles, but reports describing the cytologic features are rare.

Fine-Needle Aspiration Cytology of Mediastinal Non-Hodgkin's Nonlymphoblastic Lymphoma

The histologic features of primary mediastinal non‐Hodgkins nonlymphoblastic lymphoma (NHL) are well described in the surgical pathology literature. However, the fine‐needle aspiration (FNA) cytology of these lesions has not been characterized thoroughly.

Clinical significance of negative and equivocal urinary bladder cytology alone and in combination with DNA image analysis and cystoscopy

We evaluated the individual and combined ability of cytology (CYT), image analysis (IA), and cystoscopy (CYSTO) to predict the presence of transitional cell carcinoma (TCC) at 6 months of follow‐up in patients with or without a prior history of urothelial carcinoma and negative (NEG) or equivocal (atypical or suspicious) urinary CYT.

Radioactive Iodine-Associated Changes in Thyroid on Fine-Needle Aspiration

A 64-year-old man with adenocarcinoma of the prostate status postprostatectomy was seen for routine screening. His medical history was significant for deep vein thrombosis, persistent hyperparathyroidism after parathyroid adenoma resection, and hyperthyroidism treated with radioactive iodine ablation 4 years before this visit. Ultrasound-guided fine-needle aspiration with a 20-gauge needle was performed on bilateral thyroid nodules at this follow-up visit. Cytologic examination of the resulting smears revealed a moderately cellular aspirate with cohesive, crowded sheets of atypical follicular epithelial cells on a background of inspissated colloid. Even on low-power examination, scattered atypical giant cells were evident (Fig. C1). Closer examination showed bizarre mononuclear giant cells with dense, oxyphilic cytoplasm (Fig. C-2). The nucleus was round to oval or elongated with a smooth nuclear membrane. The chromatin was slightly hyperchromatic with heterogeneous distribution and clearing with rare intranuclear inclusions. Nucleoli and nuclear grooves were not observed. A diagnosis of atypical follicular epithelial cells consistent with changes owing to therapy was rendered. Antithyroid drugs, radioactive iodine, and surgery are the mainstays of treatment for Graves’ disease. The cytomorphological features have been well described in the literature. 1–3 However, the cytologic characteristics vary