Abstract
Serous effusion cytology is widely employed in the initial evaluation of the etiology of effusions with a high diagnostic sensitivity. To standardize practices, The International System for Reporting Serous Fluid Cytology (TIS) was developed following best international practices, the most up-to-date literature, and expert consensus. In the context of this system, ancillary techniques play an important role. Besides defining basic principles in laboratory specimen handling, adequacy criteria, and a standardized reporting terminology with five diagnostic categories, TIS provides an actionable framework for using immunohistochemical and molecular testing in effusion samples, namely, in atypical, suspicious of malignant samples. For diagnostic purposes, these tests may be employed to distinguish between a primary and secondary neoplasm, to confirm a diagnosis of malignant mesothelioma vs. reactive mesothelial hyperplasia, and to correctly classify and determine the primary location of a metastasis. Theranostic molecular tests may also be used for these samples to evaluate potential therapeutic targets. Pathologists play a central role in guiding this process by determining adequacy and selecting appropriate ancillary tests. The activity in this area of research should increase in the near future as new therapeutic targets are discovered and new drugs enter the clinical practice.
Highlights
Serous effusions develop in both neoplastic and non-neoplastic pathological states [1].Serous effusion cytology is widely employed in the initial evaluation of the etiology of effusions with a high diagnostic sensitivity [2]
TIS aims to improve the diagnostic yield of serous effusion cytology through its diagnostic categories with well-defined risk of malignancy (ROM), which, when coupled with correct sample handling, should lead to an increase in interobserver agreement and enable better, evidence driven, clinical management [12,14]
TIS applies to all serous fluid cytology samples
Summary
Serous effusions develop in both neoplastic and non-neoplastic pathological states [1]. The information extracted from these samples is not uniform between laboratories, as different collection and preparation techniques are employed, and the level of experience of cytopathologists varies greatly. This issue has been successfully tackled in several areas of cytopathology through the development of standardized reporting systems [5,6,7,8,9,10]. TIS defines five diagnostic categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM), and malignant (MAL) Each of these is characterized by strict diagnostic criteria and a well-defined risk of malignancy (ROM). We briefly summarise the nomenclature and criteria of the TIS diagnostic categories and review the proposed use of molecular tests within each category
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