Assessment Of Fine Needle Aspiration Research Articles

Analysis of Candidate miRNAs' Expression in Pancreatic Cancer.

Pancreatic cancer (PC) is one of the most aggressive types of cancer. Despite advances in molecular diagnostics, PC diagnosis relies on imaging technologies and morphological assessment of fine needle aspirates (FNAs). MicroRNA (miRNA) involvement in PC pathogenesis and potential diagnostics application have been suggested, albeit current supporting evidence is lacking. Here, we investigated the association of selected miRNAs with PC incidence and clinical characteristics. Fold expression of miR-216a-3p, -217-5p, -221-3p, -222-3p, and miR-196a-5p was assessed in 73 PC FNA cell-block sections and 6 healthy pancreas tissues using Taqman advanced miRNA assays. Potential miRNA targets were ascertained using immunocytochemistry. miR-196a-5p was upregulated in PC compared to healthy pancreatic tissue (β = -0.05, 95% CI: -0.065 - (-0.035); p < 0.001). miR-221-3p and miR-222-3p fold expression were strongly correlated (r = 0.897, p < 0.001), whereas miR-196a-5p fold expression correlated with that of miR-221-3p (r = 0.688, p < 0.001) and miR-222-3p (r = 0.489, p < 0.001). Moreover, miR-196a-5p fold expression positively correlated with tumor stage (r = 0.32, p = 0.034). miR-217-5p fold expression inversely correlated with KRAS expression (r = -0.69, p = 0.0027). Our study shows miR-196a-5p has reasonable specificity to PC and thus may have diagnostic and prognostic potential in PC as proposed in the literature. Moreover, KRAS and NFKBIA may be potential targets for miR-217-5p and miR-196a-5p, respectively. Thus, these miRNAs may be involved in tumor progression and may have valuable applications in novel therapeutics or treatment monitoring.

High Volume Rapid Adequacy Assessment of Fine Needle Aspirations and Touch Preparations Using Telecytology: A Major Cancer Center Experience

High Volume Rapid Adequacy Assessment of Fine Needle Aspirations and Touch Preparations Using Telecytology: A Major Cancer Center Experience

Relative Advantages of Interventional Radiology - Guided Fine Needle Aspiration Performed in Conjunction with Core Needle Biopsy of Solid Tumors

Introduction: The retention of tissue architecture and ability to immunophenotype the tumor has led to preference of core needle biopsy (CNB) to fine needle aspiration (FNA).We sought to evaluate the advantages of performing Interventional Radiology (IR)-guided FNA concurrently with CNB. Materials and Methods: We studied IR-guided FNA and CNB where CNB alone was used for molecular testing. Immediate assessment of FNA was performed. The tumor cellularity (TC) in FNA and CNB was scored: 1-4 scale (FNA: 0, 300 cells; CNB : 0, 50%). Optimal (OL) TC in FNA and CNB was defined as scores 3 or 4 and suboptimal(SOL) TC as scores of 1 or 2. The degree of agreement of TC between FNA and CNB was tested by Cohen’s Kappa statistic. Results:We studied 71 IR-guided FNA and CNBs from deep sites (median tumor size3.5 cm). The TC of FNA was SOL in 26 (37%) and OL in 45 (63%); TC of CNB was SOL in 43 (61%) and OL in 28 (39%). Both FNA and CNB showed OL TC in 18 (26%) cases and SOL TC in 17(24%) cases. In 9 (13%) cases, an FNA with SOL TC was associated with a CNB with OL TC and in 26(37%), an FNA with OL TC was associated with a CNB with SOL TC. There was fair agreement in TC between FNA and CNB( Kappa coefficientZ 0.23). Conclusion: FNA performed concurrently with CNB can guide the IR in accurate needle placement and can be used as a surrogate of TC in CNB. OL TC suitable formolecular testing can be encountered in FNAevenwhenCNB shows SOLTC. FNAperformed concurrentlywith CNB can obviate the need to repeat the biopsy when CNB has SOL TC that may fail molecular testing.

Telecytopathology for on-site adequacy evaluation decreases the nondiagnostic rate in endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions.

Advances in digital imaging methods have resulted in use of telecytology in the immediate assessment of fine-needle aspiration (FNA) specimens. We retrospectively compared the nondiagnostic rate for endoscopic ultrasound-guided (EUS) FNA of pancreatic lesions in two groups: one with on-site evaluation for adequacy via telecytopathology and the other without on-site adequacy evaluation. All patients undergoing EUS-FNA of pancreatic lesions over a 2-year period were included. Direct smears were immediately wet-fixed or air-dried, and any residual material was rinsed in saline for cell block or cytospin preparation. Patients were divided into two groups: Group 1 had on-site telecytopathology evaluation for adequacy by a cytopathologist, and Group 2 had no on-site adequacy evaluation. The cytologic diagnoses were reviewed, and the nondiagnostic rates for each group were calculated. The age, sex, and characteristics of pancreatic lesions (solid versus cystic) between the two groups were compared. In total, 217 patients were included. Telecytopathology on-site evaluation was provided for 95 (43.8%) cases. There was no difference between the groups in terms of age and sex. Pancreatic lesions were predominantly solid in the group that underwent telecytopathology on-site evaluation (p<0.005). The nondiagnostic rates for solid lesions in Group 1 and Group 2 were 3.7% and 25.6%, respectively (p<0.0001). Although the nondiagnostic rate for cystic lesion was higher in Group 2, it did not reach a level of statistical significance (16.5% versus 7.1%; p=0.249). After adjusting for the effects of sex and lesion characteristics (solid versus cystic lesion) with multivariate logistic regression, the odds of having a nondiagnostic specimen in Group 2 was 6.9 times greater than in Group 1, and the result was statistically significant (p=0.0013). Telecytopathology on-site evaluation of EUS-FNA of pancreatic lesions reduces the nondiagnostic rate, especially in lesions with solid characteristics, and may serve as an effective substitute for on-site evaluation by a cytopathologist.

Feasibility of Immediate Assessment of Fine Needle Aspirates of Thyroid Nodules by Telecytopathology

In this study we discuss the diagnostic accuracy and unsatisfactory rate of onsite evaluation of ultrasound-guided fine needle aspiration (USGFNA) of thyroid nodules using telecytopathology and compare it to that of a control group without telecytopathology. This was a retrospective analysis of USGFNA of thyroid nodules over a 9-month period with and without telecytopathology. There was no randomization for selection of the groups with and without telepathologist. A single provider performed all the procedures. Real-time images of Diff Quik-stained cytology smears were obtained with an Olympus Digital camera attached to an Olympus CX41 microscope and transmitted via the Internet by a cytotechnologist to a pathologist, who communicated the preliminary diagnosis and sample adequacy. The unsatisfactory specimen rate was compared between a group whose images were transmitted (n = 45) and another group without onsite adequacy assessment (nontransmitted) (n = 47). A total of 92 nodules in 67 patients were aspirated with ultrasound guidance. The unsatisfactory sample rate in the transmitted group was 13% (6 out of 45) and that of the non-transmitted group was 23% (11 out of 47). In the transmitted group, the cytology specimens of 3 patients that were initially deemed inadequate by the pathologist were considered adequate after 2 additional passes. In the transmitted group, preliminary diagnosis concurred with the final diagnosis in 96% of cases. Four passes were made in the non-transmitted group, versus 2 passes in the transmitted group. Immediate assessment of USGFNA via telecytopathology assures adequacy of the cytology sample and may reduce number of passes per nodule. Preliminary onsite telecytopathology diagnosis was highly accurate when compared to final diagnosis.

Telecytology and its evolving role in cytopathology

The advancement of telecommunication technology in the area of digital transfer of images form distant site has resulted in exploration of this technology in the area of cytopathology. Telecytology facilitates the electronic transmission of microscopic images using static, dynamic, and whole slide imaging systems. Recent articles have generated an interest in the use of this technology for immediate assessment of fine-needle aspirations. Telecytology has potential for use in second opinion, quality assurance, slide archiving, proficiency testing, and distance-based education. This review discusses the current and potential applications of telecytology in cytopathology practice and its limitation and advantages.

Feasibility of telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine needle aspiration of axillary lymph nodes in a remote breast care center

Background: In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA) specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA) of axillary lymph nodes in a remote breast care center. Materials and Methods: Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of the preliminary diagnosis was compared with the final diagnosis, retrospectively. Results: A total of 39 female patients (mean age: 50.5 years) seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases. Conclusions: This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate compared with the final cytologic evaluation. It allows pathologists to use their time more efficiently and makes on-site evaluation at a remote site possible.

Rapid assessment of fine needle aspiration and the final diagnosis--how often and why the diagnoses are changed

BackgroundOn-site rapid interpretation (RI) of fine needle aspiration (FNA) has been shown to increase the diagnostic yield of FNA and decrease the need for repeat diagnostic procedures. Because the pathologist interprets only a fraction of the sample and has limited resources available at such times, an occasional RI diagnosis will be changed at the time of the final diagnosis. We investigated how often these changes in diagnoses occur and the possible reasons for the changes.MethodsAll cytology reports from 1/1/02 to 12/31/03 from a single institution were reviewed. Cases with RI with discrepant final diagnoses were noted. The discrepant diagnoses were categorized depending on how they were changed. Possible sources for changed diagnoses were noted.ResultsBetween 1/1/02 and 12/31/03 there were 1368 RIs of FNAs. Of these 80 (5.8%) had discrepancies between the RIs and final diagnoses. Seventy-eight cases had additional slides and/or cell block at time of final diagnosis. 16 cases had ancillary studies available at final diagnosis. Consultant pathologists were used in 7 cases. Different pathologists interpreted the RI and final diagnosis in 31 cases.ConclusionAlthough uncommon, discrepancies between RIs and final diagnoses occur 5.8% of the time at our institution. Most commonly, this involves a change of diagnosis from either "non-diagnostic" or "benign" to "malignancy". Although much of this is likely due to the presence of additional material and information at the time of final diagnosis, the number of cases that had different pathologists involved in the RI and final diagnosis suggests that inter-observer variability may also play some role.This data was originally presented at the 2005 meeting of the United States and Canadian Academy of Pathology in San Antonio, Texas, March, 2005.

Ultrasound and fine needle aspiration assessment of the axilla in patients with operable invasive breast cancer

Axillary lymph node dissection has been standard practice for staging invasive breast cancer. As sentinel lymph node biopsy is being performed as an alternative less invasive procedure, identification of positive axillary nodes by ultrasound (US) needle biopsy is important in identifying involved axillae and thereby excluding patients from inappropriate sentinel node procedures.

Immunocytochemical staining of pS2 protein in fine-needle aspirate from breast cancer is an accurate guide to response to tamoxifen in patients aged over 70 years.

Fine-needle aspirates from 52 breast cancers in 50 patients over 70 years of age were immunocytochemically stained for pS2 protein. All patients were treated with tamoxifen 40 mg/day and followed up at intervals of 2 months. The size of the tumour was serially assessed with calipers and portable ultrasonography. Change in tumour size was confirmed mammographically. Clinical monitoring was performed bind of the pS2 status. Twenty-five tumours were pS2 positive, of which 23 showed a significant response; ten went into complete remission (mean time to complete remission 6.8 (range 2-14) months) and 13 demonstrated partial remission (mean follow-up 8.9 (range 6-19) months). Two tumours remained static. Twenty-seven tumours were pS2 negative and none of these responded to tamoxifen; six remained static (mean follow-up 11.5 (range 6-14) months) and 21 progressed (mean time to progression 7.0 (range 3-14) months) (P < 0.001). Immunocytochemical assessment of fine-needle aspirates from elderly women with breast cancer accurately predicts a worthwhile response to tamoxifen.

Long term survival of children with Burkitt lymphoma in Malawi after cyclophosphamide monotherapy.

Between 1991 and 1997, limited funding at times restricted available treatment for children with Burkitt lymphoma (BL) to cyclophosphamide (CPM) monotherapy at Lilongwe Central Hospital, Malawi. Our objective was to assess long-term survival in Malawian children with Burkitt lymphoma (BL) who had received one or more treatments with intravenous CPM at 40 mg/kg/dose at 14-day intervals. The study population consisted of 92 children in whom BL had been confirmed on fine needle aspirates (FNA), a home address had been documented on discharge from hospital, and the treatment records could be verified. Only the clinical site(s) of disease had been recorded. The M:F ratio was 1.4 and median age 8 years. A clinical officer on motorcycle attempted to locate the given addresses and interview parents or other sources. In 19 patients, the address was incorrect. Of 73 evaluable patients, 40 children are alive at a mean follow-up time of 59 (range: 29-104) months. The survival rate was 63.5% in 52 children with BL of the head only, and 33.3% in 21 children with primary disease involving the abdomen or other sites. Survivors had received a median number of 6 (range: 1-12), non-survivors 4 (range: 1-12), and untracable children 3 (range: 1-11) courses of CPM. We confirmed that CPM could cure children with facial and abdominal BL. The unavoidable bias in the selection of patients and the variable amount of CPM given, precludes accurate survival estimates. A prospective study with proper staging, assessment of FNA, marrow and cerebrospinal fluid with modern techniques, a standard treatment protocol, and adequate follow-up will better define the current therapeutic value of CPM monotherapy. CPM can be purchased at about 3 US dollars per 500 mg.

Ultrafast papanicolaou stain is not limited to rapid assessments: Application to permanent fine‐needle aspiration smears

Ultrafast Papanicolaou (Pap) stain, a 90-second preparation originally designed for the immediate assessment of fine-needle aspiration (FNA) smears (Yang and Alvarez, Acta Cytol 1995;39:55-60), can also be adapted for permanent FNA smears. It involves the addition of three simple steps prior to the conventional Pap procedure: the first step is to make the cells appear larger, thus increasing the resolution for analysis of cellular details; the second step is to hemolyse the background blood, thus unmasking tumor cells; and the third step is to bring out the vibrant colors in the cells and the nucleoli, which stain red.

Semiquantitative analyses of fine needle aspirates from benign and malignant breast lesions.

A scoring system for the assessment of fine needle aspirates of benign and malignant breast lesions was devised which showed a positive correlation (r = 0.67) between the scores obtained from the fine needle aspirates from ductal carcinomas and the Bloom and Richardson-type scores for their paired excision biopsy specimens. This system permitted grades II and III ductal breast carcinoma to be distinguished reliably from grade I tumours but no correlation with the lymph node state of patients with breast carcinoma was shown. Some overlap between the scores for grade I ductal carcinomas and some benign lesions was found, and this underlines a need for caution in the reporting of such equivocal aspirates. No cytological features that distinguished reliably ductal from lobular carcinoma were identified but the same spectrum of severity of cytological abnormality in the ductal and lobular carcinoma aspirates was seen. This system may be of prognostic value in the assessment of lobular carcinoma which has hitherto defied histological grading.