Cytopathology Reports Research Articles

Diagnostic terminology for urinary cytology reports including the new subcategories ‘atypical urothelial cells of undetermined significance’ (AUC‐US) and ‘cannot exclude high grade’ (AUC‐H)

We studied whether atypical, non-superficial urothelial cells (AUC) could be separated into new subcategories including AUC 'of undetermined significance' (AUC-US) and 'cannot exclude high grade'' (AUC-H) in order to help to standardize urine cytopathology reports, as it is widely accepted in the Bethesda system for gynaecological cytopathology. We investigated whether AUC-US and AUC-H, defined by distinctive cytological criteria, might be separated with statistical significance according to actual diagnosis and follow-up data. A series of 534 cyto-histological comparisons taken in 139 patients, including 221 AUC at various steps of their clinical history was studied. There were 513 (96.1%) postcystoscopy and 469 (87.8%) ThinPrep® liquid-based specimens (95.9% and 89.1% of AUC cases, respectively). Patients viewed between 1999 and 2011 had histological control in a 0- to 6-months delay and were followed-up during an additional 5.9±9.2 (0- to 56-) months period. The 221 AUC represented 0.8-2% of the specimens viewed during the study period. Among AUC-H cases, 70 out of 185 (37.8%) matched with high-grade lesions, compared with 3 of 38 (8.3%) of AUC-US cases (P=0.0003). Conservatively treated patients with AUC-H more frequently developed high-grade lesions than those with AUC-US (54.1% versus 16.7%, P=0.0007) with a 17.6-months mean delay. Nuclear hyperchromasia, a nuclear to cytoplasm (N/C) ratio>0.7 and the combination of both were the more informative diagnostic criteria, all with P<0.01. We conclude that the new subcategories could help to standardize urine cytopathology reports and contribute to the patient's management, provided it is validated by multicentric studies.

Abnormal cervical cytology risk factors in the western black sea region and the importance of health insurance

To evaluate the prevalence of abnormal cervical cytological findings in the Western Black Sea Region and investigate an association between socio-demographic risk factors and the presence of cytological abnormalities. The reports of 11,539 cervical smears diagnosed according to Bethesda System 2001 version in the Pathology Department between January 2011 and December 2012 were reviewed retrospectively from the hospital records and cytopathology reports. Repeated smear results, unsatisfactory smear results, patients with known gynecologic malignancy history, smear results of patients with hysterectomy and smear results of patients whose socio-demographic information could not be obtained were excluded from the evaluation. The results of 7,740 patients who met the criteria for the study were evaluated. The prevalence of cervical cytological abnormalities was 1.8 % in general. The prevalence rates for atypical squamous cells with undetermined significance (ASC-US), atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and atypical glandular cells (AGC) were 1.16%, 0.11%, 0.29%, 0.15%, and 0.03% respectively. The prevalence of cytologically diagnosed cervical invasive neoplasia was 0.025%. Advanced age, low education level (primary school or less) and not having health insurance were found as to be risk factors for preinvasive and invasive lesions. Women who had a high school education and previously had a smear test had decreased risk for developing preinvasive and invasive lesions. This study shows prevalence of abnormal cervical cytology findings and associated risk factors in the Western Black Sea Region of Turkey. The most important risk factor was identified as not having health insurance.

Evaluation of nonneoplastic findings on vaginal smears with comparison of intrauterine devices and oral contraceptive pill effects

Although the Pap smear is a common screening test for cervical cancer and its precursors, it can detect some benign conditions as well. In this study, the aim was to evaluate smear results with regard to nonneoplastic findings and to compare them to the detectable effects of intrauterine devices (IUDs) and oral contraceptive pills (OPs). Materials and methods: In this retrospective study, the hospital records and cytopathology reports of 4248 patients were recorded. Smear results were evaluated according to the 2001 Bethesda System and were evaluated according to age groups, menopausal/menstrual status, physical examination findings, and contraceptive method usage. Results: Of the 4248 patients, 75% were menstruating and 25% were menopausal. The most common smear result was nonspecific inflammation (NSI). In comparing the IUD (n = 730) and OP (n = 322) groups, we found Candida species, Actinomyces, and bacterial vaginosis to be significantly higher in the IUD-using group, while NSI, discharge, and erosion were found to be significantly higher in the OP group. Conclusion: Pap smears can provide information about infectious diseases that can occur in the cervicovaginal region. These results reflect the fact that the IUDs disrupt vaginal flora more than OPs do.

Cytopathological review of patients that underwent thyroidectomies based on the diagnosis of papillary thyroid carcinoma by fine needle aspiration cytology but were later found to have benign tumors by histopathology

The aim of this study is to evaluate the specificity of diagnosing PTC by fine needle aspiration (FNA) cytology. This study retrospectively reviewed the cytopathological reports of 1066 patients that underwent thyroidectomy based on a diagnosis of PTC by FNA between January 1993 and December 2008. This study re-evaluated the cytology and histopathology of the patients that received false positive diagnoses of PTC by FNA. Ten patients (0.9 %) received false positive diagnoses of PTC by FNA. Three patients were overdiagnosed as having PTC by FNA cytology. In contrast, the nuclear features of PTC in the other seven cases were confirmed by the retrospective reviews of the patients' FNA cytology. Three of the seven patients showed follicular structures in their resection specimens, thus resulting in a diagnosis of either adenomatous goiter or follicular adenoma. However, PTC could not be diagnosed by histopathology in the remaining four patients, even though the histopathology showed the nuclear features of PTC. Most cases of PTC can be easily diagnosed by cytological and morphological atypia with certain limitations. The difficulty in diagnosing PTC by cytology is because the pathological features of PTC also occur in some benign thyroid tumors. Therefore, immunohistochemical or molecular biological approaches must be combined with current cytological diagnostic techniques for the diagnosis of PTC.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of the Thyroid: Methods to Decrease the Rate of Unsatisfactory Biopsies in the Absence of an On-Site Pathologist

PurposeThe rate of unsatisfactory samples from ultrasound-guided fine-needle aspirations of thyroid nodules varies widely in the literature. We aimed to evaluate our thyroid ultrasound-guided fine-needle aspiration biopsy technique in the absence of on-site microscopic examination by a pathologist; determine factors that affect the adequacy rate, such as the number of needle passes and needle size; compare our results with the literature; and establish an optimal technique. Materials and MethodsWe performed a retrospective review of cytopathology reports from 252 consecutive thyroid ultrasound-guided fine-needle aspiration biopsies performed by a radiologist between 2005 and 2010 in our hospital’s radiology department. Sample adequacy, the number of needle passes, and needle size were determined. There was an on-site cytologist who prepared slides immediately after fine-needle aspiration but no on-site microscopic assessment of sample adequacy to guide the number of needle passes that should be performed. Cytopathology biopsy reports were classified as either unsatisfactory or satisfactory samples for diagnosis; the latter consisted of benign, malignant, and undetermined diagnoses. ResultsSeventy-seven biopsies were performed with 1 needle pass, 124 with 2 needle passes, and 51 with 3 needle passes. The rates of unsatisfactory biopsies were 33.8%, 23.4% (odds ratio [OR] 0.599 [95% confidence interval {CI}, 0.319-1.123]; P = .110), and 13.7% (OR 0.312 [95% CI, 0.124-0.788]; P = .014), respectively. ConclusionIn a hospital in which there is no on-site pathologist, a 3-pass method increases the specimen satisfactory rate by 20% compared with 1 pass, achieves similar rates to the literature, and provides a basis for further improvement of our practice.

Monitoramento externo da qualidade dos exames citopatológicos cervicais realizados pelo Sistema Único de Saúde (SUS) no Estado de Mato Grosso do Sul

To evaluate the diagnostic agreement between the cytopathology reports issued by accredited laboratories and those obtained by quality control. We calculated the overall agreement and Cohen's kappa coefficients of a convenience sample of smears selected monthly by the Information System of Cervical Cancer (SISCOLO) for External Quality Control of the 15 laboratories that performed cytopathological PAP tests for the Brazilian Public Health System (SUS) between 2002 and 2011 in Mato Grosso do Sul, a State of the Midwest Region of the country. A comparison of the reliability values (coefficient of concordance and Kappa coefficient) between the initial and final years was computed by the absolute change (delta) and relative percent difference (RPD). There were 15.989 smears sent for rereading, 48.1% of which had a report of normal/benign changes, followed by atypical/low-grade squamous intraepithelial lesions (36.3%), high grade squamous intraepithelial lesion/carcinoma/adenocarcinoma (4.2%), and unsatisfactory (11.4%). The overall correlation coefficient ranged between 0.2 and 1.0, and the median value increased from 0.7 in 2002 to 1 in 2011 (RPD=+36.6%). During the same period, the median values of the Kappa coefficient increased from 0.5 to 0.9 (RPD=+80.8%). These results emphasize the feasibility of the External Quality Control of cytopathology at the state level and its implementation results in improvement in the diagnoses performed in the SUS network.

A SIX-YEAR EPIDEMIOLOGICAL SURVEY OF VULVOVAGINAL CANDIDIASIS IN CYTOPATHOLOGY REPORTS IN THE STATE OF RIO GRANDE DO SUL, BRAZIL

Vulvovaginal candidiasis (VVC) is a common vaginal infectious disease. The constant increase in the incidence of the disease may be associated with factors such as age, HIV infection, diabetes, use of hormonal contraceptive methods and cytopathological alterations. The aim of the study was to survey the prevalence of Candida sp. in cytopathology reports in the state of Rio Grande do Sul, Brazil, in the period of 2005-2010. In this observational and retrospective study a total of 121,328 cytopathology reports (CR) of cytopathology were assessed in a period of 6 years. The mean age of patients was 35 years old. Of this total, 8,582 CR (7.1%) were positive for Candida sp. More than half of patients (53%) were using oral contraceptive. Alterations in the cervix were present in 49% of the cases. The continuity of epidemiological research is needed to monitor trends over the years to better understand the factors that predispose to VVC in Brazil.

Mullerianosis of the urinary bladder: Report of a case with diagnosis suggested in urine cytology and review of literature

Mullerianosis of the urinary bladder is a rare entity characterized by the presence of an admixture of at least two types of mullerian tissue in the muscularis propria of the bladder. We report a case of mullerianosis of the urinary bladder in a 28-year-old nulliparous woman with no history of pelvic surgery or endometriosis, and the diagnosis of mullerianosis was suggested initially in urine cytopathology report. In this study, previously reported cases of mullerianosis of urinary bladder are reviewed, and differential diagnosis of endometrial-like cells in the urine has been discussed. Fewer than 20 cases of mullerianosis of the urinary bladder have been reported in the literature, and only one of these cases had cytological description in a urine specimen. Most of patients were of reproductive age ranging from 28 to 53 years and had no previous history of pelvic surgery or Cesarean section. The clinical presentations frequently were abdominal/pelvic pain and dysuria/hematuria, which may or may not be associated with menstruation. Radiologic study revealed polypoid, mass-like lesion ranging from 1 to 4.5 cm in size, predominantly involving the dome or posterior wall of the bladder. Histological sections showed two or more of the three related benign mullerian glandular epithelial proliferations-endometriosis, endosalpingiosis, and endocervicosis. Most of the patients have good prognosis with medical management.

Avaliação crítica das nomenclaturas diagnósticas dos exames citopatológicos cervicais utilizadas no Sistema Único de Saúde (SUS)

to identify the nomenclature for reporting cervical cytological diagnoses used by laboratories which render services to the Brazilian Unified Health System (SUS) and which participate in External Quality Monitoring (MEQ). To evaluate the information acquired from gynecologists of the SUS regarding the various diagnostic classifications that they receive in the cervical cytology diagnostic reports. we evaluated 94 cytology reports issued by laboratories which participate in the MEQ in the State of São Paulo, Brazil, and 126 questionnaires applied to gynecologists who work for the SUS. out of the 94 laboratories, 81 (86.2%) use one diagnostic classification: 79 (97.6%) use the Brazilian Nomenclature for Cytological Reports (NBLC), 1 (1.2%) uses the Papanicolaou classification and 1 (1.2%) uses the Richart diagnostic classification. Of the 13 (13.8%) laboratories that use more than one classification, 5 use 2 types and 8 use 3 to 4 types, with 9 including the Papanicolau diagnostic classification. The study showed that 52 (55.3%) laboratories presented more than one descriptive diagnosis in the same report. Out of the 126 gynecologists who filled out a questionnaire evaluating the cytopathology reports, 78 (61.9 %) stated that they received laboratory reports with only one diagnostic classification, 48 (38.1%) received reports with more than one classification and 2 received reports with all 4 classifications. Among the 93 (73.8%) gynecologists who prefer only one classification, 56 (60.2%) claimed that the NBLC contributes to clinical practice, 13 (14.0%) opted for the Richart classification, 8 (8.6%) for the Reagan classification and 16 (17.2%) for the Papanicolaou classification. Out of 33 (26.2%) gynecologists who prefer more than one classification, 5 opted for the 4 classifications. these data suggest that there is still resistance on the part of pathologists about using the official nomenclature in cytology reports for SUS. There is discrepancy between the information that gynecologists would like to see in the reports and the information provided by the pathologists. Greater efforts should be made to stimulate the use of the official nomenclature.

Cellules urothéliales atypiques (AUC) : une formulation inspirée du système de Bethesda applicable à la cytologie urinaire

To investigate (1) whether sparse nuclear atypias involving deep urothelial cells have a diagnostic or prognostic value in urinary cytology, and (2) whether the terms atypical urothelial cells "of undetermined significance" (AUC-US) or "cannot exclude high grade" (AUC-H) might be used to standardize urinary cytology reports. Atypical urothelial cells (AUC) were defined as deep cells with nuclear abnormalities (increased N/C ratio, eccentric nucleus, hyperchromatism and/or irregular shape) in small number not allowing their categorization as malignant, high grade. We studied 435 urinary samples from 126 patients with AUC at any step of their clinical history, followed up over a 10-year period (1999-2009). Every case was compared with histopathology within 6 months and to long term follow-up including cystoscopy and histopathology combined. A total of 183 AUC was recorded. AUC were associated with negative, benign or low grade histological results in 36 of 106 cases (33.9 %) within 6 months, but a high grade was simultaneously documented in 70 cases (66 %). AUC preceded high-grade lesions in 66 cases (36.1 % of all AUC) in a mean interval of 10.5±12.0 months. Overall, AUC were associated with or predictive of high-grade lesions in 135 cases (73.8 %). AUC have a diagnostic and prognostic value. Applying the terms AUC-US and AUC-H to urinary cytopathology reports would allow, as for the Bethesda system for cervical or vaginal cytologic diagnoses, better appreciation of the risk of progression to high grade tumours in cases with atypias.

Use of a laboratory information system driven tool for pre-signout quality assurance of random cytopathology reports

Background: Quality assurance (QA) programs in cytopathology laboratories in the USA currently primarily involve the review of Pap tests per clinical laboratory improvement amendments of 1988 federal regulations. A pre-signout quality assurance tool (PQAT) at our institution allows the laboratory information system (LIS) to also automatically and randomly select an adjustable percentage of non-gynecological cytopathology cases for review before release of the final report. The aim of this study was to review our experience and the effectiveness of this novel PQAT tool in cytology. Materials and Methods: Software modifications in the existing LIS application (CoPathPlus, Cerner) allow for the random QA of 8% of cases prior to signout. Selected cases are assigned to a second QA cytopathologist for review and all agreement and disagreements tracked. Detected errors are rectified before the case is signed out. Data from cases selected for PQAT over an 18-month period were collected and analyzed. Results: The total number of non-gynecological cases selected for QA review was 1339 (7.45%) out of 17,967 cases signed out during this time period. Most (1304) cases (97.4%) had an agreement in diagnosis. In 2.6% of cases, there were disagreements, including 34 minor and only 1 major disagreement. Average turnaround time of cases selected for review was not significantly altered. Conclusion: The PQAT provides a prospective QA mechanism in non-gynecological cytopathology to prevent diagnostic errors from occurring. This LISdriven tool allows for peer review and corrective action to be taken prior to reporting without delaying turnaround time, thereby improving patient safety.

Ultrasound‐guided needle aspiration: Impact of immediate cytologic review

To compare the diagnostic adequacy of ultrasound-guided fine-needle aspiration biopsy (USFNA) of the head and neck with immediate on-site microscopic evaluation and feedback by a cytopathologist (IMMEDIATE) versus delayed examination without immediate feedback (DELAYED). Retrospective chart review of office-based USFNA performed in both IMMEDIATE and DELAYED settings by the same otolaryngologist. A total of 199 USFNA procedures in the head and neck were performed by one practitioner. Of these procedures, 137 biopsies were performed in the DELAYED setting, whereas 62 biopsies were performed in the IMMEDIATE setting. Cytopathology reports were reviewed for diagnostic conclusions as well as adequacy of biopsies. The results from both settings were compared using Pearson χ2 test. The ability to obtain a diagnosis from USFNA was 73.0% in the DELAYED group as compared with 90.3% in the IMMEDIATE group. The rate of adequate cells on biopsy was 89.1% in the DELAYED group as compared with 96.8% in the IMMEDIATE group. There was a statistically significant difference between observed and expected diagnostic rates (χ(2)[1] = 7.568, P = .006) and a trend toward a significant difference between the observed and expected adequacy rates (χ(2)[1] = 3.259, P = .071) when IMMEDIATE evaluation by a cytopathologist was performed. An immediate microscopic evaluation of USFNA specimens to confirm adequacy of sampling is strongly recommended. Diagnostic conclusions were increased when an evaluation of the specimen was performed at the time of biopsy. The specimen adequacy rate tended to increase with an immediate cytopathologic assessment. Laryngoscope, 2010.

PTU-081 Endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: an observational study: Abstract PTU-081

<h3>Introduction</h3> Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic lesions is a valuable tool in the investigation of suspected pancreatic cancer. Recent international studies on the diagnostic utility of this technique have reported sensitivity and accuracy levels of &gt;90%. There is a paucity of UK centre data on diagnostic performance. In this retrospective observational study we aim to report the largest UK cohort and provide comparison with international standards. <h3>Methods</h3> Hammersmith Hospital is a regional pancreatobiliary referral centre. A single experienced endosonographer provides all diagnostic and therapeutic EUS services. A retrospective analysis of patients who underwent EUS-FNA for solid pancreatic lesions between Jan 2006 and Oct 2009 was performed. Cytopathology reports for cases were scrutinised. Cytological diagnosis was compared with the reference standard of surgical or biopsy histology, clinical and radiological evidence of disease progression, or in the case of benign cytology a minimum of 6 months clinical follow-up. <h3>Results</h3> A total of 113 EUS-FNAs for a solid pancreatic lesion were identified during the study period (average age 66 years, M/F ratio 1.1:1). The final outcomes were: pancreatic carcinoma (87/113, 77%), benign disease or pancreatitis (18/113, 16%) neuroendocrine tumour (5/113, 4%), metastasis (2/113, 1.7%), lymphoma (1/113, 0.8%). 15/113 cytology specimens were graded as “C4” or “highly suspicious of adenocarcinoma”, and in all the final diagnosis was pancreatic adenocarcinoma (PPV 100%). Performance characteristics were calculated both considering the C4/suspicious specimens as false negatives for malignancy and true positives (Abstract 081). Comparing the performance of EUS-guided FNA in years 2006–2007 to years 2008–2009 there was an improvement in sensitivity (78% to 92%) and accuracy (82% to 93%), respectively. <h3>Conclusion</h3> In solid pancreatic lesions FNA specimens classified cytologically as C4 have a 100% PPV for adenocarcinoma and should be considered diagnostic for this. The performance of EUS-FNA of solid pancreatic lesions in our institution, a UK regional referral centre, is comparable to international standards. A recent improvement in sensitivities and accuracy to in excess of 90% was noted. Further endosonographer experience, better case selection and routine use of “in-room” cytopathologist support may account for this and should be considered as strategies to improve accuracy further.

Analysis of the cytopathological reports from a natural childbirth center in Fortaleza-CE: a descriptive study

The research aimed to examine the cytopathological reports made and not removed from a Centro de Parto Natural (CPN) in Fortaleza-Ce. It is a documentary study, with retrospective quantitative approach. Data collection was through the analysis of 237 reports of cervical examinations performed between the years 2005 to 2007 and not received by the women until May 2008. The results showed that most women have between 12 and 79 years. In relation to microbiological findings (27%) had Lactobacilli sp, (20.25%) cocci and bacilli, (5.9%) candidiasis, (26.58%) Gardnerella vaginallis and (3.37%) Trichomonas vaginalis. The majority (44.3%) had moderate inflammatory process, (33.8%) mild inflammation and (21.9%) severe inflamation. Gardnerella / Mobiluncus was present in 28.6% of cases of moderate inflammation and in 26.9% of cases of severe inflammation, while 87.5% of reports that showed Trichomonas vaginalis had severe inflammation. Among the reports analyzed, four cases were diagnosed with NIC I and one case of NIC III (1.1%). Thus, educational strategies in health and the active search become essential to ensure the return of women to receive the results, enabling the continuity of treatment and prevention of uterine cervical neoplasms.

OBJN Submission Online - a guide for authors

The research aimed to examine the cytopathological reports made and not removed from a Centro de Parto Natural (CPN) in Fortaleza-Ce. It is a documentary study, with retrospective quantitative approach. Data collection was through the analysis of 237 reports of cervical examinations performed between the years 2005 to 2007 and not received by the women until May 2008. The results showed that most women have between 12 and 79 years. In relation to microbiological findings (27%) had Lactobacilli sp, (20.25%) cocci and bacilli, (5.9%) candidiasis, (26.58%) Gardnerella vaginallis and (3.37%) Trichomonas vaginalis. The majority (44.3%) had moderate inflammatory process, (33.8%) mild inflammation and (21.9%) severe inflamation. Gardnerella / Mobiluncus was present in 28.6% of cases of moderate inflammation and in 26.9% of cases of severe inflammation, while 87.5% of reports that showed Trichomonas vaginalis had severe inflammation. Among the reports analyzed, four cases were diagnosed with NIC I and one case of NIC III (1.1%). Thus, educational strategies in health and the active search become essential to ensure the return of women to receive the results, enabling the continuity of treatment and prevention of uterine cervical neoplasms.

Diagnostic Controversies in Vascular Proliferations of the Thyroid Gland

Vascular lesions are one of the most controversial issues in thyroid pathology. The differential diagnosis includes benign lesions on one side, i.e., endothelial reactive hyperplasia (Masson's "hemangioma") in goiter and hemangioma, and malignant tumors on the other, i.e., angiosarcomas and undifferentiated (angio)sarcomatoid carcinomas. Benign reactive endothelial hyperplasia with atypias mimicking malignant tumors may occur in long-standing nodular goiter, as a result of spontaneous hemorrhage followed by granulation tissue and fibrous organization. Alternatively, it may follow a fine-needle aspiration biopsy (FNAB) procedure. Angiosarcoma is a rare primary malignant thyroid tumor, mainly observed in endemic goiter areas displaying morphologic and phenotypical similar to those typical of angiosarcomas in other locations (including focal cytokeratin expression). The distinction between angiosarcoma and (angio)sarcomatoid anaplastic carcinoma is difficult and the true existence of angiosarcoma has been challenged. Other extremely rare vascular lesions or mimics in the thyroid include benign hemangioma and pseudo-angiosarcomatous variant of medullary carcinoma. The differential diagnosis between benign and malignant vascular conditions in FNAB material is extremely challenging, and the cytopathology report should be remarkably cautious, especially in poorly cellular and highly hemorrhagic cases: atypias in endothelial cells are not per se indicative of malignancy, being a common feature of reactive endothelial hyperplasia in infracted goiter nodules as well.

This Month in Gastroenterology

This Month in Gastroenterology

Incidence of enteropathy - associated T-cell lymphoma: A nation-wide study of a population-based registry in The Netherlands

Objective. Enteropathy-associated T-cell lymphomas (EATLs) are T-cell non-Hodgkin lymphomas of the small bowel, which are specifically associated with coeliac disease (CD). To our knowledge no studies have previously reported on the overall incidence of EATLs in the general population. The aim of this study was to investigate the incidence of EATL and the demographic characteristics of patients with EATL in The Netherlands. Material and methods. A survey of the nation-wide network and registry of histo- and cytopathology reports in The Netherlands (PALGA) was performed. We included all T-cell lymphomas detected between January 2000 and December 2006 that initially presented in the small bowel. Crude and world standardized incidence rates were computed as well as gender- and age-specific incidence rates. Finally, the distribution of characteristics such as the localization, the Marsh classification and method of diagnosis are described. Results. Clinicopathological data were gathered for 116 cases of EATL. The mean age at primary presentation of EATL was 64 years. The crude incidence in the total Dutch population was 0.10/100,000 with an incidence of 2.08/100,000 in the over 50-year-olds. Age-specific incidences were 1.44/100,000 in the 50–59 years age group, 2.92/100,000 in the 60–69 years age group, and 2.53/100,000 in the 70–79 years age group. There was a significant predominance of males (64%, p=0.004, CI 54–72); above the age of 50 the gender-specific incidence was 2.95/100,000 in males versus 1.09/100,000 in females. Most EATLs were localized in the proximal small intestine and the diagnosis was made by surgical resection in the majority of cases. Conclusions. EATL is a rare disease with an incidence of 0.10 per 100,000 inhabitants per year, occurring in older age, with a peak incidence in the 7th decade. The tumour is mainly localized in the proximal small intestine. Although uncomplicated CD is twice as frequent in female patients, EATL is more prevalent in males.

Cytopathology Reports from Fine Needle Aspirations of the Thyroid Gland: Can They Be Improved?

Many endocrinologists are dissatisfied with the cytopathology reports from thyroidal aspirates and unsure of how to proceed with the management of their patients. Endocrinologists and cytopathologists should have a symbiotic or complementary professional relationship if patients are going to be well served. The endocrinologist has responsibilities to the pathologist and vice versa. If the endocrinologist performs the thyroidal fine needle aspirations (FNAs), he or she must provide the pathologist with adequate specimens (in terms of quantity or number of cells) that are well smeared so that cells are well preserved and accurate cytologic diagnosis may be rendered. Also, pertinent clinical history and reasonable differential diagnoses should be stated. The pathologist has responsibilities to the endocrinologist. He or she should strive constantly to provide a clear and definite diagnosis. Cytologic reports must be in a "clinical language." By this I mean a language the clinician can understand. The pathologist should not merely provide morphologic descriptions without any clinical meaning. Here I provide my views and suggestions on improving cytopathology reports based on over 30 years' experience of performing and reporting thyroidal FNAs.

Pathology Databanking and Biobanking in The Netherlands, a Central Role for PALGA, the Nationwide Histopathology and Cytopathology Data Network and Archive

Since 1991, a nationwide histopathology and cytopathology network and archive is in operation in The Netherlands under the name PALGA, encompassing all sixty-four pathology laboratories in The Netherlands. The overall system comprises decentralized systems at the participating laboratories, a central databank, and a dedicated communication and information exchange tool. Excerpts of all histopathology and cytopathology reports are generated automatically at the participating laboratories and transferred to the central databank. Both the decentralized systems and the central system perform checks on the quality and completeness of excerpts. Currently, about 42 million records on almost 10 million patients are stored in the central databank. Each excerpt contains patient identifiers, including demographic data and the so-called PALGA diagnosis. The latter is structured along five classification axes: topography, morphology, function, procedure, and diseases. All data transfer and communication occurs electronically with encryption of patient and laboratory identifiers. All excerpts are continuously available to all participating pathology laboratories, thus contributing to the quality of daily patient care. In addition, external parties may obtain permission to use data from the PALGA system, either on an ongoing basis or on the basis of a specific permission. Annually, 40 to 60 applications for permission to use PALGA data are submitted. Among external users are the Dutch cancer registry, population-based screening programs for cancer of the uterine cervix and breast cancer in The Netherlands, and individual investigators addressing a range of research questions. Many scientific papers and theses incorporating PALGA data have been published already. In conclusion, the PALGA system is a unique system that requires a minimal effort on the part of the participating laboratories, while providing them a powerful tool in their daily practices.