Fine-needle Aspiration Cell Blocks Research Articles

Self-clotting method improves cell block preparation.

The success of cell block preparation is crucial for ancillary diagnostic tests in cytology. However, achieving an optimal cell block can be challenging. The current study describes a self-clotting-based technique for fine-needle aspiration (FNA) cell block preparations and evaluates its usefulness in comparison with the conventional needle wash technique. The clinical data, FNA procedure, and cellularity of cell blocks of the self-clotting group (37 cases) and the conventional needle wash group (33 cases) were compared. The cellularity was evaluated using a scoring system (0 indicated acellular, 1 indicated 1-50 cells, and 2 indicated >50 cells). Approximately 76% of cases in the self-clotting group received a score of 2 versus 36% in the conventional needle wash group. Approximately 14% received a score of 1 in the self-clotting group compared with 9% in the conventional needle wash group, whereas 11% in the self-clotting group received a score of 0 versus 55% in the conventional needle wash group. The differences between the 2 methods were statistically significant. The results of the current study demonstrate that the self-clotting method is superior to the conventional needle wash method for FNA samples. Cancer Cytopathol 2018;126:190-9. © 2017 American Cancer Society.

LEF-1: Diagnostic utility in distinguishing basaloid neoplasms of the salivary gland.

Lymphoid enhancer binding factor 1 (LEF-1) has recently been reported as a potential immunohistochemical (IHC) marker for basal cell adenoma (BCA) and other salivary gland tumors, which may contribute to an increased accuracy in differentiating basaloid salivary gland neoplasms. We evaluated the utility of LEF-1 in fine needle aspiration (FNA) and resection specimens to distinguish pleomorphic adenoma (PA), BCA, basal cell adenocarcinoma (BCAC), and adenoid cystic carcinoma (ACC) as well as in non-neoplastic salivary gland (NNSG). Cases including 66 PA (35 FNA, 31 resections), 12 BCA (5 FNA, 7 resections), 42 ACC (11 FNA, 31 resections), 1 BCAC FNA, and 10 NNSG (5 FNA, 5 resections) were obtained and stained for LEF-1. On cell block (CB), 51% of PA and 60% of BCA were LEF-1 positive while 91% of ACC were LEF-1 negative. Among resections, there was a higher percentage of LEF-1 positive PA (84%) and BCA (86%), and a higher percentage of LEF-1 negative ACC (97%). LEF-1 staining had a low to moderate sensitivity for detecting benign basaloid neoplasms on FNA CB and resection specimens (52.5% and 84%, respectively), but a higher specificity (92% and 97% respectively), and positive predictive value (95% and 97% respectively). When comparing benign (PA and BCA) and the most common malignant basaloid salivary gland tumor (ACC), positive LEF-1 favors a benign neoplasm. Additional studies with LEF-1, specifically including other rare basaloid salivary gland neoplasms are needed to further clarify the role of LEF-1 in diagnosing these lesions on FNA.

Comparison of Diagnostic Yield of Endoscopic Ultrasound-guided Fine-needle Aspiration Cytology and Cell Block in Solid Lesions

ABSTRACT Background and Aim: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a procedure of choice for the diagnostic evaluation of submucosal and periluminal lesions. Tissue sample can be obtained by EUS-FNA cytology (FNAC) or cell block (CB). The aim of the present study is to compare diagnostic yield of EUS-FNA CB and cytology in the absence of onsite pathologist following a protocol-based EUS-FNA approach in solid lesions. Patients and Methods: Participants who underwent EUS-FNA at our center for solid submucosal or periluminal lesions (pancreas, lymph node, and liver) between 2014 and 2016 were included, retrospectively. The indication for the procedure along with the clinical and other investigation details and the final etiological diagnosis were recorded on uniform structured data forms. The diagnostic yield of cytology and CB were compared using McNemar’s test. The P < 0.05 was considered statistically significant. Results: EUS-FNA for solid lesion was performed in 130 lesions in 101 patients during the study period. Their mean age was 52.5 ± 12 years and 42.5% were female. Pancreatic masses were the most common lesions (37.7%) followed by lymph nodes (36.9%). Submucosal lesions (17.7%) and liver lesions (7.7%) accounted for rest of the cases. The overall diagnostic yield for EUS-FNAC (70%) and CB (74.6%) was not significantly different (P = 0.3) and their combined yield was 85.3%. For the 23 patients with submucosal lesion, diagnostic yield of CB (82.6%) was significantly better than cytology (47.8%, P = 0.04). Conclusions: EUS-guided CB has better yield compared to cytology in gastrointestinal submucosal lesions. The combination of CB with cytology improves the overall yield of the procedure; and hence, they should be considered complimentary rather than alternatives.

Role of Histone H3K27 Trimethylation Loss as a Marker for Malignant Peripheral Nerve Sheath Tumor in Fine-Needle Aspiration and Small Biopsy Specimens.

Accurate diagnosis of malignant peripheral nerve sheath tumor (MPNST) is often challenging on fine-needle aspiration (FNA) or core needle biopsy. Recurrent mutations in EED and SUZ12, which encode subunits of polycomb repressive complex 2 (PRC2), have been identified in 70% to 92% of MPNSTs; PRC2 inactivation leads to loss of trimethylation of lysine 27 of histone H3 (H3K27me3). We evaluated the utility of H3K27me3 immunohistochemistry for distinguishing MPNST from its cytomorphologic mimics. H3K27me3 immunohistochemistry was performed on 180 cases of spindle cell neoplasms sampled by FNA (n = 66) and needle biopsy (n = 114), and loss of nuclear staining was scored. Tumor types included MPNST, dedifferentiated liposarcoma, schwannoma, solitary fibrous tumor, leiomyosarcoma, melanoma, synovial sarcoma, sarcomatoid carcinoma, gastrointestinal stromal tumor, desmoid fibromatosis, low-grade fibromyxoid sarcoma, and unclassified spindle cell sarcoma/undifferentiated pleomorphic sarcoma. Complete loss of H3K27me3 was observed in 54% (13/24) of MPNSTs. In contrast, only two (of 156) histologic mimics showed complete loss of H3K27me3. Partial loss of H3K27me3 was present in a subset of cases (26/180), including both MPNST and non-MPNSTs. Complete loss of H3K27me3 is a highly specific (98.7%) marker of MPNST that can distinguish MPNST from cytomorphologic mimics in FNA cell block and small biopsy specimens.

Abstract 655: Development of IHC staining protocols for assessment of PD-L1 expression in cytological samples

Abstract Immunohistochemistry (IHC) staining of non-small cell lung cancer (NSCLC) samples for programmed cell death ligand 1 (PD-L1) can help identify patients that may benefit from anti-PDL1 therapy. However, resection or biopsy samples cannot be obtained for some patients with NSCLC. Fine needle aspiration (FNA) is a less invasive method for obtaining samples in such patients, and it is yet to be determined if PD-L1 can be assessed using cytological samples. In this study we had three objectives 1. Develop staining protocols on the VENTANA BenchMark ULTRA automated staining platform for cytology samples fixed with the most common methods using cell lines as a model. 2, Determine the optimal cytology fixation method for VENTANA PD-L1 (SP142) IHC Assay (PD-L1 (SP142)) staining, and 3. Assess PD-L1 expression in tumor cells (TC) and tumor-infiltrating immune cells (IC) in cytological samples prepared from NSCLC patients. KARPAS 299 cell line was used as a model system for the fixation studies. Liquid-based preparations (LBPs) fixed in PreservCyt, conventional smears (unstained and pap-stained) fixed in 95% ethanol, and paraffin embedded cell blocks (CBs) fixed in 95% ethanol, 10% neutral buffered formalin (NBF), PreservCyt, and SurePath preservative were optimized on the BenchMark ULTRA using PD-L1 (SP142) antibody and OptiView DAB Detection and Amplification Kits. NSCLC FNA CBs fixed in 10% NBF (N=69) and a subset of FNAs with matched resections (N=20) were stained with the optimized protocol. FNAs and resections were assessed for percentage of TC and IC with PD-L1 staining. Staining parameters were optimized on the BenchMark ULTRA for all sample types tested, and they all produced a range of moderate to strong PD-L1 expression. CBs fixed in 95% ethanol and 10% NBF produced the highest percentage of staining, with expression in 90% of cells. CBs fixed in PreservCyt and SurePath preservative had a lower percentage of staining, 40% and 75% respectively. LBPs had 25% cells staining and smears ranged from 20%-60%. NSCLC FNA CBs fixed in 10% NBF produced interpretable results when stained with PD-L1 (SP142). IC staining was seen in 8.7% (6/69) of samples, TC staining was seen in 8.7% (6/69) of samples, both IC and TC staining was seen in 14.5% (10/69) of samples. The subset of FNAs with matched resections showed concordance with PD-L1 IC staining in 60% (12/20) of samples and TC staining in 75% (15/20) of samples. The discordant cases showed that FNAs were negative for IC when the resection was negative and positive for TC in 5% of cases when the resection was negative. The VENTANA PD-L1 (SP142) Assay staining parameters were found to be optimal for staining NSCLC FNA CB fixed in 10% NBF. PD-L1 staining was detected in both TC and IC in FNA samples and concordance of FNA and matched resections was high for both IC and TC. A larger study is necessary to validate the use of FNAs for assessment of PD-L1 expression in a clinical setting. Citation Format: Christine Boyiddle, Mark Ruboyianes, Ed Del Valle, Lukas Bubendorf, Kerstin Trunzer, Judith Pugh, Jennifer Boone. Development of IHC staining protocols for assessment of PD-L1 expression in cytological samples [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 655. doi:10.1158/1538-7445.AM2017-655

PD-L1 assessment in FNA (EBUS) dervied samples.

11615 Background: Pembrolizumab therapy for non-small cell lung cancer requires PD-L1 immunohistochemistry (IHC). FDA approval was based on staining of resections or core biopsies. Little is known about PD-L1 expression in fine needle aspiration (FNA) specimens including EBUS of mediastinal lymph nodes. Methods: IHC was performed using the PD-L1 IHC 22C3 pharmDx test on formalin fixed paraffin embedded FNA cell blocks of 8 squamous cell carcinomas and 15 adenocarcinomas (ACA) (age: 42-84, mean: 63, median: 63; 11 female and 12 male). Mutation data (50 gene NGS panel, and ALK, ROS1, RET and MET FISH) was available for 14 ACA. Membranous PD-L1 staining of any intensity and extent was recorded in at least 100 tumor cells (tumor proportion score). The tumors were grouped as: no staining (<1%), low expression (1-49%) and high expression (50% or more). Results: Six (26%) tumors showed no staining, 6 (26%) low expression and 11 (48%) high expression (table 1). High PD-L1 expression was seen in 1 ALK, 1 braf, 1 EGFR, 1 Her2 exon20, 2 kras mutated tumors and 2 tumors with no or unknown mutation status, low PD-L1 expression in 1 braf and 1 EGFR mutated case and 1 tumor without mutation. No expression was seen in 1 ROS1, 1 kras mutated tumor and 1 tumor without mutation. One EBUS biopsy also had PD-L1 assessed on a transbronchial biopsy of the primary tumor showing similar staining (30% versus 20%). Conclusions: PD-L1 immunohistochemistry appears to be feasible using cell blocks of fine needle aspirates containing adeqaute number of viable tumor cells. The majority of ACA were also adequate for NGS mutation and FISH analysis. High PD-L1 expression was seen in approximately half the tumors, which is greater than has been observed in resections/core biopsies, this finding merits further study. High expression of PD-L1 was seen in both squamous cell carcinoma and adenocarcinoma, and tumors with and without common driver mutations. [Table: see text]

Double staining: diagnostic utility in non-small cell lung carcinoma in the era of tissue conservation

In an era of precision medicine distinguishing pulmonary squamous cell carcinoma (SQCC) from adenocarcinoma (ADC) is vital for treatment. Immunohistochemical (IHC) staining for p40, p63 and Cytokeratin 5 (CK5) are useful for SQCC, while TTF-1 and Napsin-A can be used for confirming ADC. Fine needle aspiration (FNA) cell blocks (CB) have limited tissue, hence, double IHC staining is helpful for tissue conservation for molecular analysis. Thirty six confirmed lung SQCC and 45 ADC CB were selected for IHC. Double staining was performed with p40/CK5 and p63/CK5 on all SQCC, and with TTF-1/Napsin-A on all ADC. Results were positive if at least 5% of malignant cells were immunoreactive for the antigen. P40/CK5 had (92%) sensitivity, (100%) specificity, (100%) positive predictive value (PPV), (91%) negative predictive value (NPV) and an overall diagnostic accuracy of (96%). By contrast, P63/CK5 double stains showed (92%) sensitivity, (80%) specificity, (85%) PPV, (89%) NPV and (86%) overall diagnostic accuracy, respectively. TTF-1/Napsin A staining for ADC showed a sensitivity of 80%, specificity of 96%, PPV of 97%, NPV of 71% and accuracy of 85%. P40/CK5 double stain has higher specificity, PPV, NPV, and overall accuracy than P63/CK5 double stain in the diagnosis of lung SQCC. TTF-1/Napsin-A double staining is a valuable marker with high specificity, PPV, and diagnostic accuracy in diagnosing lung ADC. The usage of P40/CK5 and TTF-1/Napsin-A as a panel can be recommended for characterizing non-small cell carcinoma (NSCC) of the lung and for conserving tissue for molecular testing.

Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression in breast cancer FNA cell blocks and paired histologic specimens: A large retrospective study.

Molecular analysis represents an increasingly important component of the pathologic examination of tumor specimens. Notably, the characterization of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression in breast cancer specimens provides critical prognostic and predictive information. The objective of the current study was to compare the concordance of these markers as determined on fine-needle aspiration (FNA) cell blocks compared with tissue blocks prepared from surgical specimens. A total of 134 cases of breast carcinoma were identified from 2002 through 2014 with both FNA cell blocks (fixed in 10% formalin) and corresponding available tissue blocks and ER, PR, and HER2 were characterized in both specimens. Negative and positive concordances were determined for ER and PR in cell blocks compared with tissue blocks, and for HER2 immunohistochemistry on cell blocks and tissue blocks versus the corresponding reference method, fluorescence in situ hybridization (FISH). Concordance for ER expression evaluated on a cell block compared with the corresponding tissue block was 96.2%. Concordance for PR expression was 77.5%. Overall agreement of HER2 FISH testing between cell blocks and tissue blocks was 96.7%. For both cell blocks and tissue blocks, HER2 expression by immunohistochemistry demonstrated ≥98% positive and negative concordance with the FISH reference method. ER, PR, and HER2 determination on FNA-acquired cell block (fixed exclusively in 10% formalin) showed excellent agreement for ER and HER2 and moderate agreement for PR with the corresponding tissue block. These findings support the equivalency of ER and HER2 evaluation performed on FNA cell blocks compared with surgical tissue blocks. Cancer Cytopathol 2016;124:828-35. © 2016 American Cancer Society.

Grading pancreatic neuroendocrine neoplasms by Ki-67 staining on cytology cell blocks: manual count and digital image analysis of 58 cases

Controversy remains as to whether Ki-67 labeling on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cell blocks (CBs) can be used to grade pancreatic neuroendocrine neoplasms (PanNENs) reliably and what would be the best methodology for doing so. A retrospective search identified cases with both EUS-FNA and correlating surgical pathology (SP) available. 58 CBs (>100 tumor cells) were identified. Ki-67 labeling on CB was counted using both manual count (MC) and digital image analysis (DIA, ImmunoRatio software). The grades determined on CB were compared with those on corresponding SP reports (kappa statistics). The correct grading rates between MC and DIA were compared (McNemar's test). Total tumor cell number (TTCN, cutoffs: 500 and 2000) was used as a stratification factor (chi-square tests for trend). Of 58 cases, the SP grade distribution was 31 grade 1, 23 grade 2, and 4 grade 3. Overall, the grading concordance of CB MC and SP was higher than that of CB DIA and SP (McNemar's P-value = 0.022). Compared with SP, CB MC correctly graded 69% (40 of 58) [κ = 0.44 (95% CI: 0.21, 0.66)]; CB DIA correctly graded 55% (32 of 58) [κ = 0.19 (95% CI: 0.04, 0.42)]. Grade 1 tumors had the highest concordance. Although the correct grading rate improved as TTCN increased, no statistical significance was found. Although Ki-67 labeling on CB can be used to grade PanNENs, limitation exists, particularly for grade 2 tumors. The method of counting makes a difference: MC is more accurate than DIA. The major reasons of discordance include non-tumor cell contamination and insufficient sampling.

FNA smears as a potential source of DNA for targeted next-generation sequencing of lung adenocarcinomas.

Diff-Quik-stained fine-needle aspiration (FNA) smears and touch preparations from biopsies represent alternative specimens for molecular testing when cell block or biopsy material is insufficient. This study describes the use of these samples for targeted next-generation sequencing (NGS) of primary and metastatic lung adenocarcinoma and reports the DNA quality and success rates of FNA smears versus other specimens from 1 year of clinical use. A validation set of 10 slides from 9 patients with prior clinical epidermal growth factor receptor (EGFR) Sanger sequencing and KRAS pyrosequencing (5 KRAS-positive/EGFR-negative and 4 KRAS-negative/EGFR-negative) underwent DNA extraction, quality assessment, and targeted NGS. Subsequently, lung adenocarcinoma specimens submitted for NGS solid tumor mutation panel testing in 1 calendar year (60 biopsies, 57 resections, 33 FNA cell blocks, 12 FNA smears, and 10 body fluid cell blocks) were reviewed for specimen adequacy, sequencing success, and DNA quality. All 10 validation samples met the DNA quality threshold (delta Ct threshold < 8; range, -2.2 to 4.9) and yielded 0.5 to 22 μg of DNA. The KRAS and EGFR mutation status from FNA smears according to NGS was concordant with previous clinical testing for all 10 samples. In the 1-year review, FNA smears were 100% successful, and this suggested a performance equivalent to or better than the performance of established specimen types, including FNA cell blocks. DNA quality according to ΔCt was significantly better with FNA smears versus biopsies, resections, and FNA cell blocks. FNA smears of lung adenocarcinomas are high-quality alternative specimens for a targeted NGS panel with a high success rate in clinical practice. Cancer Cytopathol 2016;124:406-14. © 2016 American Cancer Society.

Usefulness of translocation-associated immunohistochemical stains in the fine-needle aspiration diagnosis of salivary gland neoplasms.

Fine-needle aspiration diagnosis of pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) is challenging due to cytologic overlap with one another and with other salivary gland tumors having prominent epithelial and myoepithelial components. Recognition of characteristic chromosomal aberrations in several salivary gland tumors, including PA and ACC, has the potential to resolve diagnostic uncertainty, but molecular diagnostics are not routinely available. To leverage these molecular alterations, the authors examined a panel of commercially available immunostains directed at commonly overexpressed proteins in translocation-associated PA (PLAG1 and HMGA2) and ACC (MYB) to assess their diagnostic usefulness. Immunohistochemistry was performed on cell block samples from 74 patients, including 11 ACC specimens and 31 PA specimens with antibodies to MYB, PLAG1, and HMGA2 as well as KIT (previously considered useful in the diagnosis of ACC). ACCs demonstrated significantly greater staining for KIT compared with non-ACCs, while PAs had significantly greater staining for PLAG1 than non-PAs. MYB trended toward significance for ACC (P=.097) and HMGA2 trended toward significance for PA (P=.094). No ACC exhibited positive staining for PLAG1 or HMGA2. Only 12% of PAs were found to be positive for MYB or KIT. Combined positivity for MYB and KIT with negative PLAG1 and HMGA2 demonstrated a specificity and positive predictive value of 1.0 for ACC, whereas a positive PLAG1 or HMGA2 stain with negative MYB and KIT stains showed a sensitivity of 0.75, a specificity of 0.96, and a positive predictive value of 0.95 for PAs. An immunohistochemical panel of MYB, KIT, PLAG1, and HMGA2 on fine-needle aspiration cell blocks is useful in distinguishing ACCs and PAs from each other and other salivary gland neoplasms. Cancer Cytopathol 2016;124:397-405. © 2016 American Cancer Society.

Role of Cell Block in Guided FNAC of Abdominal Masses.

Fine Needle Aspiration (FNA) of space occupying lesions in superficial or deep anatomic sites is an increasingly common procedure, providing rapid and safe diagnosis. However, sometimes FNA does not yield sufficient information for a precise diagnosis and the risk of false negatives and indeterminate diagnosis is always present. Therefore, we attempted to obtain additional information via the preparation of Cell Block (CB) from the residual material of aspirates and thus enhance the diagnostic accuracy. This study was carried out to evaluate the role of CB as a useful adjunct to smears for establishing a more definitive cytopathologic diagnosis and for its utility in special staining and Immuno-histochemistry (IHC). A total of 66 cases of image-guided FNA of abdominal masses were studied. In addition to the routine smears, CBs were prepared from the residual tissues for all possible cases and its diagnostic efficacy was analysed. Further, the use of CBs for special staining and IHC was also established. This study included a total of 66 patients with abdominal masses who were referred for guided FNA cytology. Out of these cases, adequate material was obtained on FNAC in 64 cases (96.96%) and on CB in 45 cases (68.18%) and the diagnosis was provided. There was a good agreement between the FNA smear diagnosis and CB diagnosis. The histopathology of CB sections further helped in precise final cytopathological diagnosis. Two FNA smears were unsatisfactory for evaluation and hence the diagnosis was done on CB sections alone. With FNA cytology and CB in combination, a cytopathological diagnosis was given for all the 66 cases. The sensitivity of FNA in comparison to the histopathology of CB was 91.6% and specificity was 88.8%. The diagnostic accuracy was 62% and the discordance was 6%. CB in addition to the routine FNA is a simple, reliable and cost-effective technique that further contributes to the final cytopathological diagnosis.

Epidermal growth factor receptor mutations in nonsmall cell lung carcinoma patients in Kuwait.

Context:Nonsmall cell lung carcinoma (NSCLC) is the most frequently diagnosed form of lung cancer in Kuwait. NSCLC samples from Kuwait have never been screened for epidermal growth factor receptor (EGFR) gene aberration, which is known to affect treatment options.Aims:This study investigated the feasibility of using fine-needle aspiration (FNA) material for mutational screening, and whether common EGFR mutations are present in NSCLC samples from Kuwait.Settings and Design:Eighteen NSCLC samples from five Kuwaitis and 13 non-Kuwaitis were included in this study.Materials and Methods:DNA was extracted from FNA cell blocks and screened for EGFR gene mutations using peptide nucleic acid (PNA)-clamp assay, and EGFR gene amplification using fluorescent in situ hybridization (EGFR-FISH). EGFR protein expression was assessed using immunohistochemistry.Results:Five EGFR mutations were detected in five non-Kuwaiti NSCLC patients (27.8%). EGFR gene amplification was evident in 10 samples (55.5%) by direct amplification or under the influence of chromosomal polysomy. Four samples had EGFR mutations and EGFR gene amplification, out of which only one sample had coexisting EGFR overexpression.Conclusions:Given the evidence of EGFR gene alterations occurring in NSCLC patients in Kuwait, there is a need to incorporate EGFR gene mutational screen for NSCLC patients to implement its consequent use in patient treatment.

Differentiating Small Cell Carcinoma From Squamous Cell Carcinoma in Cytologic Specimens

Distinguishing small cell carcinoma (SCC) from poorly differentiated squamous cell carcinoma (SCCA) can be challenging on fine needle aspiration (FNA). p63 immunocytochemistry is frequently used to support the presence of squamous differentiation. However, issues relating to specificity have arisen, and the common pan-p63 clone (4A4) has been challenged by antibodies specific for the ΔN isoform of p63 (p40), which show superior specificity for SCCA. A total of 50 SCC and 25 SCCA FNA cell blocks were stained with antibodies for p40, p63, K903, and CK5/6. For each marker, both extent and intensity of immunoreactivity were recorded, blinded to diagnosis, and H-scores (extent×intensity) were calculated. A total of 4%, 34%, 4%, and 2% of SCCs were positive for p40, p63, K903, and CK5/6, respectively. The rate of p63 positivity was significantly higher than for the other markers. Median H-scores in p63-positive SCCs (40) and SCCAs (270) were significantly different (P<0.0001), though, and 94% of p63-positive SCCs showed an H-score <150. SCCs frequently express p63 (34%). In the SCCA versus SCC differential diagnosis, p40 and K903 are each marginally more sensitive (92%) than p63 (88%), whereas CK5/6 boasts the greatest specificity (98%). p63's poor specificity (66%) can be improved to 94%, if an H-score ≥150 is used as the cutoff for a positive result.

A study to improve the identification of pancreatobiliary adenocarcinoma utilizing fine-needle aspiration cytology and immunohistochemical application for KOC and S100P

The identification of pancreatic adenocarcinoma by fine-needle aspiration (FNA) cytology is a difficult, yet critical, task. This study uses a panel of two immunohistochemical (IHC) markers, KOC and S100P, to augment the interpretation of pancreatic adenocarcinoma using cytopathology specimens and to compare these to corresponding surgical specimens. We retrospectively reviewed 33 surgical specimens with pancreatic adenocarcinoma and 33 corresponding, preceding FNA cytology specimens. IHC studies for KOC and S100P were performed on both the surgical specimens and cytology cell blocks. Three pathologists reviewedthe staining intensity and amount of tumor cell staining within these blocks. The findingswerethen analyzed for sensitivity, specificity, and combined sensitivity and specificity for the 2 markers. KOC performed similarly to S100P in sensitivity for surgical specimens (90.9% for both) and better for FNA specimens (92.3% versus 82.7%, respectively). The specificity of KOC was significantly better than S100P for surgical and FNA specimens (100% for KOC in both specimens versus 72.7% and 89.7% for S100P in both specimens, respectively). The combined sensitivity of the panel of KOC and S100P was 99.2% for surgical specimens and 98.7% for FNA specimens. The combined specificity was 72.7% for surgical specimens and 89.7% for FNA specimens. We found using KOC and S100P on FNA cell block cytology specimens to be a useful adjunct for interpretation when an interpretation of atypical or suspicious for pancreatic ductaladenocarcinoma is being considered and there are atypical epithelial cell groups in the cellblock.

TROP-2 expression in papillary thyroid carcinoma: Potential Diagnostic Utility.

TROP-2 is a type I transmembrane glycoprotein which is over-expressed in various malignancies, and is related to epithelial cell adhesion molecule (EpCAM), also called TROP-1, gp40, and KSA. In this study, we evaluated TROP-2 expression in papillary thyroid carcinoma (PTC) and compared it to other thyroid neoplastic and non-neoplastic lesions. Immunohistochemical (IHC) evaluation for TROP-2 was performed on 137 thyroid fine needle aspiration (FNA) cell blocks (CB) which included classic PTC (64), follicular variant PTC (FVPTC) (10), anaplastic thyroid carcinoma (AC) (2), medullary carcinoma (MC) (8), follicular neoplasms (FN) (8), Hurthle cell neoplasms (HCN) (9), follicular lesion of uncertain significance (FLUS) (12), and benign thyroid nodule (BTN) (24). IHC for TROP-2 expression was also performed on 331 BTN and malignant tumor tissue sections in tissue microarray (TMA). Membranous staining in >5% of tumor cells was considered positive. TROP-2 stained 61 of 64 PTC CB, 7 of 10 FVPTC CB, and 9 of 12 FLUS CB. All other cases were negative for TROP-2. TROP-2 showed a sensitivity of 95.31% and specificity of 89% for classic PTC in FNA CB. In TMA samples, TROP-2 stained 54 of 60 classic PTC cases and hence showed a high sensitivity and specificity. All BTN in CB and TMA were negative. We conclude that TROP-2 is a highly sensitive and specific IHC marker for identifying classic PTC. TROP-2 may play an important role in diagnosing classic PTC, especially in equivocal cases. This study also identifies a strong role for TROP-2 in separating PTC from BTN.

Utility of SOX10 in Diagnosing Salivary Gland Oncocytic Tumors in Fine Needle Aspiration Cell Blocks

SOX10 is a transcription factor expressed from the developmental stage to adulthood in acinar and intercalated ducts of major salivary glands, and in some salivary gland tumors. Its role in cytologic specimens has been rarely documented. This study was performed to evaluate its utility in the diagnosis of salivary gland oncocytic tumors on fine …

The Utility of Astrocyte Elevated Gene-1 in Diagnosing Hepatocellular Carcinoma

Astrocyte elevated gene-1 (AEG-1) is an oncogene that plays an important role in the development and progression of hepatocellular carcinoma (HCC). Its usefulness in diagnosing HCC in fine needle aspiration (FNA) cell blocks (CB) is not well documented. The purpose of this study was to determine the utility of AEG-1 in …

BRAF V600E Antibody as an Adjunct Tool in Triaging Thyroid Fine Needle Aspiration Specimens

The sensitivity and specificity of thyroid fine needle aspiration (FNA) are 85% and 90%, respectively. The overall malignancy rate of thyroid FNA is 5%, with papillary thyroid carcinoma (PTC) being the most common subtype. Approximately 45% of PTCs have a BRAF V600E mutation. Immunohistochemical (IHC) detection of BRAF mutation on FNA cell block specimens may aid in the diagnosis …

Sensitivity and Specificity of Combined Fine Needle Aspiration Cytology and Cell Block Biopsy versus Needle Core Biopsy in the Diagnosis of Sonographically Detected Abdominal Masses

Sensitivity and Specificity of Combined Fine Needle Aspiration Cytology and Cell Block Biopsy versus Needle Core Biopsy in the Diagnosis of Sonographically Detected Abdominal Masses