Inadequate Specimens Research Articles

Association between specimen length and diagnostic yield of temporal artery biopsy

Objectives: Temporal artery biopsy (TAB) is performed in patients suspected of giant cell arteritis (GCA). Inadequate TAB specimen length is considered a possible explanation for a negative biopsy in patients with GCA. We investigated the association between specimen length and diagnostic yield of TAB.Method: We conducted a retrospective analysis of 240 patients who underwent TAB in a single hospital between 2000 and 2015. Patients were diagnosed with GCA based on positive TAB or, when TAB was negative, on clinical grounds that fulfilled the American College of Rheumatology (ACR) 1990 criteria. Baseline clinical and laboratory features and TAB length were obtained from medical records. Among patients diagnosed with GCA, the rate of TAB positivity was calculated according to biopsy length (< 5, 5–9, 10–14, and ≥ 20 mm).Results: Out of 240 patients, 88 were diagnosed with GCA: 62 had a positive TAB and 26 were diagnosed based on clinical grounds despite a negative TAB. Among those who were diagnosed with GCA, the length of the TAB specimen was similar in those with a positive and a negative TAB (1.13 ± 1.68 mm vs. 1.15 ± 0.61 mm, respectively, p = 0.928). The TAB positivity rate was similar among all ranges of biopsy length [< 5 mm: 7/10 (70%); 5–9 mm: 22/31 (71%); 10–14 mm: 11/16 (69%); 15–19 mm: 11/16 (69%); ≥ 20 mm: 11/15 (73%, p = ns] and was similar to the overall biopsy positivity rate.Conclusions: Specimen length is not associated with diagnostic yield of TAB.

Abstract 4919: Evaluating the gene expression of frozen tissue-derived prognostic signatures in FFPE colorectal cancer samples

Abstract OBJECTIVE: Defining molecular features that can predict the recurrence of colorectal cancer (CRC) for stage II and stage III patients remains a challenging problem in cancer research. Most available clinical samples are Formalin Fixed and Paraffin Embedded (FFPE). Nanostring nCounter® and Affymetrix GeneChip® Human Transcriptome Array 2.0 (HTA) are the two platforms marketed for high throughput measurement of mRNA expression from FFPE tissue samples. In this study, to identify an optimal platform for the gene expression profiling of FFPE CRC samples, we compared the expression of genes that make up published frozen tissue-derived prognostic signatures measured by these two platforms. METHODS: FFPE primary tumor tissue blocks were identified from 500 patients with stage II or III CRC and complete pathological information. We removed samples with neoadjuvant therapy, inadequate clinical follow-up or tumor specimens, samples with failure of RNA extraction and highly degraded samples. We identified 194 eligible FFPE-derived CRC primary tumors with a 7.4-year mean follow up. To measure the gene expression of the 194 samples, we designed a custom nCounter codeset using 536 gene elements from multiple published frozen tissue-derived prognostic signatures for CRC. We also performed gene expression profiling using the HTA platform on a subset of 84 of the 194 samples. For the nCounter data, samples with low total average count or with more than 20% genes having lower average count than the synthetic negative control genes were omitted to ensure adequate data quality. RESULTS: In total, for CRC samples from 42 patients, the gene expression data of 516 common genes measured by both platforms were of sufficient quality for comparative analysis. Based on HTA platform-derived data, we found that (1) 36 and 97 of the 516 common genes are significantly associated with overall survival (OS) and disease-free survival (DFS) at the single gene level (FDR &amp;lt; 0.05), respectively; and (2) two of the nine reported multi-gene signatures, for which sufficient information from the original papers enabled such evaluation, can divide patients into high-risk and low-risk groups with significantly different DFS (p ≤ 0.05). Based on nCounter platform-derived data, no individual gene was found to be significantly associated with survival at the single gene level (FDR &amp;lt; 0.05), but one of the nine published multi-gene signatures can divide patients into two groups with significantly different OS (p ≤ 0.05). Our results also showed moderate correlations between paired FFPE samples measured by nCounter and HTA platforms (the median correlation coefficient is 0.52). CONCLUSION: Our data demonstrate that while both platforms may identify gene or gene set expression differences associated with survival outcomes, the HTA appears to provide a more robust gene expression analysis dataset when using genes selected from published gene signatures. Citation Format: Jing Zhu, Natasha G. Deane, Keeli B. Lewis, Chandrasekhar Padmanabhan, Mary K. Washington, Kristen K. Ciombor, Cynthia Timmers, Richard M. Goldberg, R. Daniel Beauchamp, Xi Chen. Evaluating the gene expression of frozen tissue-derived prognostic signatures in FFPE colorectal cancer samples. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4919.

Differential diagnosis of panniculitides

Panniculitides are diseases of the subcutaneous tissue with heterogeneous etiology. They may develop consequent to infections, as areaction to drugs, after thermal injury, as part of autoimmune diseases, in metabolic disorders or due to infectious organisms. The clinical presentation with subcutaneous nodules is often nonspecific. Moreover, the differentiation from vasculitides of medium-sized vessels can be clinically challenging. Microscopic examination of biopsy specimens is of high importance in the differential diagnosis of panniculitides. Histopathologically, panniculitides can be classified according to the predominantly infiltrated area in septal and lobular panniculitides and they can be separated from vasculitides of medium-sized vessels. Diagnostic difficulties arise from inadequate biopsy specimens and from lack of clinicopathological correlation. This article summarizes diagnostic criteria of frequent and clinically important panniculitides.

ERCP tissue sampling

ERCP tissue sampling

Liver Biopsy: The Reports of Its Demise Are Greatly Exaggerated.

Liver Biopsy: The Reports of Its Demise Are Greatly Exaggerated.

Shutting Down the Chaos Engine — Or, Identifying Some ProblematicEchinodorus(Alismataceae) Types

Several names in the ornamental aquatic plant genus Echinodorus (Alismataceae) have remained dubious due to insufficient taxonomic descriptions, sterility of the type material, and apparent hybridism. Non-destructive (or nearly so) DNA sequencing methods provide means to match inadequate type specimens with other specimens in order to clarify nomenclatural instability caused by conflicting interpretations of poor type material. In this study, my aim was to shed light on several names of uncertain applicability in Echinodorus.

Repeat Ultrasound-Guided Fine-Needle Aspiration for Thyroid Nodules 10 mm or Larger Can Be Performed 10.7 Months After Initial Nondiagnostic Results.

The purpose of this study is to investigate when repeat ultrasound (US)-guided fine-needle aspiration (FNA) for thyroid nodules 10 mm or larger with initial nondiagnostic results due to inadequate or unsatisfactory specimen could be performed. A total of 228 nodules 10 mm or larger with initial nondiagnostic results in 223 patients were classified into three groups according to the first follow-up US or US-guided FNA intervals after the initial US-guided FNA: within 3 months (group 1), 3-9 months (group 2), and more than 9 months (group 3). Nodules were classified according to size change. The malignancy detection rate and clinicopathologic characteristics were compared among the three groups. Seven nodules (3.1%) were malignant, and their cancer stages were the same as that determined at the initial US-guided FNA. Malignancy detection rates, as well as tumor size, extrathyroidal extension, and lymph node metastasis at pathologic analysis, were not significantly different among the three groups. Thirteen of 228 nodules (5.7%) showed increased size at a mean (± SD) of 34.5 ± 25.1 months (range, 10.7-84.7 months) after initial US-guided FNA, and one of the 13 nodules (7.7%) was malignant, a minimally invasive follicular carcinoma without lymph node metastasis found at 63.2 months. Of 177 nodules without change, six papillary thyroid carcinomas (3.4%) were found at a mean of 10.4 months. None of the 38 nodules with decreased size during a mean follow-up interval of 26.1 ± 19.8 months (range, 2.8-79.5 months) was malignant. Repeat US-guided FNA for initial nondiagnostic thyroid nodules after 10.7 months can reduce unnecessary repeat US-guided FNAs without progression of malignancy.

Suction rectal biopsy yields adequate tissue in children

Background/purposeHirschsprung disease (HD) is diagnosed by rectal biopsy, with suction rectal biopsy (SRB), the preferred technique in neonates. Reported SRB adequacy has varied overall with concern for decreased diagnostic yield in older children. The study aim was to assess SRB adequacy by age in children with the current device used at our institution. MethodsFollowing IRB approval, a retrospective cohort of children (1 to 18years) evaluated by SRB for HD was identified through billing records. Data regarding demographics, procedure, results, and complications were collected and analyzed using SPSS. Results56 children (median age 3.9years) underwent SRB with an 80.4% overall success rate. Patients older than 5years had 90.5% adequacy rate compared to 74.3% in those younger. Univariate analysis revealed weak association of inadequate specimens with younger age and males, and no association with insurance, race/ethnicity, weight–height or BMI percentile, sedation type, or procedure location. SRB under general anesthesia (GA) had 100% adequacy (n=6). Patients with inadequate initial biopsy achieved diagnosis by SRB with increased sedation (n=5) or full thickness biopsy under GA (n=5). ConclusionWith adequacy of 80.4% overall and 90.5% for patients greater than 5years, SRB is effective in evaluating the older child for HD.

Abstract P5-13-04: A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC)

Abstract Background Activating mutations in PIK3CA occur in approximately 40% ER+BC. MK-2206 (M), a pan-AKT inhibitor, induced apoptosis of ER+ BC under estrogen deprivation in preclinical studies. We conducted this neoadjuvant trial to determine the pathologic complete response (pCR) rate of M plus anastrozole (A) for PIK3CA mutant (Mut) ER+ BC. Methods This single arm open label study of M+A used a 2-stage Simon phase II design (stage 1, n=16; stage 2, n=13, alpha=0.10, power=0.90) to test whether pCR rate &amp;lt;1% (based on historical data with A alone), against the alternative that pCR rate ≥15% in PIK3CA Mut ER+ BC. At least 1 pCR in stage 1 was required to proceed to stage 2. Eligible patients (pts) with clinical stage II or III ER+HER2- BC were pre-registered and proceeded to a research tumor biopsy for PIK3CA sequencing, followed by treatment with daily A monotherapy for 28 days (cycle 0). Pts with PIK3CA Mut BC were subsequently registered, underwent a second biopsy, and started M (150mg PO weekly) with daily A on cycle 1 day 1 (C1D1) for a maximum of four 28-day cycles followed by surgery. Goserelin was added for premenopausal pts. A tumor biopsy on C1D17, 17 days post the start of M, was performed. Those with C1D17 Ki67 &amp;gt;10% discontinued study treatment. pCR was defined as no invasive cancer in the breast and the lymph nodes. Tumor specimens collected at all timepoints are being analyzed for markers of proliferation, apoptosis, and PI3K pathway activity, gene expression microarray, intrinsic subtypes, and next generation sequencing of 83 genes. Results Of the 51 pts pre-registered, 35 pts did not register due to no PIK3CA mutation (n=22), inadequate specimen for testing (n=6), physician/pt decision (n=7). The remaining 16 pts (median age: 58, range: 40-77 years) received combination therapy. Three pts did not complete 4 cycles due to C1D17 Ki67 &amp;gt;10% (n=2) and intolerability (grade (Gr) 4 transaminase elevation in C1, n=1). Other severe toxicities possibly related to M included Gr 3 rash (25%) and pruritus (12.5%). Of the 13 pts completed study therapy and underwent surgery, all had residual disease in the breast and 7 also had positive nodes. Table 1 summarized changes in Ki67 during treatment. ComparisonsnAbsolute changes in Ki67 median (range)Wilcoxon signed rank p-valueC1D1 relative to pre-registration11-17.0% (-49.8 to 4.1%)0.0020C1D17 relative to pre-registration14-16.4% (-51.4 to 4.1%)0.0004C1D17 relative to C1D112-1.5% (-18.6 to 15.8%)0.9697C1D1, biopsy post 28 days of A alone; C1D17 biopsy post 17 days on combination therapy Although Ki67 levels post A monotherapy (C1D1) or M+A (C1D17) were significantly lower than that of pre-registration samples, Ki67 did not differ between C1D17 and C1D1 samples. Other correlative studies are ongoing and results will be presented. Conclusion Despite the small sample size, biomarker analysis on serial biopsy specimens demonstrated that M+A is unlikely to be more effective than A alone in PIK3CA Mut ER+ BC. This trial demonstrated the feasibility of genomic sequencing for pt selection and the value of a small, well-designed proof-of-principle neoadjuvant trial for the evaluation of targeted agents. Citation Format: Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-04.

Radiofrequency ablation under 3D intraoperative Iso-C C-arm navigation for the treatment of osteoid osteomas.

To evaluate the efficacy of intraoperative three-dimensional (3D) Iso-C C-arm-navigated percutaneous radiofrequency ablation (RFA) of osteoid osteomas. 35 patients (20 males and 15 females) with osteoid osteomas underwent treatment with intraoperative 3D Iso-C C-arm navigation-guided RFA. The tumour was first biopsied for pathological examination, the core needle was removed and the RFA needle was inserted into the nidus. Post-operative X-rays and CT scans were performed to evaluate the degree of ablation and to assess for recurrence at 3-month follow-up. Patients also completed a visual analogue scale (VAS) both pre-operatively and 3 days post-operatively to subjectively assess pain. Pathological diagnosis confirmed osteoid osteoma in 19 cases. The other 16 cases were not pathologically diagnosed owing to inadequate biopsy specimens. In all cases, localized pain was immediately relieved following RFA. Patients reported significantly decreased pain, with mean pre-operative VAS scores of 3.4 reducing to 0.80 at 3 days post-operatively and further to 0.06 at 3-month follow-up (p < 0.05). The mean follow-up time was 15.5 months (range: 3-38 months). 3D Iso-C C-arm navigation-guided RFA is a safe and effective option for the treatment of osteoid osteomas and may be considered in place of intraoperative CT-guided and open resection. C-arm image-guided percutaneous RFA mitigates the need for pre-operative CT as well as intraoperative scintigraphy, provides real-time imaging of the anatomy, facilitates accurate resection of the tumour and enables immediate confirmation of excision.

The clinical impact of immediate on-site cytopathology evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: a prospective multicenter randomized controlled trial.

Observational data on the impact of on-site cytopathology evaluation (OCE) during endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic masses have reported conflicting results. We aimed to compare the diagnostic yield of malignancy and proportion of inadequate specimens between patients undergoing EUS-FNA of pancreatic masses with and without OCE. In this multicenter randomized controlled trial, consecutive patients with solid pancreatic mass underwent randomization for EUS-FNA with or without OCE. The number of FNA passes in the OCE+ arm was dictated by the on-site cytopathologist, whereas seven passes were performed in OCE- arm. EUS-FNA protocol was standardized, and slides were reviewed by cytopathologists using standardized criteria for cytologic characteristics and diagnosis. A total of 241 patients (121 OCE+, 120 OCE-) were included. There was no difference between the two groups in diagnostic yield of malignancy (OCE+ 75.2% vs. OCE- 71.6%, P=0.45) and proportion of inadequate specimens (9.8 vs. 13.3%, P=0.31). Procedures in OCE+ group required fewer EUS-FNA passes (median, OCE+ 4 vs. OCE- 7, P<0.0001). There was no significant difference between the two groups with regard to overall procedure time, adverse events, number of repeat procedures, costs (based on baseline cost-minimization analysis), and accuracy (using predefined criteria for final diagnosis of malignancy). There was no difference between the two groups with respect to cytologic characteristics of cellularity, bloodiness, number of cells/slide, and contamination. Results of this study demonstrated no significant difference in the diagnostic yield of malignancy, proportion of inadequate specimens, and accuracy in patients with pancreatic mass undergoing EUS-FNA with or without OCE.

Surgeon performed ultrasound-guided fine-needle aspirates of the thyroid: 1067 biopsies and learning curve in a teaching center.

Surgeon performed ultrasound-guided fine-needle aspirates (UG-FNAs) reduce delay in diagnosis and allow for surgeon surveillance. We present the first report on a learning curve and impact of head and neck surgical trainees on adequacy rates. Thyroid UG-FNA biopsies from 2009 to 2013 were reviewed retrospectively. Specimen adequacy, cytologic diagnosis, and surgical pathology were used to calculate adequacy and accuracy. One thousand sixty-seven biopsies were examined in 723 individuals. The adequacy rate from adoption into practice improved from 71% to 78% to 85% over 300 cases. When UG-FNA was subsequently taught to trainees, adequacy rates varied among trainees (p < .037), and there were higher nondiagnostic rates earlier in training (p = .04). Adequacy was not related to size or palpability, but cystic lesions yielded more inadequate specimens (p < .001). Surgeon performed UG-FNA biopsy can be performed adequately in an outpatient setting. Adequacy rates reach acceptable levels after 300 cases, whereas trainee involvement impacts adequacy rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1281-E1284, 2016.

FNAC and frozen section correlations with definitive histology in thyroid diseases.

The ability to diagnose thyroid cancers pre-op or intra-operatively by fine needle aspiration cytology (FNAC) or frozen section (FS) leads to the delivery of appropriate one-stage surgical management. We aim to study the concordance and discordance of FNAC and FS with final histology in thyroid pathologies. All thyroid procedures from 2007 to 2011(n=423), involving FNAC and or frozen section in their management pathway were included. FNAC (n=159) were classified in a five-tier system (Nondiagnostic, Benign, Atypical, Suspicious or Malignant). FS (n=128) were classified as inconclusive, benign, suspicious or malignant. FNAC and FS were correlated with final histopathology. 159 out of 423 patients had FNAC (PPV 85.1%), 26 inadequate specimens noted, benign cytology 57, atypical (n=23), follicular neoplasm (n=27), suspicious for malignancy (n=16) and malignant 11. 13 out of 27 follicular neoplasm and 6 of atypical FNAC cases showed malignancy in their final histopathology. Frozen sections; total of 126 patients had intra-operative frozen section biopsies performed. Overall 105 out of 126 FS biopsies were benign; 21 malignancies detected intraoperatively. Three FS were inconclusive and reported benign in final histopathology. Overall, FNAC demonstrated a PPV of 66.6% and NPV of 84.6%. FS demonstrated PPV and NPV of 76.1 and 85.7%, respectively. In conclusion, FNAC is considered as the best modality to triage the thyroid nodule pre-operatively. Atypical and follicular neoplasm cytology categories warrant further clinical assessment and close follow-ups when appear benign. The intra-operative frozen sections are helpful to perform a one-stage operation for suspicious thyroid lesion. This study also highlights the recognised limitation of intra-operative frozen section analysis of thyroid neoplasia.

Accuracy and inter-observer agreement of the Procore™ 25 gauge needle for endoscopic ultrasound-guided tissue core biopsy

BackgroundScanty data on the performance of the new 25-gauge Procore™ biopsy needle are available. MethodsConsecutive patients who underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using the 25G Procore™ were retrospectively retrieved. All samples were independently reviewed by 3 pathologists for the following: histological, cytological or no specimen, neoplasia, diagnostic or non-diagnostic. Diagnostic accuracy and inter-rater concordance among pathologists were calculated. Results94 patients underwent EUS-FNB of 101 sites (69 solid masses, 25 lymph nodes, 5 wall thickening). Forty-one biopsies (40.5%) were classified as histological samples by at least two pathologists, 29 as cytological (28.7%), 31 had no sample (30.7%). Good and almost perfect agreements among pathologists in defining cytological vs. histological samples (k 0.82; 95% CI: 0.74–0.90), diagnostic vs. non-diagnostic (k 0.95; 95% CI: 0.85–1.00) and neoplastic vs. non-neoplastic (k 0.94; 95% CI: 0.83–1.00). According to consensus rating, 61 cases were diagnostic samples (60.4%). Histological samples were more likely to lead to a correct diagnosis (OR, 4.1; 95% P=0.027), while neoplastic lesions were less likely to be correctly classified than benign (OR, 0.11; P=0.04). ConclusionsEUS-FNB with the Procore™ 25G needle provided samples for histological examination in only 40% of the cases, with 31% of inadequate specimens, despite excellent results in term of inter-observer variability.

Non-Invasive Evaluation of Liver Fibrosis Using Real-Time Elastography and Comparison of Intercostal and Subcostal Approaches

In patients with chronic liver diseases, the identification of significant fibrosis is of special interest, because the presence of fibro sis is an important parameter for the estimation prognosis, for survelliance and for treatment decisions in patients with Chronic Liver Diseases. Although percutaneous liver biopsy is the gold standart method for assessing liver fibrosis, it has some limitations including its invasive nature, inconvenience, sampling errors, inadequate specimen size and interobserver variability in pathology interpretation. Therefore many studies have focused on the evaluation of noninvasive methods for the assessment of liver fibrosis stage. One of these methods is real time elastography which measures tissue elasticity. In the present study, we assessed intercostal and subcostal measurement methods to discriminate between normal and fibrotic liver .

Dermatopathologists' opinions about the quality of clinical information in the skin biopsy requisition form and the skin biopsy care process: a semiqualitative assessment.

The skin biopsy care process is prone to communication failures. We sought to solicit dermatopathologists about their opinions on the quality of clinical information provided in the requisition form (RF) that accompanies skin specimens and their suggestions on how to improve the process. A self-administered survey of the membership of the American Society of Dermatopathology was performed. Qualitative methods were used to analyze free-text comments. Of 1,102 participants, 153 completed the final question in the survey (response rate 14%). Respondent opinions fell into four critical themes: (1) quality of clinical information in the RF and adequacy of biopsy specimens, (2) training of residents and nondermatologist providers, (3) information transfer via electronic medical records, and (4) practice constraints. Dermatopathologists communicated that missing clinical information in the RF and inadequate specimens are common and adversely affect the quality of care. Multiple provider- and practice-related factors contribute to communication failures and deserve further investigation.

PD25-10 RESIDENT INVOLVEMENT IN ENDOSCOPIC BLADDER CANCER SURGERY IS ASSOCIATED WITH INADEQUATE PATHOLOGY SPECIMENS AND PROLONGED TIME TO CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Detection and Screening II1 Apr 2015PD25-10 RESIDENT INVOLVEMENT IN ENDOSCOPIC BLADDER CANCER SURGERY IS ASSOCIATED WITH INADEQUATE PATHOLOGY SPECIMENS AND PROLONGED TIME TO CYSTECTOMY Derek Bos, Christopher Allard, Shawn Dason, Vladimir Ruzhynsky, Anil Kapoor, and Bobby Shayegan Derek BosDerek Bos More articles by this author , Christopher AllardChristopher Allard More articles by this author , Shawn DasonShawn Dason More articles by this author , Vladimir RuzhynskyVladimir Ruzhynsky More articles by this author , Anil KapoorAnil Kapoor More articles by this author , and Bobby ShayeganBobby Shayegan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1659AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transurethral resection of bladder tumor (TURBT) specimens lacking detrusor muscle are associated with clinical upstaging and the need for additional procedures which may delay curative treatment. We evaluated whether resident involvement in TURBTs is associated with adequacy of pathology specimens and time to cystectomy at a single academic centre in Ontario, Canada. METHODS We identified all TURBTs performed at St. Joseph's Healthcare Hamilton from November 2011 to June 2014. Charts were reviewed to determine baseline characteristics, resident involvement, and pathologic findings including presence of detrusor muscle. Logistic regression was used to assess associations between resident involvement and adequacy of tumor specimens. Among patients who underwent cystectomy, we assessed the time to cystectomy from initial high risk TURBT (high grade, ≥T1, or CIS), excluding patients with subsequent low risk TURBTs, BCG, or neoadjuvant chemotherapy. Associations between resident involvement with pathologic outcomes and time to cystectomy were determined with Chi−square and log rank tests, respectively. RESULTS A total 664 TURBTs were performed on 471 patients during the study period. Patient and tumor characteristics were comparable for TURBTs performed by attendings and residents. Attendings were more likely to obtain muscle in specimens for all TURBTs (OR1.68 [95%CI 1.09, 2.59], p=0.018) and for the subset of 275 high risk TURBTs (OR1.99 [95%CI 1.11, 3.55], p=0.019). Senior residents (PGY3−5) had higher odds of muscle in all (OR1.91 [95%CI 1.12, 3.25], p=0.017) and high risk (OR2.9 [95%CI 1.43, 5.9], p=0.003) specimens compared with juniors. In multivariate analysis adjusting for covariates patient age, sex, and tumor size, resident involvement was associated with inadequate tumor specimens among all patients (p=0.032) and only high risk tumors (p=0.049). Resident involvement was associated with a non-significant increased need for repeat TURBT. The median time from initial high risk TURBT to cystectomy was 73.3 (IQR 51.8, 131.4) and 49.4 (IQR 31.4, 65.7) days for residents and attendings, respectively (p=0.024). CONCLUSIONS Resident involvement during TURBTs is associated with inconclusive pathology and delayed time to cystectomy. Future studies should assess educational tools to improve endoscopic surgical training techniques minimizing effects of resident learning on patient outcomes. Further studies are needed to clarify the impact of resident involvement on long-term patient outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e564 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Derek Bos More articles by this author Christopher Allard More articles by this author Shawn Dason More articles by this author Vladimir Ruzhynsky More articles by this author Anil Kapoor More articles by this author Bobby Shayegan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Touch imprint cytology: a rapid diagnostic tool for oral squamous cell carcinoma

Techniques for intraoperative pathologic examination of oral squamous cell carcinoma are rare in the literature. We evaluated the advantages and limitations of touch imprint cytology for intraoperative diagnosis of oral squamous cell carcinoma. We used 30 incisional biopsies of clinically diagnosed oral squamous cell carcinoma and compared touch imprint cytology to histopathological sections. Touch imprint cytology showed 24 specimens positive for malignancy, two suspicious for malignancy and four inadequate specimens. The accuracy of the test was 93.2%. Touch imprint cytology is an accurate, simple, rapid and cost-effective method that aids diagnosis of oral squamous cell carcinoma during operation, but it does not replace incisional biopsy.

Clinicians’ Real World Perceptions of Pre-Nephrectomy Diagnostic Biopsy Performance as a Driver of Reduction in Unnecessary Surgeries in Renal Tumors

Operative removal of oncocytomas is generally unnecessary, but not infrequent in the context of renal masses. The infrequent use of pre-nephrectomy biopsies is a function of historical limitations of histopathological differential diagnosis in this setting. Assessment of clinicians’ receptiveness to a novel molecular diagnostic approach to this challenge was undertaken by means of a survey vehicle administered to 102 practicing urologists and pathologists who met inclusion criteria related to their actual clinical activity. Survey results supported the previously reported observations on misdiagnosis with urologists’ reported rates of 25% inconclusive results, and an additional 17% disagree with the final surgical diagnosis. The self-reported rate of 9% for pre-operative biopsies was comparable to prior reports, but 39% of urologists who are not currently performing pre-operative biopsies expressed interest in introducing them into their practice for this purpose with an improved diagnostic. Almost all urologists (94%) felt it important not to resect benign oncocytomas and 62% indicated they would use a test which improved the ability to sub-type renal tumors pre-operatively. The level of performance benchmark of the unidentified prototypic microRNA-based diagnostic as reported previously in the literature was deemed sufficient to change care in these cases by 73%. Overall they predicted a 38% rate of biopsies and resulting increases in decisions to forgo nephrectomy or to perform only partial nephrectomy. Pathologists also expressed support for the use of this technology in the context of inadequate specimens and for improved sub-typing of these tumors in inconclusive cases.

Fine Needle Aspiration Cytology versus Fine Needle Capillary Sampling in Cytological Diagnosis of Thyroid Lesions.

Fine needle aspiration cytology (FNAC) is an established out- patient procedure used in primary diagnosis of palpable thyroid lesions. A modified technique fine needle capillary sampling (FNCS) obviates the need of suction, is less painful, patient friendly and reported to overcome the problem of inadequate and bloody specimens. The aim of our study was to compare the efficacy and quality of FNCS with that of conventional FNAC in the lesions of thyroid. One hundred patients, presenting between January 2011 to December 2012 at Cytopathology Department of M M Institute of Medical Sciences and Research, Mullana, with diffuse and nodular thyroid lesions were enrolled with both the techniques being executed on the patients, beginning with FNA followed by FNCS. The smears were scored using five objective parameters i.e. background blood, cellular material, cellular degeneration, cellular trauma, and retention of appropriate architecture, in a single blind setting by a cyto-pathologist. The results were analyzed using Student's test for paired data and chi- square analysis. A highly significant differences (P<0.001) in favor of FNCS was observed for the background blood, cellular material and retention of architecture while total score favored FNA for cellular degeneration and degree of cellular trauma. Total scores and average score per case for FNCS was significantly better (P<0.001) than FNA. FNCS technique yielded more diagnostically superior and lesser number of unsatisfactory smears whereas greater number of diagnostically adequate samples was obtained by FNA technique. FNCS offers more number of diagnostically better quality smears. Both techniques could be supplementary on many occasions and substitutive on a few. Combination of the two techniques could offer better diagnostic accuracy.