Interpretation Of Cytologic Specimens Research Articles

Mandatory second opinion in cytopathology

Mandatory review of outside pathologic material is intended to detect interpretive errors that may have a clinically significant impact on patient care. Prior to definitive treatment of referred patients, the University of Iowa Carver College of Medicine requires a review of pertinent pathologic material previously obtained at outside institutions. The aims of this study were to determine if this local standard of practice has a measurable impact on patient care. The pathologic diagnoses of 499 second opinion cytology cases seen at the University of Iowa Carver College of Medicine were studied. Each second opinion was classified as "no diagnostic disagreement", "minor disagreement", or "major disagreement" with respect to the originating institution's interpretation. The clinical impact of major disagreement cases was determined by pathologic and clinical follow-up via chart review. Second opinion cytology resulted in 37 cases (7.4% of total cases) with major diagnostic disagreements. Clinical and pathologic follow-up was available in 30 of the major disagreement cases; second opinion diagnosis was better supported in 22 of these cases compared to the outside diagnosis. The second opinion in 6 major disagreement cases prompted changes in clinical management. Major disagreements in second opinion cytology are common, likely reflective of the challenges inherent in the interpretation of cytologic specimens. Although mandatory second opinion of outside cytologic material prompted changes in clinical management in only a small fraction of cases (1.2%), this rate was similar to those previously published for surgical pathology second opinion. These findings support the notion that mandatory second opinion policy as an important part of patient care.

Current utilization of breast FNA in a cytology practice

Over the past decade, core biopsy rapidly replaced fine needle aspiration (FNA) in evaluation of diseases of the female breast in many centers in the USA. The inability to diagnose invasive cancer by FNA, and the general feeling of unease in interpretation of cytologic specimens among pathologists who are not trained in cytopathology are among factors leading to decline in the use of FNA. At our institution, we continue to rely heavily on FNA for evaluation of breast masses. In this article, we discuss our multidisciplinary team approach which is essential in sustaining a successful breast cancer screening program. We also review the general utility of breast FNA and core biopsy in a comparative fashion. In the second part of this article which will appear in an upcoming issue, we will review the use of FNA and core biopsy in challenging breast lesions focusing on the pitfalls and limitations of both modalities in selected specific lesions.

EUS-Guided Trucut Biopsy for Diagnosis of an Esophageal Stromal Tumor: Case Report

EUS is a sensitive method for detection of intraand extra-intestinal mass lesions and peri-intestinal lymphadenopathy.1,2 EUS-guided FNA (EUS-FNA) can be performed during the diagnostic examination. EUSguided FNA is safe and has a sensitivity for detecting malignancy of 60% to over 90%, depending on site.3,4 However, several problems may arise. Determination of the adequacy of specimens at the time of the procedure by a cytopathologist or cytotechnician may not be possible in all institutions. Furthermore, the diagnosis of certain neoplasms, such as lymphoma, stromal tumors, and well-differentiated pancreatic adenocarcinoma often is difficult based on interpretation of cytologic specimens alone.3,5,6 Larger-caliber cutting needles have been developed for a variety of indications, including evaluation of both GI and non-GI tissues, and have been shown to be safe and to provide accurate results.2-12 The investigators developed a trucut biopsy needle for use with an echoendoscope (QuickCore; Wilson-Cook Medical Inc., Winston-Salem, N.C.). Our experience with EUS-guided trucut biopsy (EUSTCB) in a swine model demonstrated that histologic material representative of the target organ sampled could be acquired safely.13 A case of an esophageal leiomyoma is reported wherein EUS-TCB established the diagnosis when EUS-FNA was non-diagnostic.