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Graham AJ, Robinson MT, Kahler J, Azadi JR, Maleki Z. Rapid on-site evaluation (ROSE) of image-guided FNA specimens improves subsequent core biopsy adequacy in clinical trial patients: The impact of preanalytical factors and its correlation with survival. Cancer Cytopathol 2024; 132:30-40. [PMID: 37768842 DOI: 10.1002/cncy.22764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/09/2023] [Accepted: 08/02/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Sufficient tumor collection has become of utmost importance in therapeutic experimental protocols. Rapid on-site evaluation (ROSE) ensures adequate sampling for quantification of biomarkers, molecular analyses, and other ancillary studies. The objectives of this study were to evaluate the role of ROSE in trial-associated fine-needle aspiration (FNA) and to analyze predictors of adequacy and cumulative survival from in-house FNA cases used in clinical trials. METHODS Clinical trial FNA biopsies performed at a large academic institution were analyzed over 10 months using a comprehensive chart review of the electronic medical records. SPSS version 28 was used for statistical analysis. RESULTS Three hundred twenty-five FNAs were collected for 57 clinical trials. In total, 225 individual patients had an average of 1.4 FNA procedures each as a result of a multidepartmental collaborative effort. ROSE was performed for all patients, and adequacy was evaluated by cytotechnologists. Seventy-eight percent of samples were considered adequate, 14% were considered less than optimal, and 8% were considered inadequate, with the latter two categories designated together as less than adequate. The imaging modalities were mainly ultrasound-guided (n = 267; 82%) and computed tomography-guided (n = 58; 18%). There was a statistically significant association between adequate sampling and ultrasound-guided biopsies (83%) compared with computed tomography-guided biopsies (59%; p < .01). The effect of body mass index (BMI) on mortality was also a significant finding. The authors observed a survival benefit in patients who had elevated BMIs (range, 25.0-34.9 kg/m2 ) compared with those who were underweight (BMI, <18.5 kg/m2 ) or class III obese (BMI, >35.0 kg/m2 ; p < .01). Therefore, the best predictors of adequacy and mortality were imaging modality and BMI, respectively. CONCLUSIONS Ultrasound-guided modalities are recommended for obtaining adequate FNA sampling for clinical trials. In addition, patients with cancer who had slightly elevated BMIs (25.0-34.0 kg/m2 ) had increased overall survival in this cohort.
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Affiliation(s)
- Ashleigh J Graham
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mahalia T Robinson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Kahler
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Javad R Azadi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lee J, Ha HJ, Kim DY, Koh JS, Kim EJ. Analysis of Under-Diagnosed Malignancy during Fine Needle Aspiration Cytology of Lymphadenopathies. Int J Mol Sci 2023; 24:12394. [PMID: 37569769 PMCID: PMC10418811 DOI: 10.3390/ijms241512394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Fine needle aspiration cytology (FNAC) is a useful tool in the evaluation of lymphadenopathy. It is a safe and minimally invasive procedure that provides preoperative details for subsequent treatment. It can also diagnose the majority of malignant tumors. However, there are some instances where the diagnosis of tumors remains obscure. To address this, we re-analyzed the misinterpreted patients' samples using mRNA sequencing technology and then identified the characteristics of non-Hodgkin's lymphoma that tend to be under-diagnosed. To decipher the involved genes and pathways, we used bioinformatic and biological analysis approaches, identifying the response to oxygen species, inositol phosphate metabolic processes, and peroxisome and PPAR pathways as possibly being involved with this type of tumor. Notably, these analyses identified FOS, ENDOG, and PRKAR2B as hub genes. cBioPortal, a multidimensional cancer genomics database, also confirmed that these genes were associated with lymphoma patients. These results thus point to candidate genes that could be used as biomarkers to minimize the false-negative rate of FNAC diagnosis. We are currently pursuing the development of a gene chip to improve the diagnosis of lymphadenopathy patients with the ultimate goal of improving their prognosis.
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Affiliation(s)
- Jeeyong Lee
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (J.L.); (D.Y.K.)
| | - Hwa Jeong Ha
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (H.J.H.); (J.S.K.)
- Convergence Institute of Biomedical Engineering and Biomaterials, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Da Yeon Kim
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (J.L.); (D.Y.K.)
- Department of Radiological and Medico-Oncological Sciences, University of Science and Technology, Daejeon 34113, Republic of Korea
| | - Jae Soo Koh
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (H.J.H.); (J.S.K.)
| | - Eun Ju Kim
- Division of Radiation Biomedical Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea; (J.L.); (D.Y.K.)
- Department of Radiological and Medico-Oncological Sciences, University of Science and Technology, Daejeon 34113, Republic of Korea
- Institute for Molecular Bioscience, The University of Queensland, Carmody Rd., St Lucia, Brisbane, QLD 4072, Australia
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Isla D, Lozano MD, Paz-Ares L, Salas C, de Castro J, Conde E, Felip E, Gómez-Román J, Garrido P, Belén Enguita A. [New update to the guidelines on testing predictive biomarkers in non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2023; 56:97-112. [PMID: 37061248 DOI: 10.1016/j.patol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 04/17/2023]
Abstract
Non-small cell lung cancer (NSCLC) presents the greatest number of identified therapeutic targets, some of which have therapeutic utility. Currently, detecting EGFR, BRAF, KRAS and MET mutations, ALK, ROS1, NTRK and RET translocations, and PD-L1 expression in these patients is considered essential. The use of next-generation sequencing (NGS) facilitates precise molecular diagnosis and allows the detection of other emerging mutations, such as the HER2 mutation and predictive biomarkers for immunotherapy responses. In this consensus, a group of experts in the diagnosis and treatment of NSCLC selected by the Spanish Society of Pathology (SEAP) and the Spanish Society of Medical Oncology (SEOM) have evaluated currently available information and propose a series of recommendations to optimize the detection and use of biomarkers in daily clinical practice.
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Affiliation(s)
- Dolores Isla
- Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Sociedad Española de Oncología Médica (SEOM), Zaragoza, España
| | - María D Lozano
- Clínica Universidad de Navarra, Sociedad Española de Citología (SEC), Sociedad Española de Anatomía Patológica (SEAP), Pamplona, España
| | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, Sociedad Española de Oncología Médica (SEOM), Madrid, España
| | - Clara Salas
- Hospital Universitario Puerta de Hierro, Sociedad Española de Anatomía Patológica (SEAP), Madrid, España
| | - Javier de Castro
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Sociedad Española de Oncología Médica (SEOM), Madrid, España
| | - Esther Conde
- Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Sociedad Española de Anatomía Patológica (SEAP), Madrid, España
| | - Enriqueta Felip
- Hospital Universitario Vall d'Hebron, Sociedad Española de Oncología Médica (SEOM), Barcelona, España
| | - Javier Gómez-Román
- Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Sociedad Española de Anatomía Patológica (SEAP), Santander, España
| | - Pilar Garrido
- Hospital Universitario Ramón y Cajal, Sociedad Española de Oncología Médica (SEOM), Madrid, España
| | - Ana Belén Enguita
- Hospital Universitario 12 de Octubre, Sociedad Española de Anatomía Patológica (SEAP), Madrid, España.
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New update to the guidelines on testing predictive biomarkers in non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology. Clin Transl Oncol 2022; 25:1252-1267. [PMID: 36571695 PMCID: PMC10119050 DOI: 10.1007/s12094-022-03046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022]
Abstract
Non-small cell lung cancer (NSCLC) presents the greatest number of identified therapeutic targets, some of which have therapeutic utility. Currently, detecting EGFR, BRAF, KRAS and MET mutations, ALK, ROS1, NTRK and RET translocations, and PD-L1 expression in these patients is considered essential. The use of next-generation sequencing facilitates precise molecular diagnosis and allows the detection of other emerging mutations, such as the HER2 mutation and predictive biomarkers for immunotherapy responses. In this consensus, a group of experts in the diagnosis and treatment of NSCLC selected by the Spanish Society of Pathology and the Spanish Society of Medical Oncology have evaluated currently available information and propose a series of recommendations to optimize the detection and use of biomarkers in daily clinical practice.
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Bode-Lesniewska B. [New aspects in fine needle biopsies of the lymph nodes]. DER PATHOLOGE 2022; 43:109-116. [PMID: 34989818 DOI: 10.1007/s00292-021-01044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The cytology of lymph nodes is a cost-effective method with a short turnaround time and low risk to patients that delivers valuable information on the cause of the lymphadenopathies. OBJECTIVES To discuss the value of lymph node cytology in the diagnosis of lymph node swellings. METHODS Analysis of the causes of the controversially discussed aspects of lymph node cytology. Presentation of the diagnostic groups of lymph node cytology according to the Sydney system. RESULTS The technical aspects of lymph node sampling during fine needle biopsy, as well as the subsequent preparation of the correctly fixed direct smears and the triage of the sample for the auxiliary studies, may pose a significant challenge for some puncturers. The whole spectrum of modern pathologic auxiliary studies can be applied to correctly triaged cytologic samples. The diagnoses of fine needle biopsies of the lymph nodes can be divided into five groups according to the recently proposed Sydney reporting system: insufficient/non-diagnostic, benign, atypical, suspicious, and malignant. Further details concerning the diagnosis as well as recommendations on how to proceed are additionally included in cytologic reports. CONCLUSIONS The improvement of lymph node sampling as well as the technical aspects of the sample handling, including the application of auxiliary studies, considerably increase the diagnostic value of fine needle biopsy of the lymph nodes. Wide implementation of the usage of the diagnostic groups for reporting fine needle biopsies of the lymph nodes can standardize reporting and improve communication with other clinical specialists.
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Affiliation(s)
- Beata Bode-Lesniewska
- Zytopathologie, Pathologie Institut Enge, Hardturmstr. 133, 8005, Zürich, Schweiz.
- Universität Zürich, Zürich, Schweiz.
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Mooney KL, Czerwinski DK, Shree T, Frank MJ, Haebe S, Martin BA, Testa S, Levy R, Long SR. Serial FNA allows direct sampling of malignant and infiltrating immune cells in patients with B-cell lymphoma receiving immunotherapy. Cancer Cytopathol 2022; 130:231-237. [PMID: 34780125 PMCID: PMC8897258 DOI: 10.1002/cncy.22531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is used to diagnose malignancies, recurrences, and metastases. The procedure is quick and well tolerated and can be facilitated by ultrasound guidance. METHODS This article describes the authors' experience in using serial FNA to harvest cellular material during 4 clinical trials of immunotherapy by in situ vaccination in patients with low-grade lymphoma. RESULTS Two hundred ninety-six FNA samples were collected from 44 patients over a span of approximately 6 weeks for each patient. Samples were sufficient in quantity and quality to be analyzed by flow cytometry and/or single-cell messenger RNA sequencing. FNA samples yielded an average of 12 × 106 cells with a mean cellular viability of 86%. Material collected from the tumor lymph nodes differed significantly in the proportions and phenotypes of cellular populations in comparison with matched peripheral blood samples. A comparison of flow cytometry results obtained by FNA directly from the patient and by FNA performed ex vivo and a dissociation of the same lymph node after surgical excision confirmed that FNA sampling of the patient accurately represented the tumor and the microenvironment. An analysis of the FNA samples from immunotherapy-treated target lymph nodes versus nodes from nontreated tumor sites provided insight into the impact of specific immunotherapy regimens. CONCLUSIONS This is the largest study describing the use of serial FNA sampling to harvest cellular material during immunotherapy clinical trials. The success of this technique opens the door for FNA sampling to expand significantly future investigations of the dynamic effects of investigational agents, be they immunotherapies or targeted therapies.
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Affiliation(s)
| | | | - Tanaya Shree
- Stanford University: Department of Medicine, Division of Oncology
| | - Matthew J. Frank
- Stanford University: Department of Medicine, Division of Oncology
| | - Sarah Haebe
- Stanford University: Department of Medicine, Division of Oncology
| | | | - Stefano Testa
- Stanford University: Department of Medicine, Division of Oncology
| | - Ronald Levy
- Stanford University: Department of Medicine, Division of Oncology
| | - Steven R. Long
- University of California, San Francisco, Department of Pathology
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Zhou F, Shum E, Moreira AL. Molecular cytology of the respiratory tract and pleura. Cytopathology 2021; 33:14-22. [PMID: 34333812 DOI: 10.1111/cyt.13045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 07/24/2021] [Indexed: 01/01/2023]
Abstract
There is growing evidence that molecular testing is feasible on all types of cytological preparation, which is fortunate as more diagnostic markers and biomarkers for targeted therapies are discovered for use in pulmonary and pleural malignancies. In this article we will discuss the pre-analytic, analytic, and post-analytic (interpretive) considerations for successful implementation of molecular tests for diagnostic and predictive markers in respiratory and pleural cytology. The vast majority of laboratories are familiar with, and have validated their molecular protocols for, formalin-fixed paraffin-embedded surgical specimens, which are not directly applicable to cytology specimens. Thus, rigorous validation must be performed for each type of fixative and cytology preparation before it is implemented in the clinical setting.
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Affiliation(s)
- Fang Zhou
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Elaine Shum
- Division of Hematology and Medical Oncology, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, NY, USA
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8
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To whom the specimen goes: a look at how touch preparations and core needle biopsies are handled in different practices and the effect on fellowship education. J Am Soc Cytopathol 2021; 10:510-516. [PMID: 34147412 DOI: 10.1016/j.jasc.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Core needle biopsies (CNBs) have proven to be an excellent source of tissue for diagnosis and ancillary testing in the era of personalized medicine, commonly yielding sufficient material for testing via a relatively minimally invasive technique. Thus, there has been an increase in touch preparations (TPs) evaluated with rapid onsite evaluation (ROSE) of these small biopsies either in isolation or with concurrent fine needle aspiration (FNA). This in turn has forced cytopathology practices to make decisions with regard to processing and workflow of CNBs, which affects cytopathology fellowship education substantially. STUDY DESIGN The present review is based on a review of recent literature and an evaluation of the authors' personal experiences. RESULTS AND CONCLUSIONS Deciding whether CNBs with associated TPs should be assigned to the cytology service, the subspecialty or general surgical pathology service, or a split between cytopathology and surgical pathology, is complicated. The workflow is variable at different institutions depending on multiple factors. Each of these routes has benefits and disadvantages that can affect patient care and laboratory workflow, in addition to having downstream effects on the quality and type of education our pathology trainees receive. Herein, the advantages and disadvantages of the different approaches for CNB triage are discussed, with an emphasis on the impact upon cytopathology fellowship education.
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9
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Al-Abbadi MA, Barroca H, Bode-Lesniewska B, Calaminici M, Caraway NP, Chhieng DF, Cozzolino I, Ehinger M, Field AS, Geddie WR, Katz RL, Lin O, Medeiros LJ, Monaco SE, Rajwanshi A, Schmitt FC, Vielh P, Zeppa P. A Proposal for the Performance, Classification, and Reporting of Lymph Node Fine-Needle Aspiration Cytopathology: The Sydney System. Acta Cytol 2020; 64:306-322. [PMID: 32454496 DOI: 10.1159/000506497] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The evaluation of lymph nodes (LN) by fine-needle aspiration cytology (FNAC) is routinely used in many institutions but it is not uniformly accepted mainly because of the lack of guidelines and a cytopathological diagnostic classification. A committee of cytopathologists has developed a system of performance, classification, and reporting for LN-FNAC. METHODS The committee members prepared a document that has circulated among them five times; the final text has been approved by all the participants. It is based on a review of the international literature and on the expertise of the members. The system integrates clinical and imaging data with cytopathological features and ancillary techniques. The project has received the endorsement and patronage of the International Academy of Cytology and the European Federation of the Cytology Societies. RESULTS Clinical, imaging, and serological data of lymphadenopathies, indications for LN-FNAC, technical procedures, and ancillary techniques are evaluated with specific recommendations. The reporting system includes two diagnostic levels. The first should provide basic diagnostic information and includes five categories: inadequate/insufficient, benign, atypical lymphoid cells of undetermined/uncertain significance, suspicious, and malignant. For each category, specific recommendations are provided. The second diagnostic level, when achievable, should produce the identification of specific benign or malignant entities and additional information by utilizing ancillary testing. CONCLUSION The authors believe that the introduction of this system for performing and reporting LN-FNAC may improve the quality of the procedure, the report, and the communication between cytopathologists and the clinicians. This system may lead to a greater acceptance and utilization of LN-FNAC and to a better interdisciplinary understanding of the results of this procedure.
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Affiliation(s)
- Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, the University of Jordan, Amman, Jordan
| | - Helena Barroca
- Serviço de Anatomia Patológica, Hospital S João-Porto, Porto, Portugal
| | | | - Maria Calaminici
- Department of Cellular Pathology, Barts Health NHS Trust and Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Nancy P Caraway
- Department of Anatomic Pathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David F Chhieng
- Department of Pathology, University of Washington Medical Center, Seattle, Washington, USA
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mats Ehinger
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Andrew S Field
- University of NSW Medical School, Sydney, New South Wales, Australia
- University of Notre Dame Medical School, Sydney, New South Wales, Australia
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - William R Geddie
- University Health Network, UHN, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arvind Rajwanshi
- Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology of Porto University (IPATIMUP), Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
| | | | - Pio Zeppa
- Department of Medicine and Surgery, Università degli Studi di Salerno, Fisciano, Salerno, Italy,
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Voyten J, Holtzman MP, Pantanowitz L, Dhir R, Beasley HS, Cuda J, Monaco SE. Lessons learned from clinical trial queries on small biopsy collections: importance of rapid on-site evaluation. J Am Soc Cytopathol 2020; 9:461-468. [PMID: 32499137 DOI: 10.1016/j.jasc.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Small biopsies and cytology specimens have become increasingly important for clinical trials and biomarker testing. Thus, institutions must ensure that adequate lesional material meeting the specifications for a multitude of different protocols is available. This can be achieved using rapid on-site evaluation (ROSE). The aim of the present study was to determine the recent clinical trial biopsy characteristics and study the feedback on these collections at our institution. MATERIALS AND METHODS Clinical trial biopsies performed at our institution and trial feedback (including "queries") were analyzed from the 2017 to 2019. The query data were reviewed in detail, in addition to any protocol modifications related to biopsy requirements and study protocol changes. RESULTS A total of 698 biopsy collections were performed for clinical trial purposes for 95 trials, with most requiring biopsies at >1 time point (63.2%), for phase I or II trials (92.6%), and for specific tumor types (67.4%). Only 18 of the trials (18.9%) requiring fresh tissue biopsies provided feedback. The feedback included data from 90 cases (12.9%), of which 27 (30.0%) had queries regarding insufficient (n = 10; 37.0%) or borderline (n = 17; 63.0%) tumor tissue. Only 1 (3.7%) of these had had ROSE by cytology. ROSE was performed in accordance with institutional guidelines (45.3%), as required by the study (1.1%), or because of trial modification (5.3%). CONCLUSIONS The present investigation has shown the high volume of clinical trial biopsies managed at our academic cancer center. Feedback from the trials was low at 18.9% and frequently involved suboptimal cases without ROSE used at acquisition. This has led to more widespread adoption of ROSE to mitigate insufficient biopsy specimens and repeat procedures. The high volume of clinical trial biopsies and variability in trial needs necessitates a collaborative multidisciplinary network, including cytology services, to facilitate these important biopsies for patients with cancer.
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Affiliation(s)
- Jamie Voyten
- Clinical Research Services, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Matthew P Holtzman
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rajiv Dhir
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - H Scott Beasley
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jackie Cuda
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Monaco SE, Pantanowitz L, Xing J, Cuda J, Kammula US. Cytologic Evaluation of Tumor-Infiltrating Lymphocytes for Adoptive Cell Therapy. Am J Clin Pathol 2020; 153:513-523. [PMID: 31895425 DOI: 10.1093/ajcp/aqz195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Novel immunotherapeutic options for refractory metastatic cancer patients include adoptive cell therapies such as tumor infiltrating lymphocytes (TILs). This study characterizes the clinicopathologic findings in a cohort of TIL specimens. METHODS Patients with metastatic malignancy who were eligible had TILs from their metastases grown and expanded and then sent to pathology. RESULTS A total of 11 TIL specimens (10 melanoma, 1 adenocarcinoma) from patients enrolled in an experimental clinical trial were reviewed. All specimens showed more than 200 lymphoid cells, stained positive for lymphoid markers confirming an activated cytotoxic T-cell immunophenotype, and morphologically showed an intermediate-sized population with immature chromatin and frequent mitoses. Six cases (55%) showed large cells with nucleomegaly and prominent nucleoli. CONCLUSIONS This report is the first describing cytopathologic findings of autologous TIL therapy including adequacy guidelines and expected cytomorphologic and immunophenotypic findings. To meet this novel clinical demand, a predefined cytology protocol to rapidly process and interpret these specimens needs to be established.
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Affiliation(s)
- Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jackie Cuda
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Udai S Kammula
- Solid Tumor Cellular Immunotherapy Program, Hillman Cancer Center, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
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