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Cooke TM, Maybody M, Aly AK, Petre EN, Santos E, Noy A, Chan AY, Lis E, Gangai N, Cornelis FH, Moussa AM. Factors Affecting Diagnostic Yield of Lesional Bone Biopsy in Hematologic Malignancy Patients. Cardiovasc Intervent Radiol 2024; 47:80-86. [PMID: 37910259 PMCID: PMC11149476 DOI: 10.1007/s00270-023-03594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To evaluate factors affecting the diagnostic yield (percent of biopsy samples leading to a pathologic diagnosis) of lesional bone biopsies in patients with hematologic malignancies. MATERIALS AND METHODS This retrospective study included 206 lesional bone biopsies in 182 patients with a hematologic malignancy between January 2017 and December 2022. The parameters that were reviewed to evaluate diagnostic yield included biopsy device type (manual vs. electric-powered drill), number of biopsy cores acquired, core biopsy needle gauge, preliminary intra-procedural sample adequacy (touch preparation cytology determining if samples are adequate for final pathologic examination), lesion morphology on Computed Tomography (CT), and presence of crush artifact. RESULTS Review of 206 lesional biopsies showed overall diagnostic yield to be 89.8% (185/206). The two statistically significant factors affecting diagnostic yield were biopsy device type and in-room adequacy. 41/42 samples obtained with the electric-powered drill and 144/164 samples obtained using a variety of manual needles were diagnostic (97.6% vs 87.8%, p = 0.03). Of the 192 samples that were assessed for sample adequacy intra-procedurally, 97/102 of the samples that were deemed adequate were diagnostic, and 77/90 of the samples where intra-procedural adequacy was not confirmed were diagnostic (95.1% vs 85.6%, p = 0.018). The remaining factors did not affect diagnostic yield. CONCLUSION The use of an electric-powered drill bone biopsy device and intra-procedural confirmation of sample adequacy are associated with a higher diagnostic yield of lesional bone biopsies in patients with hematologic malignancies. The presence or absence of crush artifact did not significantly affect the diagnostic yield in these patients. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Timothy M Cooke
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
- College of Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Majid Maybody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ahmed K Aly
- Department of Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ernesto Santos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Alexander Y Chan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA
| | - Amgad M Moussa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Suite H-118, 1275 York Ave, New York, NY, 10065, USA.
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Yadav K, Cree I, Field A, Vielh P, Mehrotra R. Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries. JCO Glob Oncol 2022; 8:e2100337. [PMID: 35213215 PMCID: PMC8887942 DOI: 10.1200/go.21.00337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The rising cancer burden in low- and middle-income countries (LMICs) stresses already weak health care systems and poses unique challenges. In resource-constrained LMICs and in circumstances where most patients must pay out of pocket for diagnostic tests, these may not be available or affordable for many. Cytopathology provides a simple, inexpensive, standardized, and low-technology diagnostic procedure that is increasingly used as an effective tool to address the hurdles faced in cancer control programs in LMICs. This review explores the potential role of cytopathology in LMICs in reducing the cancer burden. METHODS This review studied the existing literature across the globe regarding the utilization of cytopathology as a diagnostic or screening tool for various types of malignancies as well as its advantages and disadvantages, depending on the local situation. RESULTS Apart from the usefulness of cytopathology, this review also sheds light on the barriers to using cytopathology in LMICs. Most recently, SARS-CoV-2 has produced several unique challenges for cytopathology. These are being met with innovative measures to combat the effects of the pandemic and ensure the safe delivery of essential cytopathology services. CONCLUSION The usefulness of cytopathologic techniques has been demonstrated via various studies, even during the recent pandemic. If cytology is to be used appropriately, the focus needs to be on integrating it into the national cancer screening and diagnostic programs as well as providing well-trained human resources.
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Affiliation(s)
- Kavita Yadav
- Centre of Social Medicine & Community Health, JNU, New Delhi, India
| | - Ian Cree
- WHO Classification of Tumours, International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Andrew Field
- Department of Anatomical Pathology, University of NSW and Notre Dame University Medical Schools, St Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Ravi Mehrotra
- Chip Foundation, Noida, India
- Rollins School of Public Health, Emory University, Atlanta, GA
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Jones TE, Khader S, Jones MW, Lajara SB. Educational Case: Metastatic endometrial stromal sarcoma presenting as bone pain: a diagnostic approach to uterine mesenchymal tumors. Acad Pathol 2022; 9:100016. [PMID: 35600747 PMCID: PMC9115721 DOI: 10.1016/j.acpath.2022.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 01/09/2022] [Accepted: 01/16/2022] [Indexed: 12/02/2022] Open
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Sokolovski B, Scolnik M, Malkin L, Postovsky S, Weyl Ben-Arush M, Ilivitzki A. Ultrasound-guided core biopsy with on-site cytology-immediate diagnosis in pediatric oncology. Diagn Cytopathol 2021; 49:817-821. [PMID: 33811745 DOI: 10.1002/dc.24746] [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: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Accurate and swift tissue diagnosis is extremely important for the timely initiation of treatment in pediatric oncology. In our department, ultrasound-guided core needle biopsy (US-guided CNB) is used for tissue diagnosis. In 2016, we added on-site cytology, allowing for an immediate primary diagnosis. We retrospectively reviewed our performance in terms of safety and accuracy for CNBs and on-site cytology. METHODS All pediatric biopsies performed in our hospital between February 2016 and December 2020, were included. Patient clinical, procedural and follow-up data were collected. CNB pathology and cytology results were compared to the final pathologic diagnosis. RESULTS We included 71 patients for which 72 biopsies with on-site touch imprint (TI) cytology were performed; the average latency time to biopsy was 1 day. Altogether, we had 61 tumors, (58 malignant, 3 benign) and 11 other lesions. On-site cytology diagnosed 58 malignant tumors, 3 benign tumors and 11 non-tumor tissues. The cytologist correctly differentiated tumor from inflammation in all cases, and diagnosed the precise tumor type in 57 cases, with an accuracy of 94% for final diagnosis. We had no complications related to the procedure or sedation. CONCLUSION US-guided CNB with on-site TI cytology for suspected malignancy in the pediatric population is highly available, safe, and accurate, with real-time diagnosis in most cases. This accelerated diagnostic route has a huge impact on patient care.
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Affiliation(s)
- Boris Sokolovski
- Department of Radiology, Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Scolnik
- Department of Radiology, Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Leonid Malkin
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Sergey Postovsky
- Department of Pediatric Hematology and Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Myriam Weyl Ben-Arush
- Department of Pediatric Hematology and Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Anat Ilivitzki
- Department of Radiology, Pediatric Radiology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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Ultrasound-Guided Core Biopsy for Tissue Diagnosis in Pediatric Oncology: 16-Year Experience With 597 Biopsies. AJR Am J Roentgenol 2021; 216:1066-1073. [PMID: 33566633 DOI: 10.2214/ajr.20.23196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE. Percutaneous imaging-guided core needle biopsies (CNBs) for cancer diagnosis in pediatric patients are gaining interest because of their availability, lower rate of complications, and high diagnostic power compared with traditional surgical biopsies. Nevertheless, their precise role in the diagnostic algorithm of pediatric oncology is still unknown. The purpose of this study was to report our accumulated 16-year experience with CNB; discuss the availability, safety, and diagnostic accuracy of the procedure and the adequacy of ancillary testing; and compare our findings with the available literature. MATERIALS AND METHODS. Pediatric ultrasound-guided CNBs performed in our hospital between November 2003 and December 2019 were retrospectively studied. Data collection included demographics, clinical and procedural parameters, complications, and final diagnosis. RESULTS. A total of 597 biopsies were performed in 531 patients (132 performed in known oncologic patients and 465 performed to establish diagnosis). The median time between the biopsy request and the procedure was 1 day. Of 432 biopsies performed in patients with malignancies, 12 (2.8%) had false-negative results. In 165 cases of benign pathologic findings, all had true-negative results. Ancillary testing was adequate in all malignant cases. Overall sensitivity, specificity, and accuracy rates were 97.2%, 100%, and 98.0%, respectively. Five biopsies (0.8%) resulted in complications, including one major bleed and one track seeding. CONCLUSION. Our experience shows that ultrasound-guided CNB for suspected malignancy in pediatric patients has a high safety profile, availability, and accuracy rate compared with surgical biopsy. Our fast-track strategy enables early initiation of designated therapy and has the potential to become the procedure of choice.
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Satturwar S, Rekhtman N, Lin O, Pantanowitz L. An update on touch preparations of small biopsies. J Am Soc Cytopathol 2020; 9:322-331. [PMID: 32417160 DOI: 10.1016/j.jasc.2020.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 02/08/2023]
Abstract
Touch preparations (TPs) are being increasingly utilized in the era of personalized medicine. They fill a gap in cytopathology practice by providing a method to perform rapid onsite evaluation of small tissue samples such as core needle biopsies. However, there is a paucity of literature about how best to perform and interpret a TP. A high-quality TP can provide excellent diagnostic accuracy and good concordance with core needle biopsy histopathology findings. Although many of the cytomorphologic features of TPs overlap with fine needle aspirate smears, TP cytology is unique and differs from conventional smears in many aspects. It is important for cytologists to recognize these features, as well as potential pitfalls and artifacts in order to avoid misinterpretation. Core depletion of tumor cells is a notable drawback if TPs are performed too aggressively. TP slides are also valuable for ancillary testing because they often contain a cellular and pure population of whole tumor cells. This paper reviews all of the aspects of TPs including their clinical utility, proper slide preparation techniques, distinctive cytomorphologic characteristics, limitations, and potential pitfalls.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Fetzer R, Duey M, Pena V, Wanzer D, Kirkpatrick J, Chau D, Sarode VR. Role of cytotechnologists in rapid onsite adequacy assessment of cytology materials for diagnostic workup and specimen allocation for ancillary testing using a standardized protocol. J Am Soc Cytopathol 2020; 9:67-75. [PMID: 31543473 DOI: 10.1016/j.jasc.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/23/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Data on the performance of cytotechnologists in assessing specimen adequacy of needle core biopsies (NCB) is scant and their role in specimen triaging for ancillary studies have not been well established. MATERIALS AND METHODS We retrospectively analyzed rapid onsite evaluation (ROSE) performed exclusively by cytotechnologists on 248 NCB and fine-needle aspiration (FNA) specimens. Overall adequacy and accuracy rates were determined by comparing to final diagnosis. We also reviewed the process of specimen allocation for ancillary testing to determine whether specimens were appropriately triaged at the time of ROSE. RESULTS Of the 248 cases, 222 (89.5%) were touch imprint and 26 (10.5%) were FNA smears. The overall adequacy rate was 73.4% (182 of 248). Concordance for "adequate" interpretation by ROSE with unequivocal malignant or benign diagnoses on final interpretation was 95.6%. The sensitivity, specificity, and accuracy of ROSE for a final "positive for malignancy" were 89.2% (95% CI 83.04% to 93.69%), 43.24% (95% CI 31.77% to 55.28%), and 73.87% (95% CI 67.57% to 55.28%), respectively. Cases with "positive for malignancy" on final diagnosis were "adequate" by ROSE in 89.1% (132 of 148) and "inadequate" in 10.8% (16 of 148), P < 0.0001. Ancillary tests were performed in 168 of 248 (67.7%); the majority were immunohistochemical stains for determining tumor subtype. Predictive biomarkers were performed successfully in 100% of metastatic breast cancers. CONCLUSIONS Cytotechnologists performed at a high level of competency in providing ROSE and allocating specimens for ancillary testing, which were performed successfully in the majority of cases. Implementation of a standardized protocol for tissue management/prioritization is of paramount importance to maximize tissue preservation and minimize wastage.
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Affiliation(s)
- Russel Fetzer
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Michelle Duey
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Valerie Pena
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Dana Wanzer
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - James Kirkpatrick
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Donnie Chau
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Venetia R Sarode
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas.
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Krishnamurthy S, Ban K, Shaw K, Mills G, Sheth R, Tam A, Gupta S, Sabir S. Confocal Fluorescence Microscopy Platform Suitable for Rapid Evaluation of Small Fragments of Tissue in Surgical Pathology Practice. Arch Pathol Lab Med 2018; 143:305-313. [PMID: 30376375 DOI: 10.5858/arpa.2018-0352-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Rapid advances in the fields of biophotonics, computer science, and instrumentation have allowed for high-resolution imaging of biologic tissues. OBJECTIVE.— To evaluate the quality of images from an optimized confocal fluorescence microscopy (CFM) platform for rapid evaluation of small fragments of tissue, compared with hematoxylin-eosin staining. DESIGN.— Tissue fragments (up to 1.0 × 0.3 cm) were stained with 0.6 mM acridine orange for 60 seconds and imaged using a CFM platform at 488-nm and 785-nm wavelength. The imaged tissues were then fixed in formalin and processed to generate hematoxylin-eosin-stained tissue sections. The quality of CFM images was scored on a scale of 0 to 3 on the basis of the percentage of the CFM images with recognizable tissue architecture (0, 0%; 1, <20%; 2, 20%-50%; 3, >50%). The diagnoses made using CFM images were compared with those made using histopathologic analysis of the hematoxylin-eosin-stained tissue sections. RESULTS.— We imaged 118 tissue fragments obtained from 40 breast, 23 lung, 39 kidney, and 16 liver surgical excision specimens. We acquired CFM images in 2 to 3 minutes; 95.8% (113 of 118) of images showed a quality score of 3, and 4.2% (5 of 118) had a score of 2. We achieved a sensitivity of 95.5%, specificity of 97.3%, positive predictive value of 95.5%, and negative predictive value of 97.3%. CONCLUSIONS.— Our results demonstrate the suitability of the CFM platform for rapid and accurate evaluation of small tissue fragments in surgical pathology practice.
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Affiliation(s)
- Savitri Krishnamurthy
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kechen Ban
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Kenna Shaw
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Gordon Mills
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Rahul Sheth
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Alda Tam
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sanjay Gupta
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
| | - Sharjeel Sabir
- From the Departments of Pathology and Laboratory Medicine (Dr Krishnamurthy) and Pathology (Dr Ban), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (Drs Ban, Shaw, and Mills), and the Department of Interventional Radiology (Drs Sheth, Tam, Gupta, and Sabir), The University of Texas MD Anderson Cancer Center, Houston
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Fry MM, Yao B, Ríos C, Wong C, Mann S, McArt JAA, Nydam DV, Leal Yepes FA, Viesselmann L, Geick A, Goldin K, Jordan A, Behling-Kelly E. Diagnostic performance of cytology for assessment of hepatic lipid content in dairy cattle. J Dairy Sci 2017; 101:1379-1387. [PMID: 29248218 DOI: 10.3168/jds.2017-12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 10/10/2017] [Indexed: 12/26/2022]
Abstract
The objective of our study was to characterize the diagnostic performance of cytology for assessing hepatic lipid content (HLC) in dairy cows by comparing microscopic evaluation of lipid vacuolation in touch imprint slide preparations of liver biopsies with quantitative measurement of triglyceride concentration ([TG]; mg/mg of wet weight) in paired biopsy samples. Our study also sought to compare the diagnostic performance of liver cytology, plasma nonesterified fatty acid concentration ([NEFA]), and plasma β-hydroxybutyrate concentration ([BHB]) derived from a measurement performed on whole blood, for assessing HLC. Chemical extraction of TG from liver tissue remains the gold standard for quantifying HLC, largely because available blood tests, although useful for detecting some types of pathology, such as increased lipid mobilization, ketosis, or hepatocellular injury, are nonspecific as to etiology. Veterinary practitioners can sample bovine liver for cytological evaluation in a fast, minimally invasive, and inexpensive manner. Thus, if highly predictive of HLC, cytology would be a practical diagnostic tool for dairy veterinarians. In our study, liver biopsy samples from Holstein cows (219 samples from 105 cows: 52 from cows 2 to 20 d prepartum, 105 from cows 0 to 10 d in milk, 62 from cows 18 to 25 d in milk) were used to prepare cytology slides and to quantify [TG] using the Folch extraction method followed by the Hantzch condensation reaction and spectrophotometric measurement. An ordinal scale (0-4) based on amount of hepatocellular cytoplasm occupied by discrete clear vacuoles was used by 3 blinded, independent observers to rank HLC in Wright-Giemsa-stained slides. Interobserver agreement in cytology scoring was good. Corresponding plasma [NEFA] and [BHB] measurements were available for 187 and 195 of the 219 samples, respectively. Liver [TG] correlated more strongly with cytology score than with NEFA or BHB, and receiver operating characteristic curve analysis showed that cytology had better diagnostic performance than either NEFA or BHB for correctly categorizing [TG] at thresholds of 5, 10, and 15%. Hepatic lipidosis in high-producing dairy cows is of major clinical and economic importance, and this study demonstrates that cytology is an accurate means of assessing HLC. Additional work is indicated to evaluate the diagnostic utility of liver cytology.
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Affiliation(s)
- M M Fry
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville 37996
| | - B Yao
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - C Ríos
- Dirección Académica, Universidad Santo Tomás, Mendoza 120, Los Ángeles, Chile
| | - C Wong
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - S Mann
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - J A A McArt
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - D V Nydam
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853
| | - F A Leal Yepes
- Department of Animal Science, Cornell University, Ithaca NY 14853
| | - L Viesselmann
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville 37996
| | - A Geick
- College of Veterinary Medicine, University of Tennessee, Knoxville 37996
| | - K Goldin
- College of Veterinary Medicine, University of Tennessee, Knoxville 37996
| | - A Jordan
- College of Veterinary Medicine, University of Tennessee, Knoxville 37996
| | - E Behling-Kelly
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853.
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Amemiya K, Hirotsu Y, Goto T, Nakagomi H, Mochizuki H, Oyama T, Omata M. Touch imprint cytology with massively parallel sequencing (TIC-seq): a simple and rapid method to snapshot genetic alterations in tumors. Cancer Med 2016; 5:3426-3436. [PMID: 27774772 PMCID: PMC5224853 DOI: 10.1002/cam4.950] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 01/22/2023] Open
Abstract
Identifying genetic alterations in tumors is critical for molecular targeting of therapy. In the clinical setting, formalin-fixed paraffin-embedded (FFPE) tissue is usually employed for genetic analysis. However, DNA extracted from FFPE tissue is often not suitable for analysis because of its low levels and poor quality. Additionally, FFPE sample preparation is time-consuming. To provide early treatment for cancer patients, a more rapid and robust method is required for precision medicine. We present a simple method for genetic analysis, called touch imprint cytology combined with massively paralleled sequencing (touch imprint cytology [TIC]-seq), to detect somatic mutations in tumors. We prepared FFPE tissues and TIC specimens from tumors in nine lung cancer patients and one patient with breast cancer. We found that the quality and quantity of TIC DNA was higher than that of FFPE DNA, which requires microdissection to enrich DNA from target tissues. Targeted sequencing using a next-generation sequencer obtained sufficient sequence data using TIC DNA. Most (92%) somatic mutations in lung primary tumors were found to be consistent between TIC and FFPE DNA. We also applied TIC DNA to primary and metastatic tumor tissues to analyze tumor heterogeneity in a breast cancer patient, and showed that common and distinct mutations among primary and metastatic sites could be classified into two distinct histological subtypes. TIC-seq is an alternative and feasible method to analyze genomic alterations in tumors by simply touching the cut surface of specimens to slides.
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Affiliation(s)
- Kenji Amemiya
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan.,Pathology Division, Laboratory Department, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan
| | - Yosuke Hirotsu
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan
| | - Hiroshi Nakagomi
- Department of Breast Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan
| | - Hitoshi Mochizuki
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan
| | - Toshio Oyama
- Pathology Division, Laboratory Department, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan
| | - Masao Omata
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi, 400-8506, Japan.,The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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11
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Kubik MJ, Bovbel A, Goli H, Saremian J, Siddiqi A, Masood S. Diagnostic value and accuracy of imprint cytology evaluation during image-guided core needle biopsies: Review of our experience at a large academic center. Diagn Cytopathol 2015; 43:773-9. [PMID: 26119885 DOI: 10.1002/dc.23300] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/09/2015] [Accepted: 06/04/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several studies have emphasized the value of on-site evaluation of imprint cytology (IC) performed on core needle biopsies (CNB) of breast, prostate, and lung, in terms of adequacy. The aim of this study was to investigate the diagnostic value and accuracy of rapid on-site IC of CNB specimens performed for liver, lung, lymph node, bone, and soft tissue masses to evaluate whether on-site preliminary diagnosis is sufficiently accurate to allow earlier, more efficient planning of ancillary studies with decreased turnaround time. METHODS This morphology-based, retrospective study was approved by our Institutional Review Board. A total of 252 consecutive CNBs with on-site IC on masses of liver, lung, lymph node, bone, and soft tissue were included in this study. IC was reviewed by two cytopathology fellows and two board-certified cytopathologists who gave a categorical diagnosis (malignant/benign/atypical) and exact diagnosis when possible. Preliminary diagnoses were compared with corresponding histological CNB diagnoses. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. RESULTS Of the 252 cases reviewed, 30 cases were classified as atypical by IC and evaluated separately. Of the remaining 222 cases, IC classified an average of 154 (70%) as malignant, 54 (24%) as benign, and 14 (6%) as nondiagnostic. The corresponding distribution of histological diagnoses was 151 (68%) malignant and 71 (32%) benign. Overall correlation of correct IC diagnoses was 80%, with a correlation of 91% in malignant cases and 59% in benign cases. Sensitivity, specificity, PPV, and NPV were 96, 74, 92, and 87%, respectively. Diagnostic accuracy was 91%. There was no statistically significant difference in the accuracy of categorical diagnoses between IC and final histologic diagnosis. Atypical cases by IC were more likely to be malignant in lung and liver lesions (71% and 58%, respectively), than in lymph node, bone, or soft tissue lesions (17%, 0%, 0%, respectively). An exact diagnosis on IC was rendered in 113 (51%) cases, with an accuracy of 73%. Sensitivity, specificity, PPV, and NPV were 94, 41, 70, and 83%, respectively. CONCLUSION Rapid on-site IC is a useful and valuable tool for evaluating adequacy of CNB as well as providing accurate information on a categorical basis (malignant versus benign), with greater diagnostic accuracy in cases of malignancy than for benign lesions. IC provides high sensitivity with high PPV in lung, liver, lymph node, bone, and soft tissue lesions. Exact preliminary diagnoses have good diagnostic accuracy. Considering the fundamentally different diagnostic and therapeutic approach based on histologic tumor type (e.g., in lung malignancies), on-site preliminary diagnosis may allow appropriate triaging of tissue for early planning of ancillary studies with decreased turnaround times. In addition, early diagnosis may reduce anxiety in patients and expedite treatment planning.
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Affiliation(s)
- Melanie J Kubik
- Department of Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Alexandra Bovbel
- Department of Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Harish Goli
- Department of Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Jinous Saremian
- Department of Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Anwer Siddiqi
- Department of Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Shahla Masood
- Department of Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
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Thomas SV, Lagana A, Dittmar KM, Wakely PE. Imprint cytopathology of core needle biopsies: a "first responder" role for cytotechnologists. J Am Soc Cytopathol 2014; 4:16-24. [PMID: 31051668 DOI: 10.1016/j.jasc.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Imprint cytopathology (IC) of image-guided core needle biopsies (CNBs) is used to ensure adequate sampling. In our institution, cytotechnologists (CyTs) are the "first responders" for on-site adequacy assessment (OSAA) of image-guided CNBs. We report our experience with this expanded and relatively unexplored role for CyT. MATERIALS AND METHODS We reviewed all image-guided CNBs performed over a 12-month period that required OSAA. OSAA was provided primarily by CyT. Interpretation between all IC specimens and tissue diagnoses (concordance) and between adequate IC specimens and tissue diagnoses (accuracy) were analyzed. Performance was compared using the Fisher exact test. We retrospectively reviewed discrepant cases to deduce the reasons for discordance. RESULTS We evaluated 255 CNBs: 179 computed tomography-guided, 74 ultrasonography-guided, 2 endoscopy-guided. Lung (39%) followed by liver (16%) and lymph node (11%) were the most frequent sites of OSAA IC. Overall adequacy and accuracy rates were 80.8% and 87.9%, respectively, with a concordance rate of 81.2%. The performance for CyT alone, CyT/cytopathology fellow, and CyT/cytopathologist were comparable (P > 0.05). Review of discordant cases showed agreement with 91% of OSAA IC cases originally interpreted as inadequate, but with only 19% interpreted as adequate. CONCLUSIONS OSAA IC of CNBs expands the CyT's role in an effort to ensure adequate sampling. CyT performance was high in recognition of adequate versus inadequate IC slides when compared with the tissue. Reasons for discrepancy included sampling error and overinterpretation of atypia as being sufficient evidence of adequacy. Organ-specific cytologic criteria to assess adequacy are required to reduce interpretation error.
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Affiliation(s)
- Sumi V Thomas
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, Ohio
| | - Alessandro Lagana
- Department of Molecular Virology, Immunology, and Medical Genetics, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kristen M Dittmar
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, Ohio.
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