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Hendry S, Mamotte L, Mesbah Ardakani N, Leslie C, Tesfai Y, Grieu-Iacopetta F, Izaac K, Singh S, Ardakani R, Thomas M, Giardina T, Robinson C, Frost F, Amanuel B. Adequacy of cytology and small biopsy samples obtained with rapid onsite evaluation (ROSE) for predictive biomarker testing in non-small cell lung cancer. Pathology 2023; 55:917-921. [PMID: 37805343 DOI: 10.1016/j.pathol.2023.08.002] [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: 01/26/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 10/09/2023]
Abstract
Complete biomarker workup of non-small cell lung cancer (NSCLC) specimens is essential for appropriate and timely clinical management decisions. This can be challenging to achieve from small cytology and histology specimens, with increasing numbers of molecular and immunohistochemical biomarkers required. We conducted a 5 year retrospective audit of cases at our institution to assess the diagnostic and biomarker testing adequacy rates, particularly those specimens obtained with rapid onsite evaluation (ROSE), performed by a cytopathologist and a cytology scientist or pathology trainee, including all endobronchial ultrasound guided transbronchial needle aspirations (EBUS-TBNA), CT guided lung fine needle aspirations (FNA) and CT guided lung core biopsies. A total of 5,354 cases were identified, of which 92.2% had sufficient material for diagnosis. Of the 1506 cases identified with a recorded diagnosis of lung adenocarcinoma or NSCLC, not otherwise specified, 1001 (66.5%) had biomarker testing requested. Sufficient material was available in 89.5% of cases for a complete biomarker workup which included EGFR and KRAS mutational testing (all cases), ALK, ROS1 and PD-L1 immunohistochemistry (all cases), and ALK and ROS1 FISH (as required). For EGFR and KRAS mutational testing across both cytology and histology specimens, 99% of cases were sufficient. Of the samples in which a complete biomarker workup was unable to be performed, approximately half were only insufficient due to inadequate numbers of tumour cells for PD-L1 immunohistochemistry. Excluding PD-L1 IHC, 952 (95.1%) of samples obtained with ROSE were sufficient for the remainder of the testing requirements. Next generation sequencing using a 33 gene custom AmpliSeq panel was achieved in up to 72% of cases. In conclusion, small cytology and histology specimens obtained with ROSE are suitable for predictive biomarker testing in NSCLC, although attention needs to be paid to obtaining sufficient cells (>100) for PD-L1 immunohistochemistry.
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Affiliation(s)
- Shona Hendry
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia.
| | - Louis Mamotte
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Connull Leslie
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Yordanos Tesfai
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Fabienne Grieu-Iacopetta
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Katherine Izaac
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Shalinder Singh
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Rasha Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Marc Thomas
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Tindaro Giardina
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Cleo Robinson
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia; Discipline of Pathology and Laboratory Science, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Felicity Frost
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Silav ZK, Sönmez C, Aydemir B, Yıldırım M, Okay T, Aker FV. Could cytology supplant frozen section for intraoperative evaluation of thoracic lesions? A single institutional experience in a developing country. Diagn Cytopathol 2023; 51:123-134. [PMID: 36181474 DOI: 10.1002/dc.25060] [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: 06/16/2022] [Revised: 08/24/2022] [Accepted: 09/18/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The diagnostic performance of cytology was compared with the frozen results and its usability was evaluated as a rapid diagnosis method in intraoperative thoracic surgery in a single institution (Istanbul, Turkey). METHODS All 197 subsequent patient specimens (cases) from 158 patients who were sent to our department from the thoracic surgery clinic for an intraoperative diagnosis request between the years 2016 and 2021 were evaluated. Obtained results from frozen and cytology were compared with final paraffin section diagnoses. Lesions were grouped into three different groups as nonneoplastic, benign, and malignant neoplasms. RESULTS Diagnostic accuracy values of cytology and frozen sections in intraoperative consultation were 98.8% and 99.4%, respectively. Sensitivity values of cytology and frozen sections in intraoperative consultation were 96.3% and 98.7%, respectively. Specificity values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Negative predictive values of cytology and frozen sections in intraoperative consultation were 96.7% and 98.9%, respectively. Positive predictive values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Kappa statistics between cytology and frozen revealed a very high interrater reliability (Cohen's Kappa value: 0.911; p = .001; p < .01). The difficulty in distinguishing primary and metastatic carcinoma, which is mostly undecided in frozen sections and the definitive diagnosis is left to paraffin sections, seems also be a problem in the cytological examination. CONCLUSIONS Cytological diagnosis can be used in the evaluation of small biopsy specimens that require tissue preservation in intraoperative consultation, especially for immunohistochemical and advanced genetic studies.
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Affiliation(s)
- Zuhal Kuş Silav
- İstanbul Gelişim University, Occupational High School of Healthy Sciences, İstanbul, Turkey
| | - Cansu Sönmez
- Haydarpasa Numune Education and Research Hospital, Clinic of Pathology, Istanbul, Turkey
| | - Bülent Aydemir
- Siyami Ersek Chest, Heart and Vascular Surgery Education and Research Hospital, Clinic of Chest Surgery, Istanbul, Turkey
| | - Mehmet Yıldırım
- Siyami Ersek Chest, Heart and Vascular Surgery Education and Research Hospital, Clinic of Chest Surgery, Istanbul, Turkey
| | - Tamer Okay
- Siyami Ersek Chest, Heart and Vascular Surgery Education and Research Hospital, Clinic of Chest Surgery, Istanbul, Turkey
| | - Fügen Vardar Aker
- Haydarpasa Numune Education and Research Hospital, Clinic of Pathology, Istanbul, Turkey
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Bhowmik S, J. T, Manikandan A, Ravichandar S. Petals of rose: Application of rapid on-site evaluation in bronchoscopy. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i5.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In present day scenario, procedures that are minimally invasive like FNAs and Core needle biopsies are on the rise. Rapid on-site evaluation (ROSE) is a laboratory service that assesses the cytomorphologic features from FNA smears or biopsy contact imprints in the biopsy room and can provide on the spot input and suggestions for the clinician through immediate cytological examination of the biopsy sample. ROSE also allows for a preliminary diagnosis, allowing for the requirement of additional material for ancillary studies. We are presenting two cases which highlights the merits of ROSE in cytological diagnosis.
In the first case, a thirty four year old male patient came with complaints of productive cough, breathlessness and fever. Bronchoscopic needle aspiration and biopsy was done with Rapid Onsite Evaluation. ROSE revealed two non-caseating epithelioid granulomas on the 4th pass. Bronchoscopic lymph node biopsy was non- contributory. With other clinical and biochemical parameters, diagnosis of Sarcoidosis was made. This case study underscores the significance of ROSE in arriving at the diagnosis.
In the other case, a fifty seven year old male patient came to hospital with productive cough and breathlessness (MMRC grade II). CT chest revealed features suggestive of bronchogenic carcinoma. ROSE was performed along with bronchial brush cytology in which presence of atypical cells with increased nuclear cytoplasmic ratio, nuclear hyperchromatism and nuclear molding was noted. On histopathological examination, it was diagnosed as a case of non-small cell carcinoma of lung – poorly differentiated type. This case proves the advantage of ROSE in avoiding repeated invasive procedures for the patient.
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Bai S, Millis M, Wilson S, Scott M, Goulart RA, Maxfield MW, Lou F, Sood RN, Fischer AH. Liquid-based rapid onsite evaluation of endobronchial ultrasound cytologies. J Am Soc Cytopathol 2022; 11:375-384. [PMID: 36055932 DOI: 10.1016/j.jasc.2022.07.004] [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: 06/03/2022] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Rapid onsite evaluation (ROSE) generally uses smears made at the site of the procedure ("smear-based ROSE"). It requires considerable time, generally 2 individuals, technical expertise, and it can be difficult to estimate material available for ancillary studies. We developed an alternative ROSE using liquid-based cytology ThinPrep with hematoxylin and eosin (H&E) stain ("liquid-based ROSE") and assessed its advantages. MATERIALS AND METHODS Clinicians rinse the sample(s) into CytoRich Red and send to Pathology. A defined proportion of the needle rinse is removed for a ThinPrep stained with a rapid H&E. Adequacy and diagnosis were compared to final outcome. Total time was recorded. RESULTS Among 52 liquid-based ROSE readings, 28 (53.8%) were interpreted as "adequate" with final as adequate; 17 (32.7%) were interpreted as "inadequate" with final as inadequate; 7 (13.5%) were interpreted as "inadequate" with final as adequate. Of 23 readings provided with onsite diagnosis, 15 (65.2%) were interpreted as definitive positive or negative diagnoses; 6 (26%) were interpreted as nondiagnostic; and 2 (8.7%) were interpreted as atypical. All definitive diagnoses were concordant with final diagnoses. The time for liquid ROSE performance ranges from 6 to 22 minutes (mean: 13 minutes) and required only 1 individual. CONCLUSIONS Liquid-based ROSE allows accurate adequacy determination and diagnosis, takes about 15 minutes of cytologist time, and can be performed by just 1 person. The technique produces well-preserved and stained slides, it may allow a better estimation of the total amount of material in the specimen vial and may provide a better platform for telecytology.
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Affiliation(s)
- Shi Bai
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mark Millis
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Shirley Wilson
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - MaryPat Scott
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Robert A Goulart
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mark W Maxfield
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Feiran Lou
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Rahul N Sood
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Andrew H Fischer
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts.
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Hosseini SM, Stewart JM. Cytopathology assistance for optimizing interventional diagnostic procedures. Semin Diagn Pathol 2022; 39:389-393. [DOI: 10.1053/j.semdp.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
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Miranda A, Shield PW, Williams V, Starkey D, Kelly MA. Training undergraduate students for rapid on-site evaluation of fine needle aspiration cytology samples using a simulation based education activity. Cytopathology 2021; 33:321-327. [PMID: 34932830 DOI: 10.1111/cyt.13092] [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: 09/29/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Demand for rapid onsite evaluation (ROSE) of fine needle aspiration (FNA) cytology is rising and the role is increasingly being performed by non-medical cytologists. Undergraduate training for cytologists has traditionally focused on laboratory-based procedural activities and their theoretical underpinning, with minimal attention given to communication and other skills required to operate in an interprofessional setting. We evaluated the effectiveness and student reaction to a simulation-based education (SBE) exercise in ROSE designed to fill this void. METHODS We designed and evaluated a SBE exercise based on FNA ROSE across two tertiary institutions with 79 students. The exercise accurately reproduced the demands on cytologists operating as part of a multi-disciplinary team in a time- pressured environment. FINDINGS Pre- and post-simulation questionnaires indicated an improvement in technical knowledge related to the procedure. Students' perception of their competence and confidence in their role also improved significantly post simulation. Students uniformly found the exercise engaging and a valuable addition to their curriculum. DISCUSSION The simulation successfully provided a pseudo-clinical environment that highlighted the realities of practising technical and diagnostic tasks under time- pressure and interacting with other health professionals to provide an optimal patient outcome. The exercise is useful supplement to on-the-job training for ROSE.
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Affiliation(s)
- A Miranda
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - P W Shield
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Sullivan Nicolaides Pathology, Brisbane, Australia
| | - V Williams
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - D Starkey
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - M A Kelly
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
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Oezkan F, Eisenmann S, Darwiche K, Gassa A, Carbone DP, Merritt RE, Kneuertz PJ. Linear Endobronchial Ultrasound in the Era of Personalized Lung Cancer Diagnostics-A Technical Review. J Clin Med 2021; 10:jcm10235646. [PMID: 34884348 PMCID: PMC8658311 DOI: 10.3390/jcm10235646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Major advances in molecular profiling for available targeted treatments and immunotherapy for lung cancer have significantly increased the complexity of tissue-based diagnostics. Endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNA) are commonly performed for diagnostic biopsies and lymph node staging. EBUS-TBNA has increasingly become one of the main sources of tumor cells for molecular analyses. As a result, there is a growing need for high quality EBUS-TBNA samples with adequate cellularity. This has increased the technical demands of the procedure and has created additional challenges, many of which are not addressed in the current EBUS guidelines. This review provides an overview of current evidence on the technical aspects of EBUS-TBNA in light of comprehensive sample processing for personalized lung cancer management. These include sonographic lymph node characterization, optimal needle choice, suction biopsy technique, and the role of rapid on-site evaluation. Attention to these technical details will be important to maximize the throughput of EBUS-TBNA biopsies for molecular testing.
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Affiliation(s)
- Filiz Oezkan
- Comprehensive Cancer Center, Division of Medical Oncology, The Ohio State University, Columbus, OH 43210, USA;
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik-University Hospital Essen, University of Duisburg-Essen, 45239 Essen, Germany;
- Fifth Department of Internal Medicine, Faculty of University Heidelberg, University Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- German Cancer Research Center, A420 Research Group, 69120 Heidelberg, Germany
- Correspondence:
| | - Stephan Eisenmann
- Department of Pneumology, University Hospital of Martin Luther University, 06108 Halle, Germany;
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik-University Hospital Essen, University of Duisburg-Essen, 45239 Essen, Germany;
| | - Asmae Gassa
- Heart Center, Department of Cardiothoracic Surgery, Faculty of Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany;
| | - David P. Carbone
- Comprehensive Cancer Center, Division of Medical Oncology, The Ohio State University, Columbus, OH 43210, USA;
| | - Robert E. Merritt
- Comprehensive Cancer Center, Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, OH 43210, USA; (R.E.M.); (P.J.K.)
| | - Peter J. Kneuertz
- Comprehensive Cancer Center, Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, OH 43210, USA; (R.E.M.); (P.J.K.)
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Maddox A, Smart LM. Technical aspects of the use of cytopathological specimens for diagnosis and predictive testing in malignant epithelial neoplasms of the lung. Cytopathology 2021; 33:23-38. [PMID: 34717021 DOI: 10.1111/cyt.13072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 12/13/2022]
Abstract
Lung cancer is a leading cause of cancer mortality worldwide but recent years have seen a rapidly rising proportion of cases of advanced non-small cell carcinoma amenable to increasingly targeted therapy, initially based on the differential response to systemic treatment of tumours of squamous or glandular differentiation. In two-thirds of the cases, where patients present with advanced disease, both primary pathological diagnosis and biomarker testing is based on small biopsies and cytopathological specimens. The framework of this article is an overview of the technical aspect of each stage of the specimen pathway with emphasis on maximising potential for success when using small cytology samples. It brings together the current literature addressing pre-analytical and analytical aspects of specimen acquisition, performing rapid onsite evaluation, and undertaking diagnostic and predictive testing using immunocytochemistry and molecular platforms. The advantages and drawbacks of performing analysis on cell block and non-cell block specimen preparations is discussed.
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Affiliation(s)
- Anthony Maddox
- Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead Hospital, Hemel Hempstead, UK
| | - Louise M Smart
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
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Rapid On-site Evaluation and Final Cytologic Diagnoses Correlation During Endobronchial Ultrasonography. J Bronchology Interv Pulmonol 2021; 29:191-197. [DOI: 10.1097/lbr.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
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Novis DA, Coulter SN, Blond B, Perrotta P. Technical Staffing Ratios: A Summary of 3 College of American Pathologists Q-Probes Studies. Arch Pathol Lab Med 2021; 146:330-340. [PMID: 34237131 DOI: 10.5858/arpa.2020-0760-cp] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Laboratory managers and medical directors are charged with staffing their clinical laboratories as efficiently as possible. OBJECTIVE.— To report and analyze the results of 3 College of American Pathologists Q-Probes studies that surveyed the normative rates of laboratory technical staffing ratios. DESIGN.— Participants in the College of American Pathologists Q-Probes program submitted data on the levels of staffing and test volumes performed in their laboratories in 2014, 2016, and 2019. From these data, we calculated departmental productivity ratios, defined as testing volume per full-time equivalent, and degrees of managerial oversight, defined as the ratio of nonmanagement to management full-time equivalents. Participants completed general questionnaires surveying their hospital and laboratory demographics and practices, the data from which we determined demographic and practice characteristics that were significantly associated with technical staffing ratios. RESULTS.— Sixty-seven, 82, and 79 institutions submitted data for the years 2019, 2016, and 2014, respectively. Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study. With the exception of cytology departments, productivity and managerial oversight ratios did not significantly change between these 3 studies. In the 2019 study, greater testing volumes were associated with higher productivity ratios. Significant associations between managerial oversight ratios and practice characteristics were not consistent across the 3 studies. CONCLUSIONS.— Technical staffing ratios varied widely among the various laboratory departments within each institution and among different institutions participating in this study.
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Affiliation(s)
- David A Novis
- From Novis Consulting, LLC, Brunswick, Maine (Novis)
| | - Suzanne N Coulter
- The Department of Biostatistics (Coulter), College of American Pathologists, Northfield, Illinois
| | - Barbara Blond
- The Quality Practices Committee (Blond), College of American Pathologists, Northfield, Illinois
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Testing EGFR with Idylla on Cytological Specimens of Lung Cancer: A Review. Int J Mol Sci 2021; 22:ijms22094852. [PMID: 34063720 PMCID: PMC8125729 DOI: 10.3390/ijms22094852] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/14/2022] Open
Abstract
The current standard of care for advanced non-small-cell lung cancer is based on detecting actionable mutations that can benefit from targeted therapy. Comprehensive genetic tests can have long turn-around times, and because EGFR mutations are the most prevalent actionable mutation, a quick detection would enable a prompt initiation of targeted therapy. Furthermore, the scarcity of diagnostic material means that sometimes only cytologic material is available. The Idylla™ EGFR assay is a real-time PCR–based method able to detect 51 EGFR mutations in 2.5 h. Idylla is validated for use only on FFPE sections, but some researchers described their experiences with cytological material. We reviewed the relevant literature, finding four articles describing 471 cases and many types of cytological input material: smears, cell-block sections, suspensions, and extracted DNA. The sensitivity, specificity, and limit of detection appear comparable to those obtained with histological input material, with one exception: the usage of scraped stained smears as input may reduce the accuracy of the test. In conclusion, usage of cytological material as input to the Idylla EGFR test is possible. A workflow where common mutations are tested first and fast, leaving rarer mutations for subsequent comprehensive profiling, seems the most effective approach.
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Tang W, Plank C, Kiepura C, Bunting S, Waugh J, Coates M, Spencer N, Barlow A, Mogal R, Maddox A. Rapid onsite evaluation uses a very small proportion of total material aspirated at endobronchial or endoscopic ultrasound in the investigation of suspected thoracic malignancy. Cytopathology 2021; 32:416-427. [PMID: 33606285 DOI: 10.1111/cyt.12963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/02/2021] [Accepted: 01/31/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The objectives were: to measure the proportion of aspirated material used to make direct slides for rapid onsite evaluation (ROSE) at endobronchial (EBUS) and endoscopic ultrasound (EUS) in suspected thoracic malignancy; and to correlate pass weights with ROSE category and needle size. METHOD All EBUS and EUS cases for possible thoracic malignancy October 2018-May 2019 were included. All material from each pass was expelled into a Petri dish. One drop of material was placed on each of two slides; one used for ROSE, the other fixed and remaining material processed to cell block. Dish and slides were weighed before and after this procedure on a sensitive balance and weight of aspirate and slide material calculated. When ROSE identified malignancy, slide production ceased but target sampling for ancillary studies continued. RESULTS ROSE accuracy was 96.8%. Mean percentage by target of aspirated material used to make direct slides for ROSE was 1.9% in malignant cases and 3.6% in non-malignant cases (P = .027 for difference). Mean percentage by pass was 5.9%. Mean weight of a single aspirate was 128.8 mg. Mean weight of aspirates insufficient on ROSE (175.7 mg) was significantly higher than the mean weight of benign or malignant aspirates (117.1 and 114.0 mg, respectively). Mean weight of aspirates using 22G needles (132.6 mg) was significantly higher than that for 25G needles (87.1 mg). CONCLUSION Material made into direct slides at EBUS and EUS and used in part for ROSE uses a tiny proportion of aspirated material with over 98% processed to cell block and available for ancillary testing in malignant cases.
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Affiliation(s)
- Winnie Tang
- Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead Hospital, Hemel Hempstead, UK
| | - Claire Plank
- Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead Hospital, Hemel Hempstead, UK
| | - Claire Kiepura
- Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead Hospital, Hemel Hempstead, UK
| | - Sharon Bunting
- Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead Hospital, Hemel Hempstead, UK
| | - Jodie Waugh
- Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead Hospital, Hemel Hempstead, UK
| | - Matthew Coates
- Statistical Services and Consultancy Unit, University of Hertfordshire, Hatfield, UK
| | - Neil Spencer
- Statistical Services and Consultancy Unit, University of Hertfordshire, Hatfield, UK
| | - Andrew Barlow
- Department of Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford General Hospital, Watford, UK
| | - Rahul Mogal
- Department of Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford General Hospital, Watford, UK
| | - Anthony Maddox
- Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Hemel Hempstead Hospital, Hemel Hempstead, UK
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Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, Shah PL, Slebos DJ, Valipour A, Wahidi MM, Weir M, Herth FJ. Interventional Bronchoscopy. Am J Respir Crit Care Med 2020; 202:29-50. [PMID: 32023078 DOI: 10.1164/rccm.201907-1292so] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions, and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies, and the ability to biopsy a lesion under direct visualization. The last 10-15 years have seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions, and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available or are currently being investigated to treat a broad range of airway and lung parenchymal diseases, such as asthma, emphysema, and chronic bronchitis, or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat, malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This State-of-the-Art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.
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Affiliation(s)
- Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Fabien Maldonado
- Department of Medicine and Department of Thoracic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Neal Patel
- Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Pallav L Shah
- Respiratory Medicine at the Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Krankenhaus Nord, Vienna, Austria; and
| | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark Weir
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Felix J Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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14
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Glinski L, Shetty D, Iles S, Diggins B, Garvican J. Single slide assessment: A highly effective cytological rapid on‐site evaluation technique for endobronchial and endoscopic ultrasound‐guided fine needle aspiration. Cytopathology 2019; 30:164-172. [DOI: 10.1111/cyt.12670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 11/17/2018] [Accepted: 11/30/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Leonie Glinski
- Department of Diagnostic and Molecular Pathology Royal Cornwall Hospital Truro Cornwall UK
| | - Dushyant Shetty
- Department of Clinical Radiology Royal Cornwall Hospital Truro Cornwall UK
| | - Stephen Iles
- Department of Respiratory Medicine Royal Cornwall Hospital Truro Cornwall UK
| | - Benjamin Diggins
- Department of Respiratory Medicine Royal Cornwall Hospital Truro Cornwall UK
| | - James Garvican
- Department of Diagnostic and Molecular Pathology Royal Cornwall Hospital Truro Cornwall UK
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15
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The diagnosis of non-small cell lung cancer in the molecular era. Mod Pathol 2019; 32:16-26. [PMID: 30600321 DOI: 10.1038/s41379-018-0156-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022]
Abstract
Lung carcinoma is the leading cause of cancer mortality for both genders in the United States and throughout the world. Many of these tumors are being diagnosed with minimally invasive means resulting in small samples. There is a need to extract an increasing amount of therapeutic and prognostic information from progressively smaller samples. Collaboration among clinicians and pathologists is needed to produce a comprehensive final diagnosis in patients with lung cancer. This collaboration facilitates triage of small samples for ancillary studies including molecular testing. What follows represents a review of the current required testing for lung cancer specimens, an example of an algorithm currently employed at the Cleveland Clinic so that all required tests can be performed even on the smallest of specimens and suggestions on how pathologists may approach this new era of "doing more with less".
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