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Wu Y, Lepe M. Benchtop fine needle aspirations: An untapped source of cytologic educational material. Diagn Cytopathol 2024; 52:E48-E53. [PMID: 37991114 DOI: 10.1002/dc.25257] [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: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
Fine needle aspirations (FNAs) are a valuable tool for the diagnosis of a wide variety of lesions. However, obtaining proficiency in performing FNAs and finding simulated scenarios where one can practice specimen adequacy and slide smearing can all be challenging. Benchtop FNAs of fresh surgical specimens offer a novel training opportunity that addresses these needs. In this study, we describe the feasibility and practicality of benchtop FNAs of fresh surgical specimens as a training tool. We performed benchtop FNAs on multiple specimen types, although most were partial and radical nephrectomies. We documented this approach to cytology training and have provided examples of slides that were generated, along with the surgical pathology correlate. Our results suggest that benchtop FNAs of fresh surgical specimens can be a valuable training tool in the arsenal of today's cytopathologist. This technique offers several advantages over traditional training methods, including the ability to generate high-quality cytology slides, provide cyto-histo correlation, and practice almost immediate gross-microscopic correlation. However, there are also some disadvantages to this approach, including the need for immediate access to fresh surgical specimens and the potential for artifacts to be introduced. Overall, we believe that benchtop FNAs of fresh surgical specimens offer a promising new training tool that can maximize training opportunities, especially in institutions where the FNA volume is low.
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Affiliation(s)
- Yubo Wu
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Marcos Lepe
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Elmas H, Önal B, Steurer S, Hantzsch-Kuhn B, Claussen M, Mehdi E, Ince Ü, Rabe KF, Sauter G, Welker L. Rapid Remote Online Evaluation in Endoscopic Diagnostics: An Analysis of Biopsy-Proven Respiratory Cytopathology. Diagnostics (Basel) 2023; 13:3329. [PMID: 37958225 PMCID: PMC10647841 DOI: 10.3390/diagnostics13213329] [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: 09/21/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND This prospective study assesses the use of rapid remote online cytological evaluation for diagnosing endoscopical achieved biopsies. It focuses on its effectiveness in identifying benign and malignant conditions using digital image processing. METHODS The study was conducted between April 2021 and September 2022 and involved analyses of 314 Rapid Remote Online Cytological Evaluations in total (154 imprint cytologies, 143 fine needle aspirations and 17 brush cytologies) performed on 239 patients at the LungenClinic Grosshansdorf. During on-site evaluation via telecytology, the time requirement was recorded and the findings were compared with the cyto-/histological and final diagnoses. RESULTS By means of rapid remote online evaluation, findings of 86 cytological benign, 190 malignant and 38 unclear diagnoses were recorded (Ø assessment time, 100 s; range, 11-370 s). In 27 of the 37 specimens with unclear diagnoses, the final findings were malignant tumours and only 6 were benign changes. The diagnosis of another 4 of these 37 findings remained unclear. Excluding these 37 specimens, rapid remote online evaluation achieved a sensitivity of 90.5% with a specificity of 98.5% and a correct classification rate of 92.4% with regard to the final diagnosis of all cases. As expected, an increase in the sensitivity rate for the cytological detection of malignant tumours (76.1% vs. 92.5%) was found especially in fine-needle aspirations. CONCLUSIONS Rapid remote online analysis allows the fast quantitative and qualitative evaluation of clinically obtained cytological specimens. With a correct classification rate of more than 93%, sampling deficiencies can be corrected promptly and diagnostic and therapeutic approaches can be derived.
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Affiliation(s)
- Hatice Elmas
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
| | - Binnur Önal
- Acıbadem Healthcare Group, Pathology Department, Acıbadem University, 34752 Istanbul, Turkey; (B.Ö.); (Ü.I.)
| | - Stefan Steurer
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
| | - Birgit Hantzsch-Kuhn
- LungenClinic Großhansdorf, D-22927 Großhansdorf, Germany; (B.H.-K.); (M.C.); (K.F.R.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
| | - Martin Claussen
- LungenClinic Großhansdorf, D-22927 Großhansdorf, Germany; (B.H.-K.); (M.C.); (K.F.R.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
| | - Elnur Mehdi
- Department of Nuclear Medicine, National Center of Oncology, 1012 Baku, Azerbaijan;
| | - Ümit Ince
- Acıbadem Healthcare Group, Pathology Department, Acıbadem University, 34752 Istanbul, Turkey; (B.Ö.); (Ü.I.)
| | - Klaus F. Rabe
- LungenClinic Großhansdorf, D-22927 Großhansdorf, Germany; (B.H.-K.); (M.C.); (K.F.R.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
| | - Guido Sauter
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
| | - Lutz Welker
- Section Cytopathology, Institute of Pathology, University Medical Center Hamburg-Eppendorf UKE, D-20246 Hamburg, Germany; (S.S.); (G.S.); (L.W.)
- Airway Research North (ARCN), Deutsches Zentrum für Lungenforschung (DZL), D-35037 Marburg, Germany
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Avasarala SK, Matta M, Singh J, Bomeisl P, Michael CW, Young B, Panchabhai TS, Di Felice C, Dahlberg G, Maldonado F. Rapid On-site Evaluation Practice Variability Appraisal (ROSE PETAL) survey. Cancer Cytopathol 2023; 131:90-99. [PMID: 36048711 DOI: 10.1002/cncy.22641] [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: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) is frequently used during diagnostic procedures in patients with or suspected to have lung cancer. There is variation in ROSE use among bronchoscopists, and discussion of ROSE results can have significant consequences for patients. This study was performed to define ROSE practice and result disclosure patterns among bronchoscopists. METHODS This cross-sectional study was performed using an electronic survey disseminated to the members of the American Association for Bronchology and Interventional Pulmonology and the Society for Advanced Bronchoscopy. The questions centered around ROSE availability, utilization, barriers, and discussion of results with patients. RESULTS There were 137 respondents. Most identified themselves as interventional pulmonologists (109, 80%); most respondents worked in an academic setting (71, 52%). Availability of ROSE was reported by 121 (88%) respondents. Time constraints (28%), availability of cytology (22%), and scheduling conflicts (20%) were the most reported barriers to ROSE use. Endobronchial ultrasound transbronchial needle aspiration (85%) and nonrobotic peripheral bronchoscopy (65%) were the most reported procedures that used ROSE. There was heterogeneity regarding discussion of ROSE results with the patient or their caregiver in the immediate postprocedure setting: yes - always (40, 33%), yes - sometimes (32, 26%), yes - rarely (18, 15%), or no (31, 26%). Thirty-eight respondents reported they believed ROSE was ≥90% concordant with final cytology results. CONCLUSIONS The results confirmed the heterogeneity of practice patterns. Estimates of ROSE-final cytology concordance were lower than previously published concordance results. Notably, the discussion of ROSE results varied significantly.
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Affiliation(s)
- Sameer K Avasarala
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Maroun Matta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jaspal Singh
- Atrium Health and Levine Cancer Institute, Charlotte, North, Carolina, USA
| | - Philip Bomeisl
- Department of Pathology, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Claire W Michael
- Department of Pathology, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin Young
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tanmay S Panchabhai
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals - Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher Di Felice
- Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Greta Dahlberg
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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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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Geisler DL, Nestler RJ, Mosley BL, Walko AL, Cuda JM, Schoedel KE, Davison JM, Ohori NP. Accuracy of definitive rapid onsite evaluation cytopathology diagnoses: Assessment of potentially critical diagnoses as a quality assurance measure. J Am Soc Cytopathol 2022; 11:133-141. [PMID: 35260377 DOI: 10.1016/j.jasc.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Intraprocedural rapid onsite evaluation (ROSE) of cytology specimens enhances cytopathology practice. More recently, ROSE diagnoses, like frozen section (FS) diagnoses, have guided immediate clinical decisions. In this study, we evaluated the diagnostic accuracy of definitive ROSE diagnoses in our quality assurance system over a 52-month period. MATERIALS AND METHODS Cytopathology cases with ROSE from January 2017 to April 2021were retrieved from our laboratory information system. After excluding cases that were deferred or nondiagnostic/unsatisfactory, each definitive ROSE diagnosis (ie, negative for malignant cells or positive for malignant cells) was categorized as having agreement or disagreement with the final diagnosis. For comparison, concordance of FS diagnoses from the same time period were tabulated and compared to those of ROSE diagnoses by using χ2 testing with P < 0.05 considered statistically significant. RESULTS Of the 1649 ROSE diagnoses, there were 15 disagreements (0.9%) with 1 final moderate interpretive disagreement (0.06%). By comparison, of the 17,469 FS diagnoses, there were 141 disagreements (0.8%) with 49 final moderate or major interpretive disagreements (0.3%). The remaining disagreements were minor. There were no statistically significant differences in the rates of final moderate and major interpretive disagreements. CONCLUSIONS The final interpretive disagreement rates for definitive ROSE and FS diagnoses were similar in this study. Given the expanding role of ROSE and its use for immediate clinical decisions in some cases, monitoring the accuracy of definitive diagnoses may serve as an initial quality assurance measure.
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Affiliation(s)
- Daniel L Geisler
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Richard J Nestler
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Beth L Mosley
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Adrianna L Walko
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Jacqueline M Cuda
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Karen E Schoedel
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - Jon M Davison
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania.
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Kunimasa K, Matsumoto S, Nishino K, Honma K, Maeda N, Kuhara H, Tamiya M, Inoue T, Kawamura T, Kimura T, Maniwa T, Okami J, Goto K, Kumagai T. Comparison of sampling methods for next generation sequencing for patients with lung cancer. Cancer Med 2022; 11:2744-2754. [PMID: 35274488 PMCID: PMC9302352 DOI: 10.1002/cam4.4632] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/09/2022] [Accepted: 01/18/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Success of next generation sequencing (NGS) analysis is becoming indispensable in the treatment of advanced lung cancer. However, the advantages and disadvantages of each sampling method in the NGS analysis have not yet been clarified. Methods We compared the success rates of NGS analysis, and DNA and RNA yields for transbronchial biopsy (TBB), endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA), computed tomography (CT)‐guided biopsy, fluid sample, and surgical biopsy for NGS analysis in patients through the lung cancer genomic screening project for individualized medicine (LC‐SCRUM)‐Asia, a nationwide NGS screening project. In case, sufficient samples could not be collected by TBB and EBUS‐TBNA, re‐biopsy (genome re‐biopsy) was performed. Results A total of 223 patients were enrolled and success rates of NGS analysis were not different between samples obtained through TBB, EBUS‐TBNA, and CT‐guided biopsy; however, success rates for fluid samples and surgical biopsy samples were significantly higher than those of other methods. The risk of genome re‐biopsy was higher with TBB for centrally located lesions. CT‐guided biopsy yielded more samples but had a lower success rate for analysis of RNA‐based NGS than TBB. Conclusions TBB is the mainstay of sampling methods, but for centrally located lesions, EBUS‐TBNA may be a better strategy. For CT‐guided biopsy, the success rate of RNA‐based NGS analysis is low. Fluid samples are expected to yield successful results as surgical biopsy samples, but the latter are better for sample preservation. Determining the optimal method for genome biopsy for each case is important.
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Affiliation(s)
- Kei Kunimasa
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shingo Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology & Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Noboru Maeda
- Department of Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Hanako Kuhara
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takako Inoue
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahisa Kawamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Kimura
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohiro Maniwa
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
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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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Kakkar A, Kumar M, Subramanian P, Zubair A, Kumar R, Thakar A, Jain D, Mathur SR, Iyer VK. Utility of the Milan system for reporting salivary gland cytopathology during rapid on-site evaluation (ROSE) of salivary gland aspirates. Cytopathology 2021; 32:779-788. [PMID: 34273214 DOI: 10.1111/cyt.13038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/27/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Rapid on-site evaluation (ROSE) is a fine needle aspiration (FNA) technique for ensuring sampling adequacy and triaging samples. The Milan system for reporting salivary gland cytopathology (MSRSGC) is a standardised reporting system which aims to improve risk stratification. There is scant literature on the diagnostic value and agreement of MSRSGC on ROSE with final cytological diagnosis in salivary gland FNAs. We aimed to assess the concordance of MSRSCG categorisation and diagnosis on ROSE with final cytological and histological diagnosis. METHODS This prospective study included consecutive salivary gland FNAs for which ROSE was performed over a six-month period. MSRSGC category and diagnosis on ROSE were compared with the final cytological diagnosis and MSRSGC category, and histopathological diagnosis, where available. RESULTS Sixty salivary gland aspirates were included. The adequacy rate with ROSE was 100%. Using the MSRSGC classification during ROSE, 26 (43.2%) samples were categorised as benign neoplasm, 21 (35%) as malignant neoplasm, 9 (15%) as non-neoplastic, and one each (1.7%) belonged to the remaining four categories. MSRSGC categorisation on ROSE concurred with final the cytological diagnosis in 58/60 cases (96.7%). Discrepancies in MSRSGC categories on ROSE included one atypia of undetermined significance with final report as non-neoplastic, and one non-diagnostic as suspicious for malignancy. Good correlation of MSRSGC categories on ROSE with final histopathological diagnosis (88.9% concordance) was also noted. CONCLUSIONS MSRSGC on ROSE shows good concordance with final cytology and histopathology diagnosis, indicating that categorisation according to MSRSGC has utility in ensuring that adequate material is obtained and triaged appropriately for the diagnosis of salivary gland aspirates.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukin Kumar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Arshad Zubair
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guidelines from the College of American Pathologists (CAP). JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2010003] [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
With a growing number of clinically relevant biomarkers needed to guide the management of patients with non-small cell lung cancer (NSCLC), pathologists are keenly aware of the need to collect adequate tissue not only for a diagnosis, but also for ancillary studies to provide predictive and prognostic information. Small specimens collected by minimally invasive techniques such as fine needle aspiration and core needle biopsy often fall short in meeting adequacy requirements for lung cancer molecular biomarkers. The College of American Pathologists (CAP) recently published an evidence-based clinical practice guideline, “Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies”, to help direct clinicians and pathology laboratory personnel to optimally collect and handle thoracic small specimens for ancillary testing. This review summarizes the published guideline statements and provides a brief overview of the recommendations and how they impact the practice of pathology.
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