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Arshia A, Balikani L, Booth CN. Cytomorphology of monomorphic spindle epithelial tumor with thymus-like elements: A case with local recurrence after subtotal resection. Diagn Cytopathol 2024; 52:E134-E144. [PMID: 38520309 DOI: 10.1002/dc.25301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
Spindle epithelial tumor with thymus-like elements (SETTLE) is a rare biphasic thyroid tumor with low malignant potential that has a distinct morphology. Despite fine needle aspiration (FNA) being a common method for evaluating thyroid nodules and lymph nodes, there are limited cytologic descriptions of SETTLE in the literature due to its rarity. As a result, SETTLE is frequently underdiagnosed or misdiagnosed as medullary carcinoma, thymoma, teratoma, synovial sarcoma, or solitary fibrous tumor, among others. We present a case of a 28-year-old man with a history of a hemithyroidectomy diagnosed as SETTLE found to have a neck nodule along the strap muscle suspicious for recurrence 5 years post-surgery. The ultrasound-guided FNA cytology specimen of the neck nodule showed loosely cohesive, monomorphous ovoid to spindled cells with scant cytoplasm and nuclei with fine to granular chromatin. In addition, there were occasional clusters of cells with a papillary configuration. The tumor cells were associated with magenta, amorphous extracellular material. Immunocytochemical staining of the cell block material revealed that tumor cells were positive for p63, cytokeratin AE1/3, and CK8/18 and negative for TTF-1 and thyroglobulin. Overall, the morphological and immunocytochemical findings were consistent with a local recurrence of SETTLE. The subsequent left anterior strap mass excision revealed a 4 cm encapsulated tumor consistent with SETTLE. Because ofits rarity and low level of awareness, SETTLE poses a diagnostic and therapeutic challenge. We herein present the cytologic findings of monomorphic SETTLE and highlight the potential cytomorphologic and immunophenotypic pitfalls. We also highlight how tumors with high-risk features can be a therapeutic challenge.
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Affiliation(s)
- Asma Arshia
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Lame Balikani
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Christine N Booth
- Department of Pathology, RJT-Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Goyal A, Booth CN, Souers RJ, Tabbara SO, Roberson J, Henry MR, Sundling KE, Goodrich K, Nguyen L. Navigating Practice Issues Related to the Unsatisfactory Cervicovaginal Papanicolaou Test: Survey Results of Laboratories Participating in the 2020 College of American Pathologists PAP Education Program. Arch Pathol Lab Med 2024; 148:48-54. [PMID: 37074866 DOI: 10.5858/arpa.2022-0330-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT.— Unsatisfactory Papanicolaou (Pap) tests pose a unique set of challenges to the laboratory with regard to their processing, review, reporting, and performance of human papillomavirus (HPV) testing. There are no standardized guidelines for the review process and handling of unsatisfactory Pap tests. OBJECTIVE.— To assess the current practice patterns regarding various aspects of the unsatisfactory Pap test, from processing to reporting, across laboratories worldwide. DESIGN.— A supplemental questionnaire was mailed to laboratories participating in the 2020 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program, requesting data regarding the unsatisfactory Pap test. RESULTS.— Of 1520 participating laboratories, 619 (40.7%) responded, and the responses of 577 laboratories were included for further analysis. Only 64.6% (373 of 577) laboratories used the unsatisfactory Pap test criteria as specified by the 2014 Bethesda System. About three-quarters of the respondents (433 of 576; 75.2%) routinely rescreened unsatisfactory Pap tests. Routine repreparation of such Pap tests was performed by 54.9% (316 of 576) of laboratories, and 52.0% (293 of 563) used glacial acetic acid for repreparing excessively bloody specimens. HPV test results were reported for unsatisfactory Pap tests, always or sometimes, by 62.4% (353 of 566) of respondents. CONCLUSIONS.— This CAP survey reveals important information regarding the practice patterns pertaining to several aspects of the unsatisfactory Pap test. It also provides valuable insight into the quality assurance measures that can be implemented for such tests. Future studies can further aid in the standardization of all components of the handling of unsatisfactory Pap tests for overall quality improvement.
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Affiliation(s)
- Abha Goyal
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York (Goyal)
| | - Christine N Booth
- the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
| | - Rhona J Souers
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Sana O Tabbara
- the Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida (Tabbara)
| | - Janie Roberson
- the Department of Pathology, University of Alabama Birmingham Hospital, Birmingham (Roberson)
| | - Michael R Henry
- the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Henry)
| | - Kaitlin E Sundling
- the Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene and University of Wisconsin, Madison (Sundling)
| | - Kelly Goodrich
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Lananh Nguyen
- the Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
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3
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Nguyen LN, Crothers BA, Souers RJ, Barkan GA, Brainard J, Nassar A, Rollins S, Tabatabai ZL, Tabbara S, Witt B, Booth CN. Cytologic-Histologic Correlation Practices for Nongynecologic Cytology Specimens: A Survey by the College of American Pathologists Cytopathology Committee. Arch Pathol Lab Med 2023:497464. [PMID: 38051268 DOI: 10.5858/arpa.2023-0140-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 12/07/2023]
Abstract
CONTEXT.— Cytologic-histologic correlation (CHC) is a Clinical Laboratory Improvement Amendments-mandated requirement for gynecologic cytology, but no similar requirement exists for nongynecologic cytology. This study presents the findings from a College of American Pathologists' survey of nongynecologic cytology practice patterns. OBJECTIVE.— To survey the current CHC practices for nongynecologic cytology. DESIGN.— Data were analyzed from a survey developed by the committee and distributed to participants in the Nongynecologic Cytopathology Education Program mailing. RESULTS.— Adoption of CHC for nongynecologic cytology cases is worldwide, with 88.5% of institutions performing CHC on these specimens, a substantial increase from previous years. Performance of CHC varied by institution type, with clinic or regional/local independent laboratories and national/corporate laboratories performing CHC significantly less frequently than hospitals, university hospitals/academic medical centers, and Veterans Administration/Department of Defense hospital institutions. Most CHC was performed concurrently in real time, when the corresponding surgical specimen was reviewed. Selection for real-time concurrent CHC was by the interpreting pathologist, the pathologist diagnosing the surgical biopsy sample or cytopathology case, or both. Sampling was by far the most common reason for discordance. A 2-step difference was the most frequent threshold for discordance between cytology and surgical specimens, but this criterion varied among institutions, with no majority definition. The positive predictive value of a positive cytology finding was calculated rarely in North American institutions but was calculated more frequently in international institutions. CONCLUSIONS.— CHC practices for nongynecologic cytopathology mirror those found for CHC of gynecologic cytopathology.
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Affiliation(s)
- Lananh N Nguyen
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
| | - Barbara A Crothers
- Gynecologic, Breast and Cytopathology, Joint Pathology Center, Silver Spring, MD (Crothers)
| | - Rhona J Souers
- Biostatistics Department, College of American Pathologists, Northfield, IL (Souers)
| | - Güliz A Barkan
- the Department of Pathology and Laboratory Medicine, Loyola University Healthcare System, Maywood, IL (Barkan)
| | - Jennifer Brainard
- the Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Brainard, Booth)
| | - Aziza Nassar
- the Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Nassar)
| | - Susan Rollins
- Outpatient Cytopathology Center, Johnson City, Tennessee (Rollins)
| | - Z Laura Tabatabai
- the Department of Pathology, University of California San Francisco, San Francisco (Tabatabai)
| | - Sana Tabbara
- Pathology Department, Moffitt Cancer Center, Tampa, Florida (Tabbara)
| | - Benjamin Witt
- ARUP Laboratories, Department of Pathology, University of Utah, Salt Lake City (Witt)
| | - Christine N Booth
- the Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Brainard, Booth)
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Witt BL, Zhou W, Ambaye AB, Bellizzi A, Booth CN, Sundling K, Nguyen L, Russell DK, Schinstine M, Staats PN, Thomsen J, Troxell M, Souers RJ, Dvorak J, Lin X, Kurtycz DFI. Using American Type Culture Collection Cell Lines to Evaluate Interlaboratory Variables for Estrogen Receptor and Human Epidermal Growth Factor Receptor 2 Immunostaining. Arch Pathol Lab Med 2023; 147:143-148. [PMID: 35639575 DOI: 10.5858/arpa.2021-0152-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Most laboratories currently use patient tissues for validating immunohistochemical stains. OBJECTIVE.— To explore advantages of using cell lines with known antigenicity as a validation method. DESIGN.— Five American Type Culture Collection (ATCC) cell lines with known negative, low positive, and moderate to strong estrogen receptor (ER) expression as well as negative, equivocal, and positive human epidermal growth factor receptor 2 (HER2) expression were cultured and made into cell blocks. One block from each cell line was fixed in formalin and another in ethanol before cell block preparation. Two sets of paired unstained slides from each block were sent to 10 different laboratories for HER2 and ER staining to be stained on runs from different days according to each laboratory's defined protocol. RESULTS.— The 10 study participants evaluated 40 slides in a blinded fashion. For ER expression, all 80 interpretations for the ER strong and moderate positive cell lines had the target ER-positive result, and 74 of 80 ER-negative cell lines (92.5%) had agreement with the intended negative result. The ER low positive cell line showed varied but positive expression among all observers. The HER2 (3+)-positive cell lines yielded a target interpretation of 3+ in 65 of 80 interpretations (81.2%). For the HER2-negative cell line 69 of 78 interpretations (88.5%) were consistent with the target response (0 or 1+). No significant variation was observed between the ethanol- and non-ethanol-exposed cell lines, or between runs by the same laboratory. Variation from target results clustered within laboratories. CONCLUSIONS.— This study indicates that variability between laboratories can be identified by using cell lines for quantitative or semiquantitative immunohistochemistry when using cultured cell lines of known antigenicity. These cell lines could potentially play a role in aiding anatomic pathology laboratories in validating immunohistochemistry tests for formalin- and ethanol-fixed tissues.
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Affiliation(s)
- Benjamin L Witt
- From the Department of Pathology, University of Utah, Salt Lake City (Witt).,From the Institute for Clinical and Experimental Pathology, ARUP, Salt Lake City, Utah (Witt, Zhou)
| | - Wenhua Zhou
- From the Institute for Clinical and Experimental Pathology, ARUP, Salt Lake City, Utah (Witt, Zhou)
| | - Abiy B Ambaye
- From the Department of Pathology, University of Vermont Medical Center, Burlington (Ambaye, Schinstine)
| | - Andrew Bellizzi
- From the Department of Pathology, University of Iowa, Iowa City (Bellizzi)
| | - Christine N Booth
- From the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
| | - Kaitlin Sundling
- From the Department of Pathology, University of Wisconsin, Madison (Sundling, Kurtycz)
| | - Lananh Nguyen
- From the Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Nguyen)
| | - Donna K Russell
- From the Department of Pathology, University of Rochester, Rochester, New York (Russell)
| | - Malcolm Schinstine
- From the Department of Pathology, University of Vermont Medical Center, Burlington (Ambaye, Schinstine)
| | - Paul N Staats
- From the Department of Pathology, University of Maryland, Baltimore (Staats)
| | - Jean Thomsen
- From the Department of Pathology, Methodist Jennie Edmundson Hospital, Council Bluffs, Iowa (Thomsen)
| | - Megan Troxell
- From the Department of Pathology, Stanford University, Palo Alto, California (Troxell)
| | - Rhona J Souers
- From the Department of Biostatistics (Souers), College of American Pathologists, Northfield, Illinois
| | - James Dvorak
- From the Department of Proficiency Testing (Dvorak), College of American Pathologists, Northfield, Illinois
| | - Xiaoqi Lin
- From the Department of Pathology, Northwestern Medicine, Chicago, Illinois (Lin)
| | - Daniel F I Kurtycz
- From the Department of Pathology, University of Wisconsin, Madison (Sundling, Kurtycz)
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5
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Nguyen LN, Crothers BA, Davey DD, Natale KE, Nunez AL, Harkcom T, Mody DR, Barkan GA, Souers RJ, Tabatabai ZL, Booth CN. Current State of Cytologic-Histologic Correlation Implementation for North American and International Laboratories: Results of the College of American Pathologists Cytopathology Committee Laboratory Practices in Gynecologic Cytology Survey. Arch Pathol Lab Med 2023; 147:52-61. [PMID: 35271691 DOI: 10.5858/arpa.2021-0223-cp] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT.— The College of American Pathologists (CAP) updated the Laboratory Accreditation Program Cytopathology Checklist to assist laboratories in meeting and exceeding the Clinical Laboratory Improvement Amendments standards for gynecologic cytologic-histologic correlation (CHC). OBJECTIVE.— To survey the current CHC practices. DESIGN.— Data were analyzed from a survey developed by the committee and distributed to participants in the CAP Gynecologic Cytopathology PAP Education Program mailing. RESULTS.— Worldwide, CHC practice is nearly universally adopted, with an overall rate of 87.0% (568 of 653). CHC material was highly accessible. CHC was commonly performed real time/concurrently at the time the corresponding surgical pathology was reviewed. Investigation of CHC discordances varied with North American laboratories usually having a single pathologist review all discrepant histology and cytology slides to determine the reason for discordance, while international laboratories have a second pathologist review histology slides to determine the reason for discordance. The cause of CHC discordance was primarily sampling issues. The more common statistical metrics for CHC monitoring were the total percentage of cases that correlated with subsequent biopsies, screening error rate by cytotechnologist, and interpretative error rate by cytotechnologist. CONCLUSIONS.— Many laboratories have adopted and implemented the CHC guidelines with identifiable differences in practices between North American and international laboratories. We identify the commonalities and differences between North American and international institutional practices including where CHC is performed, how CHC cases are identified and their accessibility, when CHC is performed, who investigates discordances, what discordances are identified, and how the findings affect quality improvement.
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Affiliation(s)
- Lananh N Nguyen
- From the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
| | - Barbara A Crothers
- Gynecologic, Breast and Cytopathology, Joint Pathology Center, Silver Spring, Maryland (Crothers)
| | - Diane D Davey
- The Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Davey)
| | - Kristen E Natale
- The Department of Pathology, Holy Cross Hospital, Silver Spring, Maryland (Natale)
| | - Amberly L Nunez
- Pathology Group of Louisiana, Baton Rouge, Louisiana (Nunez)
| | - Timothy Harkcom
- The Department of Pathology, Fort Belvoir Community Hospital, Ft Belvoir, Virginia (Harkcom)
| | - Dina R Mody
- Pathology and Lab Medicine, Houston Methodist Hospital and Weill Cornell Medicine, Houston, Texas (Mody)
| | - Güliz A Barkan
- The Department of Pathology, Loyola University Healthcare System, Maywood, Illinois (Barkan)
| | - Rhona J Souers
- Biostatistics Department, College of American Pathologists, Northfield, Illinois (Souers)
| | - Z Laura Tabatabai
- The Department of Pathology, University of California San Francisco, San Francisco (Tabatabai)
| | - Christine N Booth
- The Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
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6
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VanderLaan PA, Roy-Chowdhuri S, Griffith CC, Weiss VL, Booth CN. Molecular testing of cytology specimens: overview of assay selection with focus on lung, salivary gland, and thyroid testing. J Am Soc Cytopathol 2022; 11:403-414. [PMID: 36184436 PMCID: PMC10225070 DOI: 10.1016/j.jasc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022]
Abstract
Ancillary and molecular testing of cytopathology specimens has emerged as a reliable and useful tool to provide diagnostic information and treatment-related biomarker status for the management of cancer patients. The cytology specimens obtained through minimally invasive means have proven suitable testing substrates for a variety of ancillary tests, including immunohistochemistry, fluorescence in situ hybridization, as well as polymerase chain reaction and next generation sequencing molecular techniques. By focusing specifically on the cytology specimen, this review provides an overview of basic testing considerations and assay selection in addition to updates on the ancillary testing of cytologic tumor specimens from the lung, salivary gland, and thyroid.
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Affiliation(s)
- Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Jebastin Thangaiah J, Booth CN, Brainard JA, Elsheikh TM, Reynolds JP, Ondrejka SL, Thilagar BP, Mukhopadhyay S, Doxtader EE. Oil Red O Staining of Pulmonary Macrophages in Bronchoalveolar Lavage Specimens Is Not Specific for Vaping-Associated Lung Injury. Am J Clin Pathol 2022; 158:723-729. [DOI: 10.1093/ajcp/aqac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use–associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Prevention guidelines. The aim of this study was to determine the specificity of ORO staining in BAL specimens with disease states other than EVALI.
Methods
Consecutive BAL specimens (October-December 2019) were stained with ORO. The lipid-laden macrophage index (LLMI) was calculated for each case.
Results
We studied BAL samples from 50 patients. Indications for BAL were surveillance bronchoscopy for lung transplantation (27/50), suspected infection (12/50), sarcoidosis/suspected sarcoidosis (3/50), nodules or ground-glass opacities (3/50), hemoptysis (2/50), asthma or eosinophilic pneumonia (2/50), and idiopathic pulmonary fibrosis (1/50). ORO staining was seen in BAL fluid macrophages in 45 of 50 cases (focal in 18, moderate in 23, diffuse in 4); LLMI ranged from 0 to 218. Using a threshold of LLMI of 85 or higher as positive, ORO was positive in 7 of 50 (14%) cases (range, 85-218).
Conclusions
ORO staining in BAL fluid macrophages is not specific for EVALI. Even when an LLMI of 85 or higher is used as a threshold for positivity, ORO positivity occurs in a significant subset of non–vaping-related cases.
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Affiliation(s)
| | - Christine N Booth
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Jennifer A Brainard
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Tarik M Elsheikh
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | | | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Bright P Thilagar
- Division of General Internal Medicine , Mayo Clinic, Rochester, MN , USA
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Erika E Doxtader
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
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Cuellar-Vite L, Weber-Bonk KL, Abdul-Karim FW, Booth CN, Keri RA. Focal Adhesion Kinase Provides a Collateral Vulnerability That Can Be Leveraged to Improve mTORC1 Inhibitor Efficacy. Cancers (Basel) 2022; 14:3374. [PMID: 35884439 PMCID: PMC9323520 DOI: 10.3390/cancers14143374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
The PI3K/AKT/mTORC1 pathway is a major therapeutic target for many cancers, particularly breast cancer. Everolimus is an mTORC1 inhibitor used in metastatic estrogen receptor-positive (ER+) and epidermal growth factor receptor 2-negative (HER2-) breast cancer. However, mTORC1 inhibitors have limited efficacy in other breast cancer subtypes. We sought to discover collateral sensitivities to mTORC1 inhibition that could be exploited to improve therapeutic response. Using a mouse model of breast cancer that is intrinsically resistant to mTORC1 inhibition, we found that rapamycin alters the expression of numerous extracellular matrix genes, suggesting a potential role for integrins/FAK in controlling mTORC1-inhibitor efficacy. FAK activation was also inversely correlated with rapamycin response in breast cancer cell lines. Supporting its potential utility in patients, FAK activation was observed in >50% of human breast cancers. While blocking FAK in mouse models of breast cancer that are highly responsive to rapamycin had no impact on tumor growth, FAK inhibition sensitized rapamycin-resistant tumors to mTORC1 inhibition. These data reveal an innate dependency on FAK when mTORC1 signaling is lost in tumors that are resistant to mTORC1 inhibitors. They also suggest a precision medicine approach to improving mTORC1 inhibitor efficacy in resistant cancers by suppressing FAK signaling.
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Affiliation(s)
- Leslie Cuellar-Vite
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Kristen L. Weber-Bonk
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Fadi W. Abdul-Karim
- Anatomic Pathology, Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (F.W.A.-K.); (C.N.B.)
| | - Christine N. Booth
- Anatomic Pathology, Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (F.W.A.-K.); (C.N.B.)
| | - Ruth A. Keri
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of General Medical Sciences-Oncology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
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9
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Khaitan N, Booth CN, Hoda RS. Cokeromyces recurvatus: A rare fungus in the Pap test of an asymptomatic woman. Diagn Cytopathol 2021; 49:894-895. [PMID: 34003605 DOI: 10.1002/dc.24758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Neha Khaitan
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine N Booth
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raza S Hoda
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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10
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Goyal A, Davey DD, Souers RJ, Tabbara SO, Goodrich K, Booth CN. Rescreening Practices of Negative Papanicolaou Tests With Positive Human Papillomavirus Test Result: Survey Results of Laboratories Participating in the College of American Pathologists Gynecologic Cytology (PAP Education) Program. Arch Pathol Lab Med 2021; 146:78-83. [PMID: 33929528 DOI: 10.5858/arpa.2020-0618-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The yield of the prospective rescreening process for "negative for intraepithelial lesion or malignancy" (NILM) Papanicolaou (Pap) tests is higher with the inclusion of a greater proportion of high-risk cases. One of the suggested criteria for classifying a Pap test finding as high-risk is recent or concurrent high-risk human papillomavirus (HPV) positivity. OBJECTIVE.— To evaluate how the results of HPV testing have been incorporated in the prospective rescreening of NILM Pap tests across a wide range of laboratories. DESIGN.— A questionnaire survey was sent to laboratories participating in the 2019 College of American Pathologists (CAP) Gynecologic Cytology (PAP Education) Program. RESULTS.— Of the 1507 participating laboratories, 667 (44%) responded to the survey. Most laboratories (59.4%; 396 of 667) had not incorporated HPV test/genotyping results to select NILM Pap tests for rescreening. Amongst the remaining laboratories, for NILM HPV-positive Pap test results, 112 (16.8%) had a policy to rescreen by a cytotechnologist only, 51 (7.6%) by a pathologist only, and 86 (12.9%) by both. Of 264 laboratories, 181 (68.6%) reported the cytology upon availability of the HPV test result and completion of the secondary review. Of 661 laboratories, 145 (21.9%) included consensus-type recommendations in the cytology report for such Pap tests. CONCLUSIONS.— This CAP survey provides significant information regarding the current trends in the use of HPV test results in prospective rescreening of NILM Pap tests. Future studies on quality improvement can further assist in the standardization of this process across different laboratories.
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Affiliation(s)
- Abha Goyal
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York (Goyal)
| | - Diane D Davey
- The Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Davey)
| | - Rhona J Souers
- Statistics/Biostatistics (Souers), College of American Pathologists, Northfield, Illinois
| | - Sana O Tabbara
- The Department of Pathology, The George Washington University, Washington, District of Columbia (Tabbara)
| | - Kelly Goodrich
- Surveys Department (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Christine N Booth
- The Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
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11
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Li Z, Souers RJ, Tabbara SO, Natale KE, Nguyen LN, Booth CN. Breast Fine-Needle Aspiration Practice in 2019: Results of a College of American Pathologists National Survey. Arch Pathol Lab Med 2020; 145:825-833. [PMID: 33351901 DOI: 10.5858/arpa.2020-0408-cp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The College of American Pathologists surveys provide national benchmarks of pathology practice for laboratories. OBJECTIVE.— To investigate breast fine-needle aspiration (FNA) biopsy practice in domestic and international laboratories in 2019. DESIGN.— We analyzed data from the College of American Pathologists Breast FNA Practice Supplemental Questionnaire that was distributed to laboratories participating in the 2019 College of American Pathologists Non-Gynecologic Cytopathology Education Program. RESULTS.— Sixty-one percent (499 of 816) of respondent laboratories routinely evaluated breast FNAs. Cystic lesions were the most common indication, and radiologists primarily performed FNAs in most settings. Forty-five percent (220 of 491) of laboratories performed ancillary studies on breast FNA samples, but 33.8% (70 of 207) did not report fixation time for breast biomarker studies. Only 54.5% (271 of 497) of laboratories had a standardized reporting system and only 16.8% (82 of 488) were aware of the International Academy of Cytology Yokohama Breast FNA Biopsy Cytology Reporting System. There were significant differences among different types of institutions in several aspects of breast FNA practice, including frequency of concurrent FNA and core needle biopsy for the same lesion, primary personnel who performed the FNA, etc. Significant differences existed between domestic and international laboratories in slide preparation, ancillary studies, fixation time reporting, standardized/descriptive diagnosis, and International Academy of Cytology Yokohama Reporting System awareness. CONCLUSIONS.— This is the first survey from the College of American Pathologists Cytopathology Committee to investigate breast FNA practices. The data reveal significant differences in breast FNA practice among different types of institutions and between domestic and international laboratories, and provide a baseline for future breast FNA studies in a variety of practice settings.
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Affiliation(s)
- Zaibo Li
- From the Department of Pathology, Ohio State University Medical Center, Columbus (Li)
| | - Rhona J Souers
- Biostatistics, College of American Pathologists, Northfield, Illinois (Souers)
| | - Sana O Tabbara
- The Department of Pathology, The George Washington University, Washington, DC (Tabbara)
| | - Kristen E Natale
- The Department of Pathology, Holy Cross Hospital, Silver Spring, Maryland (Natale)
| | - Lananh N Nguyen
- The Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
| | - Christine N Booth
- From the Department of Pathology, Ohio State University Medical Center, Columbus (Li).,The Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
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12
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Yuan L, Oshilaja O, Sierk A, Zhang G, Booth CN, Brainard J, Dyhdalo KS. Metastatic breast cancer diagnosed on cervical cytology. Cytopathology 2020; 32:127-131. [PMID: 32789952 DOI: 10.1111/cyt.12901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/21/2020] [Accepted: 08/09/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Lisi Yuan
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Olaronke Oshilaja
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anne Sierk
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gloria Zhang
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christine N Booth
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Brainard
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathryn S Dyhdalo
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Dyhdalo KS, Oshilaja O, Chute DJ, Booth CN, Suchy P, Smith K, Procop GW, Reynolds JP. Cytopathology milestones: can you get to level 5? J Am Soc Cytopathol 2020; 9:242-248. [PMID: 32340924 DOI: 10.1016/j.jasc.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION ACGME Milestones describe 6 areas of proficiency, indicating readiness for practice. Each is divided into 5 levels of mastery; Level 1 (new trainees) through Levels 4 (graduation) and 5 (aspirational). Milestones reporting began Spring 2016. We used Milestones to assess graduated fellows. MATERIALS AND METHODS We conducted phone interviews with previous fellows and collected demographic information including practice setting. We asked graduates if they fulfilled each example of mastery and recorded their answers. RESULTS A total of 22 fellows graduated from 2010 to 2017; 15 responded (10 academic, 5 private). Milestones in which nearly all respondents performed well (Level 4+) were: PC1, MK1, SBP2, SBP4, PROF1-4, ICS1-3. Some were more challenging (PC2, MK2, SBP1/3/5, PBL1). For PC2, 2 respondents achieved Level 1 (did not perform fine-needle aspirations). For MK2, 2 respondents achieved Level 1 (did not evaluate Papanicolaou). For SBP1, 80% in private practice achieved Level 5; 50% in academics achieved Level 3. For SBP3, 80% in private practice achieved Level 4+; 100% in academics achieved maximum Level 2. For SBP5, 60% of all respondents achieved maximum Level 3; only 1 achieved Level 5. CONCLUSIONS Many Milestones are attainable. Eleven of 18 yielded Level 4+ from most respondents. Three (PC2, MK1, MK2) yielded rare Level 1 due to scope of practice. Others (SBP1, SBP3) reflect more of an all-or-nothing phenomenon. For SBP5, most respondents achieved Level 3; only 1 achieved Level 5. Some Milestones are highly dependent on practice setting, and others remain aspirational.
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Affiliation(s)
- Kathryn S Dyhdalo
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Olaronke Oshilaja
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deborah J Chute
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Suchy
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kristen Smith
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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14
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Shetty S, Sharma N, Booth CN, Oshilaja O, Downs-Kelly EP, McKenney JK, Sturgis CD. Mammary Extranodal Rosai-Dorfman Disease With and Without Associated Axillary Lymphadenopathy: Insights for Practitioners of Breast Pathology. Int J Surg Pathol 2020; 28:541-548. [PMID: 31992097 DOI: 10.1177/1066896920901770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rosai-Dorfman disease is a rare proliferative histiocytic disorder of lymph nodes that is descriptively known as sinus histiocytosis with massive lymphadenopathy. Extranodal involvement of the parenchyma of the breast is uncommonly reported, with fewer than 50 cases of mammary extranodal disease detailed in the English-language literature. We characterize a retrospective series of adult female patients from a single institution with Rosai-Dorfman disease of the breast and axillary lymph nodes. Because Rosai-Dorfman disease of the breast and axillary lymph nodes may clinically, radiographically, and histologically mimic breast carcinoma and other conditions, we present an illustrated review of the disease and its relevant differential diagnoses in hopes of raising awareness and allowing for accurate management of affected patients.
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15
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Al-Nourhji O, Dermawan JK, Booth CN, Underwood D, Abdul-Karim FW. Role of ThinPrep liquid-based cytology in evaluation of the endocervical canal in patients with abnormal cervical screening. J Am Soc Cytopathol 2019; 8:278-283. [PMID: 31186178 DOI: 10.1016/j.jasc.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Endocervical sampling is frequently used as an adjunct to colposcopy. Few studies address the role of endocervical brushing (ECB) with liquid-based cytology (LBC) for evaluation of the endocervical canal. We assessed the roles of ThinPrep (TP) LBC of ECB specimens and cell blocks (CBs). MATERIALS AND METHODS Pathology archives were searched for ECB specimens from 2010-2015. Preceding Papanicolaou test interpretation, human papillomavirus status, concurrent and follow-up surgical specimens, and ECB diagnoses were recorded. CB cellularity, when available, was scored on a scale of 0 to 4. The cellularity of the TP and CBs was compared. RESULTS Of 365 ECB cases, 6 (1.6%) were insufficient for diagnosis, compared with a 5% rate for endocervical curettings. Eleven ECB cases (3%) showed low cellularity. Of the 241 (66%) cases with concurrent biopsies, the ECB diagnosis agreed with the biopsy diagnosis (within 1 grade) in 198 (82%) cases. In 9 (2.5%) cases, ECB was the only means of diagnosis of a high-grade squamous intraepithelial lesion / adenocarcinoma in situ confirmed on follow-up. Compared with TP LBC, the CBs (performed in 84 [23%] of cases) were of greater cellularity in 30 (42%) and of equal cellularity in 17 (24%). None of the CBs showed an additional epithelial abnormality missed in TP LBC. CONCLUSIONS TP LBC is capable of detecting endocervical epithelial abnormalities and may be used as a substitute for endocervical curettings. Performing a CB did not lead to detection of additional abnormalities, although it complemented TP findings and facilitates the performance of ancillary studies.
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Affiliation(s)
- Omar Al-Nourhji
- Department of Pathology & Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Josephine Kamtai Dermawan
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine N Booth
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dawn Underwood
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fadi W Abdul-Karim
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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16
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Yuan L, Biscotti CV, Zhu H, Booth CN, Abdul-Karim FW, Zhang Y. Significance of atypical endometrial cells in women younger than 40 years of age. J Am Soc Cytopathol 2019; 9:33-37. [PMID: 31353256 DOI: 10.1016/j.jasc.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The presence of atypical endometrial cells in the Papanicolaou (Pap) test has been associated with an increased rate of endometrial malignancy, with reported rates ranging from 14% to 47%. However, most reported studies have focused on patients who were aged >40 years. The purpose of the present study was to investigate the clinical significance of identifying atypical endometrial cells in Pap test samples in women aged <40 years of age. MATERIALS AND METHODS A search of the cytology Pap test database was performed from 2000 to 2014 using the keywords "atypical endometrial cells" or "atypical glandular cells favor endometrial origin" in women aged <40 years. The available ThinPrep slides were reviewed. The patients' clinical presentation, follow-up endometrial biopsy findings, treatment, and clinical follow-up data were recorded. Endometrial carcinoma tissue sections were screened for Lynch syndrome. RESULTS The database search yielded 63 study cases. Of these 63 patients, 52 had subsequently undergone endometrial biopsy. Of the 52 patients with follow-up biopsy findings available, 9 (17.3%) had premalignant (5 with atypical hyperplasia) or malignant (4 with endometrioid adenocarcinoma) lesions. In addition, 16 patients (30.8%) had other endometrial pathologic features. The 9 patients with premalignant or malignant endometrial lesions (8 white, 1 black) were overweight or obese; 3 of the patients did not have any clinical symptoms. All 4 patients with endometrioid adenocarcinoma had negative Lynch syndrome screening findings. CONCLUSIONS Our results suggest that it is important to recognize the presence of atypical endometrial cells in the Pap tests from young patients, given its association with the finding of premalignant and malignant pathologic features in subsequent endometrial biopsies.
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Affiliation(s)
- Lisi Yuan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Hui Zhu
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Yaxia Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio; Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York.
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17
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Khattab RA, Rowe JJ, Booth CN, Sneige N, Fong N, Pantanowitz L, Oshilaja O, Brainard JA, Downs-Kelly EP, Dawson A, Sturgis CD. Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses. Diagn Cytopathol 2019; 47:1100-1118. [PMID: 31343114 DOI: 10.1002/dc.24288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/06/2022]
Abstract
The Uniform Approach to Breast Fine Needle Aspiration Biopsy was put forward by a learned group of breast physicians in 1997. This landmark manuscript focused predominantly on diagnosis and reporting of mammary epithelial lesions. Today, most American practitioners turn initially to core biopsy rather than aspiration biopsy for the first line diagnosis of solid breast lesions; however, recent efforts from the International Academy of Cytology have produced a system called the Standardized Reporting of Breast Fine Needle Aspiration Biopsy Cytology (colloquially labeled in 2017 as the "Yokohama System"), suggesting a new interest in breast fine needle aspiration (FNA), especially in resource limited settings or clinical practice settings with experienced breast cytopathologists. Fibroepithelial lesions of the breast comprise a heterogeneous group of biphasic tumors with epithelial and stromal elements. Mesenchymal lesions of the breast include a variety of neoplasms of fibroblastic, myofibroblastic, endothelial, neural, adipocytic, muscular, and osteo-cartilaginous derivations. The cytology of mesenchymal breast lesions is infrequently described in the literature and is mainly limited to case reports and small series. This illustrated review highlights the cytologic features of fibroepithelial and mesenchymal mammary proliferations and discusses differential diagnoses and histomorphologic correlates.
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Affiliation(s)
- Ruba A Khattab
- Department of Pathology, University Hospitals of Case Western Reserve University, Cleveland, Ohio
| | - J Jordi Rowe
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Nour Sneige
- Department of Pathology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - Nancy Fong
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Andrea Dawson
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
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18
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Staats PN, Booth CN, Rosenthal DL, Crothers BA. Self-collected Papanicolaou tests in the United States market: more questions than answers. J Am Soc Cytopathol 2019; 8:342-351. [PMID: 31257176 DOI: 10.1016/j.jasc.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 01/21/2023]
Abstract
The United States Food and Drug Administration held a public hearing in January 2018 to consider how it should evaluate a self-collection device for cervical cytology. Although no such device has been approved for use in the US market, the implications for patients and cytologists could be both sweeping and complex. Herein, the existing literature basis for self-collected Papanicolaou testing is reviewed, and some questions raised by this testing are considered. Questions include: what would be the value to patients; how effective could self-collected Papanicolaou tests be; how might ordering and collection work; what are the unique pre-analytic, analytic, and post-analytic challenges of self-collected Papanicolaou testing; and what effect might self-collection have on cervical cancer rates?
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Affiliation(s)
- Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
| | | | - Dorothy L Rosenthal
- Department of Pathology/Cytopathology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Barbara A Crothers
- Breast, Gynecology and Cytopathology Service, Joint Pathology Center, Silver Spring, Maryland
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19
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Davey DD, Souers RJ, Goodrich K, Mody DR, Tabbara SO, Booth CN. Bethesda 2014 Implementation and Human Papillomavirus Primary Screening: Practices of Laboratories Participating in the College of American Pathologists PAP Education Program. Arch Pathol Lab Med 2019; 143:1196-1202. [DOI: 10.5858/arpa.2018-0603-cp] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Cervical cancer screening laboratory practices may evolve with new terminology and technologies.
Objective.—
To investigate changes in cervical cytopathology practice resulting from the 2014 Bethesda System updates and screening technologies.
Design.—
Questionnaires accompanied 2016 and 2017 mailings of the College of American Pathologists PAP Education program.
Results.—
In 2016, most laboratories surveyed had adopted or were planning to adopt 2014 Bethesda System updates, and the majority (53%; 365 of 689) used an age cutoff of 45 for reporting benign-appearing endometrial cells. However, 51.3% (354 of 690) of laboratories used the term low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion, for cases with indeterminate features, and 44.9% (298 of 664) of laboratories used a 5000-cell cutoff for minimum squamous cellularity for posthysterectomy and posttherapy specimens. Reporting rates for cervical cytology metrics changed very little from 2013 to 2016, and the median ratio of atypical squamous cells to squamous intraepithelial lesion cases was 1.9 for ThinPrep and 1.8 for SurePath preparations. Most laboratories (59.4%; 389 of 655) did not offer stand-alone primary human papillomavirus (HPV) testing in 2017, and primary HPV testing accounted for a low proportion of HPV testing volumes. The Roche Cobas method was the most common platform for HPV primary screening.
Conclusions.—
These questionnaire surveys provide data about the current status of cervical cytology screening, including changes related to the 2014 Bethesda System updates and the adoption of HPV primary screening techniques.
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Affiliation(s)
- Diane Davis Davey
- From the Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Dr Davey); the Department of Biostatistics (Ms Souers) and the Surveys Department (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Mody); the Department of Pathology, The George
| | - Rhona J. Souers
- From the Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Dr Davey); the Department of Biostatistics (Ms Souers) and the Surveys Department (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Mody); the Department of Pathology, The George
| | - Kelly Goodrich
- From the Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Dr Davey); the Department of Biostatistics (Ms Souers) and the Surveys Department (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Mody); the Department of Pathology, The George
| | - Dina R. Mody
- From the Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Dr Davey); the Department of Biostatistics (Ms Souers) and the Surveys Department (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Mody); the Department of Pathology, The George
| | - Sana O. Tabbara
- From the Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Dr Davey); the Department of Biostatistics (Ms Souers) and the Surveys Department (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Mody); the Department of Pathology, The George
| | - Christine N. Booth
- From the Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Dr Davey); the Department of Biostatistics (Ms Souers) and the Surveys Department (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Mody); the Department of Pathology, The George
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20
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McHugh KE, Gersey M, Rhoads DD, Procop GW, Zhang Y, Booth CN, Sturgis CD. Sensitivity of Cerebrospinal Fluid Cytology for the Diagnosis of Cryptococcal Infections: A 21-Year Single-Institution Retrospective Review. Am J Clin Pathol 2019; 151:198-204. [PMID: 30321269 DOI: 10.1093/ajcp/aqy133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives Cryptococcal meningoencephalitis is the most common fungal infection of the central nervous system diagnosed by cerebrospinal fluid cytology (CSF) studies. Existing literature suggests that routine CSF cytomorphologic evaluations are exquisitely specific; however, less is known about their sensitivity. Methods An electronic record review of the cytopathology and microbiology files was conducted for the 21-year interval from January 1, 1995, through December 31, 2015. Results In 21 years, 12,584 CSF samples were processed in the laboratory. Of these, 24 (0.2%) were reported positive for cryptococcal organisms by light microscopy, and 129 CSF fungal cultures were positive for Cryptococcus species. All cotested specimens with positive cytology results were positive on culture (15 specimens, 100% specificity). Twenty-four samples with positive culture results were negative by CSF cytology (sensitivity 39%). Conclusions When culture is used as a gold standard, CSF cytology is 100% specific and 39% sensitive, with a positive predictive value of 100% and a negative predictive value of 99.8%.
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Affiliation(s)
- Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Melanie Gersey
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Daniel D Rhoads
- Department of Pathology, Case Western Reserve University, Cleveland, OH
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Yaxia Zhang
- Department of Pathology, Hospital for Special Surgery, New York, NY
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21
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Doxtader EE, Calhoun BC, Sturgis CD, Booth CN. HER2 FISH concordance in breast cancer patients with both cytology and surgical pathology specimens. J Am Soc Cytopathol 2018; 7:31-36. [PMID: 31043248 DOI: 10.1016/j.jasc.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Fluorescence in Situ Hybridization (FISH) for Human Epidermal Growth Factor Receptor 2 (HER2) is traditionally performed on histologic specimens; there are no guidelines for validation of HER2 testing on cytology specimens. Our aim was to correlate HER2 FISH results on cytologic and histologic specimens. MATERIALS AND METHODS A retrospective search was conducted to identify breast carcinomas with HER2 FISH testing on both cytologic and histologic specimens. Results were interpreted using updated 2013 ASCO/CAP guidelines. RESULTS 54 women with HER2 FISH results on both cytologic and histologic specimens were identified. HER2 FISH was performed on 26 formalin-fixed thrombin clot cell blocks, 6 Cellient (Hologic, Inc., Bedford, MA) cell blocks and 22 ThinPrep slides, and was negative in 43 (87%), positive in 8 (15%), and equivocal in 3 (5%) cases. Of 43 negative cytology cases, the histologic specimen was also negative in 40 (93%). Of 8 positive cytology cases, the histologic specimen was positive in 5 (63%). Overall, 48 of 54 cases (89%) had a concordant result. In patients with a discordant result, the average interval between HER2 FISH testing was 7 years. Three of 6 discordant cases showed HER2 genetic heterogeneity. Five patients received adjuvant chemotherapy, 2 received endocrine therapy, and 1 received trastuzumab. CONCLUSIONS FISH is reliable for determining HER2 status in cytopathology specimens. Discordant results between cytologic and surgical specimens are uncommon; possible explanations include genetic heterogeneity or inherent molecular changes associated with disease progression and therapies that occur between testing of the primary carcinoma and the metastasis.
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22
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Zhao C, Crothers BA, Tabatabai ZL, Li Z, Ghofrani M, Souers RJ, Husain M, Fan F, Shen R, Ocal IT, Booth CN, Goodrich K, Russell D, Davey DD. False-Negative Interpretation of Adenocarcinoma In Situ in the College of American Pathologists Gynecologic PAP Education Program. Arch Pathol Lab Med 2017; 141:666-670. [PMID: 28301226 DOI: 10.5858/arpa.2016-0234-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Adenocarcinoma in situ (AIS) is difficult to correctly interpret on Papanicolaou (Pap) cytology slides and false-negative interpretations of AIS can cause significant problems in daily practice. OBJECTIVE - To investigate the false-negative interpretation rate of AIS and the factors related to false-negative interpretation through responses in an educational environment. DESIGN - We retrospectively evaluated 11 337 responses in the PAP Education Program (PAP-Edu) from 173 AIS slides from 2011 to 2015. The false-negative interpretation rate, most common false-negative interpretations, and related other factors were evaluated. RESULTS - The overall false-negative rate was 6.9% (784 of 11 337). Respondents correctly interpreted AIS 50.0% (5667 of 11 337) of the time; high-grade intraepithelial lesion (HSIL) and malignancies (adenocarcinoma, squamous cell carcinoma, and other carcinomas) accounted for 42.7% (4842 of 11 337) and low-grade intraepithelial lesion accounted for 0.4% (44 of 11 337) of responses. Overall, 92.7% (10 509 of 11 337) of responses were HSIL and above. Among 784 false-negative responses, negative for intraepithelial lesion or malignancy was the most common (61.5% [482 of 784]), followed by reparative changes (24.1% [189 of 784]) and atrophic vaginitis (7.7% [60 of 784]). Overall, pathologists' responses showed a significantly higher false-negative rate than cytotechnologists' responses (8.3%, 403 of 4835 versus 5.7%, 275 of 4816; P < .001). The false-negative response rates were not statistically different among preparation types. CONCLUSIONS - The low correct interpretation rate and higher false-negative rate for AIS demonstrate the difficulty in interpreting AIS on Pap cytology, which may cause clinical consequences. The higher false-negative rate with pathologists than with cytotechnologists suggests cytotechnologists' higher screening sensitivity for AIS or cautious interpretation to avoid false-positive results by pathologists.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Diane D Davey
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Zhao); the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers); the Department of Pathology, University of California San Francisco and VA Medical Centers, San Francisco (Dr Tabatabai); the Department of Pathology, Ohio State University Medical Center, Columbus (Drs Li and Shen); the Department of Pathology PeaceHealth Laboratories, Vancouver, Washington (Dr Ghofrani); the Departments of Biostatistics (Ms Souers) and Survey (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Clinical Sciences, University of Central Florida, Orlando (Drs Husain and Davey); the Department of Pathology, University of Kansas Medical Center, Kansas City (Dr Fan); the Department of Pathology and Laboratory Medicine, Mayo Clinic, Scottsdale, Arizona (Dr Ocal); the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); and the Department of Pathology, University of Rochester Medical Center, Rochester, New York (Ms Russell)
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Zakowski MF, Rekhtman N, Auger M, Booth CN, Crothers B, Ghofrani M, Khalbuss W, Laucirica R, Moriarty AT, Tabatabai ZL, Barkan GA. Morphologic Accuracy in Differentiating Primary Lung Adenocarcinoma From Squamous Cell Carcinoma in Cytology Specimens. Arch Pathol Lab Med 2016; 140:1116-20. [PMID: 27552093 DOI: 10.5858/arpa.2015-0316-oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT -The National Cancer Care Network and the combined College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecular Pathology guidelines indicate that all lung adenocarcinomas (ADCs) should be tested for epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements. As the majority of patients present at a later stage, the subclassification and molecular analysis must be done on cytologic material. OBJECTIVE -To evaluate the accuracy and interobserver variability among cytopathologists in subtyping non-small cell lung carcinoma using cytologic preparations. DESIGN -Nine cytopathologists from different institutions submitted cases of non-small cell lung carcinoma with surgical follow-up. Cases were independently, blindly reviewed by each cytopathologist. A diagnosis of ADC or squamous cell carcinoma was rendered based on the Diff-Quik, Papanicolaou, and hematoxylin-eosin stains. The specimen types included fine-needle aspiration from lung, lymph node, and bone; touch preparations from lung core biopsies; bronchial washings; and bronchial brushes. A major disagreement was defined as a case being misclassified 3 or more times. RESULTS -Ninety-three cases (69 ADC, 24 squamous cell carcinoma) were examined. Of 818 chances (93 cases × 9 cytopathologists) to correctly identify all the cases, 753 correct diagnoses were made (92% overall accuracy). Twenty-five of 69 cases of ADC (36%) and 7 of 24 cases of squamous cell carcinoma (29%) had disagreement (P = .16). Touch preparations were more frequently misdiagnosed compared with other specimens. Diagnostic accuracy of each cytopathologist varied from 78.4% to 98.7% (mean, 91.7%). CONCLUSION -Lung ADC can accurately be distinguished from squamous cell carcinoma by morphology in cytologic specimens with excellent interobserver concordance across multiple institutions and levels of cytology experience.
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Affiliation(s)
- Maureen F Zakowski
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Zakowski and Rekhtman); the Department of Pathology, Royal Victoria Hospital, Montreal, Quebec, Canada (Dr Auger); the Department of Pathology, Cleveland Clinic Main Campus, Cleveland, Ohio (Dr Booth); the Department of Pathology, Walter Reed Army Medical Center, Washington, DC (Dr Crothers); the Department of Pathology, Peacehealth Laboratory, Vancouver, Washington (Dr Ghofrani); the Department of Pathology, University of Pittsburgh Medical Center Shadyside, Pittsburgh, Pennsylvania (Dr Khalbuss); the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, AmeriPath, Indianapolis, Indiana (Dr Moriarty); the Department of Pathology, University of California, San Francisco (Dr Tabatabai); and the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan). Dr Zakowski is no longer affiliated with Memorial Sloan Kettering Cancer Center. Dr Khalbuss is now with GE Clarient Diagnostic Services, Riyadh, Saudi Arabia. Dr Moriarty is no longer affiliated with AmeriPath
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24
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Calhoun BC, Collie AMB, Lott-Limbach AA, Udoji EN, Sieck LR, Booth CN, Downs-Kelly E. Lobular neoplasia diagnosed on breast Core biopsy: frequency of carcinoma on excision and implications for management. Ann Diagn Pathol 2016; 25:20-25. [PMID: 27806840 DOI: 10.1016/j.anndiagpath.2016.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 11/25/2022]
Abstract
The appropriate follow-up and treatment for patients with a core biopsy diagnosis of lobular neoplasia (atypical lobular hyperplasia or lobular carcinoma in situ) remains controversial. Several studies have attempted to address this issue, with recommendations ranging from close clinical follow-up or surveillance to mandatory surgical excision in all cases. We report the findings at our institution, where virtually every core needle biopsy diagnosis of lobular neoplasia results in follow-up excision. The goal of the study was to identify potential predictors of upgrade to a more significant lesion. We identified 76 patients over a 15-year period with a core biopsy diagnosis of pure lobular neoplasia and no other high-risk lesions. Subsequent surgical excision identified 10 cases (13%) that were upgraded to carcinoma. Upgrade diagnoses included invasive ductal carcinoma (n=1), invasive lobular carcinoma (n=4), ductal carcinoma in situ (n=3), and pleomorphic lobular carcinoma in situ (n=2). All 10 upgraded cases had imaging findings suspicious for malignancy including irregular masses, asymmetric densities, or pleomorphic calcifications. Of the 10 upgraded cases, 7 were diagnosed as lobular carcinoma in situ on core biopsy. The data support a role for radiologic-pathologic correlation in the evaluation of suspicious breast lesions and suggest that the extent of lobular neoplasia in core biopsy specimens may be an indicator of the likelihood of upgrade to carcinoma.
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Affiliation(s)
- Benjamin C Calhoun
- Department of Pathology, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH.
| | | | | | - Esther N Udoji
- Breast Imaging Section, Department of Radiology, University of Chicago, Chicago, IL
| | - Leah R Sieck
- Department of Breast Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Christine N Booth
- Department of Pathology, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Erinn Downs-Kelly
- Department of Pathology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
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25
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Donaldson AR, Sieck L, Booth CN, Calhoun BC. Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management. Breast 2016; 30:201-207. [PMID: 27371970 DOI: 10.1016/j.breast.2016.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/29/2022] Open
Abstract
AIMS The risk of finding carcinoma in excisions following a core needle biopsy diagnosis of radial scar is not well defined and clinical management is variable. The aim of this study is to determine the frequency of high-risk lesions, ductal carcinoma in situ, and invasive carcinoma in excisions following a core biopsy diagnosis of radial scar. METHODS AND RESULTS Dedicated breast pathologists and radiologists correlated the histologic and radiologic findings and categorized radial scars as the target lesion or an incidental finding. High-risk lesions were defined as atypical hyperplasia or classical lobular carcinoma in situ. Of the 79 radial scars identified over a 14-year period, 22 were associated with atypia or carcinoma in the core biopsy. Thirty-seven (37) of the 57 benign radial scars underwent excision with benign findings in 30 (81%), high-risk lesions in six (16%), and flat epithelial atypia in one (3%). There were no upgrades to carcinoma. One patient with a benign radial scar developed a 3-mm focus of intermediate-grade estrogen receptor-positive ductal carcinoma in situ in the same quadrant of the ipsilateral breast 72 months after excision. One patient with an incidental un-excised benign radial scar was diagnosed with ductal carcinoma in situ at a separate site of suspicious calcifications. CONCLUSIONS In this series, none of the benign radial scars was upgraded to carcinoma. Radial scar was the targeted lesion in all cases with high-risk lesions on excision. Surgical excision may not be mandatory for patients with benign incidental radial scars on core biopsy.
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Affiliation(s)
- Alana R Donaldson
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
| | - Leah Sieck
- Imaging Institute, Department of Breast Imaging, Cleveland Clinic, Cleveland, OH, USA.
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
| | - Benjamin C Calhoun
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
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26
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Sturgis CD, Marshall CB, Barkan GA, Booth CN, Kurtycz DFI, Souers RJ, Keylock JB, Tabatabai ZL, Russell DK, Moriarty AT, Doyle MA, Thomas N, Yildiz-Aktas IZ, Collins BT, Laucirica R, Crothers BA. Respiratory Cytology--Current Trends Including Endobronchial Ultrasound-Guided Biopsy and Electromagnetic Navigational Bronchoscopy: Analysis of Data From a 2013 Supplemental Survey of Participants in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med 2016; 140:22-8. [PMID: 26717056 DOI: 10.5858/arpa.2014-0635-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Nongynecologic cytology (NGC) practices are expanding in relationship to historical gynecologic cytology screening programs. Bronchopulmonary cytology is experiencing an evolution regarding new procedural types. The College of American Pathologists (CAP) tracks practice patterns in NGC by developing questionnaires, surveying participants, and analyzing respondent data. OBJECTIVE To analyze responses to a 2013 CAP supplemental survey from the Interlaboratoy Comparison Program on bronchopulmonary NGC. DESIGN The "NGC 2013 Supplemental Questionnaire: Demographics in Performance and Reporting of Respiratory Cytology" was mailed to 2074 laboratories. RESULTS The survey response rate was 42% (880 of 2074) with 90% of respondents (788 of 880) indicating that their laboratories evaluated cytology bronchopulmonary specimens. More than 95% of respondents indicated interpreting bronchial washings (765 of 787) and bronchial brushings (757 of 787). A minority of laboratories (43%, 340 of 787) dealt with endobronchial ultrasound-guided samples, and an even smaller fraction of laboratories (14%, 110 of 787) saw cases from electromagnetic navigational bronchoscopy. Intraprocedural adequacy assessments by pathologists (and less often by cytotechnologists or pathologists-in-training) were routinely performed in percutaneous transthoracic aspiration cases (74%, 413 of 560) with less involvement for other case types. Most laboratories reported that newly diagnosed primary pulmonary adenocarcinomas were triaged for molecular testing of epidermal growth factor receptor and anaplastic lymphoma kinase. CONCLUSIONS The parameters examined in this 2013 survey provide a snapshot of current pulmonary cytopathology practice and may be used as benchmarks in the future.
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Affiliation(s)
- Charles D Sturgis
- From the Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Drs Sturgis and Booth); the Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Dr Marshall); the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Wisconsin State Laboratory of Hygiene and the Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison (Dr Kurtycz); the Departments of Biostatistics (Ms Souers) and Surveys (Mses Doyle and Thomas), College of American Pathologists, Northfield, Illinois; the Puget Sound Institute of Pathology, Seattle, Washington (Dr Keylock); the Department of Pathology, University of California San Francisco, San Francisco (Dr Tabatabai); the Department of Pathology, University of Rochester Medical Center, Rochester, New York (Ms Russell); the Department of Esoteric Testing, AmeriPath, Indianapolis, Indiana (Dr Moriarty); the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Yildiz-Aktas); the Department of Pathology, Washington University School of Medicine, St Louis, Missouri (Dr Collins); the Department of Pathology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); and the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers). Dr Yildiz-Aktas is now with the Department of Pathology, Greenwich Hospital, Greenwich, Connecticut
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Mishra MM, Reynolds JP, Sturgis CD, Booth CN. Diagnosis of mediastinal lesions unassociated with lung carcinoma diagnosed by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). J Am Soc Cytopathol 2016; 5:189-195. [PMID: 31042508 DOI: 10.1016/j.jasc.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe, cost-effective, and accurate diagnostic modality for the lung/mediastinum. Although some studies have been published on EBUS-TBNA of isolated mediastinal lesions, none have been reported from the United States. This study examines EBUS-TBNA for diagnosis of isolated mediastinal lesions. MATERIALS AND METHODS All cases of mediastinal EBUS-TBNA (defined in radioanatomic terms) during a 7-year period (July 2007-September 2014) were obtained from the anatomic pathology database. Pathologic reports, clinical notes, bronchoscopy notes, and imaging studies were reviewed. Only patients with a mediastinal lesion or non-pulmonary parenchyma-based lesions sampled by EBUS-TBNA without a prior or synchronous lung carcinoma were included in this study. RESULTS Of the 3005 EBUS-TBNA cases accessioned during this time period at our institute, 47 fulfilled the inclusion criteria. The median patient age was 61 years (range: 27-84 years). Both genders were nearly equally represented. A definitive cytologic interpretation was rendered in 40 out of 47 cases (85.1%). Malignancies included non-pulmonary carcinomas (8), sarcomas (5), hematolymphoid malignancies (5), neuroendocrine neoplasm (1), melanoma (1), and undifferentiated malignancy (1). Surgical follow-up was available in 18 of 47 cases (38.3%). There was cytologic-histologic correlation in 16 of 18 cases (88.9%). Surgical follow-up of all cysts diagnosed by cytology were benign cysts. Over the 7-year period, an increasing proportion of all EBUS-TBNAs performed were for mediastinal lesions unassociated with lung carcinoma. CONCLUSIONS EBUS-TBNA has a high accuracy rate when used to diagnose mediastinal lesions unassociated with lung carcinoma. Its utility as a primary diagnostic modality in this setting needs to be explored further.
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Affiliation(s)
- Manisha M Mishra
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Patel JB, Xing J, Deeds D, Budd GT, Booth CN, Abdul-Karim FW. The utility of repeated cytologic evaluation of cerebrospinal fluid in individuals with metastatic breast cancer. J Am Soc Cytopathol 2016; 5:86-91. [PMID: 31042495 DOI: 10.1016/j.jasc.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Metastasis of breast cancer to the central nervous system, either in the brain parenchyma or leptomeninges (LMC), is a late feature of the disease . Detection of malignant cells in the cerebrospinal fluid (CSF) is the diagnostic standard for LMC. Repeated CSF examinations are often performed following an initial diagnosis positive for malignancy. This study evaluates the significance of repeated CSF evaluation in women with metastatic breast cancer to the central nervous system. MATERIALS AND METHODS Cases of adenocarcinoma of breast diagnosed by CSF cytology from 1990 through 2012 documenting: age, radiologic findings, treatment modality, and the number of repeated CSF cytology specimens and their respective interpretations. RESULTS Fifty-one patients were identified; 28 patients (54.9%) had a single initial positive CSF performed and 23 (45.1%) had multiple CSF cytology samples (range = 2-25, mean = 5.5). Despite interval "negative" and "atypical cells" results on CSF cytology specimens, all 23 patients with multiple samples had at least one follow-up positive CSF cytology sample. CONCLUSION The prognosis of the patients with an initial CSF diagnosis of adenocarcinoma was poor, regardless of the respective interpretations on the repeated CSF specimens, even in the presence of interval negative CSF.
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Affiliation(s)
- Jinesh B Patel
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave., L25, Cleveland, Ohio.
| | - Juan Xing
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave., L25, Cleveland, Ohio
| | - David Deeds
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave., L25, Cleveland, Ohio
| | - G Thomas Budd
- Department of Hematology/Medical Oncology, Cleveland Clinic, 9500 Euclid Ave., R35, Cleveland, Ohio
| | - Christine N Booth
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave., L25, Cleveland, Ohio
| | - Fadi W Abdul-Karim
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave., L25, Cleveland, Ohio
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29
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Odronic SI, Roberson J, Booth CN. Current practice patterns in nongynecologic and fine-needle aspiration cytology. J Am Soc Cytopathol 2015; 4:239-245. [PMID: 31051760 DOI: 10.1016/j.jasc.2015.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The American Society of Cytopathology Clinical Practice Committee in collaboration with the American Society of Cytotechnology surveyed cytology practitioners to better understand current practices related to nongynecologic (NGYN) cytology. While work practices in gynecologic (GYN) cytology are highly regulated with limited variation among specimens and processing techniques, practice patterns for NGYN cytology are less standardized among laboratories. MATERIALS AND METHODS An NGYN cytology survey was created that consisted of 40 questions focusing on 6 main topic areas: (1) practice settings and demographic data; (2) NGYN non-fine-needle aspiration cytology; (3) fine-needle aspiration (FNA) cytology; (4) rapid on-site evaluation practices; (5) workload recording practices; and (6) expanding roles of the cytotechnologist (CT). The survey was sent to all American Society of Cytopathology and American Society of Cytotechnology members and remained available for 40 days. RESULTS There were 368 survey participants (14% response rate) with nearly equal participation among CTs, cytology general managers and/or supervisors, and pathologists representing a variety of practice types. Most laboratories (87%) are providing a rapid on-site evaluation service for FNA specimens. The role of CTs is expanding with the majority of respondents stating that CTs assist with both clinician-performed and pathologist-performed FNA acquisition (77% and 50%, respectively), telecytology (16%), and screening of ancillary studies, including special stains (64%), immunohistochemistry (23%), and fluorescence in situ hybridization (16%). CONCLUSIONS Knowledge of NGYN cytology practice patterns among laboratories may contribute information to better define the future of cytotechnology, support reimbursement initiatives, and enhance quality and efficiencies in the cytology laboratory.
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Affiliation(s)
- Shelley I Odronic
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Janie Roberson
- Department of Pathology, University of Alabama, Birmingham, Alabama
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio.
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Zhu H, Booth CN, Reynolds JP. Clinical presentation and cytopathologic features of malignant pericardial cytology: a single institution analysis spanning a 29-year period. J Am Soc Cytopathol 2015; 4:203-209. [PMID: 31051755 DOI: 10.1016/j.jasc.2015.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Pericardial effusion can be a consequence of various diseased states, including infection, autoimmune disease, renal failure, myocardial disease, and neoplasms. Although multiple case reports of malignancy-associated pericardial effusion have been published, few database analyses are available in these published reports. In this study, we retrospectively reviewed 1022 cytology cases and assessed malignancy-associated pericardial effusion. MATERIALS AND METHODS We reviewed our cytology reports for pericardial effusion cases from January 1, 1983 to July 31, 2013. These cases were classified as benign, atypical, malignant, and nondiagnostic. The malignant cases were further characterized based on either immunohistochemical staining results or patients' history. RESULTS We identified 1022 cases and grouped them as follows: 824 benign (80.6%), 38 atypical (3.7%), 158 malignant (15.4%), and 2 unsatisfactory (0.1%). Malignant cases included 131 adenocarcinoma (82.9%), 12 lymphoma (7.9%), 6 poorly differentiated carcinoma (3.8%), 4 mesothelioma (2.5%), 2 squamous cell carcinoma (1.3%), 1 melanoma (0.6%), 1 sarcoma (0.6%), and 1 small cell carcinoma (0.6%). Of these 131 adenocarcinomas, 83 cases had clinical history and/or immunohistochemical study available for further classification, which included 44 lung, 18 breast, 7 esophagogastric adenocarcinomas, 6 adenocarcinomas of unknown primary sites, 5 ovarian, and 2 rectal adenocarcinomas. The clinical presentation, prognosis, and cytopathologic features for malignant pericardial effusions are summarized. CONCLUSIONS In this study, 15.4% of pericardial effusion cases were caused by metastatic malignancy, with lung adenocarcinoma being the most common primary site, followed by breast and lymphoma. Relatively young patients are affected, with average age being 56 years. Prognosis is poor for patients with malignant pericardial effusion. However, targeted therapy showed improved survival.
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Affiliation(s)
- Hui Zhu
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Christine N Booth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Jordan P Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio.
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Dyhdalo KS, Booth CN, Brainard JA, Croyle MC, Kolosiwsky AM, Goyal A, Gildea TR, Almeida FA, Nassar A, Reynolds JP. Utility of GATA3, mammaglobin, GCDFP-15, and ER in the detection of intrathoracic metastatic breast carcinoma. J Am Soc Cytopathol 2015; 4:218-224. [PMID: 31051757 DOI: 10.1016/j.jasc.2015.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Breast carcinoma (BC) metastatic to the intrathoracic cavity is difficult to diagnose due to low sensitivity of current immunohistochemical (IHC) stains. Mammaglobin, gross cystic disease fluid protein-15 (GCDFP-15), and estrogen receptor (ER) immunomarkers show variable results. GATA3 is a recently described marker for detecting urothelial and breast cancers. Our goal is to test the utility of GATA3 in cell blocks from thoracic cytology specimens. MATERIALS AND METHODS We retrieved cases of BC that metastasized to the thoracic cavity from January 1, 2005 to September 30, 2013. IHC was performed on the cell blocks for the presence of GATA3, ER, GCDFP-15, and mammaglobin. Stains were scored quantitatively and qualitatively. RESULTS Fifty cases of metastatic BC found in pleural effusions and endobronchial ultrasound-guided fine-needle aspirates were identified in 48 patients. Thirty-four cases had sufficient material for IHC (19 pleural effusions, 15 endobronchial ultrasound-guided fine-needle aspirates). GATA3 showed strong nuclear positivity in 31 of 34 cases (91.2%). ER (25 of 34, 73.5%), mammaglobin (23 of 34, 67.6%) and GCDFP-15 (11 of 34, 32.6%) were positive in fewer cases. GATA3 and ER were concordant in 26 of 34 cases (76.5%) (24 ER/GATA3-positive, 2 ER/GATA3-negative). Discordant results were found in 8 of 34 cases (23.5%). Of these, GATA3 was positive and ER was negative in 7 cases. GATA3 was negative and ER was positive in 1 case. CONCLUSIONS GATA3 is more sensitive than ER, mammaglobin, or GCDFP-15 in detecting metastatic BC in cytologic specimens. GATA3 may be positive when ER is negative. In cytologic specimens with limited diagnostic material, GATA3 may be used as a first-line marker in a limited IHC panel to support metastatic BC.
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Affiliation(s)
- Kathryn S Dyhdalo
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio
| | - Christine N Booth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio
| | - Jennifer A Brainard
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio
| | - Maureen C Croyle
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio
| | - Ashley M Kolosiwsky
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio
| | - Abha Goyal
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio
| | - Thomas R Gildea
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Francisco A Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aziza Nassar
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida
| | - Jordan P Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, Ohio.
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Chen L, Booth CN, Shorie JA, Brainard JA, Zarka MA. Atypical endometrial cells and atypical glandular cells favor endometrial origin in Papanicolaou cervicovaginal tests: Correlation with histologic follow-up and abnormal clinical presentations. Cytojournal 2014; 11:29. [PMID: 25506385 PMCID: PMC4253043 DOI: 10.4103/1742-6413.144686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/05/2014] [Indexed: 11/18/2022] Open
Abstract
The 2001 Bethesda system recommends further classifying atypical glandular cells (AGCs) as either endocervical or endometrial origin. Numerous studies have investigated the clinical significance of AGC. In this study, we investigated the incidence of clinically significant lesions among women with liquid-based Papanicolaou cervicovaginal (Pap) interpretations of atypical endometrial cells (AEMs) or AGC favor endometrial origin (AGC-EM). More importantly, we correlated patients of AEM or AGC-EM with their clinical presentations to determine if AEM/AGC-EM combined with abnormal vaginal bleeding is associated with a higher incidence of significant endometrial pathology. All liquid-based Pap tests with an interpretation of AEM and AGC-EM from July, 2004 through June, 2009 were retrieved from the database. Women with an interpretation of atypical endocervical cells, AGC, favor endocervical origin or AGC, favor neoplastic were not included in the study. The most severe subsequent histologic diagnoses were recorded for each patient. During this 5-year period, we accessioned 332,470 Pap tests of which 169 (0.05%) were interpreted as either AEM or AGC-EM. Of the 169 patients, 133 had histologic follow-up within the health care system. The patients ranged in age from 21 to 71 years old (mean 49.7). On follow-up histology, 27 (20.3%) had neoplastic/preneoplastic uterine lesions. Among them, 20 patients were diagnosed with adenocarcinoma (18 endometrial, 1 endocervical, and 1 metastatic colorectal), 3 with atypical endometrial hyperplasia, and 4 with endometrial hyperplasia without atypia. All patients with significant endometrial pathology, except one, were over 40 years old, and 22 of 25 patients reported abnormal vaginal bleeding at the time of endometrial biopsy or curettage. This study represents a large series of women with liquid-based Pap test interpretations of AEM and AGC-EM with clinical follow-up. Significant preneoplastic or neoplastic endometrial lesions were identified in 20.3% of patients. Patients with Pap test interpretations of AEM or AGC-EM and the clinical presentation of abnormal vaginal bleeding should be followed closely.
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Affiliation(s)
- Longwen Chen
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Christine N Booth
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Julie A Shorie
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer A Brainard
- Address: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew A Zarka
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Calhoun BC, Booth CN. Atypical apocrine adenosis diagnosed on breast core biopsy: implications for management. Hum Pathol 2014; 45:2130-5. [DOI: 10.1016/j.humpath.2014.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 11/26/2022]
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Yori JL, Lozada KL, Seachrist DD, Mosley JD, Abdul-Karim FW, Booth CN, Flask CA, Keri RA. Combined SFK/mTOR inhibition prevents rapamycin-induced feedback activation of AKT and elicits efficient tumor regression. Cancer Res 2014; 74:4762-71. [PMID: 25023728 DOI: 10.1158/0008-5472.can-13-3627] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Resistance to receptor tyrosine kinase (RTK) blockade in breast cancer is often mediated by activation of bypass pathways that sustain growth. Src and mammalian target of rapamycin (mTOR) are two intrinsic targets that are downstream of most RTKs. To date, limited clinical efficacy has been observed with either Src or mTOR inhibitors when used as single agents. Resistance to mTOR inhibitors is associated with loss of negative feedback regulation, resulting in phosphorylation and activation of AKT. Herein, we describe a novel role for Src in contributing to rapalog-induced AKT activation. We found that dual activation of Src and the mTOR pathway occurs in nearly half of all breast cancers, suggesting potential cross-talk. As expected, rapamycin inhibition of mTOR results in feedback activation of AKT in breast cancer cell lines. Addition of the Src/c-Abl inhibitor, dasatinib, completely blocks this feedback activation, confirming convergence between Src and the mTOR pathway. Analysis in vivo revealed that dual Src and mTOR inhibition is highly effective in two mouse models of breast cancer. In a luminal disease model, combined dasatinib and rapamycin is more effective at inducing regression than either single agent. Furthermore, the combination of dasatinib and rapamycin delays tumor recurrence following the cessation of treatment. In a model of human EGFR-2-positive (HER2(+)) disease, dasatinib alone is ineffective, but potentiates the efficacy of rapamycin. These data suggest that combining mTOR and Src inhibitors may provide a new approach for treating multiple breast cancer subtypes that may circumvent resistance to targeted RTK therapies.
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Affiliation(s)
- Jennifer L Yori
- Department of Pharmacology, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Kristen L Lozada
- Department of Pharmacology, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Darcie D Seachrist
- Department of Pharmacology, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Jonathan D Mosley
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Fadi W Abdul-Karim
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christine N Booth
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chris A Flask
- Department of Radiology, Case Western Reserve University, School of Medicine, Cleveland, Ohio. Department of Biomedical Engineering, Case Western Reserve University, School of Medicine, Cleveland, Ohio. Department of Pediatrics, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Ruth A Keri
- Department of Pharmacology, Case Western Reserve University, School of Medicine, Cleveland, Ohio. Department of Genetics and Division of General Medical Sciences-Oncology, Case Western Reserve University, School of Medicine, Cleveland, Ohio.
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Khor LY, Abdul-Karim FW, Bruening AE, Weber Noffsinger DK, Booth CN. Papanicolaou tests with coexisting squamous and glandular abnormalities. Cancer Cytopathol 2014; 122:620-6. [DOI: 10.1002/cncy.21448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Li Yan Khor
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic; Cleveland Ohio
| | - Fadi W. Abdul-Karim
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic; Cleveland Ohio
| | - Amanda E. Bruening
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic; Cleveland Ohio
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Sizemore ST, Sizemore GM, Booth CN, Thompson CL, Silverman P, Bebek G, Abdul-Karim FW, Avril S, Keri RA. Hypomethylation of the MMP7 promoter and increased expression of MMP7 distinguishes the basal-like breast cancer subtype from other triple-negative tumors. Breast Cancer Res Treat 2014; 146:25-40. [PMID: 24847890 DOI: 10.1007/s10549-014-2989-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/30/2014] [Indexed: 12/30/2022]
Abstract
Identification of novel targets for the treatment of basal-like breast cancer is essential for improved outcomes in patients with this disease. This study investigates the association of MMP7 expression and MMP7 promoter methylation with subtype and outcome in breast cancer patient cohorts. Immunohistochemical analysis was performed on a breast cancer tissue microarray and validated in independent histological samples. MMP7 expression significantly correlated with patient age, tumor size, triple-negative (TN) status, and recurrence. Analysis of publically available datasets confirmed MMP7 gene expression as a prognostic marker of breast cancer metastasis, particularly metastasis to the brain and lungs. Methylation of the MMP7 promoter was assessed by methylation-specific PCR in a panel of breast cancer cell lines and patient tumor samples. Hypomethylation of the MMP7 promoter significantly correlated with TN status in DNA from patient tumor samples, and this association was confirmed using The Cancer Genome Atlas (TCGA) dataset. Evaluation of a panel of breast cancer cell lines and data from the Curtis and TCGA breast carcinoma datasets revealed that elevated MMP7 expression and MMP7 promoter hypomethylation are specific biomarkers of the basal-like molecular subtype which shares considerable, but not complete, overlap with the clinical TN subtype. Importantly, MMP7 expression was identified as an independent predictor of pathological complete response in a large breast cancer patient cohort. Combined, these data suggest that MMP7 expression and MMP7 promoter methylation may be useful as prognostic biomarkers. Furthermore, MMP7 expression and promoter methylation analysis may be effective mechanisms to distinguish basal-like breast cancers from other triple-negative subtypes. Finally, these data implicate MMP7 as a potential therapeutic target for the treatment of basal-like breast cancers.
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Affiliation(s)
- Steven T Sizemore
- Department of Pharmacology, Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4965, USA
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Fischer AH, Schwartz MR, Moriarty AT, Wilbur DC, Souers R, Fatheree L, Booth CN, Clayton AC, Kurtyz DFI, Padmanabhan V, Crothers BA. Immunohistochemistry practices of cytopathology laboratories: a survey of participants in the College of American Pathologists Nongynecologic Cytopathology Education Program. Arch Pathol Lab Med 2014; 138:1167-72. [PMID: 24840035 DOI: 10.5858/arpa.2013-0259-cp] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Immunohistochemistry (IHC) is important for cytology but poses special challenges because preanalytic conditions may differ from the conditions of IHC-positive controls. OBJECTIVE To broadly survey cytology laboratories to quantify preanalytic platforms for cytology IHC and identify problems with particular platforms or antigens. To discover how validation guidelines for HER2 testing have affected cytology. DESIGN A voluntary survey of cytology IHC practices was sent to 1899 cytology laboratories participating in the College of American Pathologists Nongynecologic Cytopathology Education Program in the fall of 2009. RESULTS A total of 818 laboratories (43%) responded to the survey by April 2010. Three hundred fourty-five of 791 respondents (44%) performed IHC on cytology specimens. Seventeen different fixation and processing platforms prior to antibody reaction were reported. A total of 59.2% of laboratories reported differences between the platforms for cytology specimens and positive controls, but most (155 of 184; 84%) did not alter antibody dilutions or antigen retrieval for cytology IHC. When asked to name 2 antibodies for which staining conditions differed between cytology and surgical samples, there were 18 responses listing 14 antibodies. A total of 30.6% of laboratories performing IHC offered HER2 testing before publication of the 2007 College of American Pathologists/American Society of Clinical Oncologists guidelines, compared with 33.6% afterward, with increased performance of testing by reference laboratories. Three laboratories validated a nonformalin HER2 platform. CONCLUSIONS The platforms for cytology IHC and positive controls differ for most laboratories, yet conditions are uncommonly adjusted for cytology specimens. Except for the unsuitability of air-dried smears for HER2 testing, the survey did not reveal evidence of systematic problems with any antibody or platform.
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Affiliation(s)
- Andrew H Fischer
- From the Department of Pathology, University of Massachusetts Memorial Health Care, Worcester (Dr Fischer); the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Schwartz); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Pathology, Massachusetts General Hospital, Boston (Dr Wilbur); the Departments of Statistics/Biostatistics (Ms Souers) and Cytology Surveys (Ms Fatheree), College of American Pathologists, Northfield, Illinois; the Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); the Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota (Dr Clayton); the Department of Cytology, Wisconsin State Laboratory of Hygiene, Madison (Dr Kurtyz); the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Padmanabhan); and the Department of Pathology and Area Laboratory Services, Walter Reed Army Medical Center, Washington, District of Columbia (Dr Crothers)
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Dyhdalo KS, Booth CN, Shorie J, Underwood DL, Mazzone P, Brainard JA. Rapid on-site evaluation of endobronchial ultrasound-guided fine-needle aspirates: correlation of adequacy assessment and final diagnosis in patients with bronchogenic carcinoma. J Am Soc Cytopathol 2014; 3:199-205. [PMID: 31051686 DOI: 10.1016/j.jasc.2014.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION We review endobronchial ultrasound-guided fine-needle aspirate samples and investigate cases with discrepancies between rapid on-site evaluation (ROSE) and final diagnosis in patients with bronchogenic carcinoma. MATERIALS AND METHODS Endobronchial ultrasound-guided fine-needle aspirates from 2009 to 2010 were studied. On-site adequacy assessments were compared with final diagnoses. Concordant diagnoses showed agreement between ROSE interpretation and final diagnosis. If the initial interpretation differed from the final diagnosis, the case was discordant. Slides from discordant aspirates were reviewed. Discordant results were categorized as sampling error or interpretive/screening error at ROSE. RESULTS A total of 340 endobronchial ultrasound-guided procedures were performed in 335 patients (168 men, 167 women, median age 65 years). Diagnostic discrepancies between ROSE and final diagnoses occurred in 65 aspirates (11%) from 51 patients with carcinoma. Of the 65 discrepant cases, 52 (83%) were subsequently called positive for carcinoma. Rescreening of slides in 47 available cases with a final positive diagnosis showed insufficient tumor for diagnosis in 28 of 47 cases (60%). The remaining 19 of 47 cases (40%) were classified as interpretive/screening errors at ROSE. Most errors occurred in aspirates called atypical or atypical suspicious, which upon rescreening were considered diagnostic (16 aspirates, 84%). CONCLUSIONS Initial and final diagnoses were concordant in 89% of aspirates from patients with carcinoma. All aspirates that were positive at ROSE were concordant. In discordant cases, all aspirates deemed "atypical suspicious for malignancy" and 86% of aspirates deemed "atypical cells" on ROSE had a final diagnosis of carcinoma. The majority of discordant cases with a positive final diagnosis were due to sampling (60%).
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Affiliation(s)
- Kathryn S Dyhdalo
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Christine N Booth
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Julie Shorie
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Dawn L Underwood
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Peter Mazzone
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer A Brainard
- Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio.
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Moriarty AT, Schwartz MR, Laucirica R, Booth CN, Auger M, Thomas NE, Souers RJ. Cytology of spontaneous nipple discharge--is it worth it? Performance of nipple discharge preparations in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. Arch Pathol Lab Med 2013; 137:1039-42. [PMID: 23899058 DOI: 10.5858/arpa.2012-0231-cp] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The usefulness of spontaneous nipple discharge analysis is controversial. Nipple discharge preparations are rare in clinical practice and malignant cases are exceptional. The College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology has included nipple discharge preparations since its inception. OBJECTIVES To evaluate participant responses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology to assess the accuracy of cytologic interpretation of nipple discharge preparation. DESIGN General diagnostic category (benign, suspicious, malignant), participant type (pathologist, cytotechnologist), stain (Papanicolaou, modified Giemsa), and program year (2005-2009) were analyzed using χ(2) and a nonlinear mixed model for slide factor correlation structure. RESULTS Of 2506 responses, 1280 (51%) were malignant, 171 (7%) were papillary, and 1055 (42%) were benign. There were 222 discordant general category responses with a false-positive/suspicious rate of 12.8% and a false-negative rate of 3.4%. The most common false-negative diagnosis was mastitis/abscess (125 of 1272 responses; 9.8%). The most common false-positive response was papillary lesion (26 of 457 responses; 5.7%). There were no differences between stains or years. Cytotechnologists performed better than pathologists; pathologists had a higher false-negative rate than cytotechnologists (15.3% versus 7.9%, P < .001). CONCLUSIONS There is poor accuracy in evaluating nipple discharge preparation in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. If the findings in the program parallel clinical practice, nipple discharge preparations may adversely impact patient care. A benign nipple discharge cytologic diagnosis does not exclude malignancy, and the false-positive/suspicious rate requires confirmation of a malignant nipple discharge prior to definitive patient management.
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Affiliation(s)
- Ann T Moriarty
- Department of Pathology, AmeriPath Indiana, Indianapolis, IN 46219-1739, USA.
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Odronic SI, Maskovyak AE, Springer BS, Dyhdalo KS, Abdul-Karim FW, Booth CN. Utility and morphologic features of granulomas on rapid on-site evaluation of endobronchial ultrasonography-guided fine-needle aspiration. J Am Soc Cytopathol 2013; 3:79-85. [PMID: 31051705 DOI: 10.1016/j.jasc.2013.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/26/2013] [Accepted: 09/26/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Endobronchial ultrasonography (EBUS)-guided fine-needle aspiration (FNA) is increasingly used to sample central lung lesions and mediastinal lymphadenopathy. We investigate the utility of EBUS-guided FNA and concomitant rapid on-site evaluation (ROSE) to diagnose granulomas, the morphologic characteristics of granulomas on ROSE, and how the diagnosis of granulomas changed the clinical impression. MATERIALS AND METHODS All pathologic reports and associated clinical records of patients who had EBUS-guided FNA of the lungs or mediastinal lymph nodes that yielded granulomas were reviewed with at least a 1-year follow-up after EBUS-guided FNA. All ROSE slides were rereviewed to evaluate granulomas for quantity, necrosis, and cohesion. RESULTS Over a 3-year period, 882 EBUS-guided FNAs were performed. One hundred and twelve patients (49% male, average age 50.8 years, range 16-83) had 161 EBUS-guided FNAs that yielded granulomas (18%). The etiologies of the granulomas were as follows: sarcoidosis (54%), infection (12%), malignancy (5%), inflammatory bowel disease-related lymphadenopathy (1%), and no specific clinical etiology (28%). Of the patients with EBUS-guided FNAs, 98 had ROSE performed (87.5%) and granulomas were seen in 70 of these patients (71%). Granulomas associated with sarcoidosis were mostly well-formed and non-necrotizing (90%). The results of the EBUS-guided FNA changed or redefined the clinical diagnosis in 79 patients (71%). CONCLUSIONS EBUS-guided FNA with concurrent ROSE is a useful technique for the diagnosis of granulomas. The quality and quantity of granulomas detected during ROSE may suggest an etiology and help direct ancillary testing.
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Affiliation(s)
- Shelley I Odronic
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amanda E Maskovyak
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bridgette S Springer
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn S Dyhdalo
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fadi W Abdul-Karim
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Sizemore GM, Sizemore ST, Pal B, Booth CN, Seachrist DD, Abdul-Karim FW, Kume T, Keri RA. FOXC1 is enriched in the mammary luminal progenitor population, but is not necessary for mouse mammary ductal morphogenesis. Biol Reprod 2013; 89:10. [PMID: 23677979 DOI: 10.1095/biolreprod.113.108001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Expression of FOXC1, a forkhead box transcription factor, correlates with the human basal-like breast cancer (BLBC) subtype, and functional analyses have revealed its importance for in vitro invasiveness of BLBC cells. Women diagnosed with this breast tumor subtype have a poorer outcome because of the lack of targeted therapies; thus, continued investigation of factors driving these tumors is critical to uncover novel therapeutic targets. Several processes that dictate normal mammary morphogenesis parallel cancer progression, and enforced expression of FOXC1 can induce a progenitor state in more-differentiated mammary epithelial cells. Consequently, evaluating how FOXC1 functions in the normal gland is critical to further understand BLBC biology. Although FOXC1 is well known to control normal development of a number of tissues, its role in the mammary gland has not yet been investigated. Herein, we describe FOXC1 expression patterning in the normal breast, where it is localized to the basal/myoepithelium, suggesting that FOXC1 would be required for normal development. However, mammary glands lacking Foxc1 have no overt defect in ductal outgrowth, alveologenesis, or lineage specification. Of significant interest, we found that expression of FOXC1 is enriched in the normal luminal progenitor population, which is the postulated cell of origin of BLBC. These results indicate that FOXC1 is unnecessary for mammary morphogenesis and that its role in BLBC likely involves processes that are unrelated to cell lineage specification.
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Affiliation(s)
- Gina M Sizemore
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Yori JL, Lozada K, Seachrist DD, Mosley J, Abdul-Karim FW, Booth CN, Flask CA, Keri RA. Abstract LB-221: Inhibition of rapamycin-induced feedback activation of AKT with dasatinib induces complete tumor regression in a preclinical model of breast cancer. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-lb-221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Resistance to receptor tyrosine kinase (RTK) blockade in breast cancer treatment is commonly mediated by activation of bypass pathways that sustain growth. We propose moving away from the individual targeting of RTKs to inhibit multiple commonly activated, overlapping, and essential downstream pathways. The mammalian Target of Rapamycin (mTOR) and the non-receptor tyrosine kinase, Src, are two intrinsic targets that intersect downstream of most RTKs. To date, limited clinical efficacy has been shown with either mTOR or Src inhibitors as single agents. Here we show that dasatinib, a dual Src/c-abl inhibitor, is able to block the well-established de-repression of AKT that occurs with rapamycin inhibition of mTOR. Furthermore, dual inhibition of these distinct, but compensatory arms of RTK signaling results in rapid and complete regression in over 80% of MMTV-PyMT-induced mammary tumors, with only moderate effects on tumor inhibition as single agents. Importantly, Src and mTOR pathway co-activation occurs in nearly half of human breast cancers, independent of tumor sub-type. These studies support the evaluation of combined mTOR and Src inhibitors in breast cancer patients. Such inhibitors are currently FDA approved, expediting the transition to clinical safety and efficacy trials. We expect this approach will prevent molecular evolution of bypass pathways and induce tumor regression.
Citation Format: Jennifer L. Yori, Kristen Lozada, Darcie D. Seachrist, Jonathan Mosley, Fadi W. Abdul-Karim, Christine N. Booth, Chris A. Flask, Ruth A. Keri. Inhibition of rapamycin-induced feedback activation of AKT with dasatinib induces complete tumor regression in a preclinical model of breast cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-221. doi:10.1158/1538-7445.AM2013-LB-221
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Booth CN, Bashleben C, Filomena CA, Means MM, Wasserman PG, Souers RJ, Henry MR. Monitoring and ordering practices for human papillomavirus in cervical cytology: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 5. Arch Pathol Lab Med 2013; 137:214-9. [PMID: 23368863 DOI: 10.5858/arpa.2012-0114-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT The association of certain types of human papillomavirus with cervical carcinoma is well established. Human papillomavirus testing is now routinely used to screen for cervical carcinoma and precursor lesions of the cervix (cotesting and reflex testing) and these results are considered in patient triage and management. OBJECTIVE To provide information about current laboratory practices in human papillomavirus testing and consensus best practice statements based on results from the College of American Pathologists' laboratory-based survey funded by the Centers for Disease Control and Prevention. DESIGN The College of American Pathologists submitted a paper-based survey to 1245 laboratories in the United States. After review of the initial results, follow-up Web-based survey results, and a literature review by an expert working group, consensus best practice statements were constructed by working group members for presentation at a national consensus conference. These best practice statements were discussed and then voted upon by conference participants. RESULTS A total of 525 laboratories responded to survey questions about human papillomavirus ordering and monitoring practices, whereas 546 responded to the overall survey. In most laboratories (87.6%), the high-risk human papillomavirus test is ordered as a reflex test by providers. A minority of laboratories (11.9%) routinely bundle low- and high-risk human papillomavirus tests. Most laboratories (84.4%) do not limit testing in patients with atypical squamous cells to women older than 20 years. More than half of laboratories (53.3%) monitor human papillomavirus positive rates in Papanicolaou tests with atypical squamous cells of undetermined significance. CONCLUSIONS It is not appropriate for laboratories to offer low-risk human papillomavirus testing for any clinical circumstance in gynecologic cytology. Laboratories should not order human papillomavirus testing to resolve diagnostic discrepancies. It is a valuable broad measure of laboratory quality to monitor the human papillomavirus-positive rates in Papanicolaou tests with atypical squamous cells.
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Affiliation(s)
- Christine N Booth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Crothers BA, Booth CN, Darragh TM, Means MM, Souers RJ, Thomas N, Moriarty AT. Atrophic vaginitis: concordance and interpretation of slides in the College of American Pathologists Cervicovaginal Interlaboratory Comparison Program in Gynecologic Cytopathology. Arch Pathol Lab Med 2013; 136:1332-8. [PMID: 23106578 DOI: 10.5858/arpa.2011-0441-cp] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Atrophic vaginitis is a commonly reported subset of Papanicolaou test results that are negative for intraepithelial lesion or malignancy, but interpretive criteria overlap with atrophic changes and other entities, hindering concordance among observers. OBJECTIVES To report on the participant concordance from 2000 to 2009 in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytopathology, with a reference interpretation of atrophic vaginitis, and to investigate cytologic features of good and poorly performing slides to identify criteria useful in the interpretation of atrophic vaginitis. DESIGN We summarized 18 302 responses from the program for slides with a reference interpretation of atrophic vaginitis. We randomly selected 18 Papanicolaou test results (3 conventional, 4 SurePath, and 11 ThinPrep) from good and poor performers for prospective, blinded criteria scoring for the following features: abundance of neutrophils, more than 100 degenerating parabasal cells, more than 25% necrotic background, more than 100 pseudoparakeratotic cells, and the presence of stripped or streaked nuclei, histiocytes, and superficial or intermediate squamous cells. RESULTS Most Papanicolaou test results (>90%) with a specific reference interpretation of atrophic vaginitis were categorized as negative. Cytotechnologists are more likely than pathologists are to label it negative for intraepithelial lesion or malignancy (NILM) and are equally likely to mistake it for a high-grade lesion. Degenerating parabasal cells, pseudoparakeratosis, and necrotic background are associated with atrophic vaginitis (P = .001) on Papanicolaou. Abundant neutrophils (>100 per ×400 field) are also significantly correlated (P = .01). CONCLUSIONS Exact concordance to atrophic vaginitis is less than 90%. Most of the discrepancies are negative results for intraepithelial lesion or malignancy. Advanced atrophic features are as significant as neutrophils are to the interpretation of atrophic vaginitis.
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Affiliation(s)
- Barbara A Crothers
- Department of Pathology and Area Laboratory Services, Walter Reed Army Medical Center, Washington, DC, USA.
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Booth CN. Anticipating the impact of the new screening guidelines on cytology and molecular laboratories. Cancer Cytopathol 2013; 121:225-7. [PMID: 23281254 DOI: 10.1002/cncy.21248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Christine N Booth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Zorzi G, Dearnaley WJ, Debbe R, Debenedetti C, Dechenaux B, Dedovich DV, Degenhardt J, Del Papa C, Del Peso J, Del Prete T, Delemontex T, Deliyergiyev M, Dell'Acqua A, Dell'Asta L, Della Pietra M, della Volpe D, Delmastro M, Delsart PA, Deluca C, Demers S, Demichev M, Demirkoz B, Deng J, Denisov SP, Derendarz D, Derkaoui JE, Derue F, Dervan P, Desch K, Devetak E, Deviveiros PO, Dewhurst A, DeWilde B, Dhaliwal S, Dhullipudi R, Di Ciaccio A, Di Ciaccio L, Di Girolamo A, Di Girolamo B, Di Luise S, Di Mattia A, Di Micco B, Di Nardo R, Di Simone A, Di Sipio R, Diaz MA, Diehl EB, Dietrich J, Dietzsch TA, Diglio S, Dindar Yagci K, Dingfelder J, Dinut F, Dionisi C, Dita P, Dita S, Dittus F, Djama F, Djobava T, do Vale MAB, Do Valle Wemans A, Doan TKO, Dobbs M, Dobinson R, Dobos D, Dobson E, Dodd J, Doglioni C, Doherty T, Doi Y, Dolejsi J, Dolenc I, Dolezal Z, Dolgoshein BA, Dohmae T, Donadelli M, Donini J, Dopke J, Doria A, Dos Anjos A, Dotti A, Dova MT, Doxiadis AD, Doyle AT, Dris M, Dubbert 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Zieminska D, Zimin NI, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. Search for magnetic monopoles in sqrt[s]=7 TeV pp collisions with the ATLAS detector. Phys Rev Lett 2012; 109:261803. [PMID: 23368550 DOI: 10.1103/physrevlett.109.261803] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 06/01/2023]
Abstract
This Letter presents a search for magnetic monopoles with the ATLAS detector at the CERN Large Hadron Collider using an integrated luminosity of 2.0 fb(-1) of pp collisions recorded at a center-of-mass energy of sqrt[s]=7 TeV. No event is found in the signal region, leading to an upper limit on the production cross section at 95% confidence level of 1.6/ϵ fb for Dirac magnetic monopoles with the minimum unit magnetic charge and with mass between 200 GeV and 1500 GeV, where ϵ is the monopole reconstruction efficiency. The efficiency ϵ is high and uniform in the fiducial region given by pseudorapidity |η|<1.37 and transverse kinetic energy 600-700<E(kin)sinθ<1400 GeV. The minimum value of 700 GeV is for monopoles of mass 200 GeV, whereas the minimum value of 600 GeV is applicable for higher mass monopoles. Therefore, the upper limit on the production cross section at 95% confidence level is 2 fb in this fiducial region. Assuming the kinematic distributions from Drell-Yan pair production of spin-1/2 Dirac magnetic monopoles, the efficiency is in the range 1%-10%, leading to an upper limit on the cross section at 95% confidence level that varies from 145 fb to 16 fb for monopoles with mass between 200 GeV and 1200 GeV. This limit is weaker than the fiducial limit because most of these monopoles lie outside the fiducial region.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg, Germany
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Odronic SI, Scheidemantel T, Tuohy MJ, Chute D, Procop GW, Booth CN. Two Cases of Cokeromyces recurvatus in Liquid-Based Papanicolaou Tests and a Review of the Literature. Arch Pathol Lab Med 2012. [DOI: 10.5858/arpa.2011-0493-cr] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present 2 cases of Cokeromyces recurvatus in routine, liquid-based Papanicolaou tests (ThinPrep). Patient 1 is a healthy, asymptomatic, 26-year-old woman with no pertinent past medical history. Patient 2 is a healthy, asymptomatic, 47-year-old woman with no pertinent past medical history. The Papanicolaou tests from both patients showed many fungal-like elements as globose, yeastlike forms measuring 10 to 30 µm in diameter with multiple, narrowly attached apparent “daughter” buds. This morphology was consistent with Paracoccidioides brasiliensis. However, broad-range fungal polymerase chain reaction and deoxyribonucleic acid sequence analysis performed with GenBank Basic Local Alignment Search Tool showed an exact match for C recurvatus. Our cases highlight the importance of molecular techniques to prevent misdiagnosis of C recurvatus as P brasiliensis, based on morphology alone. There have been 8 previously published cases of C recurvatus infection in humans, 3 of which were reported in the female genital tract.
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Affiliation(s)
- Shelley I. Odronic
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Thomas Scheidemantel
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Marion J. Tuohy
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Deborah Chute
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Gary W. Procop
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
| | - Christine N. Booth
- From the Cleveland Clinic, Pathology and Laboratory Medicine Institute, Cleveland, Ohio
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Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. Search for supersymmetry in events with three leptons and missing transverse momentum in √[s]=7 TeV pp collisions with the ATLAS detector. Phys Rev Lett 2012; 108:261804. [PMID: 23004965 DOI: 10.1103/physrevlett.108.261804] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Indexed: 06/01/2023]
Abstract
A search for the weak production of charginos and neutralinos decaying to a final state with three leptons (electrons or muons) and missing transverse momentum is presented. The analysis uses 2.06 fb(-1) of √[s]=7 TeV proton-proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with standard model expectations in two signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric and simplified models. For the simplified models, degenerate lightest chargino and next-to-lightest neutralino masses up to 300 GeV are excluded for mass differences from the lightest neutralino up to 300 GeV.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg i.Br., Germany
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Aad G, Abbott B, Abdallah J, Abdelalim AA, Abdesselam A, Abdinov O, Abi B, Abolins M, Abramowicz H, Abreu H, Acerbi E, Acharya BS, Adams DL, Addy TN, Adelman J, Aderholz M, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Akesson TPA, Akimoto G, Akimov AV, Akiyama A, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Aliyev M, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alvarez Gonzalez B, Alviggi MG, Amako K, Amaral P, Amelung C, Ammosov VV, Amorim A, Amorós G, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Andrieux ML, Anduaga XS, Angerami A, Anghinolfi F, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, Arce ATH, Archambault JP, Arfaoui S, Arguin JF, Arik E, Arik M, Armbruster AJ, Arnaez O, Artamonov A, Artoni G, Arutinov D, Asai S, Asfandiyarov R, Ask S, Asman B, Asquith L, Assamagan K, Astbury A, Astvatsatourov A, Atoian G, Aubert B, Auge E, Augsten K, Aurousseau M, Avolio G, Avramidou R, Axen D, Ay C, Azuelos G, Azuma Y, Baak MA, Baccaglioni G, Bacci C, Bach AM, Bachacou H, Bachas K, Bachy G, Backes M, Backhaus M, Badescu E, Bagnaia P, Bahinipati S, Bai Y, Bailey DC, Bain T, Baines JT, Baker OK, Baker MD, Baker S, Banas E, Banerjee P, Banerjee S, Banfi D, Bangert A, Bansal V, Bansil HS, Barak L, Baranov SP, Barashkou A, Barbaro Galtieri A, Barber T, Barberio EL, Barberis D, Barbero M, Bardin DY, Barillari T, Barisonzi M, Barklow T, Barlow N, Barnett BM, Barnett RM, Baroncelli A, Barone G, Barr AJ, Barreiro F, Barreiro Guimarães da Costa J, Bartoldus R, Barton AE, Bartsch V, Bates RL, Batkova L, Batley JR, Battaglia A, Battistin M, Battistoni G, Bauer F, Bawa HS, Beare B, Beau T, Beauchemin PH, Beccherle R, Bechtle P, Beck HP, Becker S, Beckingham M, Becks KH, Beddall AJ, Beddall A, Bedikian S, Bednyakov VA, Bee CP, Begel M, Behar Harpaz S, Behera PK, Beimforde M, Belanger-Champagne C, Bell PJ, Bell WH, Bella G, Bellagamba L, Bellina F, Bellomo M, Belloni A, Beloborodova O, Belotskiy K, Beltramello O, Ben Ami S, Benary O, Benchekroun D, Benchouk C, Bendel M, Benekos N, Benhammou Y, Benjamin DP, Benoit M, Bensinger JR, Benslama K, Bentvelsen S, Berge D, Bergeaas Kuutmann E, Berger N, Berghaus F, Berglund E, Beringer J, Bernat P, Bernhard R, Bernius C, Berry T, Bertin A, Bertinelli F, Bertolucci F, Besana MI, Besson N, Bethke S, Bhimji W, Bianchi RM, Bianco M, Biebel O, Bieniek SP, Bierwagen K, Biesiada J, Biglietti M, Bilokon H, Bindi M, Binet S, Bingul A, Bini C, Biscarat C, Bitenc U, Black KM, Blair RE, Blanchard JB, Blanchot G, Blazek T, Blocker C, Blocki J, Blondel A, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VB, Bocchetta SS, Bocci A, Boddy CR, Boehler M, Boek J, Boelaert N, Böser S, Bogaerts JA, Bogdanchikov A, Bogouch A, Bohm C, Boisvert V, Bold T, Boldea V, Bolnet NM, Bona M, Bondarenko VG, Bondioli M, Boonekamp M, Boorman G, Booth CN, Bordoni S, Borer C, Borisov A, Borissov G, Borjanovic I, Borroni S, Bos K, Boscherini D, Bosman M, Boterenbrood H, Botterill D, Bouchami J, Boudreau J, Bouhova-Thacker EV, Bourdarios C, Bousson N, Boveia A, Boyd J, Boyko IR, Bozhko NI, Bozovic-Jelisavcic I, Bracinik J, Braem A, Branchini P, Brandenburg GW, Brandt A, Brandt G, Brandt O, Bratzler U, Brau B, Brau JE, Braun HM, Brelier B, Bremer J, Brenner R, Bressler S, Breton D, Britton D, Brochu FM, Brock I, Brock R, Brodbeck TJ, Brodet E, Broggi F, Bromberg C, Brooijmans G, Brooks WK, Brown G, Brown H, Bruckman de Renstrom PA, Bruncko D, Bruneliere R, Brunet S, Bruni A, Bruni G, Bruschi M, Buanes T, Bucci F, Buchanan J, Buchanan NJ, Buchholz P, Buckingham RM, Buckley AG, Buda SI, Budagov IA, Budick B, Büscher V, Bugge L, Buira-Clark D, Bulekov O, Bunse M, Buran T, Burckhart H, Burdin S, Burgess T, Burke S, Busato E, Bussey P, Buszello CP, Butin F, Butler B, Butler JM, Buttar CM, Butterworth JM, Buttinger W, Cabrera Urbán S, Caforio D, Cakir O, Calafiura P, Calderini G, Calfayan P, Calkins R, Caloba LP, Caloi R, Calvet D, Calvet S, Camacho Toro R, Camarri P, Cambiaghi M, Cameron D, Caminada LM, Campana S, Campanelli M, Canale V, Canelli F, Canepa A, Cantero J, Capasso L, Capeans Garrido MDM, Caprini I, Caprini M, Capriotti D, Capua M, Caputo R, Cardarelli R, Carli T, Carlino G, Carminati L, Caron B, Caron S, Carrillo Montoya GD, Carter AA, Carter JR, Carvalho J, Casadei D, Casado MP, Cascella M, Caso C, Castaneda Hernandez AM, Castaneda-Miranda E, Castillo Gimenez V, Castro NF, Cataldi G, Cataneo F, Catinaccio A, Catmore JR, Cattai A, Cattani G, Caughron S, Cauz D, Cavalleri P, Cavalli D, Cavalli-Sforza M, Cavasinni V, Ceradini F, Cerqueira AS, Cerri A, Cerrito L, Cerutti F, Cetin SA, Cevenini F, Chafaq A, Chakraborty 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Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Zivković L, Zmouchko VV, Zobernig G, Zoccoli A, Zolnierowski Y, Zsenei A, Zur Nedden M, Zutshi V, Zwalinski L. Measurement of the ZZ production cross section and limits on anomalous neutral triple gauge couplings in proton-proton collisions at sqrt[s] = 7 TeV with the ATLAS detector. Phys Rev Lett 2012; 108:041804. [PMID: 22400826 DOI: 10.1103/physrevlett.108.041804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Indexed: 05/31/2023]
Abstract
A measurement of the ZZ production cross section in proton-proton collisions at sqrt[s] = 7 TeV using data corresponding to an integrated luminosity of 1.02 fb(-1) recorded by the ATLAS experiment at the LHC is presented. Twelve events containing two Z boson candidates decaying to electrons and/or muons are observed, with an expected background of 0.3 ± 0.3(stat)(-0.3)(+0.4)(syst) events. The cross section measured in a phase-space region with good detector acceptance and for dilepton masses within the range 66 to 116 GeV is σ(ZZ → ℓ+ ℓ- ℓ+ ℓ-)(fid) = 19.4(-5.2)(+6.3)(stat)(-0.7)(+0.9)(syst) ± 0.7(lumi) fb. The resulting total cross section for on-shell ZZ production, σ(ZZ)(tot) = 8.5(-2.3)(+2.7)(stat)(-0.3)(+0.4)(syst) ± 0.3(lumi) pb, is consistent with the standard model expectation of 6.5(-0.2)(+0.3) pb calculated at the next-to-leading order in QCD. Limits on anomalous neutral triple gauge boson couplings are derived.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg i.Br., Germany
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Ducatman BS, Bentz JS, Fatheree LA, Souers R, Ostrowski S, Moriarty AT, Henry M, Laucirica R, Booth CN, Wilbur DC. Gynecologic Cytology Proficiency Testing Failures: What Have We Learned?: Observations From the College of American Pathologists Gynecologic Cytology Proficiency Testing Program. Arch Pathol Lab Med 2011; 135:1442-6. [DOI: 10.5858/arpa.2010-0681-sa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Context.—In 2006, the first gynecologic cytology proficiency tests were offered by the College of American Pathologists. Four years of data are now available using field-validated slides, including conventional and liquid-based Papanicolaou tests.
Objective.—To characterize the pattern of error types that resulted in initial proficiency-test failure for cytotechnologists, primary screening pathologists, and secondary pathologists (those whose slides are prescreened by cytotechnologists).
Design.—The results of 37 029 initial College of American Pathologists Papanicolaou proficiency tests were reviewed from 4 slide-set modules: conventional, ThinPrep, SurePath, or a module containing all 3 slide types.
Results.—During this 4-year period, cytotechnologists were least likely to fail the initial test (3.4%; 614 of 18 264), followed by secondary pathologists (ie, those reviewing slides already screened by a cytotechnologist) with a failure rate of 4.2% (728 of 17 346), and primary pathologists (ie, those screening their own slides) having the highest level of failure (13.7%; 194 of 1419). Failure rates have fallen for all 3 groups over time. Pathologists are graded more stringently on proficiency tests, and more primary pathologists would have passed if they had been graded as cytotechnologists. There were no significant differences among performances using different types of slide sets. False-positive errors were common for both primary (63.9%; 124 of 194 errors) and secondary (55.6%; 405 of 728 errors) pathologists, whereas automatic failures were most common for cytotechnologists (75.7%; 465 of 614 errors).
Conclusions.—The failure rate is decreasing for all participants. The failures for primary pathologist screeners are due to false-positive responses. Primary screening cytotechnologists and secondary pathologists have automatic failures more often than do primary screening pathologists.
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