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Caputo A, Fraggetta F, Cretella P, Cozzolino I, Eccher A, Girolami I, Marletta S, Troncone G, Vigliar E, Acanfora G, Zarra KV, Torres Rivas HE, Fadda G, Field A, Katz R, Vielh P, Eloy C, Rajwanshi A, Gupta N, Al-Abbadi M, Bustami N, Arar T, Calaminici M, Raine JI, Barroca H, Canão PA, Ehinger M, Rajabian N, Dey P, Medeiros LJ, El Hussein S, Lin O, D'Antonio A, Bode-Lesniewska B, Rossi ED, Zeppa P. Digital Examination of LYmph node CYtopathology Using the Sydney system (DELYCYUS): An international, multi-institutional study. Cancer Cytopathol 2023; 131:679-692. [PMID: 37418195 DOI: 10.1002/cncy.22741] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 02/05/2023] [Revised: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND After a series of standardized reporting systems in cytopathology, the Sydney system was recently introduced to address the need for reproducibility and standardization in lymph node cytopathology. Since then, the risk of malignancy for the categories of the Sydney system has been explored by several studies, but no studies have yet examined the interobserver reproducibility of the Sydney system. METHODS The authors assessed interobserver reproducibility of the Sydney system on 85 lymph node fine-needle aspiration cytology cases reviewed by 15 cytopathologists from 12 institutions in eight different countries, resulting in 1275 diagnoses. In total, 186 slides stained with Diff-Quik, Papanicolaou, and immunocytochemistry were scanned. A subset of the cases included clinical data and results from ultrasound examinations, flow cytometry immunophenotyping, and fluorescence in situ hybridization analysis. The study participants assessed the cases digitally using whole-slide images. RESULTS Overall, the authors observed an almost perfect agreement of cytopathologists with the ground truth (median weighted Cohen κ = 0.887; interquartile range, κ = 0.210) and moderate overall interobserver concordance (Fleiss κ = 0.476). There was substantial agreement for the inadequate and malignant categories (κ = 0.794 and κ = 0.729, respectively), moderate agreement for the benign category (κ = 0.490), and very slight agreement for the suspicious (κ = 0.104) and atypical (κ = 0.075) categories. CONCLUSIONS The Sydney system for reporting lymph node cytopathology shows adequate interobserver concordance. Digital microscopy is an adequate means to assess lymph node cytopathology specimens.
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Affiliation(s)
- Alessandro Caputo
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
| | - Filippo Fraggetta
- Department of Pathology, Gravina and Santo Pietro Hospital, Caltagirone, Italy
| | - Pasquale Cretella
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Immacolata Cozzolino
- Department of Mental and Physical Health and Preventive Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano, South Tyrolean Health Care Service-South Tyrol Health Authority, Bolzano-Bozen, Italy
| | - Stefano Marletta
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | | | - Elena Vigliar
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Gennaro Acanfora
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Karen Villar Zarra
- Pathology Department, Hospital Universitario Del Henares, Coslada, Spain
| | | | - Guido Fadda
- Department of Human Pathology of the Adulthood and Developing Age "Gaetano Barresi", Section of Pathology, University of Messina, Messina, Italy
| | - Andrew Field
- Department of Anatomical Pathology, St Vincent's Hospital, University of New South Wales and University of Notre Dame, Sydney, New South Wales, Australia
| | - Ruth Katz
- Department of Pathology, Tel HaShomer Hospital, Tel Aviv, Israel
| | | | - Catarina Eloy
- Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | | | - Nalini Gupta
- Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mousa Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| | - Nadwa Bustami
- Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| | - Tala Arar
- Department of Pathology, Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan
| | - Maria Calaminici
- Specialist Integrated Hematological Malignancy Diagnostic Service, Department of Cellular Pathology, Barts Health National Health Service Trust, England, UK
- Center for Hemato-Oncology, Barts Cancer Institute, London, UK
| | - Juliet I Raine
- Specialist Integrated Hematological Malignancy Diagnostic Service, Department of Cellular Pathology, Barts Health National Health Service Trust, England, UK
| | - Helena Barroca
- Serviço de Anatomia Patológica, Hospital S João-Porto, Porto, Portugal
| | | | - Mats Ehinger
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Nilofar Rajabian
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Pranab Dey
- Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Siba El Hussein
- Department of Pathology, University of Rochester Medical Center, Rochester, New York, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University Rome, Rome, Italy
| | - Pio Zeppa
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
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Rodríguez-Rodero S, Morales-Sánchez P, Tejedor JR, Coca-Pelaz A, Mangas C, Peñarroya A, Fernández-Vega I, Fernández-Fernández L, Álvarez-López CM, Fernández AF, Arranz Álvarez M, Astudillo A, Pujante Alarcón P, Ragnarssön C, Colina Alonso A, Torres Rivas HE, Rodrigo Tapia JP, Nieto Torrero S, Pedroche-Just Y, Regojo Zapata RM, Rodríguez-García AM, Abó A, Balbín M, Menéndez E, Delgado E, Fraga MF. Classification of follicular-patterned thyroid lesions using a minimal set of epigenetic biomarkers. Eur J Endocrinol 2022; 187:335-347. [PMID: 35895726 DOI: 10.1530/eje-22-0012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The minimally invasive fine-needle aspiration cytology (FNAC) is the current gold standard for the diagnosis of thyroid nodule malignancy. However, the correct discrimination of follicular neoplasia often requires more invasive diagnostic techniques. The lack of suitable immunohistochemical markers to distinguish between follicular thyroid carcinoma and other types of follicular-derived lesions complicates diagnosis, and despite most of these tumours being surgically resected, only a small number will test positive for malignancy. As such, the development of new orthogonal diagnostic approaches may improve the accuracy of diagnosing thyroid nodules. DESIGN This study includes a retrospective, multi-centre training cohort including 54 fresh-frozen follicular-patterned thyroid samples and two independent, multi-centre validation cohorts of 103 snap-frozen biopsies and 33 FNAC samples, respectively. METHODS We performed a genome-wide genetic and epigenetic profiling of 54 fresh-frozen follicular-patterned thyroid samples using exome sequencing and the Illumina Human DNA Methylation EPIC platform. An extensive validation was performed using the bisulfite pyrosequencing technique. RESULTS Using a random forest approach, we developed a three-CpG marker-based diagnostic model that was subsequently validated using bisulfite pyrosequencing experiments. According to the validation cohort, this cost-effective method discriminates between benign and malignant nodules with a sensitivity and specificity of 97 and 88%, respectively (positive predictive value (PPV): 0.85, negative predictive value (NPV): 0.98). CONCLUSIONS Our classification system based on a minimal set of epigenetic biomarkers can complement the potential of the diagnostic techniques currently available and would prioritize a considerable number of surgical interventions that are often performed due to uncertain cytology. SIGNIFICANCE STATEMENT In recent years, there has been a significant increase in the number of people diagnosed with thyroid nodules. The current challenge is their etiological diagnosis to discount malignancy without resorting to thyroidectomy. The method proposed here, based on DNA pyrosequencing assays, has high sensitivity (0.97) and specificity (0.88) for the identification of malignant thyroid nodules. This simple and cost-effective approach can complement expert pathologist evaluation to prioritize the classification of difficult-to-diagnose follicular-patterned thyroid lesions and track tumor evolution, including real-time monitoring of treatment efficacy, thereby stimulating adherence to health promotion programs.
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Affiliation(s)
- Sandra Rodríguez-Rodero
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Paula Morales-Sánchez
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Juan Ramón Tejedor
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
| | - Andrés Coca-Pelaz
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Central University Hospital of Asturias, HUCA Otorhinolaryngology Service, Oviedo, Asturias, Spain
| | - Cristina Mangas
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
| | - Alfonso Peñarroya
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
| | - Iván Fernández-Vega
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Luís Fernández-Fernández
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Carmen M Álvarez-López
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
- University Hospital of Asturias (HUCA), Laboratory of Molecular Oncology, Oviedo, Asturias, Spain
| | - Agustín F Fernández
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
| | | | - Aurora Astudillo
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Pedro Pujante Alarcón
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Cecilia Ragnarssön
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Alberto Colina Alonso
- General Surgery, Innovation in Surgery, Transplants and Health Technologies Service, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Héctor Enrique Torres Rivas
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Juan Pablo Rodrigo Tapia
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias, HUCA Otorhinolaryngology Service, Oviedo, Asturias, Spain
| | | | | | | | | | - Anabel Abó
- Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
| | - Milagros Balbín
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
- University Hospital of Asturias (HUCA), Laboratory of Molecular Oncology, Oviedo, Asturias, Spain
| | - Edelmiro Menéndez
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Elías Delgado
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Mario F Fraga
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
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Torres Rivas HE, Villar Zarra K, Pérez Pabón LA, González Gutierréz MDLP, Zapico Ortiz N, Olmo Fernández MDM, Nieto Llanos S, Antoranz Álvarez N, Gómez Martín Á, Fernández Fernández LM. Ultrasound-Guided Fine-Needle Aspiration of Superficial Lymphadenopathy Performed by Interventional Pathologists: The Applicability of the Sydney System from 2 Years of Experience and 363 Cases. Acta Cytol 2021; 65:453-462. [PMID: 34289486 DOI: 10.1159/000517314] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/15/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The Sydney system proposal for the study and reporting of lymphadenopathy by fine-needle aspiration (FNA) constitutes one of the first attempts to standardize this procedure. Here, we review its applicability. MATERIALS AND METHODS A retrospective study in which all ultrasound-guided FNAs (USFNAs) of superficial lymphadenopathy (palpable or not) performed by interventional pathologists in 2 specialized hospital centers were quantified over 2 years. The procedure was systematized, and the diagnoses were reclassified according to the Sydney system categories. RESULTS We analyzed 363 USFNAs of lymphadenopathies. The distribution of cases by categories was as follows: insufficient (n = 13; 3.58%), benign (n = 208; 57.30%), atypia of uncertain significance (n = 7; 1.93%), suspicious (n = 21; 5.79), and malignant (n = 114; 31.40%). The risks of malignancy calculated for categories I, II, III, IV, and V were 27%, 3%, 50%, 100%, and 100%, respectively. CONCLUSION The implementation of the Sydney system allows the systematization and standardization of the lymph node FNA methodology, with increased efficacy and efficiency. Assimilating the recommendations enables the qualification of the diagnostic procedure.
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Affiliation(s)
| | - Karen Villar Zarra
- Pathology Department, Hospital Universitario del Henares, Coslada, Spain
| | | | | | - Nuria Zapico Ortiz
- Pathology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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