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Bai S, Millis M, Wilson S, Scott M, Goulart RA, Maxfield MW, Lou F, Sood RN, Fischer AH. Liquid-based rapid onsite evaluation of endobronchial ultrasound cytologies. J Am Soc Cytopathol 2022; 11:375-384. [PMID: 36055932 DOI: 10.1016/j.jasc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Rapid onsite evaluation (ROSE) generally uses smears made at the site of the procedure ("smear-based ROSE"). It requires considerable time, generally 2 individuals, technical expertise, and it can be difficult to estimate material available for ancillary studies. We developed an alternative ROSE using liquid-based cytology ThinPrep with hematoxylin and eosin (H&E) stain ("liquid-based ROSE") and assessed its advantages. MATERIALS AND METHODS Clinicians rinse the sample(s) into CytoRich Red and send to Pathology. A defined proportion of the needle rinse is removed for a ThinPrep stained with a rapid H&E. Adequacy and diagnosis were compared to final outcome. Total time was recorded. RESULTS Among 52 liquid-based ROSE readings, 28 (53.8%) were interpreted as "adequate" with final as adequate; 17 (32.7%) were interpreted as "inadequate" with final as inadequate; 7 (13.5%) were interpreted as "inadequate" with final as adequate. Of 23 readings provided with onsite diagnosis, 15 (65.2%) were interpreted as definitive positive or negative diagnoses; 6 (26%) were interpreted as nondiagnostic; and 2 (8.7%) were interpreted as atypical. All definitive diagnoses were concordant with final diagnoses. The time for liquid ROSE performance ranges from 6 to 22 minutes (mean: 13 minutes) and required only 1 individual. CONCLUSIONS Liquid-based ROSE allows accurate adequacy determination and diagnosis, takes about 15 minutes of cytologist time, and can be performed by just 1 person. The technique produces well-preserved and stained slides, it may allow a better estimation of the total amount of material in the specimen vial and may provide a better platform for telecytology.
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Affiliation(s)
- Shi Bai
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mark Millis
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Shirley Wilson
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - MaryPat Scott
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Robert A Goulart
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Mark W Maxfield
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Feiran Lou
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Rahul N Sood
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Andrew H Fischer
- Department of Pathology, UMass Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts.
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Goulart RA, M. Atkison K, Spiczka AJ. The MS Level Cytologist. Am J Clin Pathol 2020; 153:425-426. [PMID: 31802132 DOI: 10.1093/ajcp/aqz190] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert A Goulart
- New England Pathology Associates, Trinity Health of New England, Springfield, MA
| | - Karen M. Atkison
- Women’s Health and Cancer, Global Education Specialist (retired), BD Diagnostics, Durham, NC
| | - Amy J Spiczka
- Institute for Science, Technology and Policy, American Society for Clinical Pathology, Washington, DC
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Davey DD, Goulart RA, Nayar R. An advocacy victory: final USPSTF cervical cancer screening recommendations revised to include cotesting option. J Am Soc Cytopathol 2018; 7:333-335. [PMID: 31043304 DOI: 10.1016/j.jasc.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/28/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 06/09/2023]
Abstract
The recent reversal of the US Preventive Services Task Force decision to drop cotesting (Papicolaou test + high-risk human papillomavirus test) as an option for cervical cancer screening in women aged 30 to 65 years from their recommendations for cervical cancer screening was directly attributed to advocacy efforts by professional organizations and individuals. This communication summarizes the pathology and laboratory medicine community's role in this advocacy effort by collaboration of all major US Pathology organizations, via the Cytopathology Education and Technology consortium.
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Affiliation(s)
- Diane Davis Davey
- Department of Clinical Sciences, Associate Dean for Graduate Medical Education, University of Central Florida College of Medicine, Orlando, Florida.
| | - Robert A Goulart
- New England Pathology Associates of Mercy Medical Center, Director of Cytopathology Services, Trinity Health of New England, Springfield, Massachusetts
| | - Ritu Nayar
- Department of Pathology, Vice Chair for Education and Faculty Development, Medical Director for Cytopathology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Atkison K, Goulart RA, Wilbur DC. The evolution of cytotechnology: data, continuing professional development, and school infrastructure. J Am Soc Cytopathol 2018; 7:229-231. [PMID: 31043281 DOI: 10.1016/j.jasc.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 06/09/2023]
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Nayar R, Goulart RA, Davey DD. Primary HPV cervical cancer screening in the United States: Are we ready? J Am Soc Cytopathol 2018; 7:50-55. [PMID: 31043251 DOI: 10.1016/j.jasc.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 06/09/2023]
Abstract
In September 2017, the United States Preventive Services Task Force put forth updated draft guidelines for cervical cancer screening in the United States, which were then open to public comment. The recommendations allowed for every-3-year cervical cytology screening in women aged 21 to 65 years with an option for every-5-year high-risk human papillomavirus testing in women aged 30 to 65 years. There was no option for cotesting. Other recommendations were similar to those published by other professional organizations. The Cytopathology Education and Technology Consortium provided an official response during the open comment period, which is summarized here along with additional commentary by the authors.
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Affiliation(s)
- Ritu Nayar
- Department of Pathology, Northwestern University Feinberg School of Medicine. Medical Director for Cytopathology, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Robert A Goulart
- Cytopathology Services, New England Pathology Associates at Trinity Health of New England, Mercy Medical Center, Springfield, Massachusetts
| | - Diane D Davey
- Department of Clinical Sciences, University of Central Florida, Orlando, Florida
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Huh WK, Ault KA, Chelmow D, Davey DD, Goulart RA, Garcia FA, Kinney WK, Massad LS, Mayeaux EJ, Saslow D, Schiffman M, Wentzensen N, Lawson HW, Einstein MH. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. J Low Genit Tract Dis 2016; 19:91-6. [PMID: 25574659 DOI: 10.1097/lgt.0000000000000103] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2011, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology updated screening guidelines for the early detection of cervical cancer and its precursors. Recommended screening strategies were cytology or cotesting (cytology in combination with high-risk HPV (hrHPV) testing). These guidelines also addressed the use of hrHPV testing alone as a primary screening approach, which was not recommended for use at that time. There is now a growing body of evidence for screening with primary hrHPV testing, including a prospective US-based registration study. Thirteen experts including representatives from the Society of Gynecologic Oncology, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, American Cancer Society, American Society of Cytopathology, College of American Pathologists, and the American Society for Clinical Pathology, convened to provide interim guidance for primary hrHPV screening. This guidance panel was specifically triggered by an application to the FDA for a currently marketed HPV test to be labeled for the additional indication of primary cervical cancer screening. Guidance was based on literature review and review of data from the FDA registration study, supplemented by expert opinion. This document aims to provide information for health care providers who are interested in primary hrHPV testing and an overview of the potential advantages and disadvantages of this strategy for screening as well as to highlight areas in need of further investigation.
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Affiliation(s)
- Warner K Huh
- 1University of Alabama at Birmingham, Birmingham, AL, USA; 2University of Kansas Medical Center, Kansas City, KS, USA; 3Virginia Commonwealth University Medical Center, Richmond, VA, USA; 4University of Central Florida, Orlando, FL, USA; 5New England Pathology Associates, Springfield, MA, USA; 6Pima County Health Department, Tucson, AZ, USA; 7Kaiser Permanente, Sacramento, CA, USA; 8Washington University School of Medicine, St. Louis, MO, USA; 9University of South Carolina School of Medicine, Columbia, SC, USA; 10American Cancer Society, Atlanta, GA, USA; 11National Cancer Institute, Bethesda, MD, USA; 12American Society of Colposcopy and Cervical Pathology, Frederick, MD, USA; and 13Albert Einstein College of Medicine, Bronx, NY, USA
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Nayar R, Goulart RA, Tiscornia-Wasserman PG, Davey DD. Primary human papillomavirus screening for cervical cancer in the United States-US Food and Drug Administration approval, clinical trials, and where we are today. Cancer Cytopathol 2014; 122:720-9. [DOI: 10.1002/cncy.21480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Ritu Nayar
- Division of Cytopathology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Robert A. Goulart
- Division of Cytopathology; New England Pathology Associates at Mercy Medical Center; Springfield Massachusetts
| | | | - Diane Davis Davey
- Department of Clinical Sciences; University of Central Florida; Orlando Florida
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Affiliation(s)
- Yinong Wang
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA
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Setia N, Goulart RA, Leiman G, Otis CN, Modem R, Pantanowtiz L. Cytomorphology of cervicovaginal melanoma: ThinPrep versus conventional Papanicolaou tests. Cytojournal 2010; 7:25. [PMID: 21298024 PMCID: PMC3030001 DOI: 10.4103/1742-6413.75666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/01/2010] [Indexed: 11/05/2022] Open
Abstract
Background: Primary cervicovaginal melanoma is a rare malignancy associated with a high risk of recurrence. Prior studies discussing the cytomorphology of cervicovaginal melanoma have been based primarily on review of conventional Papanicolaou (Pap) smears. The aim of this study was to evaluate cervicovaginal melanomas identified in liquid-based Pap tests, in comparison with features seen on conventional Pap smear preparation. Materials and Methods: Cases of cervicovaginal melanoma identified on Pap tests with concurrent or subsequent histopathologic confirmation were collected from the Baystate Medical Center cytopathology files and personal archives of the authors over a total period of 34 years. All cytopathology (n = 6) and the available histology slides (n = 5) were reviewed. Cases were analyzed regarding clinical, histopathologic and cytomorphological findings. Results: A total of six cases with invasive cervicovaginal melanoma diagnosed on Pap tests were identified. Most patients were postmenopausal with contact bleeding, correlating with surface ulceration (identified in biopsy/excision material in 5/5 cases). Most cases had deeply invasive tumors (5/5: modified Breslow's thickness > 5 mm and Chung's level of invasion IV/V). Pap tests included four ThinPrep and two conventional smears. Overall, ThinPrep Pap tests exhibited a higher ratio of tumor cells to background squamous cells. While all Pap tests were bloodstained, tumor diathesis was prominent only within conventional smears. Melanoma cells were present both as clusters and scattered single cells in each Pap test type. Both the preparations contained epithelioid tumor cells, whereas spindled tumor cells were seen in only two ThinPrep cases. Prominent nucleoli and binucleation of tumor cells were seen in both the preparations. Melanin pigment was identified in only ThinPrep (3/4) cases and nuclear pseudo-inclusions in one conventional Pap smear. Cell blocks were made in three ThinPrep cases and immunocytochemistry (S-100, HMB45, Melan-A) performed on additional vial material (one ThinPrep slide and one cell block) was immunoreactive in melanoma cells. Conclusion: Primary cervicovaginal melanoma, a rare malignancy seen predominantly in postmenopausal women, may be successfully diagnosed in either ThinPrep Pap tests or conventional Pap smears. While ThinPrep Pap tests did not demonstrate morphological advantage over conventional smears, liquid-based cytology specimens did provide additional material for cellblock preparation and immunocytochemical evaluation in a subset of cases.
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Affiliation(s)
- Namrata Setia
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Pantanowitz L, Kuperman M, Goulart RA. Clinical history of HIV infection may be misleading in cytopathology. Cytojournal 2010; 7:7. [PMID: 20607096 PMCID: PMC2895884 DOI: 10.4103/1742-6413.64375] [Citation(s) in RCA: 10] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 01/19/2010] [Indexed: 11/22/2022] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients are at an increased risk for developing opportunistic infections, reactive conditions and neoplasms. As a result, a broad range of conditions are frequently included in the differential diagnosis of HIV-related lesions. The clinical history of HIV infection may, however, be misleading in some cases. Illustrative cases are presented in which knowledge of a patient's HIV status proved to be misleading and increased the degree of complexity of the cytologic evaluation. Case 1 involved the fine needle aspiration (FNA) of a painful 3 cm unilateral neck mass in a 38-year-old female with generalized lymphadenopathy. Her aspirate revealed a spindle cell proliferation devoid of mycobacteria that was immunoreactive for S-100 and macrophage markers (KP-1, PGM1). Multiple noncontributory repeat procedures were performed until a final excision revealed a schwannoma. Case 2 was a CT-guided FNA of a positron emission tomography positive lung mass in a 53-year-old man. The acellular aspirate in this case contained structures resembling fungal spore forms that were negative for mucicarmine and GMS stains, as well as cryptococcal antigen immunocytochemistry. A Von Kossa stain confirmed that these pseudo-fungal structures were calcified debris. Follow up revealed multiple calcified lung and hilar node based granulomata. Case 3 involved the cytologic evaluation of pleural fluid from a 47-year-old man with Kaposi sarcoma and recurrent chylous pleural effusions. Large atypical cells identified in his effusion were concerning for primary effusion lymphoma. Subsequent pleural biopsy revealed extramedullary hematopoiesis, documenting these atypical cells as megakaryocytes. These cases demonstrate that knowledge of a patient's HIV status can be misleading in the evaluation of cytology specimens, with potential for misdiagnosis and/or multiple procedures. To avoid this pitfall in the setting of HIV infection, common entities unrelated to HIV infection and artifacts should always be included in the differential diagnosis.
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Affiliation(s)
- Liron Pantanowitz
- Address: Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Abstract
OBJECTIVE To describe the cytomorphology of psammocarcinomas in peritoneal washings, including ThinPrep (Cytyc Corporation/Hologic, Marlborough, Massachusetts, U.S.A.)-processed material, in a series of patients. STUDY DESIGN A retrospective, 19-year search was performed for cases of peritoneal washings in which psammomatous calcifications were reported. All clinical findings as well as cytospin, ThinPrep and cell block slides from peritoneal washings in patients with psammocarcinoma were reviewed. RESULTS A total of 37 cases were identified with peritoneal washings containing psammomatous calcifications, 4 (11%) of which were associated with psammocarcinoma. Psammocarcinomas occurred in patients of average age 52 years (range, 39-68) and were of either peritoneal (n = 3) or ovarian (n = 1) origin. In these psammocarcinomas, peritoneal washings were bloody, were of moderate to high cellularity and contained many papillary serous cell groups. Tumor cells had high nuclear:cytoplasmic ratios, irregular nuclei, prominent nucleoli and variable hyperchromasia. Laminated psammomatous calcifications were abundant in 3 cases (> 80 bodies per cytologic slide and cell block) and of variable size (up to 150 microm), occurring both alone and in clusters associated with atypical epithelial cell groups. CONCLUSION The characteristic cytologic finding of low grade epithelial atypia in papillary cell groups accompanied by numerous psammoma bodies is very distinctive of psammocarcinoma and closely resembles the striking histopathologic findings seen in this rare subset of serous carcinomas.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, Springfield, Massachusetts 01199, USA.
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Abstract
BACKGROUND The presence of anthracotic pigment (carbon) in pleural fluid cytologic samples is unusual and to date has only been reported in individuals who are crack (freebase cocaine) smokers. We report the cytologic finding of carbon-laden macrophages in pleural fluid unrelated to crack abuse. CASES Two patients were identified with anthracotic pigment within their pleural fluid on cytologic review; an 88-year-old human immunodeficiency virus (HIV)-negative man with a transudative effusion and a 46-year-old HIV-positive man with a history of crack abuse who presented with an exudative effusion. Dense black pigment within macrophages was identified in both the ThinPrep slide and cell block material. This pigment failed to stain for iron and was present within the cytoplasm of KP-1 immunoreactive and TFF-1 negative macrophages. CONCLUSION Carbon-laden macrophages can be found in exudative and transudative pleural effusions and may be seen without any relationship to crack abuse. Because this finding may be secondary to a subclinical pneumothorax, its identification and reporting may be of clinical significance.
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Affiliation(s)
- Liron Pantanowitz
- Division of Cytopathology, Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, Springfield, Massachusetts 01199, USA.
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Abstract
With the introduction of digital imaging, pathology is undergoing a digital transformation. In the field of cytology, digital images are being used for telecytology, automated screening of Pap test slides, training and education (e.g. online digital atlases), and proficiency testing. To date, there has been no systematic review on the impact of digital imaging on the practice of cytopathology. This article critically addresses the emerging role of computer-assisted screening and the application of digital imaging to the field of cytology, including telecytology, virtual microscopy, and the impact of online cytology resources. The role of novel diagnostic techniques like image cytometry is also reviewed.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Maryanne Hornish
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Robert A. Goulart
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Pinco J, Goulart RA, Otis CN, Garb J, Pantanowitz L. Impact of digital image manipulation in cytology. Arch Pathol Lab Med 2009; 133:57-61. [PMID: 19123737 DOI: 10.5858/133.1.57] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Digital images have become an important component of cytology practice. They are used in telecytology, automated screening, educational material, and Web sites and have potential for use in proficiency testing. However, there has been no formal evaluation to date to determine if digital image manipulation (intentional or unintentional) can affect their interpretation. OBJECTIVE To investigate whether alteration of digital cytology images affects diagnosis. DESIGN Acquired digital images of ThinPrep Papanicolaou test slides were manipulated (rotated 90 degrees and brightness, contrast, red-green-blue color, and luminosity adjusted) using Photoshop. A test composed of these altered images, along with their original (unaltered) image and exact duplicates was given to 22 cytologists (13 cytotechnologists, 8 cytopathologists, and 1 fellow). All images were rated as negative, atypical (atypical squamous cells of undetermined significance), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or positive for cancer. Weighted kappa and heterogeneity chi(2) statistics were used to measure levels of agreement and assess concordance between groups. RESULTS The level of agreement for identical duplicate images was excellent (kappa = 0.81), compared with the poor agreement for manipulated image pairs (kappa = 0.21), a statistically significant difference (P < .001). For all altered image types agreement was poor. There was no significant difference between cytotechnologists and cytopathologists in level of agreement (P = .56). CONCLUSIONS Manipulation of a Papanicolaou test digital image, irrespective of the specific category of cytologic material photographed, significantly affects its interpretation by both cytotechnologists and cytopathologists. This suggests that care needs to be taken when digital cytology images are used, to specifically ensure that their alteration does not affect diagnosis.
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Affiliation(s)
- Jeffery Pinco
- Departments of Pathology, Tufts University School of Medicine, Springfield, MA 01199, USA
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Abstract
Automation and emerging information technologies are being adopted by cytology laboratories to augment Pap test screening and improve diagnostic accuracy. As a result, informatics, the application of computers and information systems to information management, has become essential for the successful operation of the cytopathology laboratory. This review describes how laboratory information management systems can be used to achieve an automated and seamless workflow process. The utilization of software, electronic databases and spreadsheets to perform necessary quality control measures are discussed, as well as a Lean production system and Six Sigma approach, to reduce errors in the cytopathology laboratory.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Division of Cytopathology, Baystate Medical Center, Tufts School of Medicine, MA, USA.
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Hollowell ML, Goulart RA, Gang DL, Otis CN, Prior J, Sachs BF, Pantanowitz L. Cytologic features of müllerian papilloma of the cervix: mimic of malignancy. Diagn Cytopathol 2007; 35:607-11. [PMID: 17703455 DOI: 10.1002/dc.20712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Müllerian papilloma is a rare benign tumor of the cervix and/or vagina that occurs predominantly in young children. The cytologic features of benign müllerian papilloma have never been described. We report for the first time, to our knowledge, the cytologic findings of a benign müllerian papilloma from the vaginal fluid specimen of a 15-mo-old girl using touch prep, ThinPrep, and cell block preparations. The deceptive cytologic features of a cellular specimen with complex papillary fronds composed of overlapping and crowded small hyperchromatic cells, with a high nuclear:cytoplasmic ratio, and feathering in this case resembled a malignant neoplasm. The clinical findings and cytomorphology of a benign müllerian papilloma can mimic those of malignant lesions of the female lower genital tract such as sarcoma botryoides and adenocarcinoma. An awareness of this entity and its potential to mimic these more aggressive neoplasms is essential for accurate diagnosis and to avoid over-treatment.
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Affiliation(s)
- Monica L Hollowell
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01109, USA
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Pantanowitz L, Panetti C, Goulart RA, Cooper R. Cholesterol crystals in the thyroid gland. Acta Cytol 2007; 51:249-51. [PMID: 17425216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Division of Cytopathology, Baystate Medical Center, Tufts School of Medicine, 759 Chestnut Street, Springfield, MA 01199, USA.
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Bonfiglio TA, Nayar R, Abdul-Karim FW, Cahill LA, Filomena CA, Goulart RA, Ali S, Atkison KN, Bourtsos E, Covell JL, Dawson AE, De Frias DV, Dieterich M, Duggan MA, Russell DK, Riedy D, Salhadar A, Smith NJ, Metzler RL, Clark J. ASCP Sets High Standards for Regulatory Gynecologic Cytology Proficiency Testing. Lab Med 2006. [DOI: 10.1309/3ja3nwch2vy9hdkl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Affiliation(s)
- Rukmini R Modem
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
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Pantanowitz L, Florence RR, Goulart RA, Otis CN. Response to Ridder et al. Diagn Cytopathol 2006. [DOI: 10.1002/dc.20478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pantanowitz L, Galan A, Gang DL, Crisi GM, LaPolice P, Goulart RA. Diagnostic cytologic features of an epididymal melanotic neuroectodermal tumor of infancy present in scrotal fluid: a case report. Acta Cytol 2006; 50:460-5. [PMID: 16901015 DOI: 10.1159/000325993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The cytologic features of melanotic neuroectodermal tumor of infancy (MNTI) have been described in rare cases only, and these reports have been based solely on direct smears obtained from aspirated tumor material or from touch preparations of resected tumors. CASE We report, to our knowledge, the first documented case of an epididymal MNTI diagnosed from aspirated hydrocele fluid processed using the ThinPrep system (Cytyc Corp., Boxborough, Massachusetts, U.S.A.). CONCLUSION Based on a 15 year retrospective review of scrotal fluids submitted for cytologic evaluation to our laboratory, MNTI represented the sole neoplasm that was represented in the fluid and could be specifically diagnosed. Compared to the direct smear evaluation in our case and other published reports, the ThinPrep method enables the recognition of both neuroblast-like cells and larger melanin-containing epithelial cells in scrotal fluid, thereby aiding in the specific diagnosis of MNTI and minimizing the risk of misdiagnosing this tumor as a more aggressive neoplasm.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
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Abstract
Breast adenoid cystic carcinoma (BACC) is a biologically distinct tumor with morphologic mimickers, which might make accurate classification problematic. Because c-kit expression has been reported in adenoid cystic carcinoma of various anatomic sites, we evaluated BACC for c-kit by immunohistochemical analysis, comparing the findings to similarly stained mimickers. Tested cases included 6 BACCs, 15 low-grade infiltrating ductal carcinomas (LGIDCs) chosen as potential mimickers, and 15 head-neck adenoid cystic carcinomas (HNACCs). All BACCs showed plasma membranous and cytoplasmic staining equal to or greater than that of adjacent benign epithelium. Five BACCs (83%) expressed c-kit in more than 50% of tumor cells. Only 2 of 15 LGIDCs expressed low-intensity, focal c-kit staining. Of the 15 HNACCs, 10 (67%) expressed c-kit. Hormone receptors were consistently negative in BACCs. All BACCs expressed c-kit, whereas LGIDCs infrequently expressed low-intensity c-kit. Immunohistochemical evaluation for c-kit might aid in accurately classifying carcinomas with histologic features overlapping adenoid cystic carcinoma and LGIDC.
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Affiliation(s)
- L Pantanowitz
- Department of Pathology, Baystate Medical Center, Springfield, Massachusets 01199, USA.
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Abstract
Breast adenoid cystic carcinoma (BACC) is a biologically distinct tumor with morphologic mimickers, which might make accurate classification problematic. Because c-kit expression has been reported in adenoid cystic carcinoma of various anatomic sites, we evaluated BACC for c-kit by immunohistochemical analysis, comparing the findings to similarly stained mimickers. Tested cases included 6 BACCs, 15 low-grade infiltrating ductal carcinomas (LGIDCs) chosen as potential mimickers, and 15 head-neck adenoid cystic carcinomas (HNACCs). All BACCs showed plasma membranous and cytoplasmic staining equal to or greater than that of adjacent benign epithelium. Five BACCs (83%) expressed c-kit in more than 50% of tumor cells. Only 2 of 15 LGIDCs expressed low-intensity, focal c-kit staining. Of the 15 HNACCs, 10 (67%) expressed c-kit. Hormone receptors were consistently negative in BACCs. All BACCs expressed c-kit, whereas LGIDCs infrequently expressed low-intensity c-kit. Immunohistochemical evaluation for c-kit might aid in accurately classifying carcinomas with histologic features overlapping adenoid cystic carcinoma and LGIDC.
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Affiliation(s)
- Giovanna M Crisi
- Department of Pathology, Baystate Medical Center/Tufts University School of Medicine, Springfield, MA 01199, USA
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Pantanowitz L, Cao QJ, Goulart RA, Otis CN. Diagnostic utility of p16 immunocytochemistry for Trichomonas in urine cytology. Cytojournal 2005; 2:11. [PMID: 15985185 PMCID: PMC1183263 DOI: 10.1186/1742-6413-2-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Accepted: 06/29/2005] [Indexed: 11/15/2022] Open
Abstract
We present a case in which p16 immunocytochemistry helped establish the diagnosis of Trichomonas in urine from a male patient. Based on this finding, we recommend p16 immunocytochemistry as a diagnostic tool for unexpected patients or specimen types in which potential trichomonads are identified following routine cytologic evaluation.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
| | - Q Jackie Cao
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
| | - Robert A Goulart
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
| | - Christopher N Otis
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
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Pantanowitz L, Florence RR, Goulart RA, Otis CN. Trichomonas vaginalis P16 Immunoreactivity in cervicovaginal Pap tests: A diagnostic pitfall. Diagn Cytopathol 2005; 33:210-3. [PMID: 16078255 DOI: 10.1002/dc.20349] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Detection of p16 is emerging as a useful biomarker for Human Papillomavirus (HPV)-related dysplastic and malignant lesions of the cervix, and as such has potential application to cervicovaginal Papanicolaou (Pap) specimens. While evaluating p16 immunocytochemistry in our laboratory we observed one Pap test in which Trichomonas vaginalis stained positively for p16. We therefore proceeded to determine the frequency of T. vaginalis immunoreactivity for p16 in 10 consecutive, satisfactory, liquid-based Pap tests diagnosed as negative for intraepithelial lesion or malignancy in which T. vaginalis was present. For each case, a ThinPrep slide prepared from residual vial material was immunostained with p16. In an additional case, a prepared cell block was stained with p16. T. vaginalis were consistently p16 positive. We document, for the first time, p16 immunoreactivity of T. vaginalis that, on a Pap slide and cell block, may be morphologically misinterpreted as small dysplastic or malignant epithelial cells. The presence of this parasite in Pap tests may also potentially hinder the use of p16 as an adjunct to liquid-based cervical screening cytology.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA.
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Collins LC, Connolly JL, Page DL, Goulart RA, Pisano ED, Fajardo LL, Berg WA, Caudry DJ, McNeil BJ, Schnitt SJ. Diagnostic agreement in the evaluation of image-guided breast core needle biopsies: results from a randomized clinical trial. Am J Surg Pathol 2004; 28:126-31. [PMID: 14707874 DOI: 10.1097/00000478-200401000-00015] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Image-guided core needle biopsies (CNBs) are commonly used as the initial sampling method for nonpalpable, mammographically detected breast lesions. Although prior studies have shown that this procedure is a highly sensitive and accurate method for the detection of breast cancer, the level of diagnostic agreement between pathologists in the analysis of CNB has not been previously studied in detail. METHODS To address this, we reviewed the pathologic findings in 2004 CNB from patients enrolled in the Radiologic Diagnostic Oncology Group 5 study, a randomized, multicenter trial designed to determine the role of CNB and fine needle aspiration biopsy in the evaluation of nonpalpable breast lesions. Slides of CNB specimens were initially diagnosed by pathologists at the 22 participating institutions (local diagnosis) and were then sent to the study pathologists for central review (central diagnosis). Local and central diagnoses were compared. RESULTS Overall, the central diagnosis and local diagnosis were concordant in 1925 cases (96%), indicating an excellent level of agreement by kappa statistic analysis (kappa = 0.90; 95% confidence interval 0.88-0.92). The level of agreement between local and central pathologists did not vary with the image guidance system (stereotactic mammography vs. ultrasound) or with the mammographic findings (soft tissue density vs. microcalcifications). The level of diagnostic agreement observed for CNB was comparable to that observed among 596 open surgical biopsies obtained from patients in this study and subjected to central pathology review (93% agreement; kappa = 0.89, 95% confidence interval 0.86-0.92). CONCLUSIONS The level of diagnostic agreement in interpretation of breast CNB is extremely high among pathologists and is comparable to that seen for open surgical biopsy.
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Affiliation(s)
- Laura C Collins
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Cao QJ, Panetti C, Marconi S, Krebs P, Lorenzana RR, Goulart RA, Bur ME. Vimentin and leukocyte common antigen-negative molding cells in pleural effusions of patients with small cell lung carcinoma. Acta Cytol 2003; 47:1033-7. [PMID: 14674074 DOI: 10.1159/000326641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether the presence of vimentin and leukocyte common antigen (LCA)-negative molding cells (VLNMC) could help in identifying rare small cell lung carcinoma (SCLC) cells. STUDY DESIGN Thirty-four cell blocks of pleural effusions (PEs) from 26 patients with confirmed SCLC were stained immunohistochemically with vimentin and LCA antibodies and compared with hematoxylin and eosin-stained preparations. RESULTS VLNMC were present in 22/22 PEs originally diagnosed as positive or atypical/suspicious for SCLC. Focal vimentin staining was seen in SCLC in 10/22 cases, and 1 case showed many vimentin-positive SCLC cells. One of 11 PEs originally interpreted as negative showed rare groups of VLNMC. This was supported by a subsequent PE obviously positive for SCLC. CONCLUSION Immunoperoxidase stains for vimentin and LCA highlight SCLC in PEs as VLNMC; however, morphologic criteria must prevail in making the final diagnosis.
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Affiliation(s)
- Q Jackie Cao
- Department of Pathology, Baystate Medical Center, Western Campus of Tufts University School of Medicine, Springfield, Massachusetts, USA.
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March DE, Coughlin BF, Barham RB, Goulart RA, Klein SV, Bur ME, Frank JL, Makari-Judson G. Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience. Radiology 2003; 227:549-55. [PMID: 12676972 DOI: 10.1148/radiol.2272020476] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the effects of removal of all ultrasonographic (US) evidence of breast lesions by using a vacuum-assisted biopsy (VAB) device. MATERIALS AND METHODS Thirty-four women with breast masses underwent US-guided biopsy with an 11-gauge VAB device, with which removal of all evidence of the lesion was attempted. Histologic findings were compared with results of surgery and follow-up imaging. Patient tolerance and perceptions of the procedure and the ability of the procedure to eliminate a palpable finding were evaluated with questionnaires and findings at follow-up physical examination. RESULTS The biopsy protocol was completed in all cases. Twenty-six benign lesions (76%) and eight malignancies (24%) were diagnosed. After VAB, 10 patients (29%) underwent surgery on the basis of histologic findings of invasive carcinoma (n = 7), ductal carcinoma in situ (n = 1), lobular neoplasia (n = 1), or atypical ductal hyperplasia (n = 1). VAB resulted in complete excision of four of 10 lesions: two of eight malignancies and two of two benign lesions. Among 21 patients with benign lesions who underwent 6-month follow-up imaging, eight (38%) had a definite residual mass. At 6-month follow-up examination, VAB was seen to have eliminated the palpable abnormality in seven (88%) of eight patients with initially palpable benign masses. Thirty-two patients (94%) described no or mild pain during biopsy, and 33 patients (97%) rated care as excellent. CONCLUSION After removal of all US evidence of breast masses with a VAB device, there was a substantial probability that residual lesion that was not visualized during the procedure would later be found at surgery or follow-up imaging. A palpable mass (< or =1.2 cm in mean diameter) was eliminated in 88% of cases, and patient tolerance and perceptions of the procedure were favorable.
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Affiliation(s)
- David E March
- Department of Radiology, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
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March DE, Coughlin BF, Polino JR, Goulart RA, Makari-Judson G. Single dilated lactiferous duct due to papilloma: ultrasonographically guided percutaneous biopsy with a vacuum-assisted device. J Ultrasound Med 2002; 21:107-111. [PMID: 11794396 DOI: 10.7863/jum.2002.21.1.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- David E March
- Department of Radiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA
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Abstract
Wegener's granulomatosis appeared as localized or infiltrative tumefactions in six patients. The tissue swellings affected the retroperitoneum, mediastinum (two), breast, retroorbital tissue (two), and gingiva. There was extensive fibroblastic proliferation in each case with a predominantly granulocytic inflammatory component, microabscess formation, and collagen necrobiosis. In one of the mediastinal lesions and in the gingiva, there was a granulomatous component as well. In the breast were scattered multinucleated histiocytes. Necrotizing vasculitis was absent or limited in all cases. All patients responded dramatically to cyclophosphamide and/or prednisone after the diagnosis was established. These observations indicate a role for tissue destruction in Wegener's granulomatosis mediated by granulocytes without a vasculitic component.
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Affiliation(s)
- R A Goulart
- Department of Pathology, Harvard Medical School, Beth Israel Hospital 02215
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