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Fine-needle aspiration cytology (FNAC) is used as a valuable method for examining suspected salivary gland lesions. It is a simple, cost-effective, and minimally invasive procedure with high specificity and sensitivity. Due to the cellular heterogeneity and overlapping architectural features, it can be difficult to distinguish between non-neoplastic processes, benign lesions, and/or malignancies in salivary glands on routine stains. Cell block methods are currently replacing surgical biopsy-based diagnostic methods on the basis of utilizing aspirates from FNAC with a rapid and reliable potential for reaching a conclusive diagnosis. Ancillary investigations including a panel of immunohistochemical markers are frequently applied on cytology specimens in the era of precision diagnostics to offer a specific diagnosis and even prognostic information for optimal patient care. [ABSTRACT FROM AUTHOR]

Context.—The cytologic distinction between pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) can be diagnostically challenging in aspirate smears. Hence a cytologic diagnosis of ‘atypical cytology’ with a differential diagnosis including PA and ACC is occasionally rendered in a subset of salivary gland fine-needle aspirations. Objective.—To evaluate the role of glial fibrillary acidic protein (GFAP) and CD57 expression in cell block material obtained during fine-needle aspiration procedure in differentiating PA from ACC. Design.—We performed GFAP and CD57 immunostains on formalin-fixed, paraffin-embedded cell block sections of 26 salivary gland fine-needle aspiration cases with the following cytologic diagnoses: (1) PA (10 cases); (2) atypical cytology, cannot exclude ACC (8 cases); and (3) ACC (8 cases). Results.—All 10 (100%) cases with cytologic diagnoses of PA were positive for GFAP, and 8 (80%) of 10 cases were positive for CD57; tissue follow-up confirmed the diagnosis of PA in all cases. All 8 (100%) cases with cytologic diagnosis of ACC were negative for both GFAP and CD57; tissue follow-up confirmed the diagnoses of ACC in all cases. Of the 8 cases with diagnoses of atypical cytology, 4 (50%) were negative and 4 (50%) were positive for both GFAP and CD57. Subsequent tissue follow-up in these cases revealed 4 cases of ACC (all negative for GFAP and CD57) and 4 cases of PA (all positive for GFAP and CD57). Conclusions.-Our results show that positive staining for GFAP and CD57 serves as a useful adjunct for the diagnosis of PA and helps to reduce the uncertainty in challenging cases. [ABSTRACT FROM AUTHOR]

Pulmonary actinomycosis is an uncommon infectious disease. Although the gold standard for diagnosis is histological examination with bacterial culture of lung tissue, cytology samples offer a fast and low-cost alternate diagnostic procedure. The cytology literature on this topic is limited to mostly case reports. Therefore, the aim of this study was to review cytological material in a series of patients with a diagnosis of pulmonary actinomycosis to characterize the main cytomorphological findings. Different cytological respiratory samples including sputum smears, bronchoalveolar lavages (BALs), transthoracic or endobronchial fine needle aspiration cytology (FNAC) and cell block preparations were used for retrospective examination. For all cases patient age, gender, symptoms, and radiological chest findings were recorded. A total of 26 cytological respiratory samples (14 sputum smears, 9 FNAC, two BALs) including direct smears and 6 cell blocks from 9 patients were examined. In sputum smears the most remarkable findings were the presence of dark cotton ball masses with projections like spider legs and/or mouse tails (75% of the samples). Sulfur granules were observed in 4 (40%) of the sputum smears and within FNAC cases. Various respiratory cytology samples including sputum smears, FNAC and BALs can reveal cytomorphological findings diagnostic of pulmonary actinomycosis. Characteristic cytological findings compatible with a diagnosis of this infection include cotton ball masses and less frequently sulfur granules. [ABSTRACT FROM AUTHOR]

Cytology specimens play an important role in the diagnosis and predictive testing of lung cancer. While morphological characterisation of small cell and non‐small cell lung carcinomas (NSCLC) on cytology is possible, further subtyping of NSCLC into adenocarcinoma and squamous cell carcinoma morphology is also mandatory in the current era of personalised medicine. Notably, cytology specimens in different forms (fine needle aspiration, exfoliative, and cell block) with or without immunocytochemistry are reliable sources for accurate diagnosis of adenocarcinoma and squamous cell carcinoma as evidenced by numerous studies present in the literature. However, there are instances where subtyping of NSCLC based on morphology alone is challenging on cytology samples, especially non‐cell block preparations. In this paper, we will discuss current concepts, advances, and challenges of subtyping NSCLC in cytology specimens. [ABSTRACT FROM AUTHOR]

Cell-block preparations have become an essential part of integrated cytology diagnosis. They are essentially microbiopsies that are formalin fixed and embedded in paraffin. This has become more prevalent with greater sample procurement due to the advent of newer biopsy techniques and needles. Cell-blocks allow retrieval of small tissue fragments from cytology specimens that sometimes cannot be processed by alternate cytologic techniques. They represent concentrated, cell-enriched preparations that provide cytologists with the opportunity to evaluate cellular architecture, as well as to perform ancillary testing. A cell-block compatible sample may thus obviate the need for a more invasive procedure such as a tissue biopsy. Microscopic examination of cell-blocks is quick, avoids obscuring material, permits cells to be evaluated in one focal plane, and allows the histologic architecture such as glandular differentiation, papillary formations, and sometimes invasion to be easily identified. This new era of "cytohistology" accordingly requires practicing cytologists to become more familiar with histopathology. This review article discusses the benefit of various architectural patterns identifiable in cell-blocks employed as an adjunct to Pap tests, exfoliative fluid specimens, and fine-needle aspirations. [ABSTRACT FROM AUTHOR]

Background: Early detection of pancreatic adenocarcinomas is essential for improving survival. In this regard, endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) has established itself as the method of choice for its ability to target lesions smaller than those which could be targeted by the traditional imaging methods like transabdominal ultrasound. Identifying these tumors correctly on FNA may be challenging because pancreatic adenocarcinomas may show a wide range of morphological features and the presence of contaminants from the gastrointestinal tract may show up as potential pitfalls. This study presents detailed cytomorphological analyses of 59 cases reported as pancreatic adenocarcinomas on smears and cell blocks. The clinical and histopathology follow-up data wherever available have also been presented. Materials and Methods: EUS-FNAC smears and cell blocks from cases reported as pancreatic adenocarcinomas were retrospectively evaluated with individual assessments of a range of features related to cellularity, cellular arrangement, cytoplasmic qualities, and nuclear features. Aspirates from peripancreatic lymph nodes, histopathology sections, and clinical records were reviewed wherever available. Results: Nonneoplastic cells like pancreatic ductal cells and acinar cells, duodenal, and gastric epithelia were detected along with neoplastic cells showing a wide range of variations in different cytomorphological characters. Often, a mixture of features was noted in the same case. Cell block preparations served as useful adjuncts since they made it possible to render unequivocal diagnoses of malignancies in cases where smears were hypocellular. Conclusion: The study creates a useful knowledge base of cytomorphological features of pancreatic adenocarcinomas. [ABSTRACT FROM AUTHOR]

Aim: To explore the cytological spectrum of the gastrointestinal stromal tumour (GIST) including its metastatic sites. Material and methods: A total of 42 patients (45 sites) diagnosed with GIST or its metastases on fine needle aspiration cytology were studied over a period of 5 years. May‐Grünwald Giemsa‐ and haematoxylin and eosin‐stained smears were reviewed and analysed for the cytomorphological spectrum of GIST. Results: Primary GIST alone was seen in 24 cases, E‐GIST in eight cases and metastasis in 11 cases (one patient showing metastasis at two distinct sites), whereas concurrent primary and metastatic lesions were noted in two cases. Amongst primary sites, the most commonly affected location was stomach (n = 22), followed by ileum (n = 2), duodenum (n = 1) and rectum (n = 1). Extra‐GIST was seen in retroperitoneum and pelvis (n = 3 each), omentum and mediastinum (n = 1 each). Fine needle aspiration cytology was done from 11 metastatic sites of GIST which included liver, gall bladder fossa, chest wall, and thigh. The classic spindle cell arrangement was the predominant cytological pattern. About 8.8% cases showed predominant epithelioid cell morphology and 15.5% cases had a mixed cytomorphology comprising of both spindle cell and epithelioid cell patterns. Nuclear pseudoinclusions, perinuclear vacuoles and multinucleation were seen in four cases. Immunocytochemistry on cell‐block sections for confirmation was performed in 18 cases and all these cases showed strong c‐KIT positivity. Conclusion: In this largest case series of cytomorphological diagnosis of GIST, we describe the cytomorphology and immunocytochemistry of primary and metastatic GIST. GISTs with predominant epithelioid cell morphology may pose a diagnostic dilemma therefore in all suspected cases of GIST, immunocytochemistry for c‐KIT and/or DOG1 should be employed on cell‐block preparations to confirm the diagnosis of GIST. This is the largest reported series on the cytomorphology of gastrointestinal stromal tumour (GIST). The details of cytomorphology and immunocytochemistry of GIST have been described. [ABSTRACT FROM AUTHOR]

Fine needle aspiration cytology (FNAC) for diagnosis of musculoskeletal tumors is well discussed and debated. The current evidence restricts its application in recurrent and metastatic lesions, with core needle biopsy as the acceptable technique/gold standard for the primary diagnosis of these challenging tumors. However, there are several studies showing reasonable sensitivity and specificity in primary diagnosis of bone and soft tissue tumors, especially in differentiating benign from malignant tumors. There is an acceptable limitation in the exact subtyping of soft tissue tumors, based on cytology smear examination, in the absence of ancillary techniques. Nonetheless, cytology constitutes an optimal material for triaging cases for ancillary techniques, such as immunocytochemistry, immunohistochemistry, molecular cytogenetics, and molecular diagnosis, in the form of smears and cell block preparations. This review focuses on the strengths and limitations of cytology versus core needle biopsy in the diagnosis of bone and soft tissue tumors, with the current evidence in the form of published studies, including the authors' experience. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the effectiveness of thyroid fine needle aspiration cytology (FNAC) using a novel-cell preserving matrix called Cytomatrix in improving diagnostic accuracy for thyroid nodules. Materials and Methods: Fifty patients undergoing thyroidectomy were enrolled and FNAC was performed on the excised thyroid glands, with the collected sample being placed on the Cytomatrix. The results were compared with histopathological analysis, and diagnostic performance was assessed statistically. Results: Cytomatrix demonstrated an accuracy of 96%, sensitivity of 84.61%, and specificity of 100%. Concordance between cytological and histopathological findings highlighted Cytomatrix's potential to enhance thyroid FNAC accuracy. Conclusion: FNAC using Cytomatrix shows promise in improving diagnostic accuracy for thyroid nodules. Its application, marked by faster processing and efficient resource utilization, coupled with the preservation of cellular architecture, holds considerable potential in enhancing cytological diagnosis, thus optimizing patient management strategies. [ABSTRACT FROM AUTHOR]

Introduction: Fine Needle Aspiration Cytology (FNAC) of the lymph node is a simple tool in the diagnosis of suspected and unsuspected primary and secondary lymph node malignancy. It is a useful first-line investigation to distinguish between infective and malignant lymphadenopathy, especially in a low-resource setting like our country. Aim: To study the utility of FNAC in the diagnosis of lymph node malignancy and to evaluate the efficacy of cytology in diagnosing the primary site of malignancy in case of metastasis. Materials and Methods: A cross-sectional retrospective and prospective study was conducted for a five-year period from July 2015 to June 2020, in the pathology department of Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra, India. A total of 112 patients diagnosed with malignancy on FNAC of lymph nodes were studied. The FNAC procedure was performed by cytopathologists using a 23/24G needle attached to a 10 ml syringe. The alcohol-fixed smears were stained with Haematoxylin & Eosin (H&E) stain and Papanicolaou (PAP) stains, while the airdried smears were stained with Giemsa stain. Diagnosis was based on cytomorphological features and clinical presentation. Results: A total of 112 patients were diagnosed with malignancy on FNAC, of which 90 were males and 22 were females, with a male-to-female ratio of 4:1. Cytological analysis of these nodes revealed metastasis in 98 cases (87.50%) and lymphoma in 14 cases (12.50%). The maximum number of patients were in the 51-60 years age group, with 38 cases (33.92%). The most common site of involvement was cervical lymph nodes, with 75 cases (66.96%). The most common cytological diagnosis was metastatic squamous cell carcinoma in 65 cases (58.02%), followed by metastatic un-differentiated carcinoma in 26 cases (23.20%). Conclusion: Fine Needle Aspiration (FNA) is a simple, safe, accurate, cost-effective, and valuable tool in the evaluation of malignant lymphadenopathy. Malignant diseases were easily diagnosed by this simple diagnostic procedure. In the case of a diagnosis of lymphoma, surgery can be completely avoided. It helps in planning further surgical management for metastatic disease, where definitive operative intervention can be performed in one session. In the case of an un-detected primary tumour, FNAC directs further investigations towards the possible primary site. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of solid pseudopapillary neoplasm (SPN) on fine needle aspiration specimens can be challenging because of morphological overlap with other pancreatic neoplasms, including pancreatic neuroendocrine tumour (PanNET). SRY‐related high‐mobility group box 11 (SOX11) is a recently described sensitive and specific marker for SPN diagnosis. However, SOX11 immunocytochemistry on cytological smears has not been reported. We evaluated the utility of SOX11 for diagnosis of SPN on cytological preparations. Methods: SOX11 immunocytochemistry was performed on Papanicolaou‐stained smears and/or corresponding cell blocks from aspirates of 7 SPN and 10 PanNET cases identified between 2005 and 2020. Findings were compared with those for beta‐catenin, a frequently used diagnostic marker for SPN. Results: Six smears and 6 cell blocks from SPN cases and 8 smears and 10 cell blocks from PanNET cases were available for immunostaining. For SPN, nuclear staining for SOX11 was seen in 6 of 6 (100%) smears and 5 of 6 (83%) cell blocks, with equivocal staining in 1 cell block. In contrast, 7 of 8 (88%) smears and 9 of 10 (90%) cell blocks were negative for SOX11 for PanNet, with equivocal staining seen in 1 case. Beta‐catenin immunocytochemistry showed nuclear staining in 6 of 7 (86%) SPN cases and no staining in all 10 (100%) PanNET cases. Conclusions: SOX11 detected by immunocytochemistry can serve as a useful diagnostic marker for SPN, in addition to beta catenin, and can be performed on cytological smears in cases without a cell block preparation. [ABSTRACT FROM AUTHOR]

Background and objective: EBUS-TBNA has emerged as an important minimally invasive procedure for the diagnosis and staging of lung cancer. Our objective was to evaluate the effect of different specimen preparation from aspirates on the diagnosis of lung cancer. Methods: 181 consecutive patients with known or suspected lung cancer accompanied by hilar / mediastinal lymphadenopathy underwent EBUS-TBNA from January 2019 to December 2022. Specimens obtained by EBUS-TBNA were processed by three methods: Traditional smear cytology of aspirates (TSC), liquid-based cytology of aspirates (LBC) and histopathology of core biopsies. Results: EBUS-TBNA was performed in 181 patients on 213 lymph nodes, the total positive rate of the combination of three specimen preparation methods was 80.7%. The diagnostic positive rate of histopathology was 72.3%, TSC was 68.1%, and LBC was 65.3%, no significant differences was observed (p = 0.29); however, statistically significant difference was noted between the combination of three preparation methods and any single specimen preparation methods (p = 0.002). The diagnostic sensitivity of histopathology combined with TSC and histopathology combined with LBC were 96.5 and 94.8%, the specificity was 95.0% and 97.5%, the PPV was 98.8% and 99.4%, the NPV was 86.4% and 81.2%, the diagnostic accuracy was 96.2% and 95.3%, respectively; The sensitivity and accuracy of above methods were higher than that of single specimen preparation, but lower than that of combination of three preparation methods. Conclusion: When EBUS-TBNA is used for the diagnosis and staging of lung cancer, histopathology combined with TSC can achieve enough diagnostic efficiency and better cost-effectiveness. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Anaplastic large cell lymphoma (ALCL), a unique non-Hodgkin lymphoma (NHL), is a CD30-positive neoplasm of T-cell lineage. Its distinctive yet variable cytomorphology makes diagnosing fine needle aspiration cytology (FNAC) challenging. This study was undertaken to study the cytomorphology and the utility of immunocytochemical (ICC) stains on cytology in ALCL and to discuss their morphological differential diagnosis. Materials and Methods: The present study was conducted in the Department of Pathology of a tertiary care center. A retrospective review was done from January 2017 to July 2022, and all histopathologically and immunohistochemically (IHC) diagnosed cases of ALCL were taken and correlated with the cytological diagnosis. Results: Twenty-one cases of histopathology examination and IHC-proven cases of ALCL were retrieved from the departmental archives and reviewed. The ages ranged from 3 to 80 years (median age 28 years). Commonly noted cytomorphologic features included singly dispersed large pleomorphic cells, hallmark cells, and Reed-Sternberg-like cells. CD15, CD30, epithelial membrane antigen, and anaplastic lymphoma kinase-1 were some of the ICC stains used in this study. All 21 cases had cytology correlation. Fourteen cases had concordant cyto-histological correlation. Seven cases of histopathologically proven ALCL were reported as Hodgkin lymphoma (HL) in three, ALCL/anaplastic diffuse large B-cell lymphoma, HL/ALCL, poorly differentiated carcinoma, and NHL in one case each on cytology. Conclusion: ALCL has a reasonably distinct cytomorphologic appearance and ICC staining pattern, and a careful interpretation of both helps arrive at a reliable FNAC diagnosis. [ABSTRACT FROM AUTHOR]

Background: The role played by cytology in primary diagnosis is undeniable. With improved management protocols and targeted therapy, the need for accurate diagnosis has become mandatory. Immunochemistry and molecular techniques are increasingly being used on limited tissue samples. Aims: This study was conducted to find out the impact of immunocytochemistry (ICC) on cytology material in cytology practice. Materials and Methods: Immunochemistry was done on alcohol-fixed smears and cell-block preparations. It was done with i6000 BioGenex autostainer using BioGenex reagents. Results: A total of 148 cases occurring over a period of 3 years (September 2010-June 2013) were analyzed. Staining was done on cytology smears in 77 cases and on cell-block sections in 71 cases. ICC helped in diagnosis in 8 cases, confirmed the diagnosis in 26 cases, helped in subtyping in 60 cases, and helped in prognostication in 6 cases. ICC has altered the diagnosis in two cases. It was noncontributory in 43 cases, and the material was inadequate in three cases. Conclusion: In 102 cases (69%), ICC proved to be a useful adjunct in the diagnosis and prognostication; hence, its use is recommended in practice to aid in cytology services. [ABSTRACT FROM AUTHOR]

Fine needle aspiration (FNA) is widely used in the examination of head and neck lesions and has been considered an important diagnostic tool in the evaluation of thyroid and parathyroid nodules. Thyroid nodules are frequent findings in the general population, although 90-95% of these nodules are benign. FNA plays a crucial role to determine which nodules are at greatest risk of malignancy and which nodules are benign and do not require surgical intervention. In the case of the parathyroid glands, the US-guided parathyroid FNA is an effective method for the identification of intrathyroidal or ectopic parathyroid tissue, and distinguish it from thyroid and other surrounding anatomical structures. In addition, the use of FNA can significantly increase the accuracy of parathyroid gland location in patients with hyperparathyroidism who are candidates for surgical treatment in cases where imaging techniques fail to identify the parathyroid. Widespread US guidance in FNA procedures, constellation of clearly defined, reproducible key diagnostic cytopathological criteria for individual lesions in conjunction with images and clinical data as well as evolutions in FNA techniques and ancillary tests facilitate further diagnostic and clinical management. This paper aims to review the current state of the art in cytological evaluation of thyroid and parathyroid lesions. [ABSTRACT FROM AUTHOR]

Cell blocks (CBs) are paraffin-embedded versions of cytology specimens. These versions are contrasted with tissues made from surgical pathology specimens of formalin-fixed paraffin-embedded (FFPE) tissue. CBs enable various elective ancillary studies of a range of specimens. These studies include the potential to perform molecular tests with the enhanced cytopathological interpretation. CBs are increasingly reported in cytology specimens. These enhanced role of CBs incorporates additives with new markers for immunohistochemistry (IHC), including the multicolored approach to IHC, and the subtractive coordinate immunoreactivity pattern. Even when archived material is retrospectively retrieved, CBs are a major tissue source for many supplementary studies. The CBs have been qualitatively and quantitatively improved. CBs are significant since they have increased molecular markers standardized on FFPE tissue. High-quality CBs can serve as useful additions to cytological smear preparations and touch imprint cytology. Most cytological specimens, such as fine-needle aspirations, cavitary effusion, washings, brushings, and gynecological and non-gynecological liquid specimens, may be used to produce CBs. This review deals with the CB-making process and discusses various historical limitations with an emphasis on recent advances. [ABSTRACT FROM AUTHOR]

Background: Several studies have investigated the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic lesions, but they have included only limited patient populations. This study aimed to clarify the diagnostic accuracy of EUS-FNA in a large number of pancreatic lesions, and to describe the factors that influence it. Methods: From March 1997 to May 2010, 944 consecutive patients who had undergone EUS-FNA for pancreatic solid lesions were evaluated retrospectively. Factors affecting EUS-FNA accuracy were then analyzed. Results: A total of 996 solid pancreatic lesions were sampled by EUS-FNA. The overall sampling adequacy and diagnostic accuracy of these lesions were 99.3 % (989/996) and 91.8 % (918/996), respectively. The sensitivity and specificity for differentiating malignant from benign lesions were 91.5 % (793/867) and 97.7 % (126/129), respectively. The diagnostic performance was significantly higher when both cytological and cell-block examinations were carried out than with only cytological examination. In multivariate analysis, final diagnosis, location of lesion, lesion size, availability of on-site cytopathological evaluation, and experience of EUS-FNA procedure were independent factors affecting the accuracy of EUS-FNA. On-site cytopathological evaluation and lesion size were found to be the most weighted factors affecting diagnostic accuracy. Conclusions: EUS-FNA for pancreatic solid lesions yielded a high accuracy and low complication rate. Both cytological and cell-block preparations and on-site cytopathological evaluation contributed to improve the accuracy. The diagnostic ability of EUS-FNA was less for smaller lesions, and repeated procedures may be needed if malignancy is suspected. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the utility of immunohistochemical staining of cytokeratin 19 (CK19), HBME-1, and galectin-3 in cell block preparations of fine-needle aspiration cytology specimens as ancillary techniques for the differential diagnosis of papillary thyroid carcinoma. Materials and methods: Immunohistochemical detection of CK19, HBME-1, and galectin-3 was completed in 45 thyroid aspiration cytology specimens fixed in paraffin-embedded blocks consisting of the following cytologic diagnoses: 1) 16 cases of papillary carcinoma, 2) 16 cases suspicious for papillary carcinoma, and 3) 13 cases involving nonneoplastic lesions. Results: The follicular cells in the cytologically unequivocal papillary carcinoma diagnosis group expressed diffusely positive (+++) CK19, HBME-1, and galectin-3 in 12/16, 12/16, and 14/16 cases, respectively. Diagnosis of papillary carcinoma was confirmed during follow-up in all 16 cases. Positive staining for CK19 or galectin-3 was not detected among the 13 cases of cytologic and histopathologic diagnosis of nonneoplastic lesions. CK19 (9/12) and galectin-3 (9/12) were diffusely positive (+++) in the majority of papillary carcinoma samples with initial cytologic diagnostics indicating suspicion of papillary carcinoma. Conclusion: The CK19, HBME-1, and galectin-3 immunostaining panel is a novel and informative adjunct for the diagnosis of papillary thyroid carcinoma from cell block material. Diffuse immunostaining for CK19 and galectin-3 contributes to improvements in accurate diagnosis of malignancy in cases of suspected papillary carcinoma. [ABSTRACT FROM AUTHOR]

Context.--Immunohistochemical staining for cytokeratin 19 (CK-19) is a useful ancillary technique for diagnosing papillary thyroid carcinoma (papillary carcinoma) in histologic specimens. Although similar results have been obtained on aspirate smears, to our knowledge the utility of CK-19 immunolocalization in cell block preparations as an adjunct to fine-needle aspiration diagnosis of papillary carcinoma has not been examined. Objective.--The purpose of this study was to determine whether CK-19 immunostaining of cell block preparations of thyroid aspirates is a useful ancillary technique for diagnosing papillary carcinoma. Materials and Methods.--Using a monoclonal antibody to CK-19 and a standard avidin-biotin complex technique, immunostaining was performed on paraffin-embedded cell blocks of 57 cases with the following cytologic diagnoses: (a) papillary carcinoma (20 cases); (b) atypical cytology, cannot exclude papillary carcinoma (19 cases); and (c) nonneoplastic thyroid (18 cases). The staining reaction in each case was graded on the basis of percentage of epithelial cells stained (1+, <10%; 2+, <10%-50%; 31, >50). Tissue follow-up was available in all cases. Results.--Nineteen (95%) of 20 cases with an unequivocal diagnosis of papillary carcinoma were positive for CK-19 (3+). Tissue follow-up confirmed papillary carcinoma in all 20 cases. Of the 19 cases with a diagnosis of atypical cytology, cannot exclude papillary carcinoma, 7 (37%) cases displayed 3+ immunostaining and subsequent excision confirmed papillary carcinoma in all 7 cases. The remaining 12 cases with 1+ immunostaining included surgically confirmed goiter (6 cases), adenoma (2 cases), lymphocytic thyroiditis (3 cases), and papillary carcinoma (1 case). The follicular cells in 18 cases with a cytologic diagnosis of nonneoplastic thyroid showed 1+ immunostaining. Histologic follow-up of these cases confirmed the non-neoplastic cytologic diagnoses. Conclusions... [ABSTRACT FROM AUTHOR]

The aim of this study was to provide the first systematic description of human placental cytology appearances and to investigate syncytiotrophoblast nuclear organisation patterns using cytology techniques. Term placentas from normal pregnancies were sampled using fine-needle aspiration (FNA) and direct scrapes. Standard histological examination was also performed to exclude pathological changes in the placentas being studied. Both Papanicolaou-stained cytospin preparations and air-dried Giemsa slides from FNA provided high-quality material for cytological assessment with good cellularity. Among the key features of the cytology preparations were villous "microbiopsies" that allowed for the three-dimensional appreciation of villous branching patterns. Cytological appearances, including nuclear characteristics of villous cytotrophoblast and syncytiotrophoblast, were also well demonstrated. In microbiopsies and detached villous trophoblast sheets, complex patterns of syncytiotrophoblast nuclear organisation, not previously described cytologically, were observed, including irregular spacing of nuclei, syncytioplasm windows and linear nuclear arrangements. This study showed that placental cytology (a) provides technically excellent material for cytological evaluation, (b) confirms the presence of complex nuclear organisational patterns in the syncytiotrophoblast by eliminating the possibility of tangential sectioning artefact, (c) provides superior nuclear detail over standard histological sections and (d) may be an untapped research resource for the investigation of normal and pathological processes because of its ability to look at the placenta in a novel way and through its potential for both ex vivo and in vivo placental sampling. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound (US) has become an integral tool for chest assessment as it provides crucial information on pleural pathologies and peripherally located lung lesions. Aim: To assess the diagnostic yield of combined fine needle aspiration (FNAB) and core needle biopsy (CNB) versus each technique ultrasound-guided in peripheral lung and pleural lesions. Methodology: The present study enrolled 30 patients presenting to Alexandria Main University Hospital, with CT scans showing undiagnosed peripheral lung or parietal pleural lesions with or without effusion. A full ultrasound chest assessment was done covering 12 regions. Assessment of the lesion of interest, vascularity was assessed via color Doppler, locating the safest entry site. Real-time US-guided FNAB was done using a spinal needle 22 gauge. Then real-time US-guided CNB using 18 gauge Trucut needle in the same setting. Duration and complications of each procedure were reported. In FNAB, three smears were prepared, fixed in alcohol, and stained with hematoxylin and eosin stain. The remaining sample was fixed in formalin and centrifuged to prepare cell blocks. On the other hand, Trucut needle biopsy specimens were fixed in formalin and processed as paraffin-embedded blocks. Immunohistochemical staining was done. The results were classified into four categories (inadequate, negative, suspicious, and positive for malignancy. Results: The diagnostic yield of combined techniques was 96.7% versus 63.3% using FNAB and 96.7% using CNB. The sensitivity of FNAB was 86% while CNB was 95%. The specificity and positive predictive value of both methods were 100%. The negative predictive value of FNAB was 57% versus 80% for CNB in peripheral lung lesions. Duration of US-guided CNB was statistically significantly longer than that of FNAB in both peripheral lung and pleural lesions. No major complications were reported using either technique. Conclusion: Combined FNAB and CNB were not superior to CNB alone regarding diagnostic yield but were superior to FNAB. Ultrasound-guided CNB has a superior diagnostic yield over FNAB, with no statistically significant difference regarding associated complications, both techniques are safe. FNAB provided sufficient material for ancillary molecular testing. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The on-site cytopathology advance report (OSCAR) procedure is a highly reliable diagnostic approach for breast masses, provided that it is performed by interventional cytopathologists in the multidisciplinary setting of a one-stop clinic (OSC). Besides dramatically limiting the rate of unsatisfactory specimens and diagnostic turnaround time, OSCAR is a highly efficient first-line approach. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19–98.31); specificity (Sp) = 94.98% (92.94–96.56); positive predictive value (PPV) = 96.80% (95.48–97.81); negative predictive value (NPV) = 95.91% (94.02–97.33); positive likelihood ratio (LR+) = 19.39 (13.75–27.32); negative predictive ratio (LR−) = 0.03 (0.02–0.04), and; accuracy = 96.45% (95.42–97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76–3827); 2.69 (1.8–3.96); 0.03 (0.02–0.04); and 0.37 (0.2–0.66), respectively. Fine-needle aspiration (FNA) cytology has been widely used for the diagnosis of breast cancer lesions with the objective of differentiating benign from malignant masses. However, the occurrence of unsatisfactory samples and false-negative rates remains a matter of concern. Major improvements have been made thanks to the implementation of rapid on-site evaluation (ROSE) in multidisciplinary and integrated medical settings such as one-stop clinics (OSCs). In these settings, clinical and radiological examinations are combined with a morphological study performed by interventional pathologists. The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The clinicoradiological, cytomorphological, and histological characteristics of all consecutive patients were retrieved from the hospital computerized medical records prospectively registered in the central information system. Histopathological analysis and ultrasound (US) follow-up (FU) were the reference diagnostic tests of the study design. In brief, we carried out either a histopathological verification or an 18-month US evaluation when a benign cytology was concordant with the components of the triple test. Overall, histology was available for 1138 masses, whereas 491 masses were analyzed at the 18-month US-FU. FNA specimens were morphologically nondiagnostic in 3.1%, false negatives were observed in 1.5%, and there was only one false positive (0.06%). The breast cancer prevalence was 62%. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19–98.31); specificity (Sp) = 94.98% (92.94–96.56); positive predictive value (PPV) = 96.80% (95.48–97.81); negative predictive value (NPV) = 95.91% (94.02–97.33); positive likelihood ratio (LR+) = 19.39 (13.75–27.32); negative predictive ratio (LR−) = 0.03 (0.02–0.04), and; accuracy = 96.45% (95.42–97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76–3827); 2.69 (1.8–3.96); 0.03 (0.02–0.04); and 0.37 (0.2–0.66), respectively. In conclusion, our study demonstrates that the OSCAR procedure is a highly reliable diagnostic approach and a perfect test to select patients requiring core-needle biopsy (CNB) when performed by interventional cytopathologists in a multidisciplinary and integrated OSC setting. Besides drastically limiting the rate of nondiagnostic specimens and diagnostic turn-around time, OSCAR is an efficient and powerful first-line diagnostic approach for patient-centered care. [ABSTRACT FROM AUTHOR]

Malignant soft tissue tumours (MSTT), unlike the benign counterpart, is far less common in clinical practice. They also have complex light microscopic features with heterogeneous compositions, posing diagnostic challenge, especially in fine needle aspiration cytology (FNA) sample. This study presents a series of MSTT cases diagnosed in cytology, Eastern Health, St John's, Newfoundland between 2014 and 2016. FNA material collected by image guided aspiration technique, was processed using liquid based (SurePath) cytology method and cell block preparations. 8 cases of MSTT presented are Ewing Sarcoma, Proximal Epithelioid Sarcoma, Chondrosarcoma, Epithelioid Angiosarcoma, Metastatic Uterine Carcinosarcoma, Undifferentiated spindle malignant tumour and Undifferentiated pleomorphic sarcomas with rhabdomyosarcoma component (UPSRS). Concurrent or subsequent core biopsy and/or resected material with relevant immunostains were correlated with cytological diagnosis. There is 100% concordance between FNA diagnosis and corresponding core biopsies in all presented cases. 5/8 cases have concordant diagnoses of FNA, core biopsy and resected material. Resected specimens are not available for one case of Ewing sarcoma and that of Angiosarcoma where patients only received palliative radiotherapy. In one case, a diagnosis of Pleomorphic Rhabdomyosarcoma was made by FNA and the correlated core biopsy whereas URSRS was made on the final resected specimen. This discrepancy is attributed to small sample size in FNA and core biopsy leading to equivocal interpretation of certain immunostains. We demonstrate that Image guided FNA is a useful tool for diagnosing soft tissue sarcoma. Accurate clinical, radiological information, adequate sampling for routine morphologic examination and ancillary tests are keys to the success. [ABSTRACT FROM AUTHOR]

Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections. [ABSTRACT FROM AUTHOR]

Thyroid nodules are quite common, and the determination of a nodule of concern is complex, involving serum testing, radiology and, in some cases, pathological evaluation. For those nodules that raise clinical concern of neoplasia, fine needle aspiration biopsy is the gold standard for evaluation; however, in up to 30% of cases, results are indeterminate for malignancy, and further testing is needed. Advances in molecular testing have shown it to be of benefit for both diagnostic and prognostic purposes, and its use has become an integral part of thyroid cancer management in the United States and in several global nations. After The Cancer Genome Atlas (TCGA) consortium published its molecular landscape of papillary thyroid carcinoma (PTC) and reduced the "black matter" in PTC from 25% to 3.5%, further work ensued to clarify the remaining fraction not neatly attributed to the BRAFV600E-like or RAS-like phenotypes of the TCGA. Over the past decade, commercial molecular platforms have been refined as data accrues, and they increasingly cover most genetic variants of thyroid carcinomas. Molecular reporting focuses on the nodule tested, including related clinical information for that nodule (size of nodule, Bethesda category, etc.). This results in a comprehensive report to physicians that may also include patient-directed, clear language that facilitates conversations about nodule management. In cases of advanced or recurrent disease, molecular testing may become essential for devising an individual therapeutic plan. In this review, we focus on the evolution of integrated molecular testing in thyroid nodules, and how our understanding of tumor genetics, combined with histopathology, is driving the next generation of rational patient management, particularly in the context of emerging small, targetable therapeutics. [ABSTRACT FROM AUTHOR]

Background. Currently, core needle biopsy is replacing fine needle aspiration biopsy (FNAB) for pathological diagnosis of breast lesions. However, FNAB is extensively used for diagnosing breast lesions, including screened lesions, at our hospital. Furthermore, direct smears as well as cell blocks (CBs) from the FNAB specimens have been used. To prepare the CBs, hematoxylin and eosin (HE) staining as well as immunostaining with a mixture of p63 and cytokeratin 5/6 antibodies are routinely used. Therefore, in the current study, we sought to assess the efficacy of diagnosing breast lesions using conventional smears and CB immunostaining. Methods. Breast FNAB reports of direct smears and CBs from The Nagoya Medical Center between December 2014 and March 2020, were reviewed. The efficiency of diagnoses made with direct smears and CBs were compared using histology-based diagnoses. Results. Among the 169 histologically confirmed malignant lesions, 12 lesions that were reported as unsatisfactory, benign, or atypia probably benign, using direct smears were diagnosed as malignant using CB. Histologically, these lesions were diagnosed as carcinomas with mild atypia or papillary structures. Ten (83.3%) of the twelve lesions were non-palpable and only detected upon imaging. Conclusion. Combined use of CB and conventional smear leads to the detection of more malignant lesions in breast FNAB specimens, particularly in lesions detected by imaging alone. Immunostaining of CB sections using a mixture of p63 and cytokeratin 5/6 antibodies provides more information than HE staining alone. Breast FNAB with CB preparation can be successfully applied for evaluation of breast lesions in developed countries. [ABSTRACT FROM AUTHOR]

The article offers information on a study on the development of cost‑effective method for cell block preparation for tumor representation. Topics discussed include role of cell block preparation in modern diagnostic approach of lung carcinoma, developing effective method for cell block preparation from fine needle aspiration (FNA) material of lung lesions; and avoiding the need of biopsy.

Background: Thyroid nodules are the most common thyroid disease and its incidence has been rising throughout the world. Thus, this study aimed to assess the patterns of fine needle aspiration cytology-diagnosed thyroid nodules among clinically suspected patients. Methods: A prospective cross-sectional study was conducted from April 2021 to March 2022 using 424 study participants who were referred to undergo fine needle aspiration cytology examination and were consecutively included. Moreover, two FNAC smears were prepared and stained using Wright and Giemsa staining solutions and then examined by an experienced licensed pathologist. Multivariate logistic regression was used to determine the association of socio-demographic and clinical variables with nodules. P-value < 0.05 was considered to be statistically significant. Results: The overall magnitude of benign and malignant nodules was 60.4% and 16.5% respectively. Moreover, the magnitude of atypical of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) and follicular neoplasm or suspicious of follicular neoplasm (FN/SFN) was 3.54% and 1.42% respectively. The magnitude of malignant thyroid nodules was 5.9% for malignant secondary adenocarcinoma, 3.5% for papillary thyroid carcinoma, 2.6% for Non-Hodgkin lymphoma, 2.4% for medullary thyroid carcinoma, 1.4% of an undifferentiated malignant thyroid tumor and 0.7% of Hodgkin lymphoma respectively. Multivariate logistic regression showed that age categories between 0 and 15 years and between 16 and 30 years, and nodule size > 2.5cm were significantly associated with malignant thyroid nodules. Conclusion: The magnitude of benign and malignant tumors was 60.4% and 16.5% respectively. Being younger and having nodule size > 2.5cm were significantly associated with malignant thyroid nodules. Therefore, fine needle aspiration cytology examination has a crucial role in the diagnosis and management of benign and malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Objectives: The diagnosis of lymphoma on cytologic preparations and core needle biopsies (CNBs) is often challenging due to limited material that precludes additional ancillary testing for accurate classification. We describe our institutional experience with patients who ultimately received a diagnosis of lymphoma using cytologic preparations and CNB material along with additional ancillary testing. Material and Methods: All patients whose cytology material (fluids, cytologic smears, and cell block) and CNB resulted in a diagnosis of lymphoma, atypical lymphoid population, or suspicious for lymphoma were retrieved. Diagnoses of lymphoma followed the established nomenclatures of the World Health Organization (WHO). For all cases, the ancillary test profiles were captured and summarized. Results: Of 389 cases identified, 17 (4.4%) were diagnosed as atypical lymphoid cells and 31 (7.9%) were suspicious for lymphoma resulting in an indeterminate rate of 12.3%. The rest of the malignant cases (341; 87.7%) were classified using 2017 WHO lymphoid classification system. Six low-grade and 26 high-grade B-cell lymphomas were not further classified because of limited tissue. B-cell lymphomas were the largest category (73.0%): Primarily diffuse large B-cell lymphoma (21.4%), followed by follicular lymphoma (17.5%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (10.9%). A total of 140 cases (36.0%) had flow cytometry results, but 30 specimens (21.4%) were insufficient. Cytogenetic and molecular studies were performed for 78 cases (20.0%). Conclusion: Full classification of lymphomas is possible with combined cytologic preparations and CNB material and it is an attractive first sampling modality in the diagnostic process for this disease group. [ABSTRACT FROM AUTHOR]

Breast carcinomas are known to metastasize to various organs of the human body. Fine needle aspiration cytology or exfoliative cytology often are the standard method for diagnosis at these metastatic sites due to ease of procurement of diagnostic material, accessibility, less complications, high sensitivity, and specificity of diagnosis and evaluation of biomarker status needed to guide future management. This comprehensive review article discusses in detail metastatic patterns, cytomorphology of metastatic breast cancer at different body sites, immunohistochemistry needed for diagnosis of breast carcinoma, sensitivity and specificity of diagnosis and breast biomarker assays in the cytology material. [ABSTRACT FROM AUTHOR]

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Thyroid nodules are a common worldwide health problem and a diagnostic challenge for clinicians and cytopathologists. Follicular growth pattern constitutes the majority of thyroid lesions. Thyroid nodules can be neoplastic or non-neoplastic, and neoplastic nodules can be classified as benign, malignant, or gray zone. Gray zone lesions include different benign and malignant entities that might be resulted in unnecessary thyroidectomies with risk of morbidity and higher health care costs. Depending on the cellularity, most cases might fall into the follicular neoplasia (FN)/ suspicious for FN (SFN) category or follicular lesion of undetermined significance (FLUS) in The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Pathologists must be aware of the relationship between this diagnostic category and follow-up patient management and avoid over-diagnosing by mastering the diagnostic criteria. [ABSTRACT FROM AUTHOR]

Objectives: Liquid-based cytology (LBC) is becoming a useful method in evaluating both gynecological and nongynecological preparations. Many studies have been conducted these days to see the quality of LBC in diagnosing thyroid lesions and its role is yet to be standardized. This study has been done to pick the cytomorphological features of thyroid lesions on LBC and to compare them with the conventional cytology of these lesions. The objective of the study is to evaluate the efficacy of thyroid fine-needle aspiration cytology processed by LBC as compared to conventional smears. Material and Methods: A prospective study has been done on 53 cases of thyroid lesions using standard conventional and LBC techniques. Results: In most of the cases, the cytological features are similar in conventional cytology smears and LBC, but the colloid film and the lymphocytic component show a clear picture on direct smears, whereas nuclear and cytoplasmic details are better evaluated in LBC slides. The preservative solution used in LBC could be efficiently used for the application of immunocytochemical and molecular techniques. Conclusion: LBC does not represent as a valid alternative to conventional cytology but it can be considered as a diagnostic utility process especially due to the possibility of applying additional techniques which enhance the efficacy of the cytological diagnosis of thyroid lesions. [ABSTRACT FROM AUTHOR]

Background: Papillary structures are frequently encountered in metastatic carcinomas from various organs and tumours of different histotypes. This study aims to investigate the predictive value of fine needle aspiration cytology (FNAC), immunohistochemistry (IHC) and the clinical parameters which can be examined in the assessment of the primary sites of metastatic carcinomas with papillary architecture. Methods: FNAC samples of metastatic carcinomas with papillary architecture were evaluated for overall cellularity, epithelial cohesion, background features, papillary architecture, cytology and IHC. The corresponding clinical information was also reviewed. Results: A total of 130 cases were included. The most common primary sites were thyroid (38.5%), lung (30.8%) and gynecological organs (22.3%); the others were pancreaticobiliary, urothelial, colorectal, and esophageal. Age (P = 0.039), biopsy site (P < 0.001) and laterality (P = 0.006) correlated with primary site. Papillary structures were confirmed on biopsy/excision of most cases (n = 85/87, 97.7%). Thyroid primaries exhibited broad papillary stalks, thin lining epithelium, fewer epithelial polymorphs, and the presence of background giant cells and histiocytes (P = 0.021‐ < 0.001). Low‐grade cytological features, nuclear grooves and inclusions (P < 0.001) were seen in thyroid primaries. High‐grade features (P < 0.001‐0.49), multinucleated tumour cells, apoptotic bodies and mitoses (P < 0.001‐0.49) were more common in lung/gynecological primaries. Multivariate analysis identified nuclear/cytoplasmic ratio, chromatin character, the presence of nuclear grooves and mitosis as independent features (P = 0.001‐0.024). TTF1/TGB/PAX8 panel results showed good agreement with the cytological assessment and site of primary. Conclusion: Papillary structures and cytological features are reproducible in FNAC assessment of metastases and their corresponding primary sites. Cytological features, IHC and clinical information are invaluable in determining the primary site. [ABSTRACT FROM AUTHOR]

Giant cell tumour (GCT), also known as osteoclastoma, is an osteolytic tumour. It involves the epiphyseal and metaphyseal regions of long bones in adults. On rare occasions, these may occur in paediatric patients, and may involve uncommon locations such as the sternum, pelvis and, particularly infrequently, rib bones. We present a rare case of GCT in the rib of a child, diagnosed on fine needle aspiration. [ABSTRACT FROM AUTHOR]

Background: Solitary fibrous tumour (SFT) is a unique mesenchymal neoplasm with classic features on histology and is characterised by the NAB2‐STAT6 gene fusion. There are rare reports of SFTs with pancreatic involvement and only two cases in the literature reporting its features by preoperative fine needle aspiration (FNA). Herein, we characterise the cytomorphological features of four SFTs involving the pancreas by FNA to establish a preoperative diagnostic approach. Methods: The anatomic pathology archives of two academic medical centres were searched to identify patients with a pancreatic FNA cytology specimen and a confirmed diagnosis of SFT by surgical resection. The clinical history, pathological diagnosis, cytomorphological findings, and results of immunohistochemistry (IHC) were reviewed. Results: Four SFTs were identified from four patients with a median age of 59 years. The morphological features were variable but most frequently showed a bland spindled‐to‐epithelioid proliferation in fragments and single cells with small, oval, elongated, and hypochromatic nuclei in a haphazard arrangement with or without dense collagen. One tumour presented with a concurrent metastasis and showed a pure epithelioid component with necrosis and enlarged, hyperchromatic nuclei with conspicuous nucleoli and scattered mitoses. IHC was necessary for all diagnoses which were confirmed by surgical resection. Conclusions: SFTs with pancreatic involvement are rare, and non‐specific features and tumour heterogeneity can pose a diagnostic challenge on FNA; however, IHC can be used to make a definitive diagnosis. As a result, FNA is a simple, safe, cost‐effective, and accurate approach that can be used to diagnose SFT in the pancreas. [ABSTRACT FROM AUTHOR]

Cytological specimens, which are obtained by minimally invasive methods, are an excellent source of diagnostic material. Sometimes they are the only material available for diagnosis as well as for prognostic/predictive markers. When cytomorphology is not straightforward, ancillary tests may be required for a definitive diagnosis to guide clinical management. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology is equivocal, to differentiate entities with overlapping morphological features, and to determine the cell lineage and the site of origin of a metastatic neoplasm. Numerous immunomarkers are available, and some are expressed in multiple neoplasms. To rule out entities within a differential diagnosis, the use of more than one marker, sometimes panels, is necessary. ICC panels for diagnostic purposes should be customised based on the clinical context and cytomorphology, and the markers should be used judiciously to preserve material for additional tests for targeted therapies in the appropriate setting. This review offers a practical guide for the use of ICC for diagnostic cytopathology, covering the most commonly encountered non‐hematolymphoid diagnostic scenarios in various body sites. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology reaches its limits. Numerous immunomarkers are available, and some are expressed in multiple neoplasms therefore use of more than one marker or sometimes panels are necessary. ICC markers/panels for diagnostic purposes should be customized based on the clinical context and cytomorphology. [ABSTRACT FROM AUTHOR]

Objectives: The practice of cytopathology has evolved over the past decade with a growing need for doing more with less tissue. Changes in clinical practice guidelines and evolving needs in tissue acquisition for diagnosis and treatment have affected various areas of cytopathology in different ways. In this study, we evaluated the changing trends in cytopathological practice at our institution over the past decade. Methods: We performed a retrospective review of our institutional database for cytopathology cases from calendar years 2009 (n = 28038) and 2019 (n = 31386) to evaluate the changing trends in practice. Results: The overall number of exfoliative cases decreased 10% over the past decade, primarily due to a 64% decrease in gynaecological Pap testing. However, the volume of serous body cavity and cerebrospinal fluids increased 125% and 44%, respectively. The overall volume of fine needle aspiration (FNA) cases increased 38% from 2009 to 2019. The number of FNA cases increased across most body sites, driven primarily by a 180% increase in endobronchial ultrasound‐guided transbronchial needle aspiration cases. In contrast, breast FNA volume decreased 43%. Ancillary studies increased substantially over the past decade, including immunostains (476%) and molecular testing (250%). Conclusions: The trends in our cytopathological practice showed an increased volume of cases, especially in non‐gynaecological specimens. As expected, the number of FNA cases used for immunostains and molecular testing increased substantially, indicating an upward trend in ancillary studies in cytopathological practice. The trends in our cytopathological practice showed an increased volume of cases, especially in non‐gynaecological specimens. The number of FNA cases used for immunostains and molecular testing increased substantially, indicating an upward trend in ancillary studies in cytopathological practice. [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound (EBUS)-guided fine-needle aspiration cytology (FNAC) is recommended for diagnosing bronchial neoplasms and evaluating mediastinal lymph nodes. However, it may not be possible to subtype or definitely categorize many bronchial neoplasms on FNAC smears alone. Obtaining adequate diagnostic material is often a problem. In such cases, cell blocks made from FNAC material may serve as a useful adjunct. Aim: To study the value and limitations of cell blocks in adding diagnostic information to EBUS guided FNAC smears. Material and Methods: One hundred and eighty-five cases of EBUS guided FNAC having concomitant cell blocks were reviewed. The cases were evaluated for the extent of adequacy, of definite benign/malignant categorization and of definite subtyping in malignant tumors in these cases. The proportion of cases in which cell blocks added information to FNAC smears alone for the above parameters were calculated. Results: Cell blocks provided additional information in 31 out of 185 cases. Cell blocks were necessary for subtyping 24/59 malignant tumors, definite categorization into benign and malignant in 10/140 adequate samples, and increasing adequacy in 6/185 total samples. A total of 45 samples were inadequate in spite of adding information from cell blocks to smears. Conclusion: Cell blocks added clinically significant information to EBUS guided FNAC and should be used routinely. To make it more useful, alternative methods of cell block preparation (including proprietary methods) may be evaluated. [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) allows precise real-time sampling of intrathoracic lesions and is a minimally invasive, safe, and cost effective technique with high diagnostic yield. The aim of the current study is to evaluate utility of EBUS-TBNA cytology with cellblocks (CBs) in the diagnosis and subtyping of the intrathoracic lesions. Materials and Methods: It was a prospective study conducted from October 2015 to October 2017. We received 233 cases of intrathoracic lesions for EBUS-TBNA, of which CB was made in 217 cases. A flexible endobronchial ultrasound scope was used to sample the lesions. Results: There were 89 females and 128 males amongst the total 217 patients (age range: 14–85 years, mean age: 48.35 years). The smears from EBUS-TBNA contained adequate material in 137/144 [95.1%] non-neoplastic cases and 34/36 [94.4%] of the neoplastic cases, whereas the CBs provided adequate material in 94/144 [65.3%] non-neoplastic cases and 37/40 [92.5%] neoplastic cases. The CB helped subtyping the malignancy in 19 cases and of these immunohistochemistry (IHC) was done on the CB in 15 cases. The biopsy was non-diagnostic in 17/36 cases of granulomatous pathology and 4/18 neoplastic cases diagnosed with EBUS-TBNA.3. Conclusions: EBUS-TBNA provides rapid diagnosis through cytology and the material recovered in the same setting for the CB preparation can be used for immunohistochemical analysis and it may at times provide the diagnosis in cases where the smears are non-diagnostic. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the feasibility, accuracy, and safety of Programmed Death-1/ Programmed Death-Ligand 1 (PD-1/ PD-L1) expression quantification in cytology cell-block samples obtained through transthoracic CT-guided fine-needle aspiration cytology (FNAC) from the interventional radiologist's perspective.Methods: We performed a consecutive unselected series of 361 CT-guided biopsies of pulmonary nodules and masses which came to our observation from June 2017 to October 2018. For each case, exhaustive clinical, morphologic, molecular and tomographic data were available. All the material obtained was fixed in formalin to obtain a cell-block for the pathologist, who performed immunohistochemical analysis to detect PD-L1 expression levels on each sample.Results: Of all the analyzed samples, 93.6% (338/361) were defined to be diagnostic, including neoplastic (72%, 260/361) and non-neoplastic lesions (21.6%, 78/361); only 6.4% (23/361) of them resulted in nondiagnostic specimens. Non-small cell lung cancer (NSCLC) accounted for 73.8% of neoplastic lesions (192/260): most of them were adenocarcinoma (83%, 160/192), followed by squamous carcinoma (14%, 27/192) and poorly differentiated carcinoma (3%, 5/192). In 96% of NSCLC (184/192), the diagnosis was reached either in the absence of complications or with early minor complications. PD-L1 expression was evaluated in all 192 NSCLC cytology specimens: 180 immunostainings were found to be adequate for PD-L1 testing. In 76% of cases, PD-L1 expression level was lower than 50%.Conclusion: The findings of our study indicate that PD-L1 quantification using a cell-block approach on CT-guided FNAC is a feasible and safe technique and should be taken into account alongside with core biopsy approach, especially in case of advanced disease and/or fragile and older patients. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative diagnostic imaging of pancreatic solid pseudopapillary neoplasms (SPNs) is challenging. A few studies have investigated the role of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) for the diagnosis of SPN. We investigated the diagnostic yield of cell‐blocks and immunohistochemistry (IHC) for SPN using EUS‐FNA specimens without cytological evaluation. Patients and methods: We retrospectively analysed the histopathology records of patients with suspected SPN, who underwent EUS‐FNA biopsy between January 1997 and January 2020. Diagnosis based on cell‐blocks (haematoxylin‐eosin staining with complementary IHC) was compared with the definitive surgical diagnosis. Results: This study included 25 patients (24 were women). Patients' mean age was 33.7 years (range 12‐78 years). The most common symptom was abdominal pain. SPN was an incidental finding in 52% of the patients. The mean lesion size was 4.3 cm (range 1.2‐11.4 cm), and the most common endosonographic features included solid‐cystic (56%) or solid (40%) tumours. Final diagnoses included SPNs (n = 23) and non‐functioning neuroendocrine tumours (n = 2). The overall accuracy of EUS‐FNA was 80%. Tumour cells showed immunopositivity for β‐catenin, CD10, CD99 and progesterone receptor (PR) in 93.7%, 87.5%, 83.3% and 66.6% of patients, respectively. No SPN showed immunopositivity for chromogranin A. Conclusions: Intention‐to‐diagnose analysis showed that the diagnostic accuracy of EUS‐FNA for SPNs using cell blocks and complementary IHC without cytological evaluation was fairly good. Evaluation of β‐catenin, CD 10, CD99 and PR expression must be included in the IHC panel for diagnostic confirmation of SPNs using EUS‐FNA biopsy specimens. The diagnosis of solid pseudopapillary neoplasm of the pancreas is challenging. Cell‐blocks and immunohistochemistry on samples obtained by endoscopic ultrasound‐guided fine needle aspiration can guarantee the diagnosis in most cases. Beta‐catenin, CD10, CD99 and progesterone receptor must be included in the immunohistochemistry panel to confirm the diagnosis. [ABSTRACT FROM AUTHOR]

Cytology of angiofibroma of soft tissue of the inguinal region I Suvendu Purkait, Suvradeep Mitra, Amit Kumar Adhya, Madhusmita Sethy, Tushar Subhadarshan Mishra i 10.1111/cyt.13039 | Version of Record Online: 04 August 2021 Angiofibroma of the soft tissue is a recently described benign fibroblastic/myofibroblastic tumour. Cytology of a subcutaneous nodule on hand: A rare case I Chinmayee Panigrahi, Tushar Subhadarshan Mishra, Amit Kumar Adhya i 10.1111/cyt.13033 | Version of Record Online: 27 July 2021 The article depicts the cytological features of a rare skin nodule along with its histopathological and immunohistochemical correlation. Opportunity to elevate the quality of data reporting in Cytopathology I Colleen M. Vrbin i 10.1111/cyt.13058 | Version of Record Online: 21 October 2021 This descriptive study of 2.5 years of I Cytopathology i articles uncovers opportunities to elevate the quality of methods and data reporting. [Extracted from the article]

Pilomatrixoma (calcifying epithelioma of Malherbe) is an uncommon benign skin appendageal tumor that differentiates toward hair matrix cells. It is misdiagnosed in up to 75% of cases by nondermatologists. Although the histopathological findings are well recognized and characteristic, diagnosis by fine-needle aspiration biopsy may be quite challenging. Several reports have emphasized the challenges in cytodiagnosis of pilomatrixoma, leading to a false-positive diagnosis. The lesions may show avidity for fludeoxyglucose on positron emission tomography/computed tomography scan, raising concern of a possible malignant neoplasm. CTNNB1 mutations have been reported in a high percentage of pilomatrixomas. Expression of β-catenin, the protein encoded by CTNNB1, is also frequently observed. To determine if routine cytological specimens can be successfully used to perform additional investigation and support or confirm the diagnosis in three cases of pilomatrixoma, we performed molecular analysis and immunohistochemistry to search for CTNNB1 mutation and β-catenin, respectively. β-Catenin positivity by immunohistochemistry was observed in basaloid cells in all three cases. Exon 3 mutations in CTNNB1 were detected in all cases. In addition, we detected a fibroblast growth factor receptor 2 (FGFR2) mutation in one of the cases. We reviewed the literature and present the clinical and morphological characteristics that must be considered along with other findings to accurately achieve the correct diagnosis, in correlation with the results of the ancillary technique. In conclusion, routine cytological specimens can be successfully used to perform additional investigations and support cytodiagnosis in difficult cases. [ABSTRACT FROM AUTHOR]

Introduction: Adenoid cystic carcinoma (ACC) is a ubiquitous tumour which can occur in several sites of the human body. Commonly, it affects the salivary glands but also can rarely occur in various extra‐salivary locations. Aim: To study the clinical and cytological features of extra‐salivary ACC on fine needle aspiration cytology. Methods: In this paper, we included 27 patients with extra‐salivary ACC on fine needle aspiration cytology over a period of 5.5 years. The complete cytomorphological spectrum of extra‐salivary ACC was studied. Results: The mean age of the patients was 50.2 years, with age ranging between 14 and 80 years. Male to female ratio was 1:1.7 with 17 females and 10 males. The most frequent primary site was the orbit, and the most frequent sites of metastasis were liver and lung. Conclusion: Cytopathologists should be alert about the full range of location as well as the cytological spectrum of extra‐salivary ACC for greater precision in diagnosis and prompt treatment. This is the largest series of extra‐salivary adenoid cystic carcinoma. Here, the clinical and cytological features of extra salivary adenoid cystic carcinoma have been described. [ABSTRACT FROM AUTHOR]

Objective: To compare the value of the thyroid imaging reporting and data system proposed by Kwak (KWAK TI‐RADS) and the 2015 American Thyroid Association (ATA) guidelines for diagnosis of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC). To confirm the role of cell block (CB)‐assisted fine‐needle aspiration (FNA) in final diagnosis of MTC. Design: Retrospective hospital‐based cohort study. Patients: Ninety‐three patients with 29 MTCs, 31 PTCs and 33 thyroid adenomas (TAs) who underwent thyroidectomy from January 2010 to May 2019 were retrospectively reviewed. The KWAK TI‐RADS and ATA guidelines were used to assess each thyroid nodule. FNA, CB‐assisted FNA and core needle biopsy (CNB) were performed in final diagnosis. Results: Age and ultrasound features (composition, echogenicity and shape) were significantly different between MTC and PTC. Sex and ultrasound features (echogenicity, margin and calcification) were significantly different between MTC and TA. The KWAK TI‐RADS and ATA guidelines showed no significant difference for MTC (area under the curve [AUC]: 0.812 and 0.808; P =.37‐.85) or PTC (AUC: 0.883 and 0.885; P =.25‐.96). The KWAK TI‐RADS and ATA guidelines showed high specificity and sensitivity for MTC (93.9% and 62.1%, 87.9% and 65.5%) and PTC (93.9% and 67.7%, 87.9% and 77.4%), respectively. For suspicious MTC (7 cases), CB‐assisted FNA provide accuracy preoperative diagnosis. Conclusions: Although the diagnostic performance of the TI‐RADS and ATA guidelines is worse for MTC than PTC, the difference is not statistically significant. CB‐assisted FNA should be performed in thyroid nodules with 4a or lower suspicion to avoid misdiagnosis of MTC. [ABSTRACT FROM AUTHOR]

Background: Being a minimally invasive diagnostic technique, Fine-Needle Aspiration Cytology (FNAC) has become the first-line test and corresponding aspirated material has become the target specimen for diagnosis and ancillary tests in lung carcinoma. Although the role of Cell Blocks (CBs) in diagnosis and in ancillary testing is well recognized in literature, limited attention has been paid to specimen procurement and triage in the preparation of CBs. In the present scenario, CBs are not consistently optimal because of its low cellularity. Aims: This study is aimed to describe an improvised technique of specimen acquisition and cell block preparation in CT-guided FNACs of lung carcinoma cases in a resource-constrained center and to assess its efficacy for optimal representation of cellularity, morphology, and architecture. Materials and Methods: Total 85 lung carcinoma cases undergoing CT-guided FNAC in our center from February 2017 to January 2018 were included in this study. 4 to 5 direct smears and subsequent CBs were made from material obtained by single pass. Cellularity of smears and corresponding cell blocks were assessed and categorized according to a scoring system (score 1 to 3 for number of cells <50, 50–100, >100, respectively). Preserved architecture and morphology were also assessed in smears and CBs. Results: The evaluated samples showed a cellularity score 3 in 65.4%CBs and score 2 in 24.7% CBs. Overall, 90.1% cell blocks had acceptable cellularity. Cell morphology was preserved in all CBs of acceptable cellularity, except for two adenocarcinoma, one squamous cell carcinoma, and one small cell carcinoma blocks. Cellular architecture was also preserved in all CBs of acceptable cellularity. Conclusions: This simple improvised technique of CB preparation optimized its cellularity, morphology, and architectural preservation, even after adequate cellular FNA smears. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is presently the preferred modality for sampling mediastinal lymph nodes. There is an unmet need for standardization of processing and reporting of cytology specimens obtained by EBUS-TBNA. The manuscript is a state-of-the-art review on the technical aspects of processing and reporting of EBUS-TBNA specimens. A literature search was conducted using the PubMed database, and the available evidence was discussed among the authors. The evidence suggests that at least one air-dried and one alcohol-fixed slide should be prepared from each lymph node pass. The remaining material should be utilized for microbiological analysis (in saline) and cell block preparation (10% formalin or other solutions). Wherever available, rapid-onsite evaluation should be performed to assess the adequacy of the sample and guide the need for additional material. The lymph node aspirate should also be collected in Roswell Park Memorial Institute solution in cases where lymphoma is under consideration. The use of liquid-based cytology provides good quality specimens that are free from blood and air-drying artifacts and can be used wherever available. Sample adequacy and the diagnostic category should be furnished separately in the cytology report. [ABSTRACT FROM AUTHOR]

Purpose: To report pathologic evaluation and diagnostic yield of an aspiration cutter-assisted biopsy of anterior segment tumors. Design: Retrospective, consecutive, interventional case series. Methods: Fifty-five eyes of 55 patients with iris and iridociliary tumors underwent an aspiration cutter-assisted biopsy at a single institution. Cytospin and cell-block preparations were performed on all biopsy samples. Bleached preparations and a panel of immunohistochemical stains were performed in selected cases. Cytologic diagnosis was correlated with clinical diagnosis and with histopathologic diagnosis, when available. Main outcome measures were (1) specimen cellularity, (2) diagnostic studies performed, (3) cytopathologic diagnosis, and (4) concordance with histopathologic diagnosis. Results: Specimen cellularity was adequate for cytopathologic interpretation of cytospin preparations in 55 (98.2%) of 56 biopsies. Twenty-three (41%) of 56 biopsy samples had diagnostic material in cell-block preparations. The most common cytopathologic diagnoses were melanoma (n = 39/56; 69.6%), melanocytoma (n = 4/56; 7.1%), nevus (n = 4/56; 7.1%), lymphoma (n = 2/56; 3.6%), and epithelial implantation cyst (n = 2/56; 3.6%). One biopsy sample (1.8%) yielded nondiagnostic material. Wide incisional or excisional biopsy confirmation was available in 13 (23.2%) of 56 aspiration cutter-assisted biopsy cases. Cytopathologic diagnoses were consistent with histopathologic diagnosis in 12 (92.3%) of 13 cases. Conclusions: Although specialized pathologic techniques were necessary to maximize material available for diagnosis, all biopsies yielded cellular material and 41% yielded diagnostic tissue in cell block preparation. Although lower than the yield of wide incisional or excisional biopsy, aspiration cutter-assisted biopsy of anterior segment tumors achieved a diagnostic yield of 98.2%. [Copyright &y& Elsevier]