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Pathology and its role in medical science and practice
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Unlike histopathology, where assessment of the tissue architecture is of prime importance, in cytopathology the characteristics of the individual cells are of most value. Essentially, in diagnostic practice the cytopathologist looks for the cytological features of malignancy (see Figure 6.3D). Admittedly, the relationships between adjacent cells can be appreciated to some extent: e.g. in an aspirate from a breast lump, loss of cohesion between cells is suggestive of malignancy, as is a high cellular nucleus:cytoplasm ratio (Figure 1.7). In screening practice, e.g. in cervical cancer programmes, the cytopathologist seeks to identify the same changes but at an earlier, pre-invasive stage, and thus give a warning of incipient cancerous changes. The biological basis and efficacy of screening programmes continue to be hotly debated.
Thyroid nodules and multinodular goiter
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Poorani N. Goundan, Stephanie L. Lee
Results of FNB can be categorized into four basic diagnostic groups: benign (negative), clinically suspicious (indeterminate), malignant (positive), and unsatisfactory (insufficient follicular cells or nondiagnostic). Classification systems have been devised to facilitate communication between cytopathologist, endocrinologist, and surgeons, and to help assign a risk of malignancy based on the diagnostic category. A commonly used classification of cytological findings, particularly in the United States, is the Bethesda system (77, 78).
Imaging of the Salivary Glands
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Articles concerning USgFNAC yields34–37 have reported sensitivities ranging from 62% to 98% and specificity ranges from 94% to 100%. For 191 salivary tumours, Howlett et al.38 conducted a 1-year audit within a rapid-access clinic setting and found a diagnostic sensitivity of 64% and specificity of 100%. Zhang et al. in 200939 published data showing that overall accuracy in distinguishing benign from malignant lesions was 79.1% and the sensitivity for salivary neoplasia was 89.4%. In 2011, a retrospective study40 looked at USgFNAC for 245 parotid and submandibular salivary aspirates without immediate adequacy assessments. A cytological diagnosis was possible in 215 aspirates (87.8%). The sensitivity, specificity and diagnostic accuracy of the test in separating benign from malignant lesions were 75.7%, 100% and 95.8% respectively. In the recent pathology literature, it seems clear that the ideal FNAC is immediately prepared by skilled technicians trained in slide preparation with further on-site ‘live’ technical expertise available for prompt adequacy assessments; however, this model has significant increased service cost implications. With this model in place, the group quotes an overall accuracy rate for salivary FNAC of between 90% and 95%. The UK National Institute for Health and Care Excellence (NICE) guidelines recommend having a cytopathologist or biomedical scientist to assess the cytology sample adequacy when the procedure is carried out.
Endoscopic ultrasound guided fine needle aspiration for the diagnosis of intra-abdominal lymphadenopathy: a systematic review and meta-analysis
Published in Scandinavian Journal of Gastroenterology, 2020
Chenyu Li, Yujun Shuai, Xiaodong Zhou
There was no threshold effect detected, and we pre-estimated five subgroups that might contribute to heterogeneity. The results showed that the sensitivity of the two studies using the combined needle pattern was higher than that of the five studies using the single needle pattern, and the difference was statistically significant (p = .04) and the overall sensitivity was significantly higher in the presence of on-site cytology than in the group without on-site cytology and the difference was also statistically significant (p = .05). Most studies have shown that rapid on-site evaluation (ROSE) by the cytopathologist can help to assess adequacy of sample and also improve diagnostic yield of the procedure. A recent study by Hikichi et al. [38] showed even when a cytopathologist is not available, rapid on-site evaluation by endosonographer is equally effective and helps to increase the diagnostic yield. In addition, I2 of the aggregate sensitivity and I2 of each subgroup sensitivity were calculated to investigate the sources of heterogeneity (Table 5). The results suggested that study design, on-site cytologic and type needle may be the sources of heterogeneity, with I2 for sensitivity dropping from 26.3 to 0.
Role of endoscopic ultrasound-guided liver biopsy: a meta-analysis
Published in Scandinavian Journal of Gastroenterology, 2022
Keyu Zeng, Zhenpeng Jiang, Jie Yang, Kefei Chen, Qiang Lu
The primary outcomes were diagnostic yield, specimen adequacy, and qualified specimens evaluated by ROSE. A liver specimen was deemed to have diagnostic yield if it allowed pathologists to make a successful pathological diagnosis. A liver specimen satisfying the following criterion was deemed adequate: TSL ≥ 15 mm and presence of CPTs ≥ 6. A specimen was deemed qualified when it was assured adequate for further evaluation by the on-site cytopathologist or cytotechnician when performing cytopathology. The secondary outcome was adverse events. An adverse event was defined as any incident deviating from the expectant postbiopsy clinical course. Adverse events were graded based on the Clavien-Dindo classification [23].
Endoscopic ultrasound with combined fine needle aspiration plus biopsy improves diagnostic yield in solid pancreatic masses
Published in Scandinavian Journal of Gastroenterology, 2022
Adalberto Gonzalez, Vaibhav Wadhwa, Harjinder Singh, Sikandar Khan, Kapil Gupta, Hong Liang, Ishtiaq Hussain, John Vargo, Sunguk Jang, Prabhleen Chahal, Amit Bhatt, Hassan Siddiki, Tolga Erim, Madhusudhan R. Sanaka
EUS-FNA was performed using either a 22 or 25 gauge Expect Slimline needle (Boston Scientific, Marlborough, MA). Combined EUS-FNA + FNB was performed using a 22 or 25 gauge Shark-core needle (Medtronics, Minneapolis, MN). After the lesion was identified by EUS, it was punctured under Doppler guidance with approximately 10–15 back and forth movements. For both techniques (FNA and combined FNA + FNB), 10 mL of suction was used for alternate passes (no suction-suction-no suction-suction). The number of needle passes was not standardized as this was a retrospective study. In FNA technique, after the tissue was acquired, the specimens were placed onto a slide using a stylet or air flush. The specimens were fixed in alcohol solution for staining at a later time; remaining aspirate was placed into a standard cytologic solution for cell block preparation. In combined FNA + FNB technique, specimens were placed on slides using a stylet or air flush; specimens were fixed in alcohol solution for staining at a later time. Then any visible core tissue was fixed in formalin for subsequent H&E staining and histologic evaluation. Remaining residual material was placed into standard cytologic solution for cell block preparation. The presence of an on-site cytopathologist was based on availability and was not controlled due to the retrospective nature of this study. Decision to have an on-site cytopathologist was based on endoscopists subjective discretion and availability of cytopathologist. The decision to proceed with combined FNA + FNB was made prior to the procedure and the results of on-site cytopathology did not preclude the second technique from being utilized. Selection of 22 guage or 25 guage needle was based on subjective discretion of the endoscopist based on the location of the lesion. In general, a more flexible 25 guage needle was used in procedures where the endoscope tip was angulated such as in descending duodenum and it was perceived that a stiffer 22 guage needle would be more difficult to pass.