ABSTRACT
ABSTRACT Introduction: Various preparations can be used in diagnostic cytology, including conventional smears (CS), liquid-based preparations (LBP) and cell block (CB). Objective: The aim of this study is to evaluate the quality of CB preparations in addition to conventional cytological specimens in cases of fine-needle aspiration biopsy (FNAB) of thyroid nodules in diagnostic routine. Method: One hundred and six consecutive cases of FNAB routine thyroid nodules were independently evaluated by two cytopathologists (Obs1 and Obs2) on the cellularity of SM, LBP and CB. Results: The cellularity was rich/moderate in 56 (52.8%) CBs for both observers. LBP showed rich/moderate cellularity in 86 (81.1%) cases for Obs1 and 91 (85.8%) for Obs2; among these cases, CB showed the same cellularity in 52/86 (60.4%) cases for Obs1 and 54/91 (59.3%) for Obs2. SM showed rich/moderate cellularity in 86 (81.1%) cases for Obs1 and 87 (82%) for Obs2; among these cases, CB showed the same cellularity in 48/86 (55.8%) cases for Obs1 and 54/87 (62%) for Obs2. CB cellularity was higher than that in LBP in only five cases for Obs1 and three for Obs2. LBP was assessed as low/absent in only five (4.7%) and six (5.6%) cases for Obs1 and Obs2, respectively. Conclusion: CB can be routinely used as additional specimen in material obtained from thyroid nodules FNAB, without adversely affecting LBP specimens, enabling the conduction of further immunohistochemical and molecular studies.
RESUMO Introdução: Vários preparados podem ser utilizados na citologia diagnóstica, como esfregaços (SM), preparados do tipo meio líquido (ML) e emblocado em parafina ou cell block (CB). Objetivo: Avaliar a qualidade do CB, além dos espécimes citológicos convencionais, em casos de biópsia aspirativa por agulha fina (BAAF) de nódulos de tireoide na rotina diagnóstica. Método: Cento e seis casos consecutivos de BAAF de nódulos de tireoide foram avaliados independentemente por dois citopatologistas (Obs1 e Obs2) quanto à celularidade dos preparados de SM, ML e CB. Resultados: A celularidade foi rica/moderada em 56 (52,8%) CB para ambos observadores. ML mostrou celularidade rica/moderada em 86 (81,1%) casos para o Obs1 e 91 (85,8%) para o Obs2; desses casos, CB mostrou a mesma celularidade em 52/86 (60,4%) casos para o Obs1 e 54/91 (59,3%) para o Obs2. SM mostrou celularidade rica/moderada em 86 (81,1%) casos para o Obs1 e 87 (82%) para o Obs2; desses casos, CB apresentou a mesma celularidade em 48/86 (55,8%) casos para o Obs1 e 54/87 (62%) para o Obs2. A celularidade do CB foi maior do que a do ML em apenas cinco casos para o Obs1 e três para o Obs2. ML foi avaliado como escasso/ausente em apenas cinco (4,7%) e seis (5,6%) casos para os Obs1 e Obs2, respectivamente. Conclusão: CB pode ser utilizado rotineiramente como espécime adicional no material obtido de BAAF de nódulos de tireoide, sem prejuízo dos espécimes de meio líquido, o que possibilita a realização de estudo complementar, principalmente imuno-histoquímico e molecular.
ABSTRACT
OBJECTIVES: With the development of next-generation sequencing (NGS) technologies, DNA sequencing has been increasingly utilized in clinical practice. Our goal was to investigate the impact of genomic evaluation on treatment decisions for heavily pretreated patients with metastatic cancer. METHODS: We analyzed metastatic cancer patients from a single institution whose cancers had progressed after all available standard-of-care therapies and whose tumors underwent next-generation sequencing analysis. We determined the percentage of patients who received any therapy directed by the test, and its efficacy. RESULTS: From July 2013 to December 2015, 185 consecutive patients were tested using a commercially available next-generation sequencing-based test, and 157 patients were eligible. Sixty-six patients (42.0%) were female, and 91 (58.0%) were male. The mean age at diagnosis was 52.2 years, and the mean number of pre-test lines of systemic treatment was 2.7. One hundred and seventy-seven patients (95.6%) had at least one identified gene alteration. Twenty-four patients (15.2%) underwent systemic treatment directed by the test result. Of these, one patient had a complete response, four (16.7%) had partial responses, two (8.3%) had stable disease, and 17 (70.8%) had disease progression as the best result. The median progression-free survival time with matched therapy was 1.6 months, and the median overall survival was 10 months. CONCLUSION: We identified a high prevalence of gene alterations using an next-generation sequencing test. Although some benefit was associated with the matched therapy, most of the patients had disease progression as the best response, indicating the limited biological potential and unclear clinical relevance of this practice.