ABSTRACT
INTRODUCTION: Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) is a biologically unique form of carcinoma that is important to identify for prognosis and treatment. The objective of this study was to evaluate the performance of the Aptima HPV assay using Diff-Quick (DQ) stained smears from fine-needle aspiration (FNA) of HPV-related oropharyngeal SCC. MATERIALS AND METHODS: Patients with a diagnosis of head and neck SCC who also had FNA sample demonstrating metastatic disease were identified. Using a mounting media-based cell transfer technique, approximately 200 tumor cells were selected and harvested from DQ-stained aspirate smeared slides. The selected cells were tested for high risk HPV using the Aptima HPV assay, an in vitro nucleic acid amplification test for the qualitative detection of E6/E7 viral messenger RNA from high-risk types of HPV. These results were compared with the p16 immunohistochemical staining of the corresponding surgical pathology specimens. RESULTS: Twenty-eight of 32 (87.5%) FNAs of p16-positive oropharyngeal SCC were positive for high-risk HPV by the Aptima assay and 18 of 18 (100%) FNAs of p16-negative SCC were negative for high-risk HPV by the Aptima assay. CONCLUSIONS: DQ-stained FNA smears can be used by the Aptima HPV assay to accurately detect high-risk HPVs in oropharyngeal SCCs with a sensitivity of 87.5% and a specificity of 100%. This provides an alternative to p16 immunohistochemical staining of FNA cell block material, which may not be available on all specimens.
ABSTRACT
INTRODUCTION: For fine-needle aspiration (FNA) biopsy, the cell block is used for precision ancillary diagnostic tests and personalized molecular evaluation. It is important to maximize quality cell blocks. Rapid on-site evaluation (ROSE) provides specimen adequacy and guides cell block collection. The study examines how immunohistochemistry (IHC) utilization correlates with cell block quality and the impact of ROSE on cell block quality. MATERIALS AND METHODS: The pathology database identified consecutive FNA biopsy cases with cell blocks. Procedural data and reporting elements were collected including ROSE, adequacy and diagnosis categories, and IHC. Each archived case was reviewed. Cell block cellularity quality scores were categorized as <10%, 10% to 25%, and >25%. Various data points were correlated with the cell block quality score. RESULTS: The ROSE cohort had a higher group score of 38.8% versus 26.3% for non-ROSE. Low scores on cell block quality were higher with the unsatisfactory and indeterminate groups (85.2% and 78.5%). A higher grouping score was 3× as likely for a satisfactory as an unsatisfactory group (46.5% versus 14.8%). Positive cases with IHC had higher cell block quality scores compared with those without IHC (56.7% versus 33.2%). CONCLUSIONS: It is important for pathologists to contribute to improving FNA biopsy cell block quality. This series shows that higher cell block quality provides better utilization for IHC assessment and for IHC testing in positive diagnostic category cases. Providing ROSE service can improve cell block quality and an assurance of a satisfactory FNA biopsy significantly contributes to improved cell block quality.
ABSTRACT
BACKGROUND: Cell blocks are critically important in fine-needle aspiration (FNA) biopsies and the increasing requirements for personalized medicine testing further highlight their value. When a cell block is inadequate, it can necessitate additional procedures. The objective of the current study was to measure the impact and outcome of dedicated aspirate pass techniques and slide cellularity on cell block quality. METHODS: Over a 6-month period, all FNA biopsy cases with cell blocks were identified. Procedural data including the number of dedicated aspirate passes were recorded. Individual cases were retrospectively reviewed and scored for multiple endpoints, including aspirate smear cellularity and cell block quality. RESULTS: A total of 605 FNA biopsy and cell block cases were identified. The cell block quality score demonstrated a progressive improvement with an increasing number of dedicated biopsies. The performance of a single dedicated biopsy demonstrated a higher percentage of intermediate to high cell block quality scores in comparison with none (+12.1%; P = .0142). The performance of 3 dedicated biopsies demonstrated a higher percentage of intermediate to high cell block quality scores in comparison with a single pass (+13.5%; P = .0138). An intermediate-quality to high-quality terminal aspirate smear was more likely to have a high cell block quality score (+31.6%; P = .0001). CONCLUSIONS: Performing at least 1 dedicated FNA biopsy pass was found to improve cell block quality and multiple dedicated biopsies resulted in nearly one-half having a higher quality score. A high-cellularity terminal FNA biopsy smear contributed significantly to obtaining a high-quality cell block. Performing dedicated FNA biopsies and the use of high-quality aspirate smears are effective clinical practices for improving cell block outcomes.
