Cytology should create structured data sets without using synoptic reporting.

Structured data sets can be created from cytology reports without the addition of synoptic reports using either natural language processing or minor changes to laboratory information systems structure.

Improving Reporting of Tumor Size in Synoptic Reports.

CONTEXT.­: Tumor size is an important prognostic feature in many synoptic reports. The best format to report this feature is not clearly defined. OBJECTIVE.­: To define formatting features that impact the significance of tumor size. DESIGN.­: We reviewed multiple formatting features of tumor size in synoptic reports and correlated them with size distribution, reproducibility, and other pathologic features. RESULTS.­: Reporting tumors in millimeters rather than centimeters was more precise because of reduced rounding error and was significantly more reproducible (P = .01). Tumor sizes where the pathologist was concerned that the size may be underestimated are associated with significantly higher tumor N stage than tumors of similar size that are not so identified. Reported tumor sizes in multifocal tumors are also associated with significantly higher N stage than unifocal tumors of the same size. CONCLUSIONS.­: Tumor sizes should be reported in millimeters, and when tumors are reported as either "at least" a specific size or as "multifocal" this information should also be recorded because these sizes likely underestimate the true biologic potential of the tumor.

High-grade urothelial carcinoma with hypochromatic chromatin in urine cytology.

INTRODUCTION: Some high-grade urothelial carcinomas (UCs) in urine cytology have hypochromatic chromatin, but the incidence and criteria for diagnosis are not well described. MATERIALS AND METHODS: Urine cytology cases with biopsy follow up were reviewed. RESULTS: Cytospin preparations from 331 cases with biopsy follow up (230 benign/low-grade UC, 101 malignant) were reviewed. There were no false-positive cases. Cases with malignant cells with hypochromatic chromatin were identified in a total of 17 cases (16.8% of all malignancies). These comprised 2 carcinoma in situ, 11 high-grade papillary UC, 3 invasive UC, and 1 adenocarcinoma. Sixteen of 93 high-grade UCs (17.2%) had cells with hypochromatic chromatin. These cells were the only type of malignant cell in 4 of 101 cases (4.0%). All cases had cells with high nuclear-to-cytoplasmic ratios and markedly indented and irregular nuclear membranes that could be identified on both cytology and subsequent histology. CONCLUSIONS: Malignant urothelial cells in urine cytology with hypochromatic chromatin can be present in 17% of cases and can be diagnosed as "positive for malignancy" based on their high nuclear-to-cytoplasmic ratio, and markedly indented and irregular nuclear membranes.

Thyroid FNA: Is cytopathologist review of ultrasound features useful?

Cytopathologist review of thyroid ultrasound (US) has been proposed to be useful in diagnosis and patient triage. This review explores the implications for practicing cytopathologists of integrating US review into the thyroid fine-needle aspiration diagnosis. At present, there is no agreed-upon system for combining cytologic and US features and communicating those results as a single report. If cytologists are performing tasks that require expertise in US interpretation, then they should know and be fully conversant with US interpretation. Whether cytologists performing aspirations require expertise in US interpretation is not clear. Regardless, cytologists should avoid using US results to alter their cytologic interpretations unless they clearly communicate that this is what they are doing. An evidence-based integrated reporting system that would allow cytologists to clearly explain to other physicians exactly how they reached their interpretation might provide value beyond current standard practice.

Risk of death due to disease for thyroid fine-needle aspirations of well-differentiated thyroid carcinomas.

The risk of malignancy for some diagnoses in thyroid fine-needle aspirations is higher than the actual risk of clinical progression. Other measures of prognosis may be helpful in managing patients with indeterminate thyroid fine-needle aspiration diagnoses. We estimated the risk of death due to disease (RDDD) for well-differentiated thyroid carcinoma using a series of over 15 000 aspirates with over 2000 excisions and data from the SEER database. RDDD was low (1.3% or less for all categories). The RDDD of some indeterminate thyroid aspirates was higher than for malignant aspirates. The RDDD may provide additional information for patients and clinicians seeking to manage patients with indeterminate thyroid fine-needle aspirates.

Needle track seeding in renal mass biopsies.

A review and analysis of the literature demonstrates that needle track seeding in renal mass biopsy has been reported 16 times. This complication occurs almost exclusively among patients with papillary renal cell carcinoma. The incidence is associated with multiple punctures of the mass, the use of core needles of ≥20 gauge, and lack of a coaxial sheath. Needle tract seeding may be associated with tumor upstaging and a worse prognosis. Fine-needle aspiration has a significantly lower rate of needle track seeding compared with large core needle biopsy (>20-gauge needle). A more formalized risk-based system for interpreting renal mass fine-needle aspiration may be useful as clinicians choose among an increasing number of therapeutic options.

Effusion cytology of epithelioid rhabdomyosarcoma.

We report a case of epithelioid rhabdomyosarcoma in a pleural effusion. In contrast to most rhabdomyosarcomas in effusions, the cells presented as cohesive clusters of atypical cells with abundant eosinophilic cytoplasm which mimicked an adenocarcinoma. Immunohistochemistry was positive for epithelial membrane antigen and muscle markers and negative for keratins.

Risk stratification of HIV infection for patients needing molecular confirmation with the Abbott 4th generation Architect System.

BACKGROUND: Some patients need their 4th generation HIV testing results confirmed with molecular testing after primary confirmatory testing which may not be immediately available. Further risk stratification of these patients pending the results of molecular testing may be of value not only for patient counseling but also for treatment of women in labor. OBJECTIVES: To determine the risk of a positive test result on molecular testing for these patients. STUDY DESIGN: The risk of a positive molecular test result for patients with a result needing molecular confirmation on a 4th generation HIV testing algorithm (Abbott Architect, Multispot/Geenius confirmatory test) was stratified based on the patient's white blood cell (WBC) count and the magnitude of Architect result Signal Cut Off ratio (S/CO). RESULTS: A total of 61,666 patients were tested with 658 (1.1%) positive results and 76 (0.12%) patients needing molecular confirmation. Patients with an S/CO of <5 or an S/CO of 5-100 with a WBC > 6.5 × 10 9 cells/l had a significantly lower risk of a positive molecular HIV test (0/48, 0%) than patients with an S/CO 5-100 with a WBC < 6.0 s × 10 9 cells/l (5/9, 56%, p < .001) or an S/CO > 100 (2/2, 100%, p < .001). Pregnant women had a significantly lower rate of positive test results (24/6924, 0.4%) than non-pregnant patients (634/54742, 1.1%, p < 0.001). All 12 cases needing molecular confirmation in pregnant women had negative NAT test results. CONCLUSIONS: Patients who need their HIV results confirmed with molecular testing using a 4th generation algorithm that includes the Abbott Architect System can be further stratified into low, intermediate, and high risk groups based on additional laboratory information pending the results of molecular testing. This risk stratification may be of value for patient counseling and treatment of women in labor.

Adequacy criteria for voided urine cytology using cytospin preparations.

BACKGROUND: Previous studies have suggested that urine cytology adequacy may be related to both specimen volume and cellularity. METHODS: The authors reviewed cytospin preparations from 314 urine specimens (162 voided and 152 instrumented specimens) found to have high-grade urothelial carcinoma on biopsy. RESULTS: The sensitivity of instrumented urine cytology was significantly higher than that of voided cytology (82% vs 25%; P < .001). The cellularity (at least 30 urothelial cells/10 high-power fields [HPF]) of instrumented urine specimens also was significantly higher than that of voided specimens (57% vs 9%; P < .001). The sensitivity of voided urine cytology with a cellularity of 20 to 39 cells per 10 HPF was significantly higher than that of cases with <20 cells per 10 HPF (77% vs 19%; P < .001). The sensitivity decreased with higher cellularity for both types of specimens. The sensitivity of voided cases with a volume of at least 30 mL was higher than that of cases with a volume <30 mL, but this was not statistically significant (31% vs 17%; P = .07). CONCLUSIONS: The sensitivity of voided urine cytology for high-grade urothelial carcinoma is significantly associated with urothelial cellularity but not specimen volume. Both the cellularity and sensitivity of voided urine specimens are less than that of instrumented specimens.