Advanced non-small cell lung cancer: Rapid evaluation of EGFR status on fine-needle cytology samples using Idylla.

Advanced non-small cell lung cancer (NSCLC) needs to be managed rapidly; therefore, a rapid assessment of the epidermal growth factor receptor (EGFR) status is mandatory. Computed Tomography (CT)-guided or Ultrasound (US)-guided Fine-Needle Aspiration Cytology (FNAC) allows a rapid diagnosis of both primary and metastatic tumor through rapid on-site evaluation (ROSE) and the proper management of diagnostic material. Idylla (Biocartis, Mechelen, Belgium) is an automated RT-PCR system which evaluates the mutational status of specific genes in less than two hours. In this study, the EGFR mutational status in advanced NSCLC was analyzed on 28 FNAC samples with Idylla. After ROSE, residual FNAC material and/or additional passes were pipetted into the Idylla EGFR cartridge. Patients endorsed a consent form before carrying out the analysis. Results were controlled by pyrosequencing. Adequate EGFR status was obtained in 26/28 cases (22 wild type and 4 mutated). Mutated cases harbored EGFR Exon 19 deletion and L858R point mutation. In 2/28 cases the analysis failed. The combination of FNAC, ROSE and Idylla is a rapid, accurate and effective method that can be conveniently used to assess EGFR status in advanced NSCLC.

Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial.

OBJECTIVE: To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology. METHODS: Women aged 20-59 years with low-grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity. RESULTS: On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI -3.6 to -1.3) lower for follow-up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow-up related satisfaction with information and support (-2.4; -3.3 to -1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th- and 18th-month time points. These differences remained when the analysis was stratified by post-school education. CONCLUSIONS: Women with low-grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women. © 2016 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

SAME-DAY FINE-NEEDLE ASPIRATION CYTOLOGY DIAGNOSIS FOR THYROID NODULES ACHIEVES RAPID ANXIETY DECREASE AND HIGH DIAGNOSTIC ACCURACY.

OBJECTIVE: The time between the moment of referral for the diagnostic workup for thyroid nodules and the outcome can be worrisome for patients. In general, patients experience high levels of anxiety during the evaluation of a lesion suspicious for cancer. Therefore, the implementation of same-day fine-needle aspiration cytology (FNAC) diagnosis is becoming standard-of-care for many solid tumors. Our aim was to assess the feasibility of same-day FNAC diagnosis for thyroid nodules and to assess patient anxiety during the diagnostic process. METHODS: For feasibility of same-day FNAC diagnosis, we assessed the proportion of patients receiving a diagnosis at the end of the visit. Accuracy was measured by comparing histology with the FNAC result. Patient anxiety was measured by the State Trait Anxiety Inventory at 6 moments during the diagnostic workup. RESULTS: Of the 131 included patients, 112 (86%) were female, and the mean age was 53 years. All patients, except those with a nondiagnostic FNAC result (n = 26; 20%), had a diagnosis at the end of the day. There were only two discordant results. Anxiety levels at the beginning of the day were high throughout the group, State Trait Anxiety Inventory (STAI) score 43.1 (SD 2.0) and decreased significantly more in patients with a benign FNAC result (STAI score 30.2), compared to patients with a malignant or indeterminate result (STAI score 39.6). CONCLUSION: Distress of patients with a thyroid nodule undergoing same-day FNAC diagnostics was high. Same-day FNAC diagnosis is feasible and accurate for the evaluation of thyroid nodules. Therefore, same-day FNAC diagnosis seems a safer, more patient-friendly approach to diagnose thyroid nodules.

The psychological impact of being screened for anal cancer in HIV-infected men who have sex with men.

BACKGROUND: Anal cancer screening may be considered in HIV-infected men who have sex with men because they are at increased risk. Cancer screening can provoke anxiety, which may lead to poorer screening compliance. OBJECTIVE: This study aimed to measure the psychological consequences of anal cancer screening in HIV-infected men who have sex with men. DESIGN: This investigation is a prospective cohort study. SETTING: This study was conducted in primary and tertiary care HIV clinics in Toronto, Canada. PATIENTS: One hundred four HIV-infected men who have sex with men were studied. MAIN OUTCOME MEASURES: : Psychological impact was measured at 4 time points (before screening, after screening, after receiving results, and before follow-up) using the Impact of Events Scale, the Illness Intrusiveness Ratings Scale, and the Psychological Consequences Questionnaire. RESULTS: Median age was 44, 77% were receiving antiretroviral therapy, and 11% had high-grade anal dysplasia (anal intraepithelial neoplasia 2/3). Fifteen to 32% of the patients reported high levels of negative psychological consequences across the 4 time points; the highest levels occurred at time 2. Higher HIV symptom count and baseline level of negative impact were significantly associated with higher Impact of Events scores, whereas younger age and a higher baseline level of negative impact were significantly associated with higher scores with use of the Illness Intrusiveness Ratings Scale. CONCLUSIONS: Anal cancer screening is not associated with greater adverse psychological impact in most HIV-infected men who have sex with men. Younger patients, those with more HIV-related symptoms and greater baseline psychological distress, are at risk for increased psychological distress during screening.

Prediction of patient discomfort during fibreoptic bronchoscopy.

OBJECTIVE: This study investigated the potential for predicting which patients would have a negative emotional reaction to bronchoscopy. METHODOLOGY: A questionnaire was distributed to 120 patients who had undergone diagnostic fibreoptic bronchoscopy. A visual analog scale to evaluate the patient's discomfort was adopted. Multiple linear regression analysis was used to determine factors significantly influencing discomfort. The regression model included the following variables: age, gender, symptoms, smoking habits, proximal bronchial brushing, distal bronchial brushing, bronchial washing, proximal transbronchial biopsy, transbronchial lung biopsy, examination time, the bronchoscopist's experience, and the patient's anxiety level. RESULTS: The bronchoscopist's experience (P = 0.001) and the patient's anxiety level (P < 0.001) were variables that significantly influenced discomfort. These results suggest that discomfort decreased with the bronchoscopist's experience and increased with the patient's anxiety regarding bronchoscopy. CONCLUSIONS: The results suggest that subjective discomfort can be predicted both by the bronchoscopist's experience and by a questionnaire about the patient's anxiety level before bronchoscopy. Therefore, it is recommended that the patient's anxiety level be determined through the use of a questionnaire before bronchoscopy, and that more experienced bronchoscopists should take charge if the patient is judged as being excessively anxious. If experienced bronchoscopists are unavailable, the more anxious patient should receive more sedatives.

Women's interpretation of cervical smear test results.

Screening for cervical cancer using the Papanicolaou smear test has been available in England since the 1960s, yet very little is known about how women interpret their test results. This questionnaire study required women to explain, in their own words, the meaning of normal and abnormal test results. It was discovered that the use of the word cell as a description of findings was extremely common, and that a proportion of subjects equated abnormal results with technical inadequacy. The frequency of circularity in the interpretations, i.e. interpreting 'normal' as 'not abnormal' and vice versa, was striking. Contrary to previous research, we find that, whilst many women interpret normal results as indicating the current absence of cancer, few appear to believe that future cancer is thereby definitively ruled out. By the same token, only a very small minority interpret abnormal results as definitive of cancer.