Validation and implementation of telecytology at an academic medical center using digital cameras and Microsoft Teams software.

INTRODUCTION: Rapid On-Site Evaluation of cytological samples obtained through fine needle aspiration for adequacy is a critical component of a cytology service; however, it imposes a significant time and cost burden for the practicing pathologist and the cytology service. Telecytology enables adequacy assessment by a pathologist remotely, greatly saving time. Telecytology also allows slide preparation and manipulation at the procedure site by an employee with less training requirements, liberating the cytotechnologist to screen cases and perform other laboratory duties - an important aspect to consider during times of cytotechnologist shortages. We propose a telecytology system with a simple setup of a microscope, microscope camera, laptop, and Microsoft Teams software. MATERIALS AND METHODS: We designed a system consisting of a mobile cart, backup battery, microscope, digital camera, and a laptop computer with microscope imaging software and Microsoft Teams software for image transmission. Validation was performed by 4 pathologists making adequacy assessments on randomly selected previously signed out cases using the telecytology system. RESULTS: Our validation of this system demonstrated a greater than 90% concurrence rate between the original adequacy call and the call made by pathologists using the telecytology system - a benchmark used by most, if not all, published validations of similar telecytology systems. In addition, the adequacy assessment concordance rate between select pathologists exceeded 90%. CONCLUSIONS: In summary, our telecytology system provides excellent adequacy services for the clinicians and patients we serve. The Microsoft Teams software is a great tool for transmission of video microscopy. This system will be used with the goal of saving time and increasing efficiency for the cytopathology department.

Prevalence of non 16/18 high risk human papilloma virus as a quality metric in gynecological cytology.

Human papillomavirus (HPV) is the most common sexually transmitted pathogen that causes anogenital disease. Cervical screening by cytology and HPV testing (co-testing) are important in prevention of cervical cancer. The Bethesda System category of atypical squamous cells (ASC) is used when a neoplastic process cannot be confidently identified. In such cases, the differential diagnosis is broad and includes benign conditions. Monitoring of ASC/SIL ratio is a commonly used laboratory quality assurance measure to prevent over- or under-use of this category. High risk human papillomavirus (hr-HPV) has been used in conjunction with the ASC/SIL ratio in determining whether a particular pathologist is over/under-using the indefinite category. However, the laboratory overall sample population prevalence rate of hr-HPV subtypes has not been previously examined for association with the ASC rate. In this study, the relationships between ASC/SIL ratio and hr-HPV prevalence rate and hr-HPV subtypes (16/18 and non-16/18) to the laboratory ASC prevalence were studied. The results demonstrate that HPV non-16/18 is the main subtype which is associated with ASC-US category. A large proportion of non-16/18 HPV-related cases are seen in young patients, which largely abates by the by fourth decade. In addition, there are differences in the ASC/SIL ratio for HPV 16/18 and non-16/18 types. The overall ASC/SIL ratio is an average of the ASC/SIL rate for the non-16/18 population and the HPV 16/18 population. Instead of basing the laboratory and practitioners' quality indicator solely on ASC/SIL ratio, the overall prevalence of HPV and its subtype ratio should also be reported as they are more reflective of laboratory performance.

Boosted charge separation via Ce2S3 over dual Z-scheme ZnO-Ce2S3-MnO2 core double-shell nanocomposite for the degradation of diverse dye pollutants.

Herein, core double-shell direct dual Z-scheme ZnO-Ce2S3-MnO2 nanocomposite was synthesized via a hydrothermal route along with pure ZnO, Ce2S3, MnO2, and characterized by numerous characterization tools for application in synthetic dyes degradation. The XRD, Raman, and FTIR analyses have confirmed the nanocomposite formation. TEM images exhibited the core double-shell morphology with an average particle diameter of 81 nm and stacking of ZnO, Ce2S3, and MnO2. EDX confirmed the existence of desired elements in the grown composition. The varied oxidation states, presence of defects, and fast charge transfer were also revealed from XPS, PL, and EIS. The ZnO-Ce2S3-MnO2 nanocomposite has an optical energy bandgap of 2.84 eV, capable of decomposing harmful dyes with excellent efficiency, 99.81% MB, 97.62% MO, 88.5% MR, and 58.9% EY in 40 min sunlight exposure. The effect of several operating parameters is also observed and obtained results showed the optimal catalyst dose was 20 mg, pH of 8, and dye concentration of 10 ppm. The scavenger's experiment suggests that •O2- and •OH are the main active radicals in the photodegradation reaction which is also evident in the dual Z-scheme formation. The MnO2 and ZnO layers covered the Ce2S3 (core) and dual Z-scheme formation allows rapid kinetics of redox reaction and provides plenteous channels for transfer of photo-generated charge carriers during photocatalysis. Thus, core double-shell direct dual Z-scheme photocatalysts having inorganic components could be an excellent choice for photocatalysis at the industrial level, particularly for water purification.

Synergistic effect of a bamboo-like Bi2S3 covered Sm2O3 nanocomposite (Bi2S3-Sm2O3) for enhanced alkaline OER.

The availability of hydrogen energy from water splitting through the electrocatalytic route is strongly dependent on the efficiency, durability, and cost of the electrocatalysts. Herein, a novel Bi2S3-covered Sm2O3 (Bi2S3-Sm2O3) nanocomposite electrocatalyst was developed by a hydrothermal route for the oxygen evolution reaction (OER). The electrochemical properties were studied in 1.00 mol KOH solution after coating the target material on the stainless-steel substrate (SS). Physical analysis via XRD, FTIR, IV, TEM/EDX, and XPS revealed that the Bi2S3-Sm2O3 composite possesses metallic surface states, thereby displaying unconventional electron dynamics and purity of phases. The Bi2S3-Sm2O3 composite shows outstanding OER activity with a low overpotential of 197 mV and a Tafel slope of 74 mV dec-1 at a 10 mA cm-2 current density as compared to pure Bi2S3 and Sm2O3. Meanwhile, the composite catalyst retains high stability even after 100 h of the chronoamperometry test. Thus, this work unveils a new avenue for the speedy flow of electrons, which is attributed to the synergetic effect between Bi2S3 and Sm2O3, as well as enriched interfacial defects, which exhibit greater oxygen adsorption capability with improved electronic assemblies in the active interfacial region. In addition, the introduced porous structure in core-shell Bi2S3-Sm2O3 provides extraordinary electrical properties. Thus, this article offers a realistic framework for electrochemical energy generation.

Bing-Neel syndrome: a rare neurological complication of Waldenström macroglobulinaemia.

Bing-Neel syndrome (BNS) is a very rare manifestation of Waldenström macroglobulinaemia (WM), in which lymphoplasmacytic cells invade the central nervous system. The clinical presentation includes symptoms of headaches, visual floaters, neuropathy, seizures and gait abnormalities. Here, we describe an elderly woman, who presented with complaints of visual floaters, progressive neuropathy and cognitive changes. Workup including a bone marrow biopsy confirmed the diagnosis of WM. Shortly afterwards, the patient experienced a seizure leading to hospitalisation, which revealed a right frontal lobe lesion on brain MRI. A biopsy of the lesion showed a small B cell lymphoma positive for an MYD88 mutation, confirming BNS. The patient was initially treated with ibrutinib, before transitioning to zanubrutinib. However, she developed disease progression necessitating radiotherapy with lenalidomide and rituximab maintenance therapy, which achieved remission. This case sheds light on the diagnosis and management of a very rare complication of a rare disease.

Understanding and Overcoming the Pitfalls in Cytopathological Diagnosis of Hyalinizing Trabecular Tumor of Thyroid.

Hyalinizing trabecular tumor (HTT), a rare low-malignant-potential thyroid neoplasm, is usually treated with conservative surgery. However, cytomorphological diagnosis of HTT is challenging due to the significant overlap of nuclear features with more common malignancies such as papillary thyroid carcinoma (PTC), which usually requires more radical surgical intervention. To avoid unnecessary overtreatment, a precise diagnosis of HTT is therefore essential. Advances in molecular diagnostics provide the opportunity to overcome the limitations of cytological analysis. We present a case of HTT in a 71-year-old male who was initially suspected to be PTC based on cytopathology. However, further molecular analysis revealed PAX8::GLIS3 gene fusion, classifying the lesion as HTT and preventing surgical overtreatment. We discuss the diagnostic pitfall of cytopathology in HTT and suggest using emerging molecular genetic tools to avoid it.

Fabrication of fullerene-supported La2O3-C60 nanocomposites: dual-functional materials for photocatalysis and supercapacitor electrodes.

Nowadays, water pollution and energy crises worldwide force researchers to develop multi-functional and highly efficient nanomaterials. In this scenario, the present work reports a dual-functional La2O3-C60 nanocomposite fabricated by a simple solution method. The grown nanomaterial worked as an efficient photocatalyst and proficient electrode material for supercapacitors. The physical and electrochemical properties were studied by state-of-the-art techniques. XRD, Raman spectroscopy, and FTIR spectroscopy confirmed the formation of the La2O3-C60 nanocomposite with TEM nano-graphs, and EDX mapping exhibits the loading of C60 on La2O3 particles. XPS confirmed the presence of varying oxidation states of La3+/La2+. The electrochemical capacitive properties were tested by CV, EIS, GCD, ECSA, and LSV, which indicated that the La2O3-C60 nanocomposite can be effectively used as an electrode material for durable and efficient supercapacitors. The photocatalytic test using methylene blue (MB) dye revealed the complete photodegradation of the MB dye under UV light irradiation after 30 min by a La2O3-C60 catalyst with a reusability up to 7 cycles. The lower energy bandgap, presence of deep-level emissions, and lower recombination rate of photoinduced charge carriers in the La2O3-C60 nanocomposite than those of bare La2O3 are responsible for enhanced photocatalytic activity with low-power UV irradiation. The fabrication of multi-functional and highly efficient electrode materials and photocatalysts such as La2O3-C60 nanocomposites is beneficial for the energy industry and environmental remediation applications.

Dual Z-scheme core-shell PANI-CeO2-Fe2O3-NiO heterostructured nanocomposite for dyes remediation under sunlight and bacterial disinfection.

Nowadays, environmental pollution due to discharge of organic pollutants from food, textile, and pharmaceutical industries into clean water and development of contagious diseases due to pathogenic organisms provide impetus to material researcher to fabricate novel design for efficient photocatalyst and antimicrobial agents. In this regard, designing a core-shell heterojunction catalyst based on metal oxides is considered an auspicious approach. In present study, combating the problems of singular oxides, core-shell PANI-CeO2-Fe2O3-NiO nanocomposite (PCFN) and CeO2-Fe2O3-NiO nanocomposite (CFN) was synthesized through sol-gel and oxidative polymerization route with cetyletrimethylammonium bromide (CTAB) as surfactant. The XRD, FTIR, and Raman confirmed the formation of nanocomposites with core-shell morphology composed of PANI (shell) and oxides (Core) in PCFN with a particle size of 52 nm (TEM). Surprisingly, PCFN has lower band gap, e-/h+ recombination, and larger charge transfer character than CFN. The decomposition test using MB and MO dyes showed that PCFN degraded 99%, 98%, while CFN degraded only 73% and 54%, respectively, under 50 min sunlight illumination. The reusability was assessed up to 7th cycle for PCFN. The influence of operational parameters (catalyst dose, dye concentration, pH) was tested for PCFN. Further, the antimicrobial action against S. aureus (gram + ve), E. coli (gram -ve) were also tested. The supreme performance of PCFN has been credited to heterostructure dual Z-scheme formation and core-shell morphology supported with PANI, which suppresses the e-/h+ recombination process by promoting their separation. The present finding indicated that the PCFN is a promising modifier for bacterial disinfection and acts as a superb photocatalyst through core-shell formation with PANI support.

Transition metal-doped SnO2 and graphene oxide (GO) supported nanocomposites as efficient photocatalysts and antibacterial agents.

In the present work, pristine and transition metal (TM) (W, Ag, Zn)-doped SnO2 nanocrystals using a facile sol-gel approach were synthesized. The grown products were anchored on graphene oxide (GO) sheets via a simple ultrasonication technique to fabricate binary nanocomposites. The structural, optical, and morphological properties of as-synthesized samples were studied by XRD, FTIR, Raman, EDX, UV-Visible, PL, and FE-SEM. The charge transferability of graphene oxide-based samples was investigated by EIS. The XRD exhibited the TM doping in SnO2 and the development of GO-based nanocomposite. FTIR data evidenced the existence of the metal-oxygen bonds. Raman spectra presented the optical phonon modes of SnO2 and the existence of oxygen vacancy defects. FE-SEM images demonstrated the anchoring of particles on the GO sheet, and EDX further approved the existence of desired dopants. The integration of SnO2 with TM doping remarkably reduced optical bandgap (3.65-3.10 eV), which was further decreased (3.10-2.99 eV) by making composite with GO. The photodegradation results exhibited that GO-based nanocomposites have the higher potential to degrade synthetic dyes (methyl red (MR), and methyl orange (MO) and SnZnO2/GO have shown superb photocatalytic performance after 80-min sunlight illumination (99.9% MR and 95.0% MO dyes) with the higher rate constant and superior stability up to 6th cycle against MR dye. The grown samples were tested for bacterial disinfection, and SnZnO2/GO sample showed a higher zone of inhibition towards S. aureus and K. pneumoniae bacteria strains. The greater charge transfer rate and lower recombination of charge carriers in GO-based composites were also observed by EIS and PL analysis. Moreover, the present article ascribed that the photocatalytic and antibacterial properties of bare SnO2 could be improved by TM doping and fabricating their composite with GO.

Energy-levels well-matched direct Z-scheme ZnNiNdO/CdS heterojunction for elimination of diverse pollutants from wastewater and microbial disinfection.

Energy-levels well-matched direct Z-scheme ZnNiNdO/CdS heterojunction was successfully fabricated using facile co-precipitation and ultra-sonication techniques and characterized with XRD, FTIR, Raman, PL, UV-vis, and FE-SEM. The XRD diffractograms confirmed the co-doping of Ni-Nd in ZnO and the formation of heterostructured nanocomposite. FTIR and Raman data showed the presence of metal-oxygen vibration and optical phonon modes of ZnO and CdS. FE-SEM images exhibited the network type morphology. The energy bandgap was redshifted by co-doping (3.37-2.9 eV) and was further reduced (2.6 eV) by making a composite with CdS. The ZnNiNdO/CdS catalyst degraded 99.7, 49, 96.6, 98.6, and 98.6% methylene blue (MB), p-nitroaniline (P-Nitro), methyl orange (MO), methyl red (MR), and rhodamine B (RhB) dyes under 50 min sunlight irradiation. Moreover, ZnNiNdO/CdS showed intense inhibition activity towards Staphylococcus aureus, Escherichia coli, Proteus vulgaris, and Pseudomonas aeruginosa bacterial strains with maximum inhibition zone diameters 30, 33, 27, and 31 mm, respectively. The synergistic effects arising from band alignment can lead to efficient vectorial charge separation, transportation, and lower recombination of photoinduced charge carriers, ultimately boosting photocatalytic and antibacterial performance. The ZnNiNdO/CdS photocatalyst has higher stability up to the 7th cycle towards MB dye with ~ 5% deficit in degradation efficiency. The higher generation of superoxide and hydroxyl radical was confirmed by species trapping experiments responsible for photodegradation of dyes molecules. Furthermore, the results showed that the photocatalytic and antibacterial performance of pristine ZnO can be enhanced by co-doping and tuning energy bandgap.

Adding Automation and Independent Dual Verification to Reduce Wrong Blood in Tube (WBIT) Events.

OBJECTIVES: Transfusions remain a complicated procedure involving many disciplines performing various steps. Pretransfusion specimen identification errors remain a concern. Over the past two decades, system changes have been made and minimal improvements in the error rates have been seen. Wrong blood in tube (WBIT) events may lead to mistransfusions of components with life-threatening complications. METHODS: A continuous quality improvement effort involving the introduction of electronic patient identification at the point of pretransfusion specimen collection (an automated system improvement), manual independent dual verification, and periodic education (human process system improvements) were implemented. RESULTS: Both automated and human system process improvements resulted in greater than 10-fold reduction in WBIT events and a 47% reduction in mislabeled specimens. CONCLUSIONS: Diligent improvement and implementation of combination automated system processes and human protocols with continuous monitoring led to great reductions in WBIT error rates and labeling discrepancies, leading to an increase in system safety. These combinations of improvement can lead to more decreased error rates if applied to other critical process steps in the transfusion process.

Effects of a Single Rapid Infusion System on Platelet Function in Stored Whole Blood: An Ex Vivo Study.

Introduction Rapid infusion systems (RIS) are used to warm and rapidly infuse crystalloids and blood products. Current guidelines do not approve of platelet transfusion through a RIS, but data supporting these guidelines are scarce. Our hypothesis was that an infusion of whole blood through a RIS would degrade platelet quantity, impede viscoelastic clot strength, and inhibit platelet aggregation response to adenosine diphosphate pathway (ADP) activation. Methods Ten iterations of a simulated scenario of transfusing whole blood via a single brand and make of RIS (Belmont Fluid Management System 2000, Belmont Medical Technologies, Billerica, MA) were performed. Units of whole blood, which were two to nine days old, were leukoreduced prestorage. Blood was used to prime the RIS and then warmed and infused at 100 mL/min into a reservoir. Blood samples were collected before and immediately after infusion. Samples were tested for platelet count, size, and viscoelastic clot strength using thromboelastographic and aggregation assays. Results The study sample (n = 10) included platelets with an average age of 5.3 days. The infusion through the RIS had a detrimental effect on all the maximal amplitudes (MA) of viscoelastic testing: MA ADP (mean difference = -18.7 mm; 95% CI: -24.1 to -13.3, P = 0.004), MA rapid thromboelastography (MA rTEG) (mean difference = -6.0; 95% CI: -10.0 to -2.0, P = 0.008), MA TEG (mean difference = -7.1; 95% CI: -10.9 to -3.4, P = 0.004), mean platelet volume (MPV) (mean difference = -0.3; 95% CI: -0.6 to -0.1, P = 0.02), and platelet count (mean difference = -68.3 × 103/µL; 95% CI: -86.9 to -49.7, P = 0.004). Conclusions Platelet quantity, viscoelastic clot strength, and platelet aggregation response to ADP each decline after infusion through a RIS. Further studies regarding microaggregates and platelet activation are required.

Sunlight-induced photocatalytic degradation of various dyes and bacterial inactivation using CuO-MgO-ZnO nanocomposite.

Novel tri-phase CuO-MgO-ZnO nanocomposite was prepared using the co-precipitation technique and investigated its physical properties using characterization techniques including XRD, FTIR, Raman, IV, UV-vis, PL, and SEM. The application of grown CuO-MgO-ZnO nanocomposite for the degradation of various dyes under sunlight and antibacterial activity against different bacteria were studied. The XRD confirmed the existence of diffraction peaks related to CuO (monoclinic), MgO (cubic), and ZnO (hexagonal) with CuO phase 40%, MgO 24%, and ZnO 36%. The optical energy gap of nanocomposite was 2.9 eV, which made it an efficient catalyst under sunlight. Raman and FTIR spectra have further confirmed the formation of the nanocomposite. SEM images revealed agglomerated rod-shaped morphology. EDX results showed the atomic percentage of a constituent element in this order Cu>Zn>Mg. PL results demonstrate the presence of intrinsic defects. The photocatalytic activity against methylene blue (MB), methyl orange (MO), rhodamine-B (RhB), cresol red (CR), and P-nitroaniline (P-Nitro) dyes has shown the excellent degradation efficiencies 88.5%, 93.5%, 75.9%, 98.8%, and 98.6% at 5 ppm dye concentration and 82.6%, 83.6%, 64.3%, 93.1%, and 94.3% at 10 ppm dye concentration in 100 min, respectively, under sunlight illumination. The higher degradation is due to the generation of superoxide and hydroxyl radicals. The recyclability test showed the reusability of catalyst up to the 5th cycle. The antibacterial activity against Escherichia coli, Klebsiella pneumoniae, Proteus Vulgaris, Staphylococcus aureus, and Pseudomonas aeruginosa bacteria with the zone of inhibition 30, 31, 30, 30, and 30 mm, respectively, was achieved.

Evaluation of A plasma for incompatible patients.

BACKGROUND: Plasma transfusion is a critical treatment in managing bleeding patients. In an effort to make plasma immediately available in spite of the limited amount of AB plasma, providers have begun using A plasma in life-threatening emergencies. As this practice becomes widely adopted it is important to evaluate safety. Hemolytic transfusions reactions are underreported, and hemolysis may be subclinical. STUDY DESIGN AND METHODS: A retrospective study was performed at the University of Florida/Shands Hospital of B and AB patients who received 1 unit or more of A plasma. Patient charts were reviewed and data collected included age; sex; mortality; intensive care unit (ICU) length of stay; and laboratory tests used in identifying hemolysis including direct antiglobulin test, lactate dehydrogenase, haptoglobin, indirect bilirubin, aspartate aminotransferase, urinalysis, hemoglobin, and hematocrit. The primary end points of the study were immune mediated hemolysis, mortality, and length of ICU stay. RESULTS: Ninety-three patients were identified as eligible for the study. One patient suffered a delayed hemolytic transfusion reaction determined to be due to an anti-Jka . No evidence of hemolysis due to ABO-incompatible plasma transfusion was identified. The volume of A plasma transfused was found to be weakly related to mortality and ICU stay. CONCLUSION: No evidence of ABO immune-mediated hemolysis was observed in the patient population. The results of the study support the safety of A plasma transfusion in B and AB patients. We hypothesize the relationship observed between A plasma volume and mortality/ICU stay may be from collinearity with disease severity.

Effect of single operator cholangioscopy on accuracy of bile duct cytology.

INTRODUCTION: This is the first study to evaluate the accuracy of bile duct brushings since the introduction of single operator cholangioscopy SpyGlass DS system in 2015. The primary aim of our study was to compare the accuracy of cytology brushings against biopsies obtained at endoscopic retrograde cholangiopancreatography (ERCP) and cholangioscopy. METHOD: A retrospective search for bile duct brushing specimens was performed and the charts reviewed. The gold standard for definitive diagnosis of malignancy was surgical tissue or compelling clinical evidence of malignancy. Definite negative diagnosis relied on lack of clinical/imaging features of malignancy on follow-up. RESULTS: There was no significant difference in diagnostic accuracy of cytology specimens obtained at different procedures. Overall sensitivity for all methods was 59%, specificity 90% and accuracy of 82%. Notably, all four false-positive cases except for one were from patients with primary sclerosing cholangitis or primary biliary sclerosis. There was no significant difference in sensitivity or specificity between biopsies procured by the two methods. The combined biopsy sensitivity for all modalities was 44% with a specificity of 100%. There was 70% concordance between cytology and biopsy cases. The overall specificity and sensitivity of the combined cytology and biopsy result was 85% and 65.3%, respectively. Ranking of factors that predict clinical diagnosis shows cytology results to surpass other parameters including pancreatic mass, age and stenosis length. Similarly, the presence of two cell populations and three-dimensional clusters was not nearly as predictive of malignancy as single malignant cells. CONCLUSION: Biliary brush cytology specimens performed better than biopsies irrespective of whether they are procured during ERCP or cholangioscopy. The combination of cytology and biopsy had the best accuracy than either one alone.

Soluble antigens in plasma allow mismatched transfusion without hemolysis.

BACKGROUND: Universal plasma is a scarce resource when a massive transfusion protocol has been initiated. Previous studies have reported success using group A plasma in place of the universal plasma, group AB. It is unclear why there are not more reports of hemolytic reactions occurring from this practice. One possible explanation is the presence of water-soluble antigens in the patient plasma that bind to, and neutralize, the soluble antibodies present in the transfused plasma. STUDY DESIGN AND METHODS: Expired units of plasma were used to make dilutions that consisted of mixtures of group A and B plasma and saline. Serial dilutions of these samples were performed starting from undiluted up to 1024. The dilutions were titrated using a group B red blood cell preparation. The titrations were read after incubation. RESULTS: The titers that resulted from the mixed plasma dilutions were significantly lower or showed no agglutination when compared to the group A-specific saline dilutions. The differences between the saline dilutions and mixed group dilutions were significant (p < 0.001). CONCLUSION: Our study shows that secretor status would provide protection from isoantibodies. The dissolved B antigens in the group B plasma absorb and/or bind to the group B isoantibodies in the group A plasma. This mechanism gives a protective effect against hemolytic reactions in massive transfusion situations in the trauma setting when group A plasma is used instead of group AB plasma. This protective effect is revealed with the paucity of intravascular hemolysis observed in these out-of-group massive transfusions.

Frozen section evaluation of margins in radical prostatectomy specimens: a contemporary study and literature review.

The utility of routine frozen section (FS) analysis for margin evaluation during radical prostatectomy (RP) remains controversial. A retrospective search was conducted to identify RPs evaluated by FS over a 5-year period. The potential of FS to discriminate between benign and malignant tissue and to predict final margins was evaluated. During the study period, 71 (12.3%) of 575 cases underwent FS evaluation of margins, generating 192 individual FSs. There were 8 FSs diagnosed as atypical/indeterminate because of significant freezing, crushing, and/or thermal artifacts; 11 as positive for carcinoma; and 173 as benign. Two FSs classified as benign were diagnosed as positive for carcinoma on subsequent permanent section. Frozen sections' sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of prostatic adenocarcinoma were 85%, 100%, 100%, 99%, and 99%, respectively. Overall RP final margin predictive accuracy was 81%. Positive FS was significantly associated with perineural invasion on biopsy and extraprostatic extension and higher stage disease on RP, but not with the overall final margin status. The high FS accuracy supports its use to guide the extent of surgery. However, FS cannot be used to predict the overall final margin status. Recognition of the histological artifacts inherent to the FS procedure is important to ensure appropriate utilization.

Diagnostic error assessment and associated harm of endoscopic ultrasound-guided fine-needle aspiration of neuroendocrine neoplasms of the pancreas.

BACKGROUND: Over the past decade, the standardization of error classification in anatomic pathology has become an important issue. The objective of the current study was to assess the extent of errors occurring in the cytopathologic diagnosis of neuroendocrine lesions of the pancreas, and to classify these errors and their associated harm. METHODS: Information on all cases diagnosed as a neuroendocrine neoplasm either by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in cytology or by surgical pathology between 2000 and 2012 was collected. Using standardized error and harm classification, the authors reviewed the cytology and surgical pathology material and evaluated the type and the cause of diagnostic errors and their impact on the patient. RESULTS: A total of 177 patients who underwent EUS-FNA were diagnosed with a neuroendocrine neoplasm either by cytology or surgical pathology. Eighty of these cases had surgical follow-up available at the study institution. Of these 80 cases, 56 had an adequate cell block and immunohistochemistry was performed. There were 14 discrepancies noted between cytologic and surgical pathologic diagnoses. There were 9 false-negative cases, consisting of 3 interpretation errors and 6 cytology sampling errors. There were 5 misclassifications, including 4 cases of solid pseudopapillary neoplasm and 1 case of neuroendocrine carcinoma (diagnosed as adenocarcinoma on cytology). There were no surgical pathology errors noted. All errors were associated with no or minor harm. CONCLUSIONS: EUS-FNA of pancreatic neuroendocrine neoplasms has excellent diagnostic performance, with no false-positive diagnoses reported. When an adequate sample is obtained, the most significant error is misclassification, which is most often associated with solid pseudopapillary neoplasm. The harm associated with diagnostic errors is at most minor.