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Woolman M, Katz L, Tata A, Basu SS, Zarrine-Afsar A. Breaking Through the Barrier: Regulatory Considerations Relevant to Ambient Mass Spectrometry at the Bedside. Clin Lab Med 2021; 41:221-246. [PMID: 34020761 DOI: 10.1016/j.cll.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rapid characterization of tissue disorder using ambient mass spectrometry (MS) techniques, requiring little to no preanalytical preparations of sampled tissues, has been shown using a variety of ion sources and with many disease classes. A brief overview of ambient MS in clinical applications, the state of the art in regulatory affairs, and recommendations to facilitate adoption for use at the bedside are presented. Unique challenges in the validation of untargeted MS methods and additional safety and compliance requirements for deployment within a clinical setting are further discussed. Development of a harmonized validation strategy for ambient MS methods is emphasized.
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Affiliation(s)
- Michael Woolman
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada; Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Lauren Katz
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada; Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada
| | - Alessandra Tata
- Laboratorio di Chimica Sperimentale, Istituto Zooprofilattico delle Venezie, Viale Fiume 78, 36100 Vicenza, Italy
| | - Sankha S Basu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Arash Zarrine-Afsar
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Toronto, Ontario M5G 1P5, Canada; Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, Ontario M5G 1L7, Canada; Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada; Keenan Research Center for Biomedical Science & the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
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Field AS, Kurtycz DFI, Raymond WA, Schmitt F. The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: Analysis and discussion of the response to a web-based survey. Cancer Cytopathol 2020; 129:450-459. [PMID: 33369266 DOI: 10.1002/cncy.22397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND A group of international experts in breast fine needle aspiration biopsy (FNAB) cytopathology, supported by the International Academy of Cytology (IAC), drafted a comprehensive system for reporting breast FNAB cytopathology in 2017-2018. The editorial team produced a survey to assess the international response to the proposed category structure, definitions, and management recommendations in this draft. METHODS A web-based survey of 186 questions was generated using the Qualtrics software package (Provo, Utah) supported by the Division of Information Technology at the University of Wisconsin-Madison. The survey was advertised widely-including through the IAC, American Society of Cytopathology, Japanese Society of Clinical Cytology, Papanicolaou Society of Cytopathology, and Australian Society of Cytology and to audiences at national and international meetings-and was available from April to June 2018. The data obtained from the 265 respondents was assessed by the editorial team. RESULTS The survey provided a snapshot of the current role and use of breast FNAB and the international variations. Demographic questions were followed by specific questions based on the draft category definitions and statements and focused on issues that had generated discussion among the authors, including the FNAB diagnosis of ductal carcinoma in situ. CONCLUSION The survey results strongly supported the development of the IAC Yokohama System and informed subsequent discussions among the authors regarding the final text.
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Affiliation(s)
- Andrew S Field
- Medical Schools, University of New South Wales and Notre Dame University Medical Schools, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, Wisconsin
| | - Wendy A Raymond
- Department of Surgical Pathology, Flinders Medical Centre and Flinders University of South Australia, Adelaide, South Australia, Australia.,Clinpath Laboratories, Adelaide, South Australia, Australia
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of Porto University, Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
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Field AS, Raymond WA, Rickard M, Arnold L, Brachtel EF, Chaiwun B, Chen L, Di Bonito L, Kurtycz DFI, Lee AHS, Lim E, Ljung BM, Michelow P, Osamura RY, Pinamonti M, Sauer T, Segara D, Tse G, Vielh P, Chong PY, Schmitt F. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology. Acta Cytol 2019; 63:257-273. [PMID: 31112942 DOI: 10.1159/000499509] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/07/2019] [Indexed: 01/29/2023]
Abstract
The International Academy of Cytology (IAC) gathered together a group of cytopathologists expert in breast cytology who, working with clinicians expert in breast diagnostics and management, have developed the IAC Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy (FNAB) Cytology. The project was initiated with the first cytopathology group meeting in Yokohama at the 2016 International Congress of Cytology. This IAC Yokohama System defines five categories for reporting breast cytology, each with a clear descriptive term for the category, a definition, a risk of malignancy (ROM) and a suggested management algorithm. The key diagnostic cytopathology features of each of the lesions within each category will be presented more fully in a subsequent atlas. The System emphasizes that the crucial requirements for diagnostic breast FNAB cytology are a high standard for the performance of the FNAB and for the making of direct smears, and well-trained experienced cytopathologists to interpret the material. The performance indicators of breast FNAB, including specificity and sensitivity, negative predictive value, positive predictive value and ROM stated in this article have been derived from the recent literature. The current practice of breast FNAB has evolved with the increasing use of ultrasound guidance and rapid on-site evaluation. Two recent publications have shown a range of ROM for the insufficient/inadequate category of 2.6-4.8%, benign 1.4-2.3%, atypical 13-15.7%, suspicious of malignancy 84.6-97.1%, and malignant 99.0-100%. The management algorithm in the System provides options because there are variations in the management of breast lesions using FNAB and core-needle biopsy in those countries utilizing the "triple test" of clinical, imaging, and FNAB assessment, and also variations in the availability of CNB and imaging in low- and middle-income countries. The System will stimulate further discussion and research, particularly in the cytological diagnostic features of specific lesions within each category and in management recommendations. This will lead to continuing improvements in the care of patients with breast lesions and possible modifications to the IAC Yokohama System.
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Affiliation(s)
- Andrew S Field
- Department of Pathology, St Vincent's Hospital, and University of NSW and University of Notre Dame Medical Schools, Sydney, New South Wales, Australia,
| | - Wendy A Raymond
- South Australian Pathology, Department of Surgical Pathology, Flinders Medical Centre, Flinders University of South Australia, and Clinpath, Adelaide, South Australia, Australia
| | - Mary Rickard
- BreastScreen NSW and Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Arnold
- Sydney Breast Clinic, Sydney, New South Wales, Australia
| | - Elena F Brachtel
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Benjaporn Chaiwun
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Lan Chen
- Pathology Department, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Luigi Di Bonito
- Department of Anatomical Pathology, University of Trieste, Trieste, Italy
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, Wisconsin, USA
| | - Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Elgene Lim
- Connie Johnson Breast Cancer Research Laboratory, Garvan Institute of Medical Research, St Vincent's Hospital, UNSW Medical School, Sydney, New South Wales, Australia
| | - Britt-Marie Ljung
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Pamela Michelow
- Department of Anatomical Pathology, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
| | - Robert Y Osamura
- Nippon Koukan Hospital, Kawasaki, Japan
- Keio University School of Medicine, Tokyo, Japan
| | | | - Torill Sauer
- Institute of Clinical Medicine, Department of Pathology, Faculty of Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - Davendra Segara
- Breast Surgical Oncologist, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Gary Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Philippe Vielh
- Laboratoire National de Santé, Departement de Pathologie Morphologique et Moleculaire, Dudelange, Luxembourg
| | - Phek Y Chong
- Department of Pathology, Sengkang General Hospital, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology, Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
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Saba K, Niazi S, Bukhari MH, Imam SF. Use of supravital toluidine blue staining to improve the efficiency of fine-needle aspiration cytology reporting in comparison to papanicolaou stain. Pak J Med Sci 2015; 31:1146-51. [PMID: 26649003 PMCID: PMC4641272 DOI: 10.12669/pjms.315.8411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To see the efficiency, adequacy and accuracy of toluidine blue stained smears of FNAC of Breast thyroid and salivary glands swelling with comparison to conventional stained FNAC smears with Papanicolaou. METHODS A total of 114 aspirates from various sites were included in the study. The smears were stained with toluidine blue and conventional Papanicolaou stain and the cytomorphology of both the smears were compared. The values were tabulated and statistical tests of significance was applied. RESULTS Of the 114 aspirates included in our study the diagnostic accuracy by using papanicolaou was 78%, while it was upto 100% with supravital toluidine blue stained smears. The percentage of inadequacy was reduced to just 25%. The observations were statistically significant. Breast 37/48 (77%) and Salivary glands 11/48 (23%) respectively. The most commonly used categorization of a five-tier system was used for reporting of breast cytology, with categories ranging from insufficient materials (C1), benign (C2), atypical (C3), suspicious of malignancy (C4), or (C5) frankly malignant. Most of breast lesions were benign 25 (67.56%). There were only 9 (24.32%) malignant cases followed by 2 cases of C-4 and one case of C-3. Benign thyroid lesion were more frequent comprising of 51 (72.27%) cases. One case (1.5%) of papillary carcinoma was found while 13 case were follicular lesions. There were 4 (36.4%) cases of pleomorphic adenoma and 3 (27.3) cases of non-specific sialadenitis. There was one case (9%) of each lesion for mucoepidermoid carcinoma, adenoidcytic carcinoma and benign cyst. CONCLUSION Toluidine blue stained study of FNAC improves the diagnostic accuracy by minimizing the smearing and drying artifact, loss of cell sample during fixation and staining which influences the diagnostic accuracy.
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Affiliation(s)
- Kanwal Saba
- Kanwal Saba, Department of Pathology and Medicine, Fatima Jinnah Medical College, Lahore, Pakistan
| | - Shahida Niazi
- Shahida Niazi, Dept. of Pathology, King Edward Medical University, Lahore, Pakistan
| | - Mulazim Hussain Bukhari
- Mulazim Hussain Bukhari, Department of Pathology and Medicine, Fatima Jinnah Medical College, Lahore, Pakistan
| | - Sardar Fakhar Imam
- Sardar Fakhar Imam, Department of Pathology and Medicine, Fatima Jinnah Medical College, Lahore, Pakistan
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Sofi LA, Sherwani RK, Hasan M, Nobin H. On-spot brilliant cresyl blue staining in fine needle aspiration, a novel technique for cytological diagnosis. Acta Cytol 2013; 57:641-5. [PMID: 24107798 DOI: 10.1159/000354027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/24/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Application of on-spot staining with brilliant cresyl blue, a supravital stain, was investigated in fine needle aspirates from breast, lymph node and thyroid. STUDY DESIGN Patients with palpable breast lumps, lymph nodes and thyroid nodules were included in the study. Brilliant cresyl blue was used to stain the smears, which were evaluated for smear adequacy as well as cytological diagnosis. Smears were decolorized and subjected to Pap and/or HE staining for comparison. RESULTS Smears which were deemed hemorrhagic on the first attempt with brilliant cresyl blue correlated with Pap staining; then sites were reaspirated within minutes to obtain satisfactory cellular smears. Morphologically, cells which were designated malignant on supravital staining were mostly malignant on Pap/HE staining. CONCLUSION On-spot brilliant cresyl blue staining increases the diagnostic potential on preliminary examination by decreasing the staining time and is as good as conventional stains in exhibiting cellular morphology.
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Affiliation(s)
- Lateef Ahmad Sofi
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh, India
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Mendoza P, Lacambra M, Tan PH, Tse GM. Fine needle aspiration cytology of the breast: the nonmalignant categories. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:547580. [PMID: 21660275 PMCID: PMC3108472 DOI: 10.4061/2011/547580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/21/2011] [Accepted: 03/21/2011] [Indexed: 11/24/2022]
Abstract
Currently, accurate diagnosis of breast lesions depends on a triple assessment approach comprising clinical, imaging and pathologic examinations. Fine needle aspiration cytology (FNAC) is widely adopted for the pathologic assessment because of its accurracy and ease of use. While much has been written about the atypical and maliganant categories of FNAC diagnosis, little covers the non-malignanat category which represents a sheer number in all FNAC cases. Moreover, any false-negative diagnosis of the non-malignant cases may lead to missed diagnosis of cancer. This paper aims to discuss the issues of smear adequacy, the cytologic features of benign breast lesions and the dilemma of a false-negative aspirate. Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC. Various benign lesions could be easily diagnosed at FNAC; however, they have cytologic features overlapped with malignant lesions. False negativity of FNAC does occur; this could be caused by either “true” false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or “false” false-negative cases due to interpretational errors. Though false-positive cases are less commonly found, they will also be discussed briefly.
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Affiliation(s)
- Paulo Mendoza
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Nassar A. Core needle biopsy versus fine needle aspiration biopsy in breast--a historical perspective and opportunities in the modern era. Diagn Cytopathol 2010; 39:380-8. [PMID: 20949457 DOI: 10.1002/dc.21433] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/05/2010] [Indexed: 01/08/2023]
Abstract
Breast fine-needle aspiration biopsy (FNAB) by palpation is on the decline, due to its limitations in diagnostic accuracy, decreased sensitivity, and its replacement with core needle biopsy (CNB). Despite its decreasing utility, superficial fine-needle aspiration (FNA) in breast is still the main modality for evaluating metastatic lesions, recurrence, and axillary lymph node metastasis. New modalities including proteomic pattern expression and methylation profiling of breast lesions are other promising techniques that can be used as ancillary tests for refining the diagnosis of breast lesions using FNAB. Image-guided breast FNA proves to be a successful alternative with high sensitivity and specificity. In this review, the advantages, disadvantages, and inherent limitations of breast FNA and CNB, and new advanced techniques are discussed.
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Affiliation(s)
- Aziza Nassar
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55902, USA.
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Gomez-Macías GS, Garza-Guajardo R, Segura-Luna J, Barboza-Quintana O. Inadequate fine needle aspiration biopsy samples: pathologists versus other specialists. Cytojournal 2009; 6:9. [PMID: 19621092 PMCID: PMC2710760 DOI: 10.4103/1742-6413.52831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 03/20/2009] [Indexed: 12/21/2022] Open
Abstract
Background: Fine needle aspiration biopsy (FNAB) is a simple, sensitive, quick and inexpensive method in which operator experience is essential for obtaining the best results. Methods: A descriptive study in which the aspiration biopsy cases of the Pathology and Cytopathology Service of the University Hospital of the UANL (2003–2005) were analyzed. These were divided into three study groups: Group 1, FNAB performed by a pathologist; Group 2, FNAB performed by specialists who are not pathologists, Group 3, FNAB guided by an imaging study with immediate evaluation by a pathologist. The samples were classified as adequate and inadequate for diagnosis, the organ, the size and characteristics of the lesions were taken into consideration. Results: A total of 1905 FNAB were included. In Group 1: 1347 were performed of which 1242 (92.2%) were adequate and 105 (7.7%) were inadequate. Of the 237 from Group 2, 178 were adequate (75.1%) and 59 inadequate (24.8%); in Group 3 there were 321 of which 283 (88.1%) were adequate and 38 (11.8%) inadequate. A statistically significant difference was found between FNAB performed by Group 1 (p< 0.001) and the other groups. A multivariate analysis was done where the organ punctured, the study groups, the size and characteristics of the lesion by study group were compared, finding that the most important variable was the person who performed the procedure. Conclusion: The experience and training of the person performing the aspiration biopsy, as well as immediate evaluation of the material when it is guided, substantially reduces the number of inadequate samples, improving the sensitivity of the method as well as reducing the need for open biopsies to reach a diagnosis.
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Affiliation(s)
- G S Gomez-Macías
- Department of Pathology and Cytopathology, Monterrey, Nuevo Leon, Mexico.
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Abati A, Simsir A. Breast Fine Needle Aspiration Biopsy: Prevailing Recommendations and Contemporary Practices. Clin Lab Med 2005; 25:631-54, v. [PMID: 16308084 DOI: 10.1016/j.cll.2005.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 1996, a National Cancer Institute conference was held in Bethesda,Maryland to define parameters for the practice of breast fine needle aspiration (BFNA). Representatives of the American Society of Cytopathology, Papanicolaou Society of Cytopathology, American College of Radiology, American College of Obstetricians & Gynecologists, Society of Surgical Oncology, American Academy of Family Physicians, College of American Pathologists, National Consortium of Breast Centers, International Academy of Cytology, American Society of Clinical Pathologists, American Cancer Society, American College of Surgeons, and American Society for Cytotechnology developed and reviewed recommendations. These guidelines were referred to as "The Uniform Approach to Breast Fine Needle Aspiration Biopsy." This article reviews these recommendations and the contemporary evolution of the practice of BFNA since their original publication.
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Affiliation(s)
- Andrea Abati
- Cytopathology Section, National Cancer Institute/National Institutes of Health, Bethesda, MD 20892, USA.
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