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Tralongo P, Bruno C, Policardo F, Vegni F, Feraco A, Carlino A, Ferraro G, Milardi D, Navarra E, Pontecorvi A, Lombardi CP, Raffaelli M, Larocca LM, Pantanowitz L, Rossi ED. Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology. Cancer Cytopathol 2023; 131:693-700. [PMID: 37519189 DOI: 10.1002/cncy.22745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The presurgical evaluation of cervical lymph nodes (CLNs) in the management of thyroid malignant lesions is crucial for the extent of surgery or detection of metastases. In these last decades, fine-needle aspiration cytology (FNAC) has been shown to have a central role in the detection of nodal thyroid metastases. It is adopted for the possibility of confirming suspected metastases either in the presurgical phase or in the follow-up of patients after thyroidectomy. However, FNAC from CLNs can be challenging, especially in cystic lesions. In this regard, the combination of FNAC with thyroglobulin measurement in the eluate from FNAC (Tg-FNAC) seems to increase the sensitivity of FNAC in the detection of CLN metastases. The role of FNAC and Tg-FNAC was investigated in this series. METHODS One hundred fifty-three prospective cytological samples of CLNs were studied along with surgical follow-up in the period between 2020 and 2022. Immunocytochemistry (ICC) was performed on liquid-based cytology-stored material. RESULTS One hundred fifty-nine enlarged CLNs included 19 central lymph nodes and 140 CLNs. Forty-two thyroidal CLN metastases and 117 reactive lymph nodes were found. Thirty-one CLN dissections were performed in patients with a previous diagnosis of thyroid carcinoma (mostly papillary thyroid carcinoma [PTC]), whereas 128 CLNs with a concomitant suspicious and/or malignant thyroid nodule were found. There was one false-positive case among all the malignant histologically confirmed cases, and two of 117 reactive CLNs (1.7%) had a diagnosis of metastatic PTC. Markedly high Tg-FNAC was found in all metastatic CLNs, including 11 cystic metastatic CLNs detected by Tg-FNAC with a negative FNAC. ICC (including Tg, CK-19, and LCA) recognized nine cases with low Tg-FNAC and scant suspicious thyrocytes. Tg-FNAC plus FNAC diagnosed 94.2% of malignancies. CONCLUSIONS FNAC represents a valid method for the evaluation of CLNs, especially combined with ICC. Tg-FNAC is an additional method with a useful role in FNAC.
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Affiliation(s)
- Pietro Tralongo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Carmine Bruno
- Division of Endocrinology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Policardo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Vegni
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Feraco
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Carlino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Giulia Ferraro
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Domenico Milardi
- Division of Endocrinology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Elena Navarra
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine-Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine-Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
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Dell'Aquila M, Tralongo P, Granitto A, Martini M, Capodimonti S, Curatolo M, Fiorentino V, Pontecorvi A, Fadda G, Lombardi CP, Raffaelli M, Pantanowitz L, Larocca LM, Rossi ED. Update regarding the role of PD-L1 in oncocytic thyroid lesions on cytological samples. J Clin Pathol 2023; 76:671-677. [PMID: 35701142 DOI: 10.1136/jclinpath-2022-208215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/24/2022] [Indexed: 11/04/2022]
Abstract
AIMS Several papers have shown that programmed death-ligand 1 (PD-L1) expression is a relevant predictive biomarker in anti-PD-L1 cancer immunotherapy. While its role in several human cancers is correlated with poor prognosis and resistance to anticancer therapies, in thyroid cancers the role of PD-L1 remains questionable. Few articles have studied PD-L1 in thyroid fine-needle aspiration cytology (FNAC), demonstrating a possible correlation with papillary thyroid carcinoma. However, its role in oncocytic thyroid lesions remains controversial. We accordingly examine the performance of PD-L1 immunostaining in liquid based cytology (LBC) from oncocytic lesions. METHODS From January 2019 to March 2021, 114 thyroid lesions diagnosed by FNAC from lesions with a predominant oncocytic component, were enrolled for evaluation by PD-L1 immunostaining on both LBC and corresponding histology samples. RESULTS The FNAC cohort included 51 benign (B, negative controls), 4 atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS), 57 follicular lesions (follicular neoplasm/suspicious for FN, FN/SFN) and 2 suspicious for malignancy (SFM) cases. Fifty-four cases (11B, 2 AUS/FLUS, 39 FN/SFN and 2 SFM) had histological follow-up including: 1B case resulted as a hyperplastic oxyphilic nodule in Hashimoto thyroiditis (HT), 10B as goitre, 2 AUS/FLUS cases as oncocytic adenomas (OAs); 39 FN/SFN included 27 OAs, 4 FA and 8 oncocytic follicular carcinoma (OFC). The two SFM cases were diagnosed on histopathology as OAs. Increased plasma membrane and cytoplasmic PD-L1 expression were found in 47 cases of the LBC cases (41.2%). Among the histological series, 67.3% of OAs and 75% of OFC had PD-L1 expression, while negative PD-L1 was found in hyperplastic oncocytic cells in HT. A positivity in more than 30% of the neoplastic cells was found in 72.9% of the cases including six OFC. CONCLUSIONS These data suggest that PD-L1 expression is expressed in oncocytic thyroid lesions. While weak PD-L1 expression failed to discriminate benign from malignant lesions, OFC demonstrated more intense cytoplasmic and membranous expression.
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Affiliation(s)
- Marco Dell'Aquila
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Pietro Tralongo
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alessia Granitto
- Anatomic Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Maurizio Martini
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Sara Capodimonti
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Mariangela Curatolo
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Vincenzo Fiorentino
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alfredo Pontecorvi
- Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Guido Fadda
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Celestino Pio Lombardi
- Endocrine Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Maco Raffaelli
- Endocrine Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, Michigan, USA
| | - Luigi Maria Larocca
- Anatomic Pathology and Histology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Esther Diana Rossi
- Anatomic Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Policardo F, Tralongo P, Arciuolo D, Fiorentino V, Cardasciani L, Pierconti F, Carlino A, Curatolo M, Pontecorvi A, Fadda G, De Crea C, Lombardi CP, Raffaelli M, Larocca LM, Pantanowitz L, Rossi ED. p53 expression in cytology samples may represent a marker of early-stage cancer. Cancer Cytopathol 2023; 131:392-401. [PMID: 36974003 DOI: 10.1002/cncy.22694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND TP53 gene plays a major role in the negative control of cell proliferation and in the regulation of signaling cascades. TP53 mutation may have a relevant role in the malignant transformation of thyroid cells as well as thyroid tumor progression. TP53 mutation has been detected only in few well differentiated thyroid carcinomas and is absent in benign conditions. METHODS A total of 162 prospective thyroid cytology and corresponding histological samples diagnosed from atypia of indeterminate significance (AUS) to malignant, were studied via immunocytochemistry for p53. Hence, 50 benign lesions (B) were used as negative control. Molecular analysis for p53 only was performed. RESULTS The cytology resulted in 50 B, 48 AUS, 40 follicular neoplasms (FNs), 23 suspicious for malignancy (SFM), and 1 malignant (M) case. The authors reported 102 negative and 60 positive p53 cases. The 60 positive cases included 27 cases with weak and/or focal cytoplasmic positivity (+1) and 33 with cases moderate (2+) to strong (3+) cytoplasmic and/or nuclear expression. Overall, 71 cases had histology (2 B, 11 AUS, 37 FN, 20 SFM, and 1 M) including 61.7% benign and 38.2% malignant diagnoses. Only 16 of 71 (5 FN, 10 SFM, and 1 M) were p53-positive. Furthermore, 100% AUS and 86.5% FN cases were p53-negative, none of which had malignant histology. All p53-positive cases were associated with a larger nodule size, tall-cell variant subtype, multifocality, extra thyroidal infiltration, and nodal metastases. Noninvasive follicular thyroid neoplasm with papillary like nuclear features were negative for p53. Few discrepancies in p53 intensity were observed on histology; there were no differences with the molecular testing. CONCLUSIONS p53 might be useful in discriminating thyroid follicular lesions. p53 is likely to be a useful diagnostic marker in recognizing indeterminate lesions that are well-differentiated thyroid cancers.
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Affiliation(s)
- Federica Policardo
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Damiano Arciuolo
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Lina Cardasciani
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Angela Carlino
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Mariangela Curatolo
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | | | - Guido Fadda
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Carmela De Crea
- Division of Endocrine-Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine-Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine-Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Hearth, Rome, Italy
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Rossi ED, Pantanowitz L. Effect of COVID-19 restrictions on thyroid cytopathology: delay in the diagnosis of indeterminate lesions. Lancet Diabetes Endocrinol 2023; 11:377-379. [PMID: 37127042 DOI: 10.1016/s2213-8587(23)00089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, 00168 Rome, Italy.
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Concordance between Three PD-L1 Immunohistochemical Assays in Head and Neck Squamous Cell Carcinoma (HNSCC) in a Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12020477. [PMID: 35204568 PMCID: PMC8871075 DOI: 10.3390/diagnostics12020477] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/15/2022] Open
Abstract
The introduction of immunotherapy targeting the programmed death-1 (PD-1)/programmed death-ligand-1 (PD-L1) axis has represented a turning point in the treatment of HNSCC. Harmonization studies comparing the different antibodies and immunohistochemistry platforms available for the evaluation of PD-L1 expression with Combined Positive Score (CPS) in HNSCC are strongly required. Tissue microarrays (TMA) constructed from formalin-fixed, paraffin-embedded (FFPE) tissue blocks of HNSCC tumor were stained with two commercial in-vitro diagnostic (IVD) PD-L1 immunohistochemical assays (22C3 pharmDx on Autostainer Link48 and Omnis platforms, and SP263) and were reviewed by seven trained pathologists to assess CPS. We found a very similar distribution for PD-L1 expression between 22C3 pharmDx assay with both platforms and SP263 assay and a strong significant correlation between the two assays in different platforms (p < 0.0001). The interobserver reliability among pathologists for the continuous scores of CPS with intraclass correlation coefficient (ICC) and the correlation between the two assays were both good. Moreover, the agreement rate between assays was high at all cut-offs, while the kappa values were from substantial to almost perfect. These data suggest the interchangeability of the two antibodies and of the different immunohistochemical platforms in the selection of patients with HNSCC for immunotherapy.
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Does Locally Advanced Thyroid Cancer Have Different Features? Results from a Single Academic Center. J Pers Med 2022; 12:jpm12020221. [PMID: 35207709 PMCID: PMC8879437 DOI: 10.3390/jpm12020221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Despite the fact that the majority of thyroid cancers are indolent, 15% of patients with well-differentiated carcinoma including papillary thyroid carcinoma (PTC) present with locally advanced thyroid cancer (LATC) at diagnosis. The current study analyzes a cohort of patients with LATC focusing on their risk for local recurrence, distant metastases, and overall survival. Materials and methods: From January 2010 to December 2020, 65 patients with LATC were retrieved, including 42 cases with preoperative cytological samples. BRAFV600E and TERT mutations were performed on both cytology and histopathology specimens in this cohort. Results: Among the 65 cases, 42 (65%) were women. The median age was 60.1 years. Histological diagnoses included 25 (38.4%) with classic PTC and 30 (46.1%) aggressive variants of PTC, mostly tall cell variant (17 cases, 26.1%). Multifocality was seen in 33 cases (50.8%). All patients had nodal metastases. The most common site of extrathyroidal extension was the recurrent laryngeal nerve (69.2%). Staging revealed 21 cases were stage I, none were stage II, 33 were stage III, and 7 were stage IVa and 4 stage IVb. No differences were found between well and poorly/undifferentiated thyroid cancers. Conclusion: These data suggest that locally advanced thyroid cancers, including variants of PTC, exhibit a more aggressive biological course and should accordingly be more assertively managed.
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Anand N, Agrawal T, Gupta A, Shukla S, Pradhan R, Husain N. Diagnostic Efficacy of BRAFV600E Immunocytochemistry in Thyroid Aspirates in Bethesda Category IV and Papillary Thyroid Carcinoma. J Cytol 2021; 38:113-119. [PMID: 34703086 PMCID: PMC8489694 DOI: 10.4103/joc.joc_248_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/01/2021] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background In papillary thyroid carcinoma (PTC), BRAFV600E is a common mutation and is associated with aggressive clinical behaviour. Immunocytochemistry (ICC) and molecular testing are recommended in the Bethesda System for Reporting Thyroid Cytopathology 2017 (TBSRTC) category III, IV and V. Aims The current study aimed to evaluate the diagnostic efficacy of conventional FNAC versus FNAC with BRAFV600E immunostaining in cases of TBSRTC category IV, cases of suspicious for PTC and cases of PTC. Methods and Material The study included a prospective case series of 45 patients with clinically palpable thyroid nodules with TBSRTC category IV, category V (suspicious for PTC) and PTC. The corresponding histology specimens of all the 45 cases were also analyzed. Immunostaining for BRAFV600E was performed on FNAC cell blocks and their corresponding histology sections using anti-BRAF (VE1) clone (Ventana). The diagnostic efficacy of the BRAFV600E immunostaining was compared on cytological specimens with histological specimens. Results BRAFV600E immunostaining helped to improve the sensitivity of the cytology to confirm the PTC as a diagnostic aid for thyroid FNAs. Cytology alone had a sensitivity of 62.96% and a lower specificity of 60.70%. The combination of both the tests together provided 84.62% sensitivity and much higher specificity of 100%. PPV was also increased to 100% and NPV was raised 94.12%. Conclusions The performance of BRAFV600E immunostaining on the cytological specimen is a rapid, simple and cost-effective test and could be considered in TBSRTC category IV and suspicious and malignant cases of PTC.
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Affiliation(s)
- Nidhi Anand
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tushar Agrawal
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anurag Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Saumya Shukla
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Roma Pradhan
- Department of Endocrine Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kanber Y, Pusztaszeri M, Auger M. Immunocytochemistry for diagnostic cytopathology-A practical guide. Cytopathology 2021; 32:562-587. [PMID: 34033162 DOI: 10.1111/cyt.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Cytological specimens, which are obtained by minimally invasive methods, are an excellent source of diagnostic material. Sometimes they are the only material available for diagnosis as well as for prognostic/predictive markers. When cytomorphology is not straightforward, ancillary tests may be required for a definitive diagnosis to guide clinical management. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology is equivocal, to differentiate entities with overlapping morphological features, and to determine the cell lineage and the site of origin of a metastatic neoplasm. Numerous immunomarkers are available, and some are expressed in multiple neoplasms. To rule out entities within a differential diagnosis, the use of more than one marker, sometimes panels, is necessary. ICC panels for diagnostic purposes should be customised based on the clinical context and cytomorphology, and the markers should be used judiciously to preserve material for additional tests for targeted therapies in the appropriate setting. This review offers a practical guide for the use of ICC for diagnostic cytopathology, covering the most commonly encountered non-hematolymphoid diagnostic scenarios in various body sites.
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Affiliation(s)
- Yonca Kanber
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Manon Auger
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
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Dell'Aquila M, Fiorentino V, Martini M, Capodimonti S, Cenci T, Lombardi CP, Raffaelli M, Pontecorvi A, Fadda G, Pantanowitz L, Larocca LM, Rossi ED. How limited molecular testing can also offer diagnostic and prognostic evaluation of thyroid nodules processed with liquid-based cytology: Role of TERT promoter and BRAF V600E mutation analysis. Cancer Cytopathol 2021; 129:819-829. [PMID: 34076961 DOI: 10.1002/cncy.22454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mutational analysis contributes to the diagnosis and prognosis of thyroid nodules analyzed with fine-needle aspiration cytology (FNAC). Although several advanced molecular tests based on multiple molecular markers are available for clinical use and have increased their impact on clinical management of patients, they are not widely available. Among them is BRAF V600E, one of the most studied mutations. Other genetic alterations, such as TERT promoter mutations, may coexist in thyroid carcinomas. Previous studies have demonstrated that this duet might be involved in the aggressiveness of thyroid cancer, although its prognostic value related to mortality remains undefined. The detection of such genetic alterations in thyroid liquid-based cytology (LBC) thus may assist with patient management. METHODS From January 2013 to June 2014, 356 thyroid FNAC samples were processed by LBC, including 174 surgical follow-up samples. BRAF V600E and TERT mutation analyses were performed on both LBC and histopathology. RESULTS The study included 119 samples categorized as atypia of undetermined significance, 42 categorized as follicular neoplasms, 61 categorized as suspicious for malignancy, and 34 categorized as positive for malignancy. BRAF V600E mutation was detected in 10.4% of all cases, whereas TERT promoter mutations were identified in 1.1%. TERT-mutated cases belonged to the positive for malignancy category, with a histologic diagnosis of tall cell variant of papillary thyroid carcinoma. These genetic alterations correlated with lymph node metastases (P = .0349) and higher disease stage. CONCLUSIONS BRAF V600E and TERT analysis can be performed on LBC. TERT mutations are rarely identified in well differentiated thyroid carcinoma but are associated with higher stage. Although a larger molecular panel may offer more information, analyzing these few point mutations is still likely to be useful for managing potentially more aggressive thyroid carcinomas.
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Affiliation(s)
- Marco Dell'Aquila
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
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Predictive value of NLR, TILs (CD4+/CD8+) and PD-L1 expression for prognosis and response to preoperative chemotherapy in gastric cancer. Cancer Immunol Immunother 2021; 71:45-55. [PMID: 34009410 PMCID: PMC8738448 DOI: 10.1007/s00262-021-02960-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
The combination of perioperative chemotherapy plus complete surgical resection is currently accounted as the first-choice strategy in patients with locally advanced Gastric Cancer (LAGC). Nevertheless, the partial response rate makes it necessary to search biological parameters useful to select patients who would benefit most from neoadjuvant chemotherapy (NAD-CT). We performed a retrospective analysis on a cohort of 65 LAGC cases, EBV negative and without MMR defect, submitted to perioperative chemotherapy plus surgical resection. We evaluated the neutrophil-lymphocytes ratio (NLR) in peripheral blood, the TILs density (reported as CD4/CD8 tissue ratio) and PD-L1 expression by immunohistochemistry on bioptic tissues before the treatment. Results were correlated with the biological features, histological response (TRG) and clinical outcome (PFS and OS). We found that NLR, TILs and PD-L1 expression showed a significant correlation with TNM stage, lymphovascular invasion and response to NAD-CT (TRG). Correlating the NLR, TILs and PD-L1 expression with PFS and OS, we found that patients with lower NLR levels (< 2.5 ratio), lower TILs (< 0.2 ratio) and higher PD-L1 level (CPS ≥ 1) had a significantly better PFS and OS than those with higher NLR, higher TILs and lower PD-L1 expression (p < 0.0001). Multivariate and multiple regression analyses confirmed the predictive and prognostic role of all three parameters, especially when all three parameters are combined. Our study demonstrated that pre-treatment NLR, TILs and PD-L1 expression are predictive and prognostic parameters in NAD-CT-treated LAGC suggesting a pivotal role of the systemic and tumor microenvironment immunological profile in the response to chemotherapy.
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Dell'Aquila M, Musarra T, Fiorentino V, Brunelli C, De Marco C, Raffaelli M, Traini E, Pio Lombardi C, Fadda G, Larocca LM, Pantanowitz L, Rossi ED. Relevance of rosette patterns in variants of papillary thyroid carcinoma. Cytopathology 2020; 31:533-540. [PMID: 32654236 DOI: 10.1111/cyt.12885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The detection of rosette-like clusters (RLC) of follicular cells in thyroid carcinoma has been reported mostly in the columnar cell variant of papillary thyroid carcinoma (PTC). Despite the fact that diagnosing variants of PTC is no longer encouraged by The Bethesda System for Reporting Thyroid Cytopathology, the identification of cytomorphological features such as RLC linked with these tumours might help reduce possible misinterpretation in thyroid fine needle aspiration (FNA) cytology. We accordingly investigated the potential correlation of architectural patterns including RLC with PTC variants. METHODS We analysed 225 thyroid FNA cytology cases diagnosed as suspicious for malignancy (SFM) and positive for malignancy (M) over a 1-year time where all samples had corresponding histology. We also included 150 benign lesions from the same period. The presence of RLC vs similar appearing solid clusters, papillary structures and microfollicles were evaluated. We also performed immunocytochemistry and molecular testing for BRAFV600E. RESULTS We included 100 (44.4%) SFM favouring PTC and 125 (55.6%) M cases with cyto-histological correlation. On histology, all SFM and M cases showed malignancy including 140 (62.2%) classic PTC and 85 (37.8%) PTC variants. The cytomorphological patterns in all FNA samples included solid (74%), papillary (89%), microfollicular (70%), and pseudo-RLC morphology (25.7%). We identified only pseudo-RLC in 33 FNA specimens from PTC variant cases that included tall cell variant (42.4%), hobnail variant (21.2%) and miscellaneous variants (36.3%) of PTC. No definitive RLC were detected in our series. Immunocytochemistry and BRAFV600E were not specifically linked with an RLC pattern. CONCLUSIONS These findings demonstrate that in our dataset the architectural pattern of RLC was not recognised within PTC variants. However, we did identify a pseudo-RLC pattern that was observed in association with tall cell variant and hobnail variant cases of PTC.
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Affiliation(s)
- Marco Dell'Aquila
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Teresa Musarra
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Vincenzo Fiorentino
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Chiara Brunelli
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Costanza De Marco
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine-Surgery, Fondazione Policlinico "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Emanuela Traini
- Division of Endocrine-Surgery, Fondazione Policlinico "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine-Surgery, Fondazione Policlinico "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Guido Fadda
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Luigi Maria Larocca
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology and Clinical Labs, University of Michigan-Ann Harbor, Michigan, MI, USA
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology-Fondazione policlinico universitario, "Agostino Gemelli"-IRCCS, Rome, Italy
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12
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VE1 Immunohistochemistry Improves the Limit of Genotyping for Detecting BRAFV600E Mutation in Papillary Thyroid Cancer. Cancers (Basel) 2020; 12:cancers12030596. [PMID: 32150939 PMCID: PMC7139976 DOI: 10.3390/cancers12030596] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
Detection of BRAFV600E is useful for making diagnosis and risk stratification of papillary thyroid carcinoma (PTC). Molecular testing, however, is not always available for routine clinical use. To assess the clinical utility and reliability of VE1 immunohistochemistry (IHC) for detecting BRAFV600E mutation in PTC, VE1 IHC was performed on the tissue microarrays of 514 patients with PTC and was compared with Sanger sequencing results. Of 514 PTC cases, 433 (84.2%) were positive for VE1 expression. Among 6 discordant cases between VE1 IHC and Sanger sequencing, 3 initial VE1-false negative cases turned out to be true false negative on repeat testing, and 3 VE1-false positive cases showed BRAFV600E mutation using digital PCR analysis. PTCs with low variant allele fraction were positive for VE1 IHC but were not detected using sequencing. VE1 IHC showed 99.3% sensitivity, 100% specificity, 100% positive predictive value, and 96.4% negative predictive value. The BRAFV600E mutation was significantly associated with older age, multifocality, extrathyroidal extension, lymph node metastasis, and advanced tumor stage. In conclusion, VE1 IHC is a reliable method for detecting BRAFV600E mutation in PTC specimens.
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13
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Cells with ganglionic differentiation frequently stain for VE1 antibody: a potential pitfall. Brain Tumor Pathol 2019; 37:14-21. [PMID: 31820133 DOI: 10.1007/s10014-019-00356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
Mitogen-activated protein kinase (MAPK) pathway plays a major role in pediatric low-grade gliomas (pLGGs). Immunohistochemistry with mutant-specific antibody, VE1, has appeared to be the most affordable and rapidly deployable method to identify tumors with aberrant MAPK signaling pathway, by highlighting tumor with BRAFV600E mutation. Nonetheless, positive staining cases but not associated with BRAFV600E mutation are also seen. We analyzed 62 pLGGs for the two commonest genetic aberrations in MAPK pathway: KIAA1549-BRAF fusion, using reverse-transcriptase polymerase chain reaction, and BRAFV600E mutation, using VE1 antibody and Sanger sequencing. We recorded a specificity and accuracy rate of 68.75% and 75%, respectively, for VE1, when strong cytoplasmic staining is observed. Interestingly, we observed that cells with ganglionic features frequently bind VE1 but not associated with BRAFV600E mutation. Such observation was also confirmed in four cases of differentiating neuroblastoma. This false positive staining may serve as an important confounder in the interpretation of VE1 immunoreactivity with major therapeutic implication. It is important to confirm the presence of BRAFV600E mutation by DNA-based method, especially in tumor entities not known to, or rarely harbor such mutations.
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14
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Dell’Aquila M, Granitto A, Martini M, Capodimonti S, Cocomazzi A, Musarra T, Fiorentino V, Pontecorvi A, Lombardi CP, Fadda G, Pantanowitz L, Larocca LM, Rossi ED. PD‐L1 and thyroid cytology: A possible diagnostic and prognostic marker. Cancer Cytopathol 2019; 128:177-189. [DOI: 10.1002/cncy.22224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Marco Dell’Aquila
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Alessia Granitto
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Alessandra Cocomazzi
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Liron Pantanowitz
- Department of Pathology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS Rome Italy
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15
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Dell’Aquila M, Gravina C, Cocomazzi A, Capodimonti S, Musarra T, Sfregola S, Fiorentino V, Revelli L, Martini M, Fadda G, Pantanowitz L, Larocca LM, Rossi ED. A large series of hyalinizing trabecular tumors: Cytomorphology and ancillary techniques on fine needle aspiration. Cancer Cytopathol 2019; 127:390-398. [DOI: 10.1002/cncy.22139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Marco Dell’Aquila
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Carmen Gravina
- Division of Endocrine‐Surgery Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Alessandra Cocomazzi
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Stefania Sfregola
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Luca Revelli
- Division of Endocrine‐Surgery Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Liron Pantanowitz
- Department of Pathology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology Fondazione Policlinico “Agostino Gemelli”, IRCCS Rome Italy
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16
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Straccia P, Brunelli C, Rossi ED, Lanza P, Martini M, Musarra T, Lombardi CP, Pontecorvi A, Fadda G. The immunocytochemical expression of
VE
‐1 (
BRAF
V600E‐related) antibody identifies the aggressive variants of papillary thyroid carcinoma on liquid‐based cytology. Cytopathology 2019; 30:460-467. [DOI: 10.1111/cyt.12690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/14/2019] [Accepted: 03/06/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Chiara Brunelli
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Esther D. Rossi
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Paola Lanza
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology Catholic University of Sacred Heart Foundation “Agostino Gemelli” University Hospital Rome Italy
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17
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Martini M, Capodimonti S, Cenci T, Bilotta M, Fadda G, Larocca LM, Rossi ED. To Obtain More With Less: Cytologic Samples With Ancillary Molecular Techniques-The Useful Role of Liquid-Based Cytology. Arch Pathol Lab Med 2019; 142:299-307. [PMID: 29494225 DOI: 10.5858/arpa.2017-0148-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Fine-needle aspiration cytology has been increasingly used as the first tool in the evaluation of several diseases. Although cytology has a relevant role in the discrimination between benign and malignant lesions, conventional slides cannot lead to 100% conclusive results. It was hoped that the introduction of liquid-based cytology (LBC) would improve the efficacy of cytology through standardization, quality improvement, and the possibility of carrying out ancillary techniques on the residual stored material. In recent decades, the application of genomic alterations has been studied on cytologic samples with feasible and reliable results. The molecular analysis offers a powerful aid to define the best clinical or surgical approaches and follow-up for patients. In recent years, the application of different ancillary techniques has been carried out on conventional slides even though LBC represents a useful additional and alternative method for molecular testing. OBJECTIVE - To demonstrate the relevance of LBC as a valid aid to overcoming the difficulties encountered in the application of ancillary techniques on conventional slides. DATA SOURCES - We examined and reviewed our experience with the application of ancillary techniques on LBC performed on different body sites. CONCLUSIONS - We emphasize that LBC achieves significant and accurate results. It represents a valid method for cytologic evaluation and it provides highly reproducible and informative molecular yields.
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Affiliation(s)
| | | | | | | | | | | | - Esther Diana Rossi
- From the Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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18
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Rossi ED, Martini M, Capodimonti S, Cenci T, Bilotta M, Pierconti F, Pontecorvi A, Lombardi CP, Fadda G, Larocca LM. Morphology combined with ancillary techniques: An algorithm approach for thyroid nodules. Cytopathology 2018; 29:418-427. [PMID: 29683529 DOI: 10.1111/cyt.12555] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Several authors have underlined the limits of morphological analysis mostly in the diagnosis of follicular neoplasms (FN). The application of ancillary techniques, including immunocytochemistry (ICC) and molecular testing, contributes to a better definition of the risk of malignancy (ROM) and management of FN. According to literature, the application of models, including the evaluation of ICC, somatic mutations (ie, BRAFV600E ), micro RNA analysis is proposed for FNs. This study discusses the validation of a diagnostic algorithm in FN with a special focus on the role of morphology then followed by ancillary techniques. METHODS From June 2014 to January 2016, we enrolled 37 FNs with histological follow-up. In the same reference period, 20 benign nodules and 20 positive for malignancy were selected as control. ICC, BRAFV600E mutation and miR-375 were carried out on LBC. RESULTS The 37 FNs included 14 atypia of undetermined significance/follicular lesion of undetermined significance and 23 FN. Specifically, atypia of undetermined significance/follicular lesion of undetermined significance resulted in three goitres, 10 follicular adenomas and one NIFTP whereas FN/suspicious for FN by seven follicular adenomas and 16 malignancies (nine non-invasive follicular thyroid neoplasms with papillary-like nuclear features, two invasive follicular variant of papillary thyroid carcinoma [PTC] and five PTC). The 20 positive for malignancy samples included two invasive follicular variant of PTC, 16 PTCs and two medullary carcinomas. The morphological features of BRAFV600E mutation (nuclear features of PTC and moderate/abundant eosinophilic cytoplasms) were associated with 100% ROM. In the wild type cases, ROM was 83.3% in presence of a concordant positive ICC panel whilst significantly lower (10.5%) in a negative concordant ICC. High expression values of MirR-375 provided 100% ROM. CONCLUSIONS The adoption of an algorithm might represent the best choice for the correct diagnosis of FNs. The morphological detection of BRAFV600E represents the first step for the identification of malignant FNs. A significant reduction of unnecessary thyroidectomies is the goal of this application.
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Affiliation(s)
- E D Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - M Martini
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - S Capodimonti
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - T Cenci
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - M Bilotta
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - F Pierconti
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - A Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - C P Lombardi
- Division of Endocrine-Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - G Fadda
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
| | - L M Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli" School of Medicine, Rome, Italy
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19
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Smith AL, Williams MD, Stewart J, Wang WL, Krishnamurthy S, Cabanillas ME, Roy-Chowdhuri S. Utility of the BRAF p.V600E immunoperoxidase stain in FNA direct smears and cell block preparations from patients with thyroid carcinoma. Cancer Cytopathol 2018; 126:406-413. [PMID: 29579361 DOI: 10.1002/cncy.21992] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND The identification of BRAF mutations in thyroid cancer has prognostic and therapeutic implications. Although the gold standard for identifying BRAF mutations is molecular testing, the ability to perform BRAF p.V600E immunostaining on fine-needle aspiration (FNA) samples can facilitate the rapid triaging of patients to treatment options. METHODS A total of 50 thyroid carcinoma FNA samples, including papillary (29 samples), poorly differentiated (10 samples), anaplastic (9 samples), and Hurthle cell (2 samples) carcinomas, with a known BRAF p.V600E mutation status were selected for the current study. Immunostaining was performed on smears and cell block sections using an anti-BRAF p.V600E antibody (clone VE1). The results were compared with the known mutation status obtained by molecular testing and/or immunostaining of surgical pathology material from the same patient. RESULTS Of the total of 50 cases, 26 cases had smears available for the evaluation of BRAF p.V600E immunostaining; positive immunostaining was noted in 16 samples and negative immunostaining was noted in 4 samples, whereas 6 cases were equivocal. Of the 34 cases for which cell blocks were available for evaluation, BRAF p.V600E immunostaining was positive in 17 cases, negative in 16 cases, and equivocal in 1 case. The overall sensitivity and specificity of BRAF p.V600E immunostaining on the cell block preparation was 94.4% and 100%, respectively, whereas for the smears it was 80% and 63.6%, respectively. CONCLUSIONS BRAF p.V600E immunostaining can be performed reliably on thyroid FNA cell block preparations. However, false-positive results on direct smears limit their utility and therefore need to be interpreted with caution. Cancer Cytopathol 2018;126:406-13. © 2018 American Cancer Society.
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Affiliation(s)
- Amber L Smith
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle D Williams
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei-Lien Wang
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Savitri Krishnamurthy
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Division of Pathology and Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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20
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Oh HS, Kwon H, Park S, Kim M, Jeon MJ, Kim TY, Shong YK, Kim WB, Choi J, Kim WG, Song DE. Comparison of Immunohistochemistry and Direct Sanger Sequencing for Detection of the BRAF(V600E) Mutation in Thyroid Neoplasm. Endocrinol Metab (Seoul) 2018; 33:62-69. [PMID: 29388401 PMCID: PMC5874197 DOI: 10.3803/enm.2018.33.1.62] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The BRAF(V600E) mutation is the most common genetic alteration identified in papillary thyroid carcinoma (PTC). Because of its costs effectiveness and sensitivity, direct Sanger sequencing has several limitations. The aim of this study was to evaluate the efficiency of immunohistochemistry (IHC) as an alternative method to detect the BRAF(V600E) mutation in preoperative and postoperative tissue samples. METHODS We evaluated 71 patients who underwent thyroid surgery with the result of direct sequencing of the BRAF(V600E) mutation. IHC staining of the BRAF(V600E) mutation was performed in 49 preoperative and 23 postoperative thyroid specimens. RESULTS Sixty-two patients (87.3%) had PTC, and of these, BRAF(V600E) was confirmed by direct sequencing in 57 patients (91.9%). In 23 postoperative tissue samples, the BRAF(V600E) mutation was detected in 16 samples (70%) by direct sequencing and 18 samples (78%) by IHC. In 24 fine needle aspiration (FNA) samples, BRAF(V600E) was detected in 18 samples (75%) by direct sequencing and 16 samples (67%) by IHC. In 25 core needle biopsy (CNB) samples, the BRAF(V600E) mutation was detected in 15 samples (60%) by direct sequencing and 16 samples (64%) by IHC. The sensitivity and specificity of IHC for detecting the BRAF(V600E) mutation were 77.8% and 66.7% in FNA samples and 99.3% and 80.0% in CNB samples. CONCLUSION IHC could be an alternative method to direct Sanger sequencing for BRAF(V600E) mutation detection both in postoperative and preoperative samples. However, application of IHC to detect the BRAF(V600E) mutation in FNA samples is of limited value compared with direct sequencing.
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Affiliation(s)
- Hye Seon Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suyeon Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jene Choi
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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21
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Rossi ED, Bizzarro T, Granja S, Martini M, Capodimonti S, Luca E, Fadda G, Lombardi CP, Pontecorvi A, Larocca LM, Baltazar F, Schmitt F. The expression of monocarboxylate transporters in thyroid carcinoma can be associated with the morphological features of BRAF V600E mutation. Endocrine 2017; 56:379-387. [PMID: 27484771 DOI: 10.1007/s12020-016-1044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
BRAF V600E mutation, usually performed by DNA techniques, is one of the most common diagnostic markers in papillary thyroid carcinoma. Few papers have demonstrated that plump cells (eosinophilic cytoplasms and papillary thyroid carcinoma nuclei) and peculiar sickle-shaped nuclei represent morphological features of BRAF V600E on papillary thyroid carcinomas. These features seem to be linked to glycolytic phenotype whereby monocarboxylate transporters 1-4 are hypothesized to have a dominant role as lactate transporters. We investigated the association between these morphological features and monocarboxylate transporters 1 and 4 in 48 cyto-histological samples diagnosed as "positive for malignancy-favoring papillary thyroid carcinoma". These cases were processed with liquid-based cytology and underwent BRAF V600E mutational analysis (pyrosequencing) on liquid-based cytology and monocarboxylate transporters immunostaining on histology. The expression of monocarboxylate transporter 1, monocarboxylate transporter 4, glucose trasporter-1 and carbonic anhidrase were scored semi-quantitatively with expression from 0 to 3+ (strong positivity). The 33 mutated and 15 wild type cases showed 100 % cyto-histological concordance. The cytological evaluation revealed plump cells and sickle nuclear shape in 100 % mutated cases. Monocarboxylate transporter 1 yielded 76 % positivity in the mutated cases especially in both the plump cells and sickle-shaped nuclei, whereas the wild types showed 13.3 % positive monocarboxylate transporter 1 (p = 0.00013). Monocarboxylate transporter 4 resulted in 100 % positivity in mutated and 40 % in wild types (p < 0.005). Furthermore, 20 % of the wild types showed weak monocarboxylate transporter 1 nuclear expression associated to a less aggressive behavior. The analysis of glucose trasporter-1 and carbonic anhidrase did not highlight any statistical significance (p > 0.05). This is the first report analyzing the association between monocarboxylate transporter expression and the morphological features of BRAF V600E mutated papillary thyroid carcinomas suggesting the possible involvement of lactate in the morphological features.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology, Catholic University of Sacred Heart-Rome, Milano, Italy.
| | - Tommaso Bizzarro
- Division of Anatomic Pathology, Catholic University of Sacred Heart-Rome, Milano, Italy
| | - Sara Granja
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maurizio Martini
- Division of Anatomic Pathology, Catholic University of Sacred Heart-Rome, Milano, Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology, Catholic University of Sacred Heart-Rome, Milano, Italy
| | - Emilia Luca
- Division of Anatomic Pathology, Catholic University of Sacred Heart-Rome, Milano, Italy
| | - Guido Fadda
- Division of Anatomic Pathology, Catholic University of Sacred Heart-Rome, Milano, Italy
| | | | | | - Luigi Maria Larocca
- Division of Anatomic Pathology, Catholic University of Sacred Heart-Rome, Milano, Italy
| | - Fatima Baltazar
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Fernando Schmitt
- Medical Faculty/University, Porto, Portugal
- Institute of Pathology/Molecular Immunology of Porto, Porto, Portugal
- Laboratorie National de Sante-Luxembourg, Luxembourg, Luxembourg
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Abstract
The detection of thyroid nodules, consisting of different diseases, represents a common finding in population. Their evaluation and diagnosis are mostly achieved with fine-needle aspiration cytology (FNAC). Even though the majority of thyroid nodules are correctly diagnosed, a total of 25% to 30% of them are classified "indeterminate" comprising lesions with varying risk of malignancy and different types of management. Although the number of thyroid FNACs, including small lesions, is increasing due to the reliance upon sonographic and cytologic interpretations, there are issues concerning cytomorphologic interpretation and interobserver reproducibility. Different classification systems have tried to better define the criteria for inclusion in specific categories and to therefore reduce the rate of indeterminate diagnoses such as atypia of undetermined significance, follicular neoplasms, and suspicious for malignancy. However, the support of ancillary techniques (eg, immunocytochemistry and molecular analysis) are reshaping morphologic diagnoses made on materials obtained from FNAC.
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23
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Bizzarro T, Martini M, Capodimonti S, Straccia P, Lombardi CP, Pontecorvi A, Larocca LM, Rossi ED. Young investigator challenge: The morphologic analysis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on liquid-based cytology: Some insights into their identification. Cancer Cytopathol 2016; 124:699-710. [DOI: 10.1002/cncy.21777] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/22/2016] [Accepted: 08/08/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Tommaso Bizzarro
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Celestino Pio Lombardi
- Department of Endocrine Surgery; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Alfredo Pontecorvi
- Department of Endocrinology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
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24
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Martinuzzi C, Pastorino L, Andreotti V, Garuti A, Minuto M, Fiocca R, Bianchi-Scarrà G, Ghiorzo P, Grillo F, Mastracci L. A combination of immunohistochemistry and molecular approaches improves highly sensitive detection of BRAF mutations in papillary thyroid cancer. Endocrine 2016; 53:672-80. [PMID: 26296380 DOI: 10.1007/s12020-015-0720-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/08/2015] [Indexed: 12/19/2022]
Abstract
The optimal method for BRAF mutation detection remains to be determined despite advances in molecular detection techniques. The aim of this study was to compare, against classical Sanger sequencing, the diagnostic performance of two of the most recently developed, highly sensitive methods: BRAF V600E immunohistochemistry (IHC) and peptide nucleic-acid (PNA)-clamp qPCR. BRAF exon 15 mutations were searched in formalin-fixed paraffin-embedded tissues from 86 papillary thyroid carcinoma using the three methods. The limits of detection of Sanger sequencing in borderline or discordant cases were quantified by next generation sequencing. BRAF mutations were found in 74.4 % of cases by PNA, in 71 % of cases by IHC, and in 64 % of cases by Sanger sequencing. Complete concordance for the three methods was observed in 80 % of samples. Better concordance was observed with the combination of two methods, particularly PNA and IHC (59/64) (92 %), while the combination of PNA and Sanger was concordant in 55 cases (86 %). Sensitivity of the three methods was 99 % for PNA, 94.2 % for IHC, and 89.5 % for Sanger. Our data show that IHC could be used as a cost-effective, first-line method for BRAF V600E detection in daily practice, followed by PNA analysis in negative or uninterpretable cases, as the most efficient method. PNA-clamp quantitative PCR is highly sensitive and complementary to IHC as it also recognizes other mutations besides V600E and it is suitable for diagnostic purposes.
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Affiliation(s)
- Claudia Martinuzzi
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Lorenza Pastorino
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - Virginia Andreotti
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - Anna Garuti
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - Michele Minuto
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
- Surgery 1 Unit, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Roberto Fiocca
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
- Pathology Unit, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Giovanna Bianchi-Scarrà
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
- Genetics of Rare Tumors, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Paola Ghiorzo
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy.
- Genetics of Rare Tumors, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
| | - Federica Grillo
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
- Pathology Unit, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Luca Mastracci
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
- Pathology Unit, IRCCS AOU San Martino-IST, Genoa, Italy
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25
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Rossi ED, Schmitt F. When Morphology Meets Somatic Mutations: The New Possible Scenario in Thyroid Fine-Needle Aspiration. Acta Cytol 2016; 60:93-6. [PMID: 27288325 DOI: 10.1159/000446796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/04/2016] [Indexed: 12/30/2022]
Abstract
This study points to the analysis of the morphological features suggestive of somatic mutations, mostly the BRAFV600E mutation, on cytological samples of thyroid carcinomas. According to the literature, the application of ancillary techniques on cytology comes in handy as a challenging aid in ruling out a malignant outcome on both conventional and liquid-based cytological preparations. However, the evaluation of somatic mutations, including BRAFV600E, usually performed by DNA techniques, may have some limitations in a worldwide diffusion. In this perspective, few authors emphasized the morphological search for BRAFV600E mutations harbored in papillary thyroid carcinoma (PTC) and characterized by specific architectural and cellular findings (i.e. eosinophilic cells defined as 'plump cells' and sickle-shaped nuclei). Hence, the detection of eosinophilic cytoplasm of mutated PTC cells seems to suggest the possible involvement of the 'Warburg effect' pioneering the ability of cancer cells to convert glucose into lactic acid. The recent yields of immunohistochemical expression of monocarboxylate transporters in mutated PTCs may suggest the accumulation of lactate in these plump cells. Equally importantly, the detection of these morphological findings using fine-needle aspiration cytology may be helpful in triaging thyroid lesions and limiting costs. Additionally, it may lead to the stratification of the malignant risk and personalized management in cases with multifocal lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Universitx00E0; Cattolica del Sacro Cuore, Rome, Italy
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26
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Rossi ED, Bizzarro T, Martini M, Capodimonti S, Cenci T, Fadda G, Schmitt F, Larocca LM. Morphological features that can predict BRAF V600E -mutated carcinoma in paediatric thyroid cytology. Cytopathology 2016; 28:55-64. [PMID: 27256275 DOI: 10.1111/cyt.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE BRAFV600E represents the most common diagnostic marker in papillary thyroid carcinoma (PTC). A few papers have demonstrated the correlation between BRAFV600E and specific morphological findings on PTCs in the adult population. This is the first reported series investigating cytological morphological parameters in paediatric thyroid carcinoma. METHODS One hundred and nineteen paediatric samples (56 male and 63 female patients), diagnosed in the period between April 2013 and July 2015, were enrolled in the study. Fifteen patients with inadequate results were excluded. Cytological cases were processed with liquid-based cytology (LBC). BRAFV600E and immunocytochemistry for the VE1 antibody were performed on LBC. RESULTS The diagnostic series included 10 mutated and 94 wild-type (WT) cases. Twenty two percent surgical samples showed 96% cytohistological concordance. The morphological analysis revealed plump cells (abundant eosinophilic cytoplasm and PTC nuclei) in all 10 mutated cases with only four cases showing a focal (less than 20% of the cells) plump component. None of the WT showed plump cells. A sickle nuclear shape was seen only in the mutated cases. VE1 yielded 100% positivity on mutated cases with three cytohistological discrepancies. CONCLUSIONS The BRAFV600E mutation is also seen in paediatric cytology and the morphological features showed a high accuracy as both predictive mutational parameters and a helpful aid in management mainly of the aggressive BRAFV600E mutated carcinomas.
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Affiliation(s)
- E D Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - T Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - M Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - S Capodimonti
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - T Cenci
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - G Fadda
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - F Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal.,Laboratorie National de Sante, Dudelange, Luxembourg
| | - L M Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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27
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Collet JF, Lacave R, Hugonin S, Poulot V, Tassart M, Fajac A. BRAF V600E detection in cytological thyroid samples: A key component of the decision tree for surgical treatment of papillary thyroid carcinoma. Head Neck 2016; 38:1017-21. [PMID: 26854757 DOI: 10.1002/hed.24393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/03/2015] [Accepted: 12/17/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Whether preoperative knowledge of the BRAF mutation status would help to determine the extent of surgery for thyroid nodules is still under investigation. METHODS We developed a method to state the V600E mutation before surgery on fine-needle aspiration (FNA) stained smears checked to contain tumor cells. We evaluated the interest of the preoperative assessment of the mutation for surgical strategy of nodules, diagnosed as malignant, suspicious for malignancy or follicular neoplasms. RESULTS The mutation was found in 81% (79 of 97) malignant, 59% (20 of 34) suspicious nodules, and in none of follicular neoplasms (n = 29). Overall, the mutation was detected in 82% of papillary carcinomas. The sensitivity, specificity, and positive and negative predictive values for the diagnosis of malignancy were 75%, 100%, 100%, and 46%, respectively. CONCLUSION The preoperative knowledge of the V600E mutation status is fundamental to plan total thyroidectomy with certainty and should be part of the decision tree for the management of thyroid nodules. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1017-1021, 2016.
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Affiliation(s)
- Jean-François Collet
- Anatomie et Cytologie Pathologiques, Hôpital Tenon HUEP, APHP, Paris, France.,Institut de Pathologie, Paris, France
| | - Roger Lacave
- Unité de Génomique des Tumeurs Solides, Hôpital Tenon HUEP, APHP, Paris, France
| | - Sylvain Hugonin
- Unité de Génomique des Tumeurs Solides, Hôpital Tenon HUEP, APHP, Paris, France
| | - Virginie Poulot
- Unité de Génomique des Tumeurs Solides, Hôpital Tenon HUEP, APHP, Paris, France
| | - Marc Tassart
- Radiologie, Hôpital Tenon, HUEP, APHP, Paris, France
| | - Anne Fajac
- Anatomie et Cytologie Pathologiques, Hôpital Tenon HUEP, APHP, Paris, France
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28
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Bongiovanni M, Trimboli P, Rossi ED, Fadda G, Nobile A, Giovanella L. DIAGNOSIS OF ENDOCRINE DISEASE: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy. Eur J Endocrinol 2016; 174:R53-63. [PMID: 26450171 DOI: 10.1530/eje-15-0817] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/07/2015] [Indexed: 01/21/2023]
Abstract
Thyroid fine-needle aspiration (FNA) cytology is a fast growing field. One of the most developing areas is represented by molecular tests applied to cytological material. Patients that could benefit the most from these tests are those that have been diagnosed as 'indeterminate' on FNA. They could be better stratified in terms of malignancy risk and thus oriented with more confidence to the appropriate management. Taking in to consideration the need to improve and keep high the yield of thyroid FNA, professionals from various fields (i.e. molecular biologists, endocrinologists, nuclear medicine physicians and radiologists) are refining and fine-tuning their diagnostic instruments. In particular, all these developments aim at increasing the negative predictive value of FNA to improve the selection of patients for diagnostic surgery. These advances involve terminology, the application of next-generation sequencing to thyroid FNA, the use of immunocyto- and histo-chemistry, the development of new sampling techniques and the increasing use of nuclear medicine as well as molecular imaging in the management of patients with a thyroid nodule. Herein, we review the recent advances in thyroid FNA cytology that could be of interest to the 'thyroid-care' community, with particular focus on the indeterminate diagnostic category.
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Affiliation(s)
| | - P Trimboli
- Institute of PathologyUniversity Hospital, Rue du Bugnon 25, 1011 Lausanne, SwitzerlandSection of Endocrinology and DiabetologyOspedale Israelitico, Piazza San Bartolomeo all'Isola 21, 00186 Rome, ItalyDepartment of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Viale Officina 3, 6500 Bellinzona, SwitzerlandDivision of Anatomic Pathology and HistologyDepartment of Laboratory Medicine, 'Agostino Gemelli' School of Medicine and Hospital, Catholic University, Largo Francesco Vito 1, 00168 Rome, Italy Institute of PathologyUniversity Hospital, Rue du Bugnon 25, 1011 Lausanne, SwitzerlandSection of Endocrinology and DiabetologyOspedale Israelitico, Piazza San Bartolomeo all'Isola 21, 00186 Rome, ItalyDepartment of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Viale Officina 3, 6500 Bellinzona, SwitzerlandDivision of Anatomic Pathology and HistologyDepartment of Laboratory Medicine, 'Agostino Gemelli' School of Medicine and Hospital, Catholic University, Largo Francesco Vito 1, 00168 Rome, Italy
| | - E D Rossi
- Institute of PathologyUniversity Hospital, Rue du Bugnon 25, 1011 Lausanne, SwitzerlandSection of Endocrinology and DiabetologyOspedale Israelitico, Piazza San Bartolomeo all'Isola 21, 00186 Rome, ItalyDepartment of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Viale Officina 3, 6500 Bellinzona, SwitzerlandDivision of Anatomic Pathology and HistologyDepartment of Laboratory Medicine, 'Agostino Gemelli' School of Medicine and Hospital, Catholic University, Largo Francesco Vito 1, 00168 Rome, Italy
| | - G Fadda
- Institute of PathologyUniversity Hospital, Rue du Bugnon 25, 1011 Lausanne, SwitzerlandSection of Endocrinology and DiabetologyOspedale Israelitico, Piazza San Bartolomeo all'Isola 21, 00186 Rome, ItalyDepartment of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Viale Officina 3, 6500 Bellinzona, SwitzerlandDivision of Anatomic Pathology and HistologyDepartment of Laboratory Medicine, 'Agostino Gemelli' School of Medicine and Hospital, Catholic University, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - L Giovanella
- Institute of PathologyUniversity Hospital, Rue du Bugnon 25, 1011 Lausanne, SwitzerlandSection of Endocrinology and DiabetologyOspedale Israelitico, Piazza San Bartolomeo all'Isola 21, 00186 Rome, ItalyDepartment of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Viale Officina 3, 6500 Bellinzona, SwitzerlandDivision of Anatomic Pathology and HistologyDepartment of Laboratory Medicine, 'Agostino Gemelli' School of Medicine and Hospital, Catholic University, Largo Francesco Vito 1, 00168 Rome, Italy
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29
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Kim YH, Yim H, Lee YH, Han JH, Lee KB, Lee J, Soh EY, Jeong SY, Kim JH. Evaluation of the VE1 Antibody in Thyroid Cytology Using Ex Vivo Papillary Thyroid Carcinoma Specimens. J Pathol Transl Med 2015; 50:58-66. [PMID: 26657312 PMCID: PMC4734968 DOI: 10.4132/jptm.2015.10.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 10/08/2015] [Accepted: 10/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background: Recently, VE1, a monoclonal antibody against the BRAFV600E mutant protein, has been investigated in terms of its detection of the BRAFV600E mutation. Although VE1 immunostaining and molecular methods used to assess papillary thyroid carcinoma in surgical specimens are in good agreement, evaluation of VE1 in thyroid cytology samples is rarely performed, and its diagnostic value in cytology has not been well established. In present study, we explored VE1 immunoexpression in cytology samples from ex vivo papillary thyroid carcinoma specimens in order to minimize limitations of low cellularity and sampling/targeting errors originated from thyroid fineneedle aspiration and compared our results with those obtained using the corresponding papillary thyroid carcinoma tissues. Methods: The VE1 antibody was evaluated in 21 cases of thyroid cytology obtained directly from ex vivo thyroid specimens. VE1 immunostaining was performed using liquid-based cytology, and the results were compared with those obtained using the corresponding tissues. Results: Of 21 cases, 19 classic papillary thyroid carcinomas had BRAFV600E mutations, whereas two follicular variants expressed wild-type BRAF. VE1 immunoexpression varied according to specimen type. In detection of the BRAFV600E mutation, VE1 immunostaining of the surgical specimen exhibited 100% sensitivity and 100% specificity, whereas VE1 immunostaining of the cytology specimen exhibited only 94.7% sensitivity and 0% specificity. Conclusions: Our data suggest that VE1 immunostaining of a cytology specimen is less specific than that of a surgical specimen for detection of the BRAFV600E mutation, and that VE1 immunostaining of a cytology specimen should be further evaluated and optimized for clinical use.
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Affiliation(s)
- Yon Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Hyunee Yim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Yong-Hee Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Ho Han
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Kyi Beom Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Euy Young Soh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seon-Yong Jeong
- Department of Medical Genetics, Ajou University School of Medicine, Suwon, Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
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30
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Pusztaszeri MP, Krane JF, Faquin WC. BRAF testing and thyroid FNA. Cancer Cytopathol 2015; 123:689-95. [PMID: 26335367 DOI: 10.1002/cncy.21614] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/18/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Marc P Pusztaszeri
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - William C Faquin
- Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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31
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BRAF p.Val600Glu (V600E) mutation detection in thyroid fine needle aspiration cell block samples: a feasibility study. Pathology 2015; 47:432-8. [DOI: 10.1097/pat.0000000000000273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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32
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Rossi ED, Martini M, Bizzarro T, Capodimonti S, Cenci T, Lombardi CP, Pontecorvi A, Fadda G, Larocca LM. UncommonBRAFmutations in the follicular variant of thyroid papillary carcinoma: New insights. Cancer Cytopathol 2015; 123:593-602. [DOI: 10.1002/cncy.21586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine; Catholic University of the Sacred Heart; Rome Italy
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Wobker SE, Kim LT, Hackman TG, Dodd LG. Use of BRAF v600e immunocytochemistry on FNA direct smears of papillary thyroid carcinoma. Cancer Cytopathol 2015; 123:531-9. [DOI: 10.1002/cncy.21575] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Sara E. Wobker
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill North Carolina
| | - Lawrence T. Kim
- Department of Surgery; University of North Carolina; Chapel Hill North Carolina
| | - Trevor G. Hackman
- Department of Otolaryngology/Head and Neck Surgery; University of North Carolina; Chapel Hill North Carolina
| | - Leslie G. Dodd
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill North Carolina
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Na JI, Kim JH, Kim HJ, Kim HK, Moon KS, Lee JS, Lee JH, Lee KH, Park JT. VE1 immunohistochemical detection of the BRAF V600E mutation in thyroid carcinoma: a review of its usefulness and limitations. Virchows Arch 2015; 467:155-68. [PMID: 25894433 DOI: 10.1007/s00428-015-1773-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/23/2015] [Accepted: 04/08/2015] [Indexed: 01/17/2023]
Abstract
The BRAF V600E mutation is a valuable prognostic factor in thyroid carcinoma despite lingering debate. Successful immunohistochemical (IHC) detection of the BRAF V600E mutation using a VE1 antibody was introduced recently. The objective of this study was to verify the usefulness of IHC detection of the BRAF V600E mutation in thyroid carcinoma using the VE1 antibody. IHC detection of BRAF V600E was performed on various thyroid carcinoma subtypes. IHC results were compared with those obtained from real-time polymerase chain reaction (PCR) detection. Discordant cases were re-examined using a direct sequencing method following nested PCR amplification. The BRAF V600E mutation was detected in 68 % (71/104) of papillary carcinoma cases and 78 % (7/9) of anaplastic carcinoma cases. The mutation was not detected in patients with follicular carcinoma (0/18) or in medullary carcinoma (0/21). The overall sensitivity and specificity of IHC using the VE1 antibody were 100 and 94 %, respectively, suggesting that molecular-based results were indeterminable in four VE1-positive cases. IHC using the VE1 antibody is a highly sensitive and specific method for BRAF V600E mutation detection and may represent a future replacement for DNA-based molecular tests.
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Affiliation(s)
- Jong-In Na
- Department of Pathology, Chonnam National University Medical School, #5 Hak-dong, Dong-gu, Gwang-ju, 501-746, South Korea
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Trimboli P, Crescenzi A. Thyroid core needle biopsy: taking stock of the situation. Endocrine 2015; 48:779-85. [PMID: 25129650 DOI: 10.1007/s12020-014-0382-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/01/2014] [Indexed: 01/08/2023]
Abstract
Recently, the microhistologic evaluation by core needle biopsy (CNB) has been reported as high accurate to diagnose thyroid nodules with previous indeterminate or not adequate fine-needle aspiration cytology. In addition, sparse data have been reported regarding the use of CNB in other conditions. Aim of this review was to furnish the state of the art of this topic by summarizing published data about the diagnostic performance of CNB in thyroid lesions, and provide an easy to use reference for clinical practice. Sources encompass studies published through May 2014. Original articles were investigated and following specific aspects were discussed: 1. The "large" needle biopsy in 90's; 2. Complications by and patient's comfort with thyroid CNB; 3. Advantages provided by examination of a microhistologic sample of thyroid nodule; 4. Use of CNB in thyroid nodules with previous not adequate (Thy 1/Class 1/Category I) cytology; 5. Use of CNB in thyroid neoplasms (Thy 3/Class 3/Category III-IV) cytology; 6. Use of CNB in specific ultrasonographic presentations of thyroid nodules or in patients with peculiar clinical contexts; 7. First-line approach by CNB in thyroid nodules; 8. Immunohistochemistry and molecular tests on CNB samples; and 9. Future perspective.
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Affiliation(s)
- Pierpaolo Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Via Fulda 14, 00148, Rome, Italy,
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Chen S, Randolph M, Cramer HM, Watkins T, McCullough H, Post KM, Sen JD, Cheng L, Wu HH. Detection of BRAF mutation in metastatic melanoma utilizing cell-transferred cytological smears. Acta Cytol 2014; 58:478-82. [PMID: 25359156 DOI: 10.1159/000368273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/09/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Fine-needle aspiration (FNA) is frequently used to diagnose metastatic melanoma. In this study, we validated the use of cell-transferred cytological smears for BRAF molecular testing. STUDY DESIGN We conducted a search of our laboratory information system for the period 2011-2013 in order to identify surgical pathology cases of either primary or metastatic melanomas in which BRAF mutation analyses had already been performed. Thirty FNA cases with diagnoses of metastatic melanoma from the same patients were identified. Direct smears from each FNA case were selected for mutation analyses using the cell transfer technique. RESULTS Mutation analyses were successfully performed on 28 of 30 FNA cases (93%) using the cell-transferred cytological smears. In 25 cases (8 BRAF mutations and 17 BRAF wild types), there was 100% agreement for the BRAF mutation between the cell-transferred cytological smears and the formalin-fixed paraffin-embedded tissues. Three FNA cases showed BRAF mutations that had not been detected in the correlated surgical specimens which were tested twice, and 2 cases failed to work. CONCLUSIONS Cell-transferred cytological smears are a reliable and alternative resource for detecting BRAF mutations in metastatic melanoma.
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Affiliation(s)
- Shaoxiong Chen
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Ind., USA
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Rossi ED, Bizzarro T, Martini M, Capodimonti S, Fadda G, Larocca LM, Schmitt F. Morphological parameters able to predictBRAFV600E-mutated malignancies on thyroid fine-needle aspiration cytology: Our institutional experience. Cancer Cytopathol 2014; 122:883-91. [DOI: 10.1002/cncy.21475] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/25/2014] [Accepted: 07/30/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology of the Catholic University of the Sacred Heart; Agostino Gemelli School of Medicine; Rome Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology of the Catholic University of the Sacred Heart; Agostino Gemelli School of Medicine; Rome Italy
| | | | | | - Guido Fadda
- Division of Anatomic Pathology and Histology of the Catholic University of the Sacred Heart; Agostino Gemelli School of Medicine; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology of the Catholic University of the Sacred Heart; Agostino Gemelli School of Medicine; Rome Italy
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology, University of Porto; Porto Portugal
- Department of Laboratory Medicine and Pathobiology; Faculty of Medicine, University of Toronto; Toronto Canada
- Department of Pathology; University Health Network; Toronto Canada
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Toll AD, Rossi ED, Ali SZ. Role of ancillary testing in thyroid fine needle aspiration: Review and update. J Am Soc Cytopathol 2014; 3:218-224. [PMID: 31051689 DOI: 10.1016/j.jasc.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/04/2014] [Indexed: 06/09/2023]
Abstract
Thyroid nodules are common, and ultrasound-guided fine needle aspiration identifies 70-75% as benign, and 4% as malignant. The remainder falls into categories of "indeterminate" with a widely ranging malignancy rate from 10-75%. The diagnosis and clinical management of indeterminate lesions is evolving, and we will review ancillary testing as an aid to diagnosis.
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Affiliation(s)
- Adam D Toll
- Department of Pathology, Jersey Shore Medical Center, Neptune, New Jersey
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, Maryland; Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland.
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Rossi ED, Fadda G, Schmitt F. The nightmare of indeterminate follicular proliferations: when liquid-based cytology and ancillary techniques are not a moon landing but a realistic plan. Acta Cytol 2014; 58:543-51. [PMID: 25033918 DOI: 10.1159/000363439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/06/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Thyroid nodules are a common finding in the general population, including both nonneoplastic and neoplastic entities. Fine-needle aspiration cytology (FNAC) is the first tool for evaluating thyroid nodules. In spite of its high diagnostic accuracy, 25% of nodules result in the category of follicular neoplasms (FN), with varying risk of malignancy and different management strategies. STUDY DESIGN The use of ancillary techniques is reshaping the practice of FNAC. These tools can significantly empower the morphological diagnosis and prognosis of thyroid nodules, allowing a more accurate prediction of the nature of the lesion. Several studies have underlined the role of single or multiple testing for the category of FN as strong indicators of cancer. Every cytological preparation can be used for the application of ancillary techniques but the introduction of liquid-based cytology (LBC) might facilitate the application. RESULTS Our experience involving an immunocytochemical panel made up of HBME-1 and galectin-3 pointed to an 81% overall diagnostic accuracy in discriminating between low and high risk of malignancy in FN. CONCLUSIONS The application of these techniques on LBC represents an adjunct to the morphological evaluation of FN. They represent a critical and challenging, but also a feasible, tool in the preoperative diagnoses, allowing specific prognostic and predictive details regardless of the cytological preparation. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of Sacred Heart, Rome, Italy
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