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Kurtycz DFI, Crothers B, Schmitt F, Kholova I, Maldant-Savary B, Mikou P, Minamiguchi S, Önal B, Teuzaba E, VandenBussche CJ, Wang H, Chandra A. The International System for Serous Fluid Cytopathology (TIS) survey in preparation for TIS 2.0. J Am Soc Cytopathol 2025; 14:110-122. [PMID: 39794264 DOI: 10.1016/j.jasc.2024.12.001] [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: 10/15/2024] [Revised: 12/02/2024] [Accepted: 12/03/2024] [Indexed: 01/13/2025]
Abstract
INTRODUCTION The International System for Serous Fluid Cytopathology (TIS) has gained acceptance and has led to literature validating original concepts and suggesting refinements. In preparation for the second edition of TIS, editors generated a survey to solicit experience with and opinions about TIS. MATERIALS AND METHODS An online survey available from March 8 to June 15, 2024, included 56 questions, offered in 7 languages, related to the practice of serous fluid cytopathology. RESULTS A total of 598 respondents accessed the survey. Information was collected regarding certification, work setting, work volume and years in practice. In the respondent group, 78% (401 of 513) were pathologists, 18% (92 of 513) cytologists of cytotechnologists, 2% (10 of 513) trainees, and 2% (10 of 513) medical scientists. A total of 23% of participants came from academia. Also, 59% of respondents were (280 of 474) from Asia, 17% Europe, 12% North America, and 10% South America. In all, 61% (287 of 474) have adopted TIS. Over 50% issue a preliminary report awaiting ancillary test results. Another 20% issue such a report depending on circumstance. The most frequent request for refinement of criteria centered around Atypia of Uncertain Significance (AUS). Only small numbers of participants provided data on diagnostic category percentage and risk of malignancy (ROM); however, those that did reported a decrease in nondiagnostic and atypical results with corresponding decreases in ROM for those categories. Variable use of cytochemical and immunocytochemical stains for resolving mesothelial proliferations was reported. Respondents indicated a desire for incorporation of recommendations on clinical management and extension of TIS into body fluid types beyond pleural, pericardial, and peritoneal. CONCLUSIONS This survey examines acceptance of TIS and advice for future directions.
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Affiliation(s)
- Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin.
| | | | | | - Ivana Kholova
- Department of Pathology, Fimlab Laboratories and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | | | | - Binnur Önal
- Department of Pathology, Acibadem University, Istanbul, Turkey
| | - Esperanza Teuzaba
- Department of Pathology, Universidad del Rosario, School of Medicine and Health Sciences, Bogotá, Colombia
| | | | - He Wang
- Department of Pathology, Yale University, New Haven, Connecticut
| | - Ashish Chandra
- Department of Cellular Pathology, Guy's & St. Thomas' NHS Foundation Trust, London, UK
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Torous VF, Pineda CM, Quintana LM, Chebib I, VanderLaan PA. Pericardial effusion cytology: malignancy rates, patterns of metastasis, comparison with pericardial window, and genomic correlates. J Am Soc Cytopathol 2025; 14:132-141. [PMID: 39843307 DOI: 10.1016/j.jasc.2024.12.005] [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: 11/12/2024] [Revised: 12/06/2024] [Accepted: 12/06/2024] [Indexed: 01/24/2025]
Abstract
INTRODUCTION Cytologic evaluation of pericardial fluid is essential for diagnosing malignant pericardial effusions secondary to metastatic disease and for guiding appropriate clinical management; however, large cohort and up-to-date studies on malignancy rates and distribution of primary tumor sites is lacking. MATERIALS AND METHODS A retrospective analysis of pericardial fluid specimens from 2 large academic medical centers over a 10-year period was conducted. Clinical and specimen characteristics were correlated with cytologic diagnoses, and compared with surgical pathology pericardial specimens when available. In addition, genomic testing results were examined in a subset of malignant cases. RESULTS A total of 1667 pericardial fluid specimens were evaluated, with 15.3% diagnosed as malignant. Lung cancer (50.6%) was by far the most common primary tumor causing malignant pericardial effusions, followed by breast (13.0%), hematolymphoid (12.6%), and gastrointestinal (6.1%) cancers. A subset of patients with paired cytology and surgical pathology pericardial specimens showed concordance in 84.2% of cases, with discordant cases more frequently presenting with a positive cytology but negative surgical pathology result. Genomic analysis of a subset of malignant pericardial effusions revealed the most frequently mutated genes to be TP53, KRAS, CDKN2A/B, and PIK3CA, with a larger proportion of high tumor mutational burden (≥10 muts/Mb) in pericardial fluid samples compared to primary or metastatic sites. CONCLUSIONS While lung cancer is the most frequent cause of a cytology-confirmed malignant pericardial effusion, familiarity with relative frequencies of metastases from other sites can be particularly helpful, especially in the diagnostic work-up of an occult malignant pericardial effusion.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cristiana M Pineda
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Liza M Quintana
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Beg S, Xu K, Solomon JP, Alperstein SA, Siddiqui MT. Impact of serous fluid volume on next-generation sequencing: a significant step forward for optimization of serous fluid sample collection. J Am Soc Cytopathol 2024; 13:397-405. [PMID: 39068145 DOI: 10.1016/j.jasc.2024.07.001] [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: 05/06/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Current literature lacks data regarding the influence of serous fluid volume (SFV) on next-generation sequencing (NGS) performed on malignant cases. In this study, we highlight the impact of SFV and other parameters influencing the outcome of NGS analysis. MATERIALS AND METHODS We evaluated 827 samples of serous fluids from 607 patients. Of these, 72 samples underwent NGS analysis. Effusion volume, tumor cellularity, DNA, and RNA quality metrics, as well as clinicopathologic and molecular data were evaluated. Pleural fluid accounted for 56.3% of the fluid samples collected. The most common primary tumor site was gastrointestinal/pancreatobiliary, adenocarcinoma was the most common histologic type. Overall mean volume was 293 mL. The mean Qubit DNA of the 72 effusion samples that underwent NGS analysis was 14.3 ng/μL and mean Qubit RNA was 28.2 ng/μL. The mean Qubit DNA concentration increases in SFV up to 100 mL only. RESULTS No correlation exists between SFV and mean tumor cellularity. In addition, 74.6% (50 of 67) of sequenced samples showed oncogenic drivers; KRAS was the most common driver followed by EGFR. Three cases displayed ALK fusions, and 1 case displayed NTRK1 fusion. The DNA yield is higher in SFV of 100 mL as a cutoff. Beyond 100 mL, there is no impact of SFV on DNA yield. SFV does not impact RNA yield and mean tumor cellularity. Effusion samples should be submitted for molecular testing despite low tumor cellularity. CONCLUSIONS Our results as a pilot study are important in optimization of SFV for both diagnosis as well as NGS analysis for improving management.
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Affiliation(s)
- Shaham Beg
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Kemin Xu
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - James P Solomon
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Susan A Alperstein
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York.
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Christofidis K, Theochari M, Mavropoulos Papoudas S, Kiohou L, Sousouris S, Dimitriadou A, Volakakis N, Maounis N, Mikou P. Optimal Volume Assessment for Serous Fluid Cytology. Biomedicines 2024; 12:899. [PMID: 38672252 PMCID: PMC11048718 DOI: 10.3390/biomedicines12040899] [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: 03/12/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the optimal volume of serous fluid needed for accurate diagnosis using The International System for Reporting Serous Fluid Cytopathology (TIS), as well as to provide information on the distribution of serous effusion cases in the TIS categories (ND: non-diagnostic, NFM: negative for malignancy, AUS: atypia of undetermined significance, SFM: suspicious for malignancy, MAL: malignant) and relevant epidemiological data. METHODS A retrospective analysis of 2340 serous effusion cases (pleural, peritoneal, and pericardial) from two hospitals between 2018 and 2020 was conducted. TIS categories were assigned to each case, and for 1181 cases, these were correlated with the volume of the analyzed fluid. RESULTS Our study found statistically significant differences in volume distributions between certain TIS categories. Statistically lower volumes were observed in NFM compared to MAL, in UNCERTAIN (ND, AUS, SFM) compared to both MAL and NFM, and in NOT MAL (ND, NFM, AUS, SFM) compared to MAL. However, these differences were not substantial enough to hold any clinical relevance. CONCLUSIONS This study suggests that while fluid volume may slightly influence the TIS category, it does not impact the diagnostic accuracy of serous effusion cytology. Therefore, the ideal serous effusion specimen volume can be defined solely by practical parameters.
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Affiliation(s)
| | - Maria Theochari
- Oncology Unit, “Hippokration” General Hospital of Athens, 11527 Athens, Greece
| | | | - Lamprini Kiohou
- Cytopathology Laboratory, “Sismanoglio-Amalia Fleming” General Hospital of Athens, 15127 Athens, Greece
| | - Stylianos Sousouris
- Cytopathology Laboratory, “Laiko” General Hospital of Athens, 11527 Athens, Greece
| | - Areti Dimitriadou
- Oncology Unit, “Hippokration” General Hospital of Athens, 11527 Athens, Greece
| | - Nikolaos Volakakis
- Oncology Unit, “Hippokration” General Hospital of Athens, 11527 Athens, Greece
| | - Nicoletta Maounis
- Cytopathology Laboratory, “Sismanoglio-Amalia Fleming” General Hospital of Athens, 15127 Athens, Greece
| | - Panagiota Mikou
- Cytopathology Laboratory, “Laiko” General Hospital of Athens, 11527 Athens, Greece
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Piggott LM, Hayes C, Greene J, Fitzgerald DB. Malignant pleural disease. Breathe (Sheff) 2023; 19:230145. [PMID: 38351947 PMCID: PMC10862126 DOI: 10.1183/20734735.0145-2023] [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: 08/15/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Malignant pleural disease represents a growing healthcare burden. Malignant pleural effusion affects approximately 1 million people globally per year, causes disabling breathlessness and indicates a shortened life expectancy. Timely diagnosis is imperative to relieve symptoms and optimise quality of life, and should give consideration to individual patient factors. This review aims to provide an overview of epidemiology, pathogenesis and suggested diagnostic pathways in malignant pleural disease, to outline management options for malignant pleural effusion and malignant pleural mesothelioma, highlighting the need for a holistic approach, and to discuss potential challenges including non-expandable lung and septated effusions.
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Affiliation(s)
- Laura M. Piggott
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin, Ireland
- These authors contributed equally
| | - Conor Hayes
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin, Ireland
- These authors contributed equally
| | - John Greene
- Department of Oncology, Tallaght University Hospital, Dublin, Ireland
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