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Lim KH, Ahmed SS, Cheng XM, Hwang JSG, Karunanithi J, Mantoo S, Takano AM, Sultana R, Khor LY. A single tertiary institution review of the international system for serous fluid cytopathology and the impact of cell block and ancillary studies on its performance. J Am Soc Cytopathol 2023; 12:48-57. [PMID: 36192336 DOI: 10.1016/j.jasc.2022.09.001] [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: 06/19/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION We sought to assess the utility of the International System for Serous Fluid Cytopathology (TIS) in the context of our department's routine practice. MATERIALS AND METHODS We examined 1028 archived effusion cytology (pleural, peritoneal, and pericardial) cases from 2018 to 2019, and re-classified them along the international system into the following diagnostic categories: nondiagnostic (ND), negative for malignancy (NFM), atypia cells of undetermined significance (AUS), suspicious for malignancy (SFM), and malignant (MAL). RESULTS The full distribution of the cases examined was as follows: ND 2.0%; NFM 66.1%; AUS 6.0%; SFM 4.7%; MAL 21.2%. Overall risk of malignancy for each category was calculated as: ND 30.0%; NFM 18.0%; AUS 61.9%; SFM 100%; MAL 94.4%. The overall performance attributes of TIS were as follows: sensitivity 57.1%; specificity 98.3%; positive predictive value 94.4%; negative predictive value 82.0%; diagnostic accuracy 84.5%. CONCLUSIONS The new classification was simple and intuitive to use and our results appear to fall within the expected ranges of the new guidelines, with risk of malignancy and accuracy comparable to similar studies. The availability of a cell block allowed for refinement of the diagnosis in a majority of cases with equivocal cytology, though this was dependent on the cell yield.
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Affiliation(s)
- Kok Hing Lim
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore.
| | - Syed Salahuddin Ahmed
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore
| | - Xin Min Cheng
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore
| | - Jacqueline Siok Gek Hwang
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore
| | - Jayanthi Karunanithi
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore
| | - Sangeeta Mantoo
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore
| | - Angela Maria Takano
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Li Yan Khor
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Academia, Singapore; Duke-NUS Medical School, Singapore
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Oliveira CR, Niccolai P, Ortiz AM, Sheth SS, Shapiro ED, Niccolai LM, Brandt CA. Natural Language Processing for Surveillance of Cervical and Anal Cancer and Precancer: Algorithm Development and Split-Validation Study. JMIR Med Inform 2020; 8:e20826. [PMID: 32469840 PMCID: PMC7671846 DOI: 10.2196/20826] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Accurate identification of new diagnoses of human papillomavirus–associated cancers and precancers is an important step toward the development of strategies that optimize the use of human papillomavirus vaccines. The diagnosis of human papillomavirus cancers hinges on a histopathologic report, which is typically stored in electronic medical records as free-form, or unstructured, narrative text. Previous efforts to perform surveillance for human papillomavirus cancers have relied on the manual review of pathology reports to extract diagnostic information, a process that is both labor- and resource-intensive. Natural language processing can be used to automate the structuring and extraction of clinical data from unstructured narrative text in medical records and may provide a practical and effective method for identifying patients with vaccine-preventable human papillomavirus disease for surveillance and research. Objective This study's objective was to develop and assess the accuracy of a natural language processing algorithm for the identification of individuals with cancer or precancer of the cervix and anus. Methods A pipeline-based natural language processing algorithm was developed, which incorporated machine learning and rule-based methods to extract diagnostic elements from the narrative pathology reports. To test the algorithm’s classification accuracy, we used a split-validation study design. Full-length cervical and anal pathology reports were randomly selected from 4 clinical pathology laboratories. Two study team members, blinded to the classifications produced by the natural language processing algorithm, manually and independently reviewed all reports and classified them at the document level according to 2 domains (diagnosis and human papillomavirus testing results). Using the manual review as the gold standard, the algorithm’s performance was evaluated using standard measurements of accuracy, recall, precision, and F-measure. Results The natural language processing algorithm’s performance was validated on 949 pathology reports. The algorithm demonstrated accurate identification of abnormal cytology, histology, and positive human papillomavirus tests with accuracies greater than 0.91. Precision was lowest for anal histology reports (0.87, 95% CI 0.59-0.98) and highest for cervical cytology (0.98, 95% CI 0.95-0.99). The natural language processing algorithm missed 2 out of the 15 abnormal anal histology reports, which led to a relatively low recall (0.68, 95% CI 0.43-0.87). Conclusions This study outlines the development and validation of a freely available and easily implementable natural language processing algorithm that can automate the extraction and classification of clinical data from cervical and anal cytology and histology.
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Affiliation(s)
- Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Patrick Niccolai
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Anette Michelle Ortiz
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, United States
| | - Eugene D Shapiro
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States.,Departments of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Linda M Niccolai
- Departments of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Cynthia A Brandt
- Departments of Emergency Medicine, Biostatistics, and Health Informatics, Yale Schools of Medicine and Public Health, New Haven, CT, United States.,Veteran Affairs Connecticut Healthcare System, West Haven, CT, United States
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Poller DN, Schmitt F. Should uncertainty concerning the risk of malignancy be included in diagnostic (nongynecologic) cytopathology reports? Cancer Cytopathol 2020; 129:16-21. [PMID: 32649050 DOI: 10.1002/cncy.22322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
In diagnostic cytology, the known site-specific false positive rates at various anatomical sites for the risk malignancy (ROM) when a confirmed malignant diagnosis is made are comparatively well documented. ROM figures for diagnostic cytology specimens may vary according to the anatomical site of the specimen, the exact nature of the specimen received, the staining method(s) used, and the use of additional laboratory techniques including molecular profiling; furthermore, they often differ to some extent from institution to institution, between differing cytologists within the same institution, and over time. A brief literature review for a selected group of routine diagnostic cytology specimens shows a published ROM for a confirmed malignant diagnosis as follows: bile duct brushings, ~99% (range, 97%-100%); breast fine needle aspiration, 98.5% (range, 92%-100%); serous effusion fluid, 98.9% (range, 90%-100% although lower for squamous cell carcinoma, mesothelioma, and lymphoma), pulmonary endobronchial ultrasound cytology, ~99% (range, 86.6%-100%); thyroid FNA, 98% (range, 97%-99% if NIFTP tumors are excluded), salivary gland FNA, ~90%; (range 57%-100%) and lateral neck cyst FNA, ~99% (range, 95.5%-100%). Because most diagnostic cytology specimens have a small but accepted false-positive rate, this information is vitally important for the clinical management of patients and for shared patient decision making. In our view, the known false-positive rate for a given diagnostic cytology specimen could be included within the cytology report to assist in explaining the limitations of the diagnostic cytology interpretation and help facilitate the clinical decision-making process.
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Affiliation(s)
- David N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,Medical Faculty of Porto University, Porto, Portugal
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Mezei T. Current classification systems and standardized terminology in cytopathology. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:655-663. [PMID: 33817706 PMCID: PMC8112797 DOI: 10.47162/rjme.61.3.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
The history of classification systems and the search for a unified nomenclature in cytopathology spans several decades and expresses the preoccupation of all those involved to make cytopathology a reliable diagnostic tool and a trusted screening method. Early classification schemes, applicable to exfoliative and aspiration cytology, attempted to set some basic standards for how non-gynecological cytopathology findings should be reported. While useful in establishing some basic guidelines, these were not specific to the various fields of non-gynecologic cytopathology, often burdened with specific problems. Cytopathology has evolved tremendously in the last couple of decades, undoubtedly boosted by the emergence of various classification schemes that, more than ever, are based on evidence gathered by professionals across the globe. The benefit of classification systems and standardized nomenclature in cytopathology is to provide useful, clear, and clinically relevant information for clinicians and ultimately to provide the best patient care. Standardized reporting systems make cytopathology reports more meaningful and robust. It now became standard that these include by default elements, such as adequacy criteria, diagnostic groups, risk of malignancy (ROM), and recommendations for patient management. In this brief review, we attempted to summarize how these classification schemes emerged and how they are reshaping the landscape of diagnostic cytopathology.
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Affiliation(s)
- Tibor Mezei
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Romania;
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Arnold JE, Camus MS, Freeman KP, Giori L, Hooijberg EH, Jeffery U, Korchia J, Meindel MJ, Moore AR, Sisson SC, Vap LM, Cook JR. ASVCP Guidelines: Principles of Quality Assurance and Standards for Veterinary Clinical Pathology (version 3.0): Developed by the American Society for Veterinary Clinical Pathology's (ASVCP) Quality Assurance and Laboratory Standards (QALS) Committee. Vet Clin Pathol 2020; 48:542-618. [PMID: 31889337 DOI: 10.1111/vcp.12810] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Melinda S Camus
- Department of Pathology, University of Georgia College of Veterinary Medicine, Athens, GA, USA
| | | | - Luca Giori
- Department of Biomedical and Diagnostic Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, USA
| | - Emma H Hooijberg
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Unity Jeffery
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jérémie Korchia
- Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, TX, USA
| | | | - A Russell Moore
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sandra C Sisson
- Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Linda M Vap
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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Urken ML, Randolph G, Orloff L, Wenig BM, Machado R, Osorio M, Griffin M, Tuttle RM. THE ROLE OF ELECTRONIC FEEDBACK LOOPS IN THE CONTINUOUS QUALITY IMPROVEMENT OF THYROID NODULE AND THYROID CANCER CARE. Endocr Pract 2017; 23:1024-1027. [PMID: 28614008 DOI: 10.4158/ep161739.co] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology. Adv Anat Pathol 2016; 23:193-201. [PMID: 27233050 DOI: 10.1097/pap.0000000000000118] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The main purpose of urine cytology is to detect high-grade urothelial carcinoma. With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of high-grade urothelial carcinoma. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. TPS Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme's universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.
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Barkan GA, Wojcik EM, Nayar R, Savic-Prince S, Quek ML, Kurtycz DFI, Rosenthal DL. The Paris System for Reporting Urinary Cytology: the quest to develop a standardized terminology. J Am Soc Cytopathol 2016; 5:177-188. [PMID: 31042521 DOI: 10.1016/j.jasc.2016.04.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The main purpose of urine cytology is to detect high-grade urothelial carcinoma (HGUC). With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of HGUC. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. The Paris System Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme's universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and the limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.
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Affiliation(s)
- Güliz A Barkan
- Department of Pathology, Loyola University Healthcare System, 2160 S. First Ave, Building 110, Room 2238, Maywood, Illinois, 60153.
| | - Eva M Wojcik
- Department of Pathology, Loyola University Healthcare System, 2160 S. First Ave, Building 110, Room 2238, Maywood, Illinois, 60153
| | - Ritu Nayar
- Department of Pathology, Northwestern Memorial Hospital, Chicago Illinois
| | | | - Marcus L Quek
- Department of Urology, Loyola University Health Systems, Maywood, Illinois
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Odronic SI, Roberson J, Booth CN. Current practice patterns in nongynecologic and fine-needle aspiration cytology. J Am Soc Cytopathol 2015; 4:239-245. [PMID: 31051760 DOI: 10.1016/j.jasc.2015.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The American Society of Cytopathology Clinical Practice Committee in collaboration with the American Society of Cytotechnology surveyed cytology practitioners to better understand current practices related to nongynecologic (NGYN) cytology. While work practices in gynecologic (GYN) cytology are highly regulated with limited variation among specimens and processing techniques, practice patterns for NGYN cytology are less standardized among laboratories. MATERIALS AND METHODS An NGYN cytology survey was created that consisted of 40 questions focusing on 6 main topic areas: (1) practice settings and demographic data; (2) NGYN non-fine-needle aspiration cytology; (3) fine-needle aspiration (FNA) cytology; (4) rapid on-site evaluation practices; (5) workload recording practices; and (6) expanding roles of the cytotechnologist (CT). The survey was sent to all American Society of Cytopathology and American Society of Cytotechnology members and remained available for 40 days. RESULTS There were 368 survey participants (14% response rate) with nearly equal participation among CTs, cytology general managers and/or supervisors, and pathologists representing a variety of practice types. Most laboratories (87%) are providing a rapid on-site evaluation service for FNA specimens. The role of CTs is expanding with the majority of respondents stating that CTs assist with both clinician-performed and pathologist-performed FNA acquisition (77% and 50%, respectively), telecytology (16%), and screening of ancillary studies, including special stains (64%), immunohistochemistry (23%), and fluorescence in situ hybridization (16%). CONCLUSIONS Knowledge of NGYN cytology practice patterns among laboratories may contribute information to better define the future of cytotechnology, support reimbursement initiatives, and enhance quality and efficiencies in the cytology laboratory.
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Affiliation(s)
- Shelley I Odronic
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Janie Roberson
- Department of Pathology, University of Alabama, Birmingham, Alabama
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio.
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Rao S, Rao S, Lal A, Barathi G, Dhanasekar T, Duvuru P. Bronchial wash cytology: A study on morphology and morphometry. J Cytol 2014; 31:63-7. [PMID: 25210231 PMCID: PMC4159898 DOI: 10.4103/0970-9371.138664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Bronchial wash cytology of lung lesions is a non/minimally invasive procedure utilized for diagnosis of pulmonary lesions. Aim: The aim of this study was to evaluate the efficacy of bronchial wash cytology in the diagnosis of bronchopulmonary lesions and assess the role of morphometry in categorizing dysplastic/malignant lesions. Materials and Methods: All cases of bronchial wash cytology received from January 2006 to June 2010 were retrieved and reviewed. Cases with adequate clinical data or a subsequent biopsy were selected for the study and cytodiagnosis was correlated with available clinical details. Morphometry was done on alcohol fixed hematoxylin and eosin stained cytosmears using computer assisted Image Pro software. Results: One hundred and seventy-six cases of the 373 cases of bronchial cytology received were included for the study. Bronchial wash cytology technique showed high specificity. Cytohistopathology correlation showed 62.06% concordance rate. Cells from normal epithelium, reactive atypia, neoplastic atypia, squamous metaplasia, non-small cell and small cell carcinoma showed a mean nuclear diameter of 7.4 μm, 11.7 μm, 13.9 μm, 13.0 μm, 10.7 μm, and 17.7 μm, respectively, which was statistically significant with P < 0.05. Multiple comparisons between various groups using analysis of variance and Bonferroni tests also showed remarkable statistical significance. Conclusions: Bronchial wash cytology has low sensitivity in detecting pulmonary lesions. It can be of value in patients with contraindication for biopsy. Morphometry can be a useful adjunct to cytomorphology, especially in situations where biopsy is contraindicated.
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Affiliation(s)
- Shalinee Rao
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, India
| | - Shivani Rao
- Department of Community Medicine, Saveetha Medical College, Thandalam, Chennai, Tamil Nadu, India
| | - Archana Lal
- Dr. Lal Pathlabs National Reference Laboratory, New Delhi, India
| | - Gunabooshanam Barathi
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, India
| | - Thangaswamy Dhanasekar
- Department of Tuberculosis and Pulmonary Medicine, Sri Ramachandra Medical College and Research Institute, Porur, India
| | - Prathiba Duvuru
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, India
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Renshaw AA, Birdsong GG. Issues in reporting cytology: From headers and critical values to categorical data and natural language parsers. J Am Soc Cytopathol 2014; 3:37-41. [PMID: 31051728 DOI: 10.1016/j.jasc.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/16/2013] [Accepted: 05/21/2013] [Indexed: 06/09/2023]
Abstract
The standards for reporting cytology, including critical values in cytology, are rapidly evolving. The issues and standards for the use of headers, reporting critical values, and the switch to categorical data elements are reviewed. The way in which cytology is reported is evolving, and the amount of information that is routinely generated from that report is increasing.
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Grapsa D, Ekaterini Politi. Standardized categorical reporting of cytopathology results: the strengths and weaknesses of a constantly evolving and expanding system. Diagn Cytopathol 2013; 41:917-21. [PMID: 23619922 DOI: 10.1002/dc.22927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/09/2012] [Indexed: 11/09/2022]
Abstract
Since the success of the Bethesda nomenclature system in standardizing Pap smear results, there has been growing interest in adopting Bethesda-like standardized categorical formats in areas of nongynecologic cytopathology. Standardized categorical reporting may have several advantages over descriptive reporting, in enhancing cytopathologist-clinician communication and inter-institutional exchange of information, providing better guidance for treatment planning, and facilitating statistical analysis for research purposes or quality control studies. On the other hand, descriptive reporting may be more effective as a tool of communication between cytopathologists, may better express the uncertainty of the observer in diagnostically difficult and equivocal cases and may better serve the purposes of training and continuing education of cytopathologists. Future studies on the pros and cons of the different reporting systems used in cytopathology may provide further insight on these issues. The most problematic areas need to be identified and optimal solutions decided. Despite the ongoing debate on the optimal reporting format in cytopathology, there is general agreement on the need for high quality cytology reports (whether descriptive or standardized) in terms of their diagnostic accuracy, clarity and clinical value.
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Affiliation(s)
- Dimitra Grapsa
- Cytopathology Department, Areteion University Hospital, Athens, Greece
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Gupta PK. Progression from on-site to point-of-care fine needle aspiration service: Opportunities and challenges. Cytojournal 2010; 7:6. [PMID: 20607093 PMCID: PMC2895872 DOI: 10.4103/1742-6413.63195] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 03/19/2010] [Indexed: 11/20/2022] Open
Abstract
Background Standard-of-care requires the availability of an efficient, economical and accurate on-site fine needle aspiration (FNA) service. Presence of a trained individual during the procedure ensures an improved patient care. Appropriate selection of the equipment, interaction with the clinicians and compliance with the various regulations during the procedure is essential. This is often done by an on-site FNA service. Organization and implementation of such a system in a large academic center is challenging. Method we reviewed the ambulatory care needs in the new Perelman Center for Advanced Medicine (PeCAM). Multiple (9) FNA sites have been established keeping in view the patient's convenience, clinic demands, various regulatory requirements and laboratory staff. Each location has dedicated FNA station with microscopes and supplies. In addition, state- ofthe -art technologies including a mobile FNA cart (Penn-A- Cart), remote specimen evaluation (TeleCyP) have been incorporated. Results The new set up is extremely efficient and much valued by the patients and the clinicians. It has improved patient care. Conclusion With necessary investments and resources a point-of-care FNA service has been created which has improved patient care. This, albeit with certain modifications may serve as a model for FNA service.
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Affiliation(s)
- Prabodh K Gupta
- Address: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania,3400 Spruce St., Pennsylvania - 19104, Philadelphia
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