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Shen Y, Gosnell JM, Nawgiri R, Muthukumarana V. Application of the newly published International System for Reporting Serous Fluid Cytopathology in atypical and suspicious diagnosis: a four-year retrospective analysis. J Am Soc Cytopathol 2024:S2213-2945(24)00021-8. [PMID: 38637263 DOI: 10.1016/j.jasc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Serous fluids offer crucial diagnostic insights, but inconsistent analysis hampers reporting quality, especially in indeterminate (ID) categories like atypia of undetermined significance (AUS) and suspicious for malignancy (SFM). The 2020 International System for reporting Serous Fluid Cytopathology (TIS) aims to standardize communication and reduce reporting disparities. This study evaluates TIS's role in AUS and SFM categories within our institution. MATERIAL AND METHODS A 4-year retrospective search of cytopathology reports from December 2015 to December 2019 for AUS and SFM diagnoses in pleural, ascitic, pericardial fluids, and peritoneal washings was performed and results reclassified using TIS definitions. The risk of malignancy (ROM) was calculated for existing and reclassified diagnoses. RESULTS Over 4 years, we received 2998 serous fluid specimens. AUS constituted 2.3% (70 cases), while SFM constituted 0.5% (16 cases). Excluding repeats, 80 cases were TIS-reviewed. Sixteen cases of ID diagnoses were reclassified. Two cases of AUS were changed to negative for malignancy (NFM) and 12 to SFM. Two SFM cases were upgraded to malignancy. ROM shifted from 63% to 60% for AUS and 100% to 85% for SF (TIS's ROM range: AUS: 66% ± 10%; SFM: 82% ± 4.8%). CONCLUSIONS This institution's ID diagnosis rate is low. AUS ROM is challenging but aligns with TIS, primarily favoring benign. All SFM diagnoses are highly suspicious but quantitatively inadequate for definitive malignancy, explaining the elevated ROM. AUS rate should gauge quality, not serve as a catch-all category. Algorithmic cytology with cell blocks and ancillary studies aids reclassification. TIS is user-friendly and is a consistent methodology for standardized reporting. Further studies are needed to evaluate ROM and define reproducible diagnostic criteria for each category for better system utilization.
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Affiliation(s)
- Yuan Shen
- Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Joseph M Gosnell
- Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Ranjana Nawgiri
- Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Vidarshi Muthukumarana
- Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Galveston, Texas.
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Aggarwal P, Handa U, Bhagat R, Aggarwal D. Morphological markers of chromosomal instability as predictors of malignancy in pleural effusion. Diagn Cytopathol 2024; 52:76-81. [PMID: 37946685 DOI: 10.1002/dc.25249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Malignancy in pleural effusion is an indication of poor prognosis. The distinction between malignant cells and reactive mesothelial cells in effusion cytology is sometimes difficult and requires ancillary techniques. Evaluation of morphological indicators of chromosomal instability (CI) like micronuclei (MN), chromatin bridging (CB), nuclear budding (NB), and multipolar mitosis (MM) on routine cytology smears is a promising tool to distinguish malignant from benign ascitic fluids. However, it has been scarcely evaluated in pleural effusions. The present study was conducted to evaluate the diagnostic value of these markers in differentiating between malignant and benign pleural fluids. METHODS It is a cross sectional study in which a total of 72 pleural fluid samples over a period of 2 years received in the cytology department of the hospital were evaluated. The cytological analysis was done by two independent cytopathologists and interpreted as either malignant or benign. Four morphological markers of CI were counted in the May-Grünwald Giemsa (MGG) stained smears of all the cases and the score was compared with the conventional cyto-morphological diagnosis. RESULTS Out of 72 cases, there were 42 malignant and 30 benign effusions on cytological examination. The mean score of micronuclei count, nuclear budding, chromatin bridging and multipolar mitosis in malignant effusions were 7.26 ± 2.74, 9.55 ± 5.53, 1.83 ± 1.17, and 2.21 ± 1.62 respectively that was significantly higher than the benign effusions (1 ± 0.71, 1.1 ± 0.86, 0.38 ± 0.50, and 0.15 ± 0.37 respectively) (p < .05). On Receiver operating characteristic (ROC) curve analysis, a cut-off of 5 for the MN count had a sensitivity of 88% and specificity of 100% in detecting malignant pleural effusion [Area under curve (AUC) 95.8%, p < .001]. CONCLUSION Evaluation of morphological indicators of CI on routine MGG stained smears is a simple and cost-effective method to differentiate between benign and malignant pleural fluids.
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Affiliation(s)
- Phiza Aggarwal
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Ranjeev Bhagat
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Aggarwal
- Department of Pulmonary, Critical Care & Sleep Medicine, Government Medical College and Hospital, Chandigarh, India
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Hruaii V, Thirunavukkarasu B, Prabha V, Mathur S, Iyer VK, Nambirajan A, Jain D. Claudin-4 immunocytochemistry is specific and sensitive for the diagnosis of malignant carcinomatous effusions: Results from a pilot study. Diagn Cytopathol 2024; 52:30-41. [PMID: 37837242 DOI: 10.1002/dc.25238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Claudin-4, a tight junction associated protein expressed in epithelial cells, is purported as a highly specific and sensitive marker for epithelial malignancies. Our aim was to assess the sensitivity, specificity and real-time utility of claudin-4 immunocytochemistry (ICC) in the diagnostic work-up of suspected malignant effusions. METHODS Claudin-4 (3E2C1 clone) ICC was performed prospectively in effusion cell blocks where other ICC markers were being performed as part of reporting over 3 months. Based on claudin-4 staining in unequivocal malignant and reactive effusions, the sensitivity and specificity was calculated. In cases signed out as inconclusive encompassing atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) and negative for malignancy, change in diagnostic category based on addition of claudin-4 ICC was assessed. RESULTS Study included 107 effusions. Claudin-4 stained 100% of metastatic adenocarcinomas including those with primaries in lung, breast, ovary, female genital tract, gastrointestinal tract and pancreatic-biliary tract, and was negative in all reactive mesothelial and mesothelioma effusions with sensitivity of 100% (48/48) and specificity of 95% (20/21) for adenocarcinoma. Claudin-4 upgraded the diagnostic category to positive in 70% (16/23) of SFM, 20% (1/5) of AUS, and in 50% (5/10) of negative effusions. Among cases with confirmed serosal involvement status on follow-up, claudin-4 showed sensitivity, specificity, positive predictive value and negative predictive values of 85% (11/13), 100% (3/3), 100% (10/10) and 75% (3/4), respectively, for metastatic adenocarcinoma. CONCLUSION Claudin-4 as a single marker is sensitive and specific for adenocarcinoma and is a valuable addition to the ICC armamentarium.
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Affiliation(s)
- Vanlal Hruaii
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vindhya Prabha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Mikou P, Pergaris A, Engels M, Chandra A. Review of the impact of the International System for Serous Fluid Cytopathology. Cytopathology 2024; 35:16-22. [PMID: 37795809 DOI: 10.1111/cyt.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
The International System for Reporting Serous Fluid Cytology (TIS) has been proposed by an expert working team composed of the International Academy of Cytology and the American Society of Cytopathology, following an international survey. Since its introduction, the TIS has gained worldwide acceptance, and this review aims to assess its global impact. A literature search revealed 25 studies which have presented data on the impact of the TIS. Most of them provide data, including risk of malignancy (ROM) for each diagnostic category, separately for pleural, peritoneal and pericardial effusions, while a few do not separate them. A few studies focus on specific diagnoses like mesothelioma on specific types of fluids or more specific issues like the optimal fluid volume for cytology or interobserver variability. A synopsis of the data from the literature search is presented in four tables. The ROM assessment is discussed, as well as interobserver variability and the use of ancillary diagnostic immunochemistry. In conclusion, our review of the published data suggests that the TIS is a valid classification scheme that has been widely accepted by pathologists globally, is highly reproducible and makes a valuable contribution to clinical therapeutic management.
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Affiliation(s)
| | - Alexandros Pergaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Nikas IP, Souza da Silva R, Sousa-Pinto B, Schmitt F. Challenging the concept of "risk of malignancy" in cytology. Cancer Cytopathol 2023. [PMID: 38126672 DOI: 10.1002/cncy.22787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Several standardized systems for nongynecological cytopathology have been published following the successful implementation of The Bethesda System for Reporting Cervical Cytology. Each of these systems comprises a set of reporting categories accompanied by a risk of malignancy. However, in most cases, these risk of malignancy estimates have not been based on high-quality evidence and often may not be consider proper "risks" (because they have been estimated based on cross-sectional studies). This commentary discusses the problems related to the data used to generate these risks. To make nongynecological cytopathology reporting more evidence-based, large-scale prospective cohort studies and randomized trials, in addition to high-quality systematic reviews and meta-analyses, should be performed.
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Affiliation(s)
- Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Ricella Souza da Silva
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Faculty of Medicine, CINTESIS@RISE - Health Research Network, University of Porto, Porto, Portugal
| | - Fernando Schmitt
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
- Faculty of Medicine, CINTESIS@RISE - Health Research Network, University of Porto, Porto, Portugal
- Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
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Beg S, Zanettini C, Queiroz L, Marchionni L, Alperstein SA, Siddiqui MT. Optimal fluid volume for detecting malignancy in serous effusions: a single institution experience. J Am Soc Cytopathol 2023; 12:415-422. [PMID: 37419704 DOI: 10.1016/j.jasc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Detection of malignant cells in serous fluids is an indicator of advanced stage of malignancy and is critical in clinical management decisions and prompt treatment initiation. The minimum volume which is ideal for detecting malignancy in serous fluid is not well established. In this study, we aim to identify optimal volume that will be ideal for adequate cytopathological diagnosis. MATERIALS AND METHODS A total of 1597 samples of serous fluids from 1134 patients were included in the study. Samples were diagnosed based on International System for Reporting Serous Fluid Cytopathology (ISRSFC). Clinicopathologic results from different diagnostic groups were compared and statistically analyzed. RESULTS Pleural fluids comprised 890 (55.7%) specimens, followed by 456 (28.6%) peritoneal, 128 (8%) ascites, and 123 (7.7%) pericardial fluid specimens. The majority were negative for malignancy (1138, 71.3%), followed by malignant (376, 23.5%), atypical (59, 3.7%), and suspicious for malignancy (24, 1.5%). Malignancy was identified in sample with volumes from 5 mL to 5000 mL. Rate of detection of malignant cells increased significantly with higher sample volumes. For malignancy detection the optimal volume for overall serous fluid is 70 mL. Pericardial fluid is an exception, with lower mean volume and significantly lower proportion of cases with malignant diagnosis. CONCLUSIONS Our study indicates that higher fluid volumes have a higher rate of malignancy detection and a low false-negative rate. We recommend a minimum of 70 mL of serous fluid for optimal cytopathologic examination and malignancy detection. Pericardial fluid is an exception, with lower mean volume and thus lower requirement.
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Affiliation(s)
- Shaham Beg
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Claudio Zanettini
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Lucio Queiroz
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York; Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, State of Minas Gerais, Brazil
| | - Luigi Marchionni
- 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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Gaur G, Awasthi NP, Gupta A, Agarwal A, Sachan R, Malhotra KP, Shukla S, Singh AK, Singh P, Husain N. Diagnostic accuracy of flow cytometry in detecting malignant epithelial cells in serous effusions. J Am Soc Cytopathol 2023; 12:423-435. [PMID: 37839931 DOI: 10.1016/j.jasc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION This study aims to evaluate diagnostic accuracy of flow cytometry (FCM) in detecting malignant epithelial cells in serous effusions. MATERIALS AND METHODS Flow cytometric assessment of 96 serous fluids (86 ascitic, 10 pleural) was performed by using epithelial cell adhesion molecule (EpCAM) (in all 96 fluids) and MUC-1 (in a subgroup of 40 fluids) as epithelial markers and CD45 and CD14 as leucocyte markers. The percentage of EpCAM positivity and MUC-1 positivity was calculated in the CD14 and CD45 dual negative population by selective gating. The findings were then correlated with the defined gold standard criteria. RESULTS The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for EpCAM was found to be 92.06%, 96.96%, 98.31%, 86.48%, and 93.75%, respectively, while that for MUC-1 was 79.16%, 93.75%, 95%, 71.4%, and 85%, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for dual positivity for EpCAM and MUC-1 was found to be 83.3%, 100%, 100%, 80%, and 90% respectively. On combining FCM with cytomorphology the sensitivity, specificity, PPV, NPV, and diagnostic accuracy all increased greatly to 95.3%, 100%, 100%, 91.4%, and 96.8%, respectively. CONCLUSIONS This study highlights the importance of multicolored flow cytometric analysis in detecting epithelial malignancies in effusions specially in cases belonging to the atypia of undetermined significance and suspicious for malignancy categories and in cases with strong clinical suspicion of malignancy with negative fluid cytology. We recommend the combined use of FCM and cytology for this specific subgroup of patients in routine clinical practice for fast and accurate reporting.
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Affiliation(s)
- Gauri Gaur
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Namrata P Awasthi
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Anurag Gupta
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Akash Agarwal
- Department of Surgical Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ruchita Sachan
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kiran Preet Malhotra
- 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
| | - Arvind Kumar Singh
- Department of Community Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradyumn Singh
- Department of Pathology, 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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Sachan R, Gupta A, Awasthi PN, Singh P, Anand N, Chandra S, Gaur G, Husain N, Sachan KD. Application of international system for reporting serous fluid cytology (ISRSFC) in effusion samples-a prospective study in an oncology setting. J Am Soc Cytopathol 2023; 12:351-361. [PMID: 37244848 DOI: 10.1016/j.jasc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Serous fluid cytology is a cost-effective procedure that can help in the diagnosis, staging, and origin of the malignancy. Recently introduced International System for Reporting Serous Fluid Cytology (ISRSFC) standardizes the reporting of serous fluid cytology in the 5 categories: Category 1: Nondiagnostic (ND), Category 2: negative for malignancy (NFM), Category 3: atypia of undetermined significance (AUS), Category 4: suspicious for malignancy (SFM), and Category 5: malignant (MAL). Here, we present our experience adopting the ISRSFC. MATERIALS AND METHODS We implemented ISRSFC in December of 2019 at our institute and included a cohort of 555 prospective effusion samples. The pertinent surgical pathology, radiology, and clinical follow-up were also extracted to assess the risk of malignancy (ROM) and performance parameters. RESULTS The assessment of interobserver reliability indicated substantial concordance (κ = 0.717) between the 2 investigators for serous fluid categorization. A total of 555 effusion samples were classified as follows: ND, 14 (2.5%); NFM, 394 (71%); AUS, 12 (2.2%); SFM, 13 (2.3%); and MAL, 122 (22%). The ROM for the ND, NFM, AUS, SFM, and MAL categories was 57.1%, 9.9%, 66.7%, 66.7%, and 97.2%, respectively, in peritoneal effusions and 57.1%, 7.1%, 66.7%, 100%, 100%, respectively, in pleural effusions. The ROM for NFM and MAL was 0% and 100%, respectively, in pericardial effusion. CONCLUSIONS Application of the proposed ISRSFC can help in achieving uniformity and reproducibility in diagnoses and also help in risk stratification in cytology. ISRSFC was successfully adopted by our cytology laboratory and clinicians, with overall diagnostic performance similar to previous studies.
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Affiliation(s)
- Ruchita Sachan
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anurag Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Punit Namrata Awasthi
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradyumn Singh
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nidhi Anand
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subrat Chandra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gauri Gaur
- Department of Pathology, 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
| | - Kumar Dheerendra Sachan
- Department of Radiation Oncology, Shrimant Rajmata Vijayaraje Scindia Medical College, Shivpuri, Madhya Pradesh, India
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Li JJX, Cheung W, Ng JKM, Tse GM. Application of algorithmic cytomorphological assessment and immunocytochemistry with the international system for reporting serous fluid cytopathology on pericardial fluid cytology. J Clin Pathol 2023:jcp-2023-209078. [PMID: 37643837 DOI: 10.1136/jcp-2023-209078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
AIMS The international system for reporting serous fluid cytopathology (ISRSFC) set forth a five-tiered reporting system with comprehensive validation on pleural and peritoneal fluid cytology. An algorithmic approach for cytomorphological assessment and immunocytochemistry was also described in ISRSFC. Limited data on pericardial fluid are supportive but would benefit from further investigation. METHODS Consecutive pericardial fluid cytology over a 4-year period was reviewed by multiple board-certified pathologists according to the ISRSFC. Cytomorphology and immunocytochemistry were assessed sequentially, with respective diagnostic performances computed and compared. Literature review was performed. RESULTS In total 358 specimens, including 53 with immunocytochemistry available, were reviewed. There were 137 benign and 221 malignant (MAL) cases. The risks of malignancy were 23.5% non-diagnostic (ND), 29.2% negative for malignancy (NFM), 56.0% atypia of undetermined significance (AUS), 82.6% suspicious for malignancy (SFM) and 99.2% (MAL) for cytomorphological assessment, improving to 23.5% (ND), 29.1% (NFM), 56.8% (AUS), 78.9% (SFM) and 99.3% (MAL) incorporating immunocytochemistry. Ten cases (2.8%) received a change in diagnosis after review of immunocytochemistry. All revisions of diagnostic category were appropriate upgrades/downgrades referenced against clinical information. Cytomorphological typing was accurate for adenocarcinoma (n=81/83, 97.6%), while other carcinomas and lymphomas required immunocytochemistry. Certain subcategories within AUS and SFM pertaining to bland indeterminate epithelial cells or mucinous material were not seen for pericardial fluid. CONCLUSIONS The ISRSFC shows robust diagnostic performance for pericardial fluid cytology. For pericardial effusion, disease composition and applicable cytological subcategories differ from its peritoneal and pleural counterparts. Incorporating immunocytochemistry by an algorithmic approach improves diagnostic accuracy. Cytomorphology is accurate for identifying adenocarcinomas, but further typing necessitates immunocytochemistry is necessary.
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Affiliation(s)
- Joshua J X Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Cheung
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Joanna K M Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
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Rakheja G, Singh M, Priyadarshnee B, Marimuthu B, Dhar L, Jain S, Khurana N, Rathore A. Categorisation of peritoneal serous effusions using the International System for Reporting Serous Fluid Cytopathology-A study on gynaecological samples. Cytopathology 2023; 34:138-145. [PMID: 36530023 DOI: 10.1111/cyt.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cytology of serous effusions is an indispensable diagnostic tool for the diagnosis of non-neoplastic as well as neoplastic effusions, aiding in the categorisation, staging, and prognostication of the patient. This study focuses on reclassifying cases of peritoneal fluid cytology following the International System for Reporting Serous Fluid Cytopathology (TIS), highlighting various challenges encountered and adding to the body of data regarding the risk of malignancy (ROM), focussing on peritoneal effusions due to gynaecological causes. METHODS Peritoneal effusion samples were retrieved from our department's archives and reclassified according to the TIS. The ROM for each category was calculated based on available surgical follow-up. RESULTS A total of 818 peritoneal effusions were studied. Following the definitions and guidelines of the TIS, the cases were reclassified with 125 (15.2%) in the category of non-diagnostic (ND), 595 (72.7%) as negative for malignancy (NFM), 26 (3.2%) as atypia of undetermined significance (AUS), 12 (1.5%) as suspicious for malignancy (SFM), and 60 (7.3%) as malignant (MAL). The respective ROM values for each category were 16.9%, 12.1%, 50%, 80%, and 100%, respectively. By considering the MAL and SFM groups as positive, and the ND, NFM, and AUS groups as negative, the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were determined as 85.2%, 36.7%, 99.1%, 91.7%, and 84.5%, respectively. CONCLUSIONS Peritoneal cytology categorisation following the proposed TIS offered a practical approach for categorisation of the fluids received. The ROMs reported in our study were mostly concordant with those published according to the TIS.
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Affiliation(s)
- Garima Rakheja
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | | | | | - Lity Dhar
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Asmita Rathore
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, India
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Basset C, Collin L, Vielh P, Courtade-Saïdi M. [Serous fluid cytopathology: International system]. Ann Pathol 2023; 43:96-113. [PMID: 36907792 DOI: 10.1016/j.annpat.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 03/12/2023]
Abstract
The International System for Serous Fluid Cytopathology is a cytologic classification which purpose is to establish a consensus on diagnostic terminology. Five diagnostic categories are proposed associated to an increased rate of malignancy and specific cytological criteria. The categories are reported as: (I) Non-diagnostic (ND), the cells are insufficient for interpretation; (II) Negative for malignancy (NFM), only benign cells are present; (III) Atypia of undetermined significance (AUS), the cells present mild atypia more likely to be benign, but a malignant process cannot be definitively excluded; (IV) Suspicious for malignancy (SFM), the cells are present with atypia or in a number suspect of malignancy but with insufficient ancillary studies to give a positive malignant diagnosis; (V) Malignant (MAL), the cytological criteria are absolutely and definitively malignant. Malignant neoplasia can be primitive, it involves mesothelioma and serous lymphoma but most are secondary and correspond mainly to adenocarcinomas in adults and leukemia/lymphoma in children. The diagnostic should always be provided in the appropriate clinical context and be as definitive as possible. The ND, AUS and SFM are temporary or last intention categories. Immunocytochemistry in association with FISH or flow cytometry allow in most cases a conclusive diagnosis. These ancillary studies as well as ADN and ARN tests on effusion's fluids are particularly suited to give reliable theranostic results for personalized therapies.
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Affiliation(s)
- Céline Basset
- Département d'anatomie et de cytologie pathologiques, institut universitaire du cancer Toulouse-Oncopole, 1, avenue Irène Joliot-Curie-IUCTO, 31059 Toulouse cedex, France.
| | - Laetitia Collin
- Medipath Feuillants, 116, route d'Espagne, Hélios 3, 31100 Toulouse, France
| | - Philippe Vielh
- Medipath, hôpital américain de Paris, 17, rue Gazan, 75014 Paris, France
| | - Monique Courtade-Saïdi
- Département d'anatomie et de cytologie pathologiques, institut universitaire du cancer Toulouse-Oncopole, 1, avenue Irène Joliot-Curie-IUCTO, 31059 Toulouse cedex, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sun T, Wang M, Wang H. Risk of malignancy assessment of the International System for Reporting Serous Fluid Cytopathology: Experience in a community hospital setting and comparison with other studies. Cancer Cytopathol 2022; 130:964-973. [PMID: 35994357 DOI: 10.1002/cncy.22638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The International System for Reporting Serous Fluid Cytopathology (ISRSFC) was published recently to provide standard reporting terminology for serous fluid. To date, several ISRSFC reclassification studies have reported a wide range of diagnostic category frequency and the associated risk of malignancy (ROM). Herein, the authors applied the ISRSFC to report pleural and peritoneal effusions retrospectively in a community hospital setting. METHODS With Internal Review Board approval, 446 peritoneal effusion specimens and 299 pleural fluid specimens from 576 patients in three community hospitals over a 12-month period were reviewed and reclassified according to the ISRSFC. RESULTS After reclassification, in pleural effusions, 18 (5.0%) were nondiagnostic (ND), 273 (76.0%) were negative for malignancy (NFM), 18 (5.0%) were atypia of undetermined significance (AUS), 6 (1.7%) were suspicious for malignancy (SFM), and 44 (12.3%) were malignant (MAL). In peritoneal effusions, after reclassification, 11 (5.5%) were ND, 168 (77.1%) were NFM, 9 (4.1%) were AUS, 2 (0.9%) were SFM, and 27 (12.4%) were MAL. The calculated ROM was 0.0% for ND, 1.8% for NFM, 37.5% for AUS, 83.3% for SFM, and 100.0% for MAL in peritoneal effusions; and the ROM was 8.3% for ND, 1.2% for NFM, 44.4% for AUS, and 100.0% for both SFM and MAL in pleural effusions. Further analysis demonstrated notable heterogeneity among published ISRSFC reclassification studies, although the overall ROMs did not differ significantly from the ISRSFC-determined ROMs (all p values were > .05 for mean ROM comparisons). CONCLUSIONS The findings suggested the necessity for each laboratory to perform its own ROM analysis based on its statistics for ISRSFC-tiered classification terminology.
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Affiliation(s)
- Tong Sun
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Minhua Wang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - He Wang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Kolte S, Zaheer S, Aden D, Ranga S. Application of the international system for reporting serous fluid cytopathology on reporting various body fluids; experience of a tertiary care hospital. Cytojournal 2022; 19:52. [PMID: 36128470 PMCID: PMC9479562 DOI: 10.25259/cytojournal_49_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: Cytological examination of effusion sample is a preliminary and minimally invasive method for the diagnosis of body fluids. Recently, the International System For Reporting Serous Fluid Cytopathology (ISRSFC) and the Indian Academy of Cytologist (IAC) have published guidelines for reporting effusion cytology and calculating the risks of malignancy (ROMs) for each defined category. We report our 2 years of experience in reclassifying and assessing the feasibility of applying ISRFSC and IAC categories to effusion fluid and to provide an estimate of the risk of malignancy for each diagnostic category. Material and Methods: Cytological reports of patients from January 2019 to December 2020 were retrieved and reclassified into a five-tiered classification scheme as per ISRSFC guidelines. Cellblock and immunohistochemistry were performed in selected cases. Clinico radiological and histopathological information were obtained and correlated with the cytological findings wherever available. Results: In the study, 652 cases were included during the 2 years. Out of these, 328 (50.3%) were women and 314 (47.3%) were men. Patient’s ages ranged between 2 92 years with a mean age of 47.4 years. There were 366 (56.1%) cases of ascitic fluid followed by 262 (40.1%) cases of pleural fluid and 24 (3.8%) cases of pericardial fluid in the analysis. Of all the cases, 13 (2%) were non-diagnostic (ND), 464 (71.6%) were negative for malignant (NFM) cells, 16 (2.4%) were atypia of uncertain significance, 31 (4.7%) were suspicious of malignancy, and 125 (19.3%) were malignant. Cellblock was prepared in 65 cases. Lung cancer followed by breast cancer was the most common malignancies involving the pleural effusion and ovarian cancer was the most common cause of peritoneal effusion. ROM for each diagnostic category was 23% for ND, 25% for NFM, 56% for the atypical category, 80.6% in suspicious, and 90% were for positive for malignancy category. Conclusion: The use of a five-tiered system as per the ISRFC and IAC guidelines are feasible for the standardized reporting of effusion samples, thus avoiding subjective variation of reporting.
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Affiliation(s)
- Sachin Kolte
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India,
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India,
| | - Durre Aden
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India,
| | - Sunil Ranga
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India,
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Zhu YL, Ren WH, Wang Q, Jin HZ, Guo YY, Lin DM. A retrospective analysis of serous effusions based on the newly proposed international system for reporting serous fluid cytopathology: a report of 3633 cases in an oncological center. Diagn Pathol 2022; 17:56. [PMID: 35780135 PMCID: PMC9250735 DOI: 10.1186/s13000-022-01241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The International System for Reporting Serous Fluid Cytopathology (TIS) was recently proposed. We retrospectively applied TIS recommendations for reporting the cytological diagnosis of serous effusions and reported our experience. Methods All the serous effusions from January 2018 to September 2021 were retrieved from the database. Recategorization was performed using the TIS classification, the risk of malignancy (ROM) was calculated for each TIS category. In addition, on the basis of the original TIS classification, we further subdivided the TIS category IV (suspicious for malignancy, SFM) into 2 groups (IVa and IVb) according to cytological characteristics (quality and quantity) to explore the necessity of SFM subclassification. The performance evaluation was carried out using different samples (pleural, peritoneal and pericardial effusions) and preparation methods (conventional smears, liquid-based preparations and cell blocks). Results A total of 3633 cases were studied: 17 (0.5%) were diagnosed as ‘nondiagnostic’ (I, ND), 1100 (30.3%) as ‘negative for malignancy’ (II, NFM), 101 (2.8%) as ‘atypia of undetermined significance’ (III, AUS), 677 (18.6%) as ‘suspicious for malignancy’ (IV, SFM), and 1738 (47.8%) as ‘malignant’ (V, MAL). The ROMs for the categories were 38.5%, 28.6%, 52.1%, 99.4% and 100%, respectively. The ROM for SFM was significantly higher than that for AUS (P < 0.001), while the difference between the ROMs for IVa and IVb was insignificant. The sensitivity, negative predictive value (NPV) and diagnostic accuracy of liquid-based preparations were all superior to those of conventional smears and cell blocks in detecting abnormalities. Using the three preparation methods simultaneously had the highest sensitivity, NPV and diagnostic accuracy. Conclusion Serous effusion cytology has a high specificity and positive predictive value (PPV), and TIS is a user-friendly reporting system. Liquid-based preparations could improve the sensitivity of diagnosis, and it is best to use three different preparation methods simultaneously for serous effusion cytologic examination.
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Affiliation(s)
- Yan-Li Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Wen-Hao Ren
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Qian Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Hai-Zhu Jin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yi-Yi Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Dong-Mei Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
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Coconubo DM, Baskota SU, Li R, Srivastava P, Cuda J, Khader S. Reassessing the optimal volume for malignancy detection in serous fluid cytology. Cancer Cytopathol 2022; 130:551-557. [PMID: 35468659 DOI: 10.1002/cncy.22577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The international system for reporting serous fluid cytopathology (TIS) recommends submitting at least 50-75 mL of serous fluid to decrease false-negative results. However, prior studies did not agree on specific volume requirements or consensus adequacy criteria. Our study aims to assess whether fluid volume affects the adequacy rate and to assess the minimum volume necessary for optimal adequacy in pleural and peritoneal fluids. METHODS A total of 8530 serous fluid cytology cases were identified in the laboratory information system. Differences in mean fluid volume received in the laboratory were compared using an ANOVA Games-Howell test based on TIS category. The percentage of malignant diagnoses across the volume ranges of 0 to 5 mL, 5 to 10 mL, 10 to 25 mL, 25 to 50 mL, 50 to 75 mL, 75 to 100 mL, 100 to 150 mL, 150 to 250 mL, 250 to 500 mL, 500 to 2000 mL was compared in pleural and peritoneal fluids using a chi-square test, and a SiZer analysis was performed. RESULTS Mean fluid volume in inadequate, atypical, and negative cases was significantly lower compared to positive cases. A SiZer analysis showed a positive relationship between the malignancy fraction of pleural and peritoneal fluids and fluid volume. The percentage of malignant diagnoses in pleural and peritoneal fluid samples increased significantly up to a volume range of 75-100 mL. CONCLUSIONS There is a significant relationship between fluid volume, adequacy and detection of malignancy in serous effusion cytopathology. The malignancy fraction increases with larger fluid volumes but at least 75-100 mL of fluid should be submitted for optimal diagnosis of malignancy in pleural and peritoneal fluids.
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Affiliation(s)
| | | | - Runjia Li
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Pooja Srivastava
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jackie Cuda
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samer Khader
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Bharti S, Nalwa A, Elhence PA, Rao M, Bharti JN, Khera S, Vedant D, Vishwajeet V, Goel A. Risk Stratification of Pleural Fluid Cytology Based on the International System for Reporting Serous Fluid Cytology in a Tertiary Care Centre. Acta Cytol 2022; 66:449-456. [PMID: 35413720 DOI: 10.1159/000524144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND The International Academy of Cytology and the American Society of Cytopathology proposed the international system for reporting serous fluid cytology (TISRSFC) in 2019 to form uniform reporting terminologies for fluid cytology. This system defines a spectrum of diagnostic categories to be used in daily clinical practice. Fluid cytology is a widely accepted, cost-effective, minimally invasive earliest diagnostic method for the investigation that aids management decisions. The present study aims to reclassify pleural fluid cytology and calculate the risk of malignancy (ROM) for each diagnostic category. MATERIAL AND METHODS It is a retrospective 2 years observational study comprising 690 pleural fluid specimens. Retrospective reviews were performed, and cases were reclassified into five categories as per TISRSFC. Immunohistochemistry was applied whenever needed. Cytological diagnosis was correlated with respective histopathology and/or clinical and/or radiological diagnosis. ROM was calculated for all diagnostic categories. RESULTS In the present study of 690 cases, 7.97% were non-diagnostic (ND), 84.1% cases were negative for malignancy (NFM), 0.87% were atypia of undetermined significance (AUS), 1.16% were suspicious for malignancy (SFM), and 5.94% were malignant (MAL). Cell blocks were prepared in 33 (4.8%) cases and immunohistochemistry was applied in 7 cases. The commonest site for pleural fluid metastasis was the lungs, accounting for 4.64% (32/690) cases. Further, ROM was calculated for all diagnostic categories as follows: (1) ND: 30.9%, (2) NFM: 12.9%, (3) AUS: 100%, (4) SFM: 100%, and (5) MAL: 90.2%. CONCLUSION Cytological examination of pleural fluids is an accurate, prompt, and affordable technique. This standardized ISRSFC reporting system will maintain uniformity and reproducibility in reporting, leading to improved clinical decision-making of pleural fluids.
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Affiliation(s)
- Sushma Bharti
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Aasma Nalwa
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Poonam Abhay Elhence
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Meenakshi Rao
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Sudeep Khera
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Vedant
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Vikarn Vishwajeet
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Akhil Goel
- Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Engels M. [Cytology of body cavity fluids - established methods and new developments]. Pathologe 2022; 43:91-98. [PMID: 34994855 DOI: 10.1007/s00292-021-01042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Body cavity fluids are among the most frequently examined samples in cytology. Cytomorphology is supplemented by additive testing. An international system of terminology and classification has been recently presented. OBJECTIVES Cytopreparation and staining techniques as well as some exemplary morphological patterns are presented. "The International System for Serous Fluid Cytopathology" (TIS) is briefly presented. MATERIALS AND METHODS Pleural effusion, pericardial effusion, and ascites: special technical issues, immunocytochemistry, molecular diagnostics, and reporting system issues are discussed. RESULTS Body cavity fluids are important samples that provide significant information. Additive testing is established for routine use. The form and structure of reports is widely divergent in practical use. DISCUSSION A reporting system for serous fluid cytopathology that is easily applied and recognized internationally is highly desirable. TIS is a valuable approach to this goal.
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Affiliation(s)
- Marianne Engels
- Institut für Pathologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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19
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Straccia P, Chiappetta M, Magnini D, Cancellieri A. Application of the International System for Reporting Serous Fluid Cytopathology (TIS): A Retrospective Institutional Study. Cytopathology 2022; 33:305-311. [PMID: 35213747 DOI: 10.1111/cyt.13113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cytology of serous effusions is an important diagnostic tool for the diagnosis of cancer, staging and prognosis of the patient. Herein, we retrospectively applied the TIS on reporting serous cytopathology and provided the corresponding risk of malignancy (ROM). METHODS Pleural, pericardial and peritoneal effusion samples were retrieved from the archives of our department and reclassified according to the TIS. The ROM for each category was calculated based on available surgical follow-up. RESULTS A total 3790 effusions were available for the study. 1292 pleural samples were reclassified: 27 (2.1%) non-diagnostic (ND), 1014 (78.5 %) negative for malignancy (NFM), 86 (6.6 %) atypia of undetermined significance (AUS), 29 (2.3 %) suspicious of malignancy (SFM) and 136 (10.5%) malignant (M). 241 pericardial samples were reclassified: 4 (1.6 %) as ND, 173 (71.8 %) as NFM, 10 (4.1 %) as AUS, 7 (3 %) as SFM, and 47 (19.5%) as M. 2257 peritoneal cases were re-categorized as follows: 31 (1.4 %) as ND, 1897 (84 %) as NFM, 39 (1.7 %) as AUS, 53 (2.4 %) as SFM, and 237 (10.5 %) as M. The ROM was, respectively, for each of the aforementioned categories, 18.5%, 15%, 45.3%, 93%, 100% in pleural effusions, 25%, 13.2%, 35%, 100%, 100% in pericardial effusions and 19.3%, 10.4%, 43.5%, 100%, 100% in peritoneal effusions. CONCLUSIONS Pleural, pericardial, and peritoneal cytology show high specificity and moderate sensitivity in the evaluation of serous effusions. The ROM reported in our study was mostly concordant with ROM published by the TIS.
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Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, Largo Francesco Vito, 1-00168, Rome
| | - Marco Chiappetta
- Thoracic Surgery, Largo Francesco Vito, 1-00168, Rome.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Magnini
- Bronchoscopy and Pneumology Unit, Largo Francesco Vito, 1-00168, Rome
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Ahuja S, Malviya A. Categorisation of serous effusions using the International System for Reporting Serous Fluid Cytopathology and assessment of risk of malignancy with diagnostic accuracy. Cytopathology 2021; 33:176-184. [PMID: 34913541 DOI: 10.1111/cyt.13089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT The International System for Reporting Serous Fluid Cytopathology (ISRSFC) standardises the reporting of serous effusion cytology under five categories: Non-Diagnostic (ND), Negative for Malignancy (NFM), Atypia of Undetermined Significance (AUS), Suspicious for Malignancy (SFM), and Malignant (M). Very few studies have been conducted so far to confirm the risk of malignancy of the different categories. AIMS The main objectives of our study were to classify serous effusions according to the ISRSFC categories and assess their risk of malignancy (ROM) and performance parameters. MATERIALS AND METHODS All serous effusion samples received from January 2019 to December 2020 were reclassified according to the ISRSFC. Using histopathological diagnosis as the gold standard, ROM and performance parameters were calculated. RESULTS A total of 831 pleural effusion samples were reclassified as follows: ND, 3 (0.4%); NFM, 635 (76.4%); AUS, 65 (7.8%); SFM, 60 (7.2%); and M, 68 (8.2%). For 457 peritoneal effusion samples, the reclassifications were ND, 5 (1.1%); NFM, 368 (80.5%); AUS, 19 (4.2%); SFM, 17 (3.7%); and M, 48 (10.5%). All 12 (100%) pericardial effusions belonged to the NFM category. The ROM for the ND, NFM, AUS, SRM, and M categories was 0%, 2.1%, 33.3%, 94.1%, 100%, respectively, in pleural effusions, and 50%, 4.8%, 22.2%, 83.3%, 100%, respectively, in peritoneal effusions. The ROM was 0% for NFM in pericardial effusions. CONCLUSION The ISRSFC is an excellent system for accurately classifying serous effusions with greater reproducibility of reports and better communication between pathologist and clinician.
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Affiliation(s)
- Sana Ahuja
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttrakhand, India
| | - Avneesh Malviya
- Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttrakhand, India
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Abstract
Cytological examination of the effusion fluid provides valuable information regarding the presence of malignancy. At times, it is challenging to diagnose malignant cells in serous effusion. The various ancillary techniques are available to solve the problem including immunocytochemistry, DNA ploidy, and multicolored flow cytometry. At present, the molecular tests on the effusion sample are of growing interest. The effusion sample is rich in cells and cell-free fluid that contains free DNA, cytokines, and extracellular vesicles. Molecular tests in effusion sample not only provide a diagnosis of malignancy but can also give valuable information that may be essential for the individualized therapy, management, and prognostic assessment. In this paper, we reviewed the application of the different molecular tests in the effusion sample.
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Affiliation(s)
- Saumya Sahu
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Parikshaa Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Pranab Dey
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
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Pergaris A, Stefanou D, Keramari P, Sousouris S, Kavantzas N, Gogas H, Mikou P. Application of the International System for Reporting Serous Fluid Cytopathology with Cytohistological Correlation and Risk of Malignancy Assessment. Diagnostics (Basel) 2021; 11:2223. [PMID: 34943460 PMCID: PMC8700584 DOI: 10.3390/diagnostics11122223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/22/2022] Open
Abstract
The International System for Reporting Serous Fluid Cytopathology (TIS) classifies serous effusions into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM) and malignant (MAL). The main objectives of this classification comprise the establishment of a universal code of communication between cytopathologists and clinicians and histopathologists, as well as between different laboratories worldwide, paving the way for the setting of clinical management guidelines based on the risk of malignancy assessment for each diagnostic category. We retrieved the total number of pleural and peritoneal effusion cases of our department for the three-year time period between 2018 and 2020, yielding a total of 528 and 500 cases, respectively. We then proceeded to reclassify each specimen according to TIS guidelines and calculate the risk of malignancy (ROM) for each category by searching each patients’ histology records, medical history and clinical follow-up. For pleural effusions, 3 (0.57%) cases were classified as ND, 430 (81.44%) cases as NFM, 15 (2.84%) as AUS, 15 (2.84%) as SFM and 65 (12.31%) as MAL. ROM amounted to 0%, 5.3%, 33.33%, 93.33% and 100% for each category, respectively. As far as peritoneal effusions are concerned, 6 (1.2%) were categorized as ND with ROM estimated at 16.66%, 347 (69.4%) as NFM (ROM = 9%), 13 (2.6%) as AUS (ROM = 38.46%), 12 (2.4%) as SFM (ROM = 83.33%) and 122 (24.4%) as MAL (ROM = 100%). Our results underline the utility of the current classification, both as a means of communication between doctors of different specialties and as general guidelines for the further clinical management of patients.
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Song MJ, Jo U, Jeong JS, Cho KJ, Gong G, Cho YM, Song JS. Clinico-cytopathologic analysis of 574 Pericardial Effusion Specimens: Application of the international system for reporting serous fluid cytopathology (ISRSFC) and long-term clinical follow-up. Cancer Med 2021; 10:8899-8908. [PMID: 34747147 PMCID: PMC8683522 DOI: 10.1002/cam4.4408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A pericardial effusion (PE) has a variable etiology and the primary role is diagnosis of metastatic malignancy. We analyzed the PE cytology in a large cohort in accordance with the international system for reporting serous fluid cytopathology (ISRSFC) and evaluated the long-term patient outcomes. METHODS PE specimens from 2010 to 2014 with an available clinical history, cytologic data, and pericardial biopsy results were collected. RESULTS A total of 574 PE specimens were obtained from 486 patients, representing 1.5% (574/38,589) of all body fluid specimens. Three hundred and eighty-two (66.6%) cases were "negative," 54 (9.4%) cases were "atypia of undetermined significance," 10 (1.7%) cases were "suspicious for malignancy," and 128 (22.3%) cases were "malignancy". The most common origin for malignant PE was the lung (82.1%), in both men (70.5%) and women (50.6%). Breast cancer (20%) in women and gastric cancer (4.9%) in men were the second most common malignant PE, respectively. The mean interval from the occurrence of malignant PE to death was 10.06 months (range; 0-116.03 months, median 3.5 months), and the 1-year survival rate was 16.7%. In addition, the 1-year survival rates after malignant PE onset were 0% for gastric cancer, 13.9% for lung cancer, 19.8% for breast cancer, and 21.1% for the other cancers (p = 0.011). CONCLUSION Our present study is the first to our knowledge to classify the pericardial fluid from 574 cases in accordance with the recently published ISRSFC, and to present the long-term outcomes of patients with malignant PE at the same time. Moreover, we report for the first time that it is gastric and not lung cancer patients that have the poorest prognosis after the occurrence of malignant PE.
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Affiliation(s)
- Min Jeong Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Uiree Jo
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Seon Jeong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Mee Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chandra A, Schmitt F. Cytologic diagnosis of "atypical" in serous fluid cytopathology. Approach of the international system for reporting serous fluid cytopathology. Diagn Cytopathol 2021; 50:208-211. [PMID: 34499418 DOI: 10.1002/dc.24864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022]
Abstract
Diagnostic uncertainty may occur with almost any entity on cytological evaluation, depending on the quality and quantity of the provided sample. In serous fluid cytopathology, until recently, there had been no defined or agreed criteria for atypia and suspicious categories. Historically, the two descriptive terms appear to have been used almost interchangeably. The international system for serous fluid cytopathology is the first attempt by an expert international authorship to suggest the scenarios in which these terms are used and propose some diagnostic criteria and clinical management strategies.
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Affiliation(s)
- Ashish Chandra
- Department of Cellular Pathology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Fernando Schmitt
- IPATIMUP-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,RISE@CINTESIS, Porto, Portugal
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Jha S, Sethy M, Adhya AK. Application of the International System for Reporting Serous Fluid Cytopathology in routine reporting of pleural effusion and assessment of the risk of malignancy. Diagn Cytopathol 2021; 49:1089-1098. [PMID: 34289263 DOI: 10.1002/dc.24837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The International System for Reporting Serous Fluid Cytopathology (ISRSFC) was proposed by the International Academy of Cytology and the American Society of Cytopathology. AIM OF THE STUDY We have applied this system for reporting of pleural effusion cytology and report our experience. MATERIALS AND METHODS All the pleural effusions from January 2019 to June 2020 were retrieved from the database. All these cases were reviewed and recategorized according to the proposed system of 5 categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspicious for malignancy (SFM), and malignant (MAL). The risk of malignancy (ROM) for each category was evaluated. RESULTS A total of 939 cases were studied. The age of patients ranged from 2 to 88 years, and the volume of fluid ranged from 1 to 600 ml. There were 41 ND (4.37%), 697 NFM (74.23%), 44 AUS (4.69%), 27 SFM (2.88%), and 130 MAL (13.84%) cases. The ROM for the categories were found to be 87.5%, 51.61%, 88.23%, 87.5%, and 100% respectively. CONCLUSIONS The ISRSFC is a user-friendly system for use in reporting of pleural fluid. The criteria for defining the various categories need to be further elaborative and stricter for this system to be more effective. More studies are required for the estimation of the ROM for each category.
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Affiliation(s)
- Shilpy Jha
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Madhusmita Sethy
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Amit Kumar Adhya
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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Pinto D, Cruz E, Branco D, Linares C, Carvalho C, Silva A, Chorão M, Schmitt F. Cytohistological Correlation in Pleural Effusions Based on the International System for Reporting Serous Fluid Cytopathology. Diagnostics (Basel) 2021; 11:1126. [PMID: 34203073 PMCID: PMC8235437 DOI: 10.3390/diagnostics11061126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
The International System for Reporting Serous Fluid Cytology (TIS) was recently developed. Given its novelty, most studies looking into the risk of malignancy (ROM) of serous effusion diagnostic categories were published before the development of TIS. We searched the database of our department for pleural effusions diagnosed in the last five years, excluding those without a corresponding pleural biopsy. Cases were reviewed and reclassified according to the TIS. A cytohistological correlation was performed. In total, 350 pleural effusion specimens with one or more corresponding pleural biopsies were included. After reclassification, 5 (1.43%) were nondiagnostic (ND), 253 (72.29%) were negative for malignancy (NFM), 7 (2.00%) had atypia of unknown significance (AUS), 14 (4.00%) were suspicious for malignancy (SFM), and 71 (20.57%) were malignant (MAL). Calculated ROM was 40% for ND, 20.16% for NFM, 42.86% for AUS, 78.57% for SFM, and 100% for MAL. Effusion cytology sensitivity and specificity were 60.29% and 98.56%, respectively. This is the first publication looking into the cytohistological correlation of a retrospective cohort of pleural effusions based on the TIS. We add to the body of data regarding the ROM for TIS categories, highlighting areas of potential future research.
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Affiliation(s)
- Daniel Pinto
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, 1349-019 Lisboa, Portugal; (D.P.); (E.C.); (D.B.); (C.L.); (C.C.); (A.S.); (M.C.)
- NOVA Medical School, 1169-056 Lisboa, Portugal
| | - Eduardo Cruz
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, 1349-019 Lisboa, Portugal; (D.P.); (E.C.); (D.B.); (C.L.); (C.C.); (A.S.); (M.C.)
| | - Diamantina Branco
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, 1349-019 Lisboa, Portugal; (D.P.); (E.C.); (D.B.); (C.L.); (C.C.); (A.S.); (M.C.)
| | - Cláudia Linares
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, 1349-019 Lisboa, Portugal; (D.P.); (E.C.); (D.B.); (C.L.); (C.C.); (A.S.); (M.C.)
| | - Conceição Carvalho
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, 1349-019 Lisboa, Portugal; (D.P.); (E.C.); (D.B.); (C.L.); (C.C.); (A.S.); (M.C.)
| | - Amélia Silva
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, 1349-019 Lisboa, Portugal; (D.P.); (E.C.); (D.B.); (C.L.); (C.C.); (A.S.); (M.C.)
| | - Martinha Chorão
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, 1349-019 Lisboa, Portugal; (D.P.); (E.C.); (D.B.); (C.L.); (C.C.); (A.S.); (M.C.)
| | - Fernando Schmitt
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-135 Porto, Portugal
- RISE@CINTESIS, 4200-450 Porto, Portugal
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Xu Y, Hu AY, Wang SM, Wang Q, Pan YC, Zhang SH. A retrospective analysis of pleural effusion specimens based on the newly proposed International System for Reporting Serous Fluid Cytopathology. Diagn Cytopathol 2021; 49:997-1007. [PMID: 34019334 DOI: 10.1002/dc.24804] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, the International System for Reporting Serous Fluid Cytopathology (TIS) has been established, with an aim to standardize reporting and guide clinical decision making. METHODS The cytological and clinicopathological data of pleural effusions were retrieved from the pathology database and electronic medical records. All specimens were evaluated and reclassified in accordance with the TIS recommendations. Finally, the risk of malignancy (ROM) and performance parameters were measured. RESULTS A total of 2454 pleural effusion specimens were included, among which 30 (1.2%), 1670 (68.1%), 151 (6.2%), 54 (2.2%) and 549 (22.4%) patients were classified into non-diagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM) and malignancy (MAL) groups, respectively. The most commonly diagnosed malignancies were lung cancer (48.4%), ovary cancer (10.2%), breast cancer (7.5%), and 21.3% unknown primary site (UPS). Among the 36 UPS patients, the most common site of origin was lung (36.1%), followed by ovary (13.9%) and breast (11.1%) via immunocytochemistry of cell block. The calculated ROM values were 26.7%, 12%, 62.3%, 77.8% and 100% for ND, NFM, AUS, SFM and MAL groups, respectively. When considering MAL as the only positive group, the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were determined to be 95.2%, 81.9%, 100%, 100% and 93.6%, respectively. CONCLUSION The newly proposed TIS is an easy-to-master, user-friendly, and standardized classification system, especially when applying on pleural effusions. An adequate serous sample, application of immunocytochemistry, review of cytomorphological data and past medical history could enhance the accuracy of cytological diagnosis.
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Affiliation(s)
- Yi Xu
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Ai-Yan Hu
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Shou-Mei Wang
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Qian Wang
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Yun-Cui Pan
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Shu-Hui Zhang
- Department of Pathology, Yueyang integrated traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
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Sahu S, Sharma S, Gupta P, Dey P. MOC31 Immunostaining in the Diagnosis of Metastatic Adenocarcinoma in Serous Fluid: Special Emphasis on Atypical Cytological Cases. Acta Cytol 2021; 65:242-249. [PMID: 33827073 DOI: 10.1159/000515173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The diagnosis of atypical cases in the effusion cytology sample often poses a challenge to the cytologists. AIMS AND OBJECTIVES We evaluated the diagnostic role of MOC31 in the metastatic adenocarcinoma in effusion fluid. MATERIALS AND METHODS The cytological examination and MOC31 immunostaining in the cell block sections were carried out in 64 cases of serous effusion. A total of 23 cases showed atypical cytology, out of which suspicious for malignancy (SFM) and atypia of undetermined significance (AUS) were 19 and 4 cases, respectively. In these cases, we also performed calretinin immunostaining. The cytological features, results of MOC31 immunostaining, and follow-up data were correlated to find out the sensitivity and specificity of MOC31 immunostaining in the diagnosis of metastatic adenocarcinoma. RESULT The sensitivity and specificity of MOC31 were 100%. MOC31 detected all the cases of metastatic adenocarcinoma. MOC31 showed strong positivity in 19 cases of SFM. All these cases had a malignant outcome in histopathology or follow-up data. In AUS cases, MOC31 immunostaining was negative with a benign outcome. In all the atypical but malignant cases calretinin stain showed diffuse cytoplasmic and nuclear positivity. In contrast, MOC31 showed strong membranous positivity and occasionally cytoplasmic positivity. CONCLUSION MOC31 is an excellent marker of metastatic adenocarcinoma in the serous effusion. The membranous positivity of MOC31 and negative calretinin immuno-staining are helpful in atypical cytological cases to avoid the diagnostic dilemma. The MOC31 positivity is significantly useful in discrete atypical cells which are more challenging to recognize.
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Affiliation(s)
- Saumya Sahu
- Department of Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shelly Sharma
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Pinto D, Chandra A, Schmitt F. The International System for Reporting Serous Fluid Cytopathology: How to Incorporate Molecular Data in Cytopathology Reports. JMP 2021; 2:66-76. [DOI: 10.3390/jmp2020007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Serous effusion cytology is widely employed in the initial evaluation of the etiology of effusions with a high diagnostic sensitivity. To standardize practices, The International System for Reporting Serous Fluid Cytology (TIS) was developed following best international practices, the most up-to-date literature, and expert consensus. In the context of this system, ancillary techniques play an important role. Besides defining basic principles in laboratory specimen handling, adequacy criteria, and a standardized reporting terminology with five diagnostic categories, TIS provides an actionable framework for using immunohistochemical and molecular testing in effusion samples, namely, in atypical, suspicious of malignant samples. For diagnostic purposes, these tests may be employed to distinguish between a primary and secondary neoplasm, to confirm a diagnosis of malignant mesothelioma vs. reactive mesothelial hyperplasia, and to correctly classify and determine the primary location of a metastasis. Theranostic molecular tests may also be used for these samples to evaluate potential therapeutic targets. Pathologists play a central role in guiding this process by determining adequacy and selecting appropriate ancillary tests. The activity in this area of research should increase in the near future as new therapeutic targets are discovered and new drugs enter the clinical practice.
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Abstract
Serous fluids/effusions are common cytology samples that reflect a wide range of diseases and lend themselves to a multitude of investigations that include microscopy, chemical analysis, cell count, cultures, and analysis for biomarkers and immunomarkers. In recent years, effusions have also served as a liquid biopsy that can be interrogated by molecular tests for thoranostic and prognostic markers and selection of targeted therapy. The recently published International Reporting System for Serous Fluid Cytopathology (IRSSF) provides a standardized reporting terminology with well- defined diagnostic criteria. This editorial provides a global review of the progress in the work-up of effusions and a summary of the IRSSF book and its most significant contributions. The editorial also includes a summary of the diagnostic categories including their definition and the significant relevant information.
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Affiliation(s)
- Claire W Michael
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
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Kundu R, Srinivasan R, Dey P, Gupta N, Gupta P, Rohilla M, Gupta S, Bal A, Rajwanshi A. Application of Indian Academy of Cytologists Guidelines for Reporting Serous Effusions: An Institutional Experience. J Cytol 2021; 38:1-7. [PMID: 33935385 PMCID: PMC8078616 DOI: 10.4103/joc.joc_224_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Recently, the Indian Academy of Cytologists (IAC) has published the guidelines for interpretation and reporting of serous effusions. Till date, there are no studies on its applicability. Aims: The present study was carried out to assess the feasibility of applying the IAC reporting categories to effusions, determine the frequency, and provide an estimate of the risk of malignancy (ROM) for individual diagnostic categories. Materials and Methods: All cases of serous effusion fluids reported in the year 2019 were retrieved from the archives and reassigned as per the IAC diagnostic categories. The clinical and histopathological follow-up information was obtained wherever possible. Results: A total of 1340 effusion samples were received from 1085 patients. There were 561 (51.7%) males and 524 (48.3%) females. Majority were pleural (1066, 79.5%), followed by peritoneal (187, 14%) and pericardial (87, 6.5%) effusions. The age ranged from 7 months to 92 years. There were 35 (2.6%) samples in category 1 (non-diagnostic), 954 (71.2%) in category 2 (benign), 17 (1.3%) in category 3 (atypical), 59 (4.4%) in category 4 (suspicious for malignancy) and 275 (20.5%) in category 5 (malignant). The estimated ROM in serous effusion samples was 20% for category 1, 16.7% for category 2, 50% for category 3, 94.4% for category 4 and 100% for category 5. Conclusions: The categorization of serous effusion cytology samples as per the IAC diagnostic categories and as per the reporting format developed by the IAC is feasible and the management recommendations are mostly appropriate.
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Affiliation(s)
- Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shruti Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hou T, Landon G, Stewart J, Roy-Chowdhuri S. The value of a tiered cytology diagnostic reporting system in assessing the risk of malignancy in indeterminate serous effusions. Cancer Cytopathol 2020; 129:75-82. [PMID: 32809259 DOI: 10.1002/cncy.22345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The International System for Reporting Serous Fluid Cytopathology was recently proposed as a tiered structure to provide consistent reporting terminology for serous effusions. Because of the variation in reporting practices for indeterminate serous effusions, namely, the atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) groups, the authors retrospectively reviewed cases in these 2 categories at their institution and determined the associated risk of malignancy (ROM). METHODS Pleural, peritoneal, and pericardial effusions that were reported as AUS or SFM over a 1-year period were reviewed, and their associated ROMs were calculated based on confirmation of malignancy by previous and/or subsequent fluid and/or tissue biopsy specimens from the same general location. RESULTS In total, 145 AUS and 98 SFM serous effusion cases were identified. The AUS category was used when the cells in question lacked the requisite quantitative (cell number) and/or qualitative (morphologic) features for a definitive diagnosis. Immunohistochemistry (IHC) or flow cytometry (FCM) was available in 15% of cases (n = 22) with inconclusive results. The ROM based on 69 cases with available follow-up results was 39%. In contrast, the SFM category demonstrated cells that were morphologically suspicious for malignancy but sparse, precluding IHC or FCM (n = 63; 64%) or yielding inconclusive results (n = 35; 36%). The ROM in the SFM category, based on follow-up results of 61 cases, was 64%. CONCLUSIONS The ROM for SFM was significantly higher than that for AUS (P < .01), supporting separate diagnostic categories for these 2 groups.
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Affiliation(s)
- Tieying Hou
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gene Landon
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Savari O, Jassim S, Ferrer H, Ganocy SJ, Ganesan S. Role of CD68 immunohistochemistry in categorizing benign nonmesothelial cell population and refining "atypical" category in serous fluid cytology. Diagn Cytopathol 2020; 48:1199-1204. [PMID: 32644272 DOI: 10.1002/dc.24541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/26/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Body fluids are rich in histiocytes and may mimic atypical epithelial cells morphologically. Histiocytes can pose a significant challenge in serous fluid cytology as they tend to appear atypical due to prolonged accumulation in serous fluids in vivo and processing by liquid-based cytology in vitro. Not many studies have documented the utilization of histiocytic marker such as CD68 in serous fluid cytology, which can subsequently reduce the "atypical" diagnostic category. METHODS One thousand one hundred and twenty-nine cases of serous fluid cytology from 2016 to 2019 were reviewed and reclassified based on proposed classification of the international system for reporting serous fluid cytology. There were 133 cases with atypical diagnoses, out of which 51 cases had cellblocks. An immunohistochemistry (IHC) panel, including two mesothelial markers, two epithelial markers, and one histiocytic marker was applied to the atypical samples. Same IHC panel was utilized to evaluate 15 cases each from negative for malignancy (NFM), suspicious for malignancy (SFM), and malignant (MAL) categories for further comparison. RESULTS After reevaluation of the cytology material with IHC stains, 924 (82%), 133 (12%), 23 (2%), and 49 (4%) of the cases were reclassified as NFM, atypia of uncertain significance, SFM, and MAL, respectively. Twenty-five out of 51 atypical cases (49%) were downgraded to "benign" after reevaluation with CD68 IHC. CONCLUSION Histiocytes can mimic atypical epithelial cells in body fluids. Effective utilization of CD68 IHC will be beneficial in further refining the "atypical" diagnostic category in serous fluid cytology.
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Affiliation(s)
- Omid Savari
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarmad Jassim
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Hector Ferrer
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen J Ganocy
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio, USA
| | - Santhi Ganesan
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Pinto D, Chandra A, Crothers BA, Kurtycz DFI, Schmitt F. The international system for reporting serous fluid cytopathology-diagnostic categories and clinical management. J Am Soc Cytopathol 2020; 9:469-477. [PMID: 32620534 DOI: 10.1016/j.jasc.2020.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Effusions can develop inside serous cavities in several pathologic states, both neoplastic and non-neoplastic. They are easy to drain and can provide useful diagnostic information. However, the reported diagnostic efficacy of these specimens has not been uniform across different laboratories. To standardize practices, the international system for reporting serous fluid cytology (TIS) was developed in accordance with the best international practices, the most up-to-date reported data, and expert consensus. RESULTS TIS has set the basic principles for laboratory handling of serous effusion specimens, defined the adequacy criteria, and set a standardized reporting terminology with well-defined criteria for each diagnostic category. These include nondiagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. Each can provide useful inherent information for appropriate clinical management and follow-up, with a defined expected diagnostic category incidence and risk of malignancy. CONCLUSIONS TIS applies to serous fluids collected from the pleura, peritoneal, and pericardial cavities. Using TIS, indeterminate categories are presented as either preliminary or as options of last resource. TIS has emphasized the role of ancillary tests in arriving at the correct interpretation within each category. It also has emphasized the importance of a malignant diagnosis as a definitive diagnosis, comparable to histologic examinations. Because of the well-documented outcomes in the adoption of uniform cytology terminology for other organ systems, we recommend the use of the upcoming TIS and believe its use will be paramount to improving the diagnostic yield in this area of cytology.
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Affiliation(s)
- Daniel Pinto
- Serviço de Anatomia Patológica, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal; NOVA Medical School, Lisboa, Portugal
| | - Ashish Chandra
- Department of Cellular Pathology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Barbara A Crothers
- Joint Pathology Center, Silver Springs, Maryland; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Fernando Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
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Lobo C, Costa J, Petronilho S, Monteiro P, Leça L, Schmitt F. Cytohistological correlation in serous effusions using the newly proposed International System for Reporting Serous Fluid Cytopathology: Experience of an oncological center. Diagn Cytopathol 2020; 49:596-605. [PMID: 32339444 DOI: 10.1002/dc.24440] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/14/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cytological analysis is part of the initial etiological evaluation of serous effusions. The newly proposed International System for Reporting Serous Fluid Cytopathology (ISRSFC) aims to standardize reporting. METHODS All pleural and peritoneal effusion samples admitted for cytological analysis at our institution between 2012 and 2016, and pericardial effusion samples admitted between 2008 and 2018, were reviewed and reclassified according to the ISRSFC. Risk of malignancy (ROM) and performance parameters were calculated. RESULTS 1496 pleural effusion samples were reclassified: 12(0.8%) non-diagnostic (ND), 944(63.1%) negative for malignancy (NFM), 9(0.6%) atypia of undetermined significance (AUS), 54(3.6%) suspicious of malignancy (SFM) and 477(31.9%) malignant (M). 64 pericardial effusion samples were reclassified: 23(35.9%) NFM, 1(1.6%) AUS, 4(6.3%) SFM and 36(56.2%) M. 763 peritoneal effusion samples were reclassified: 5(0.7%) ND, 457(59.9%) NFM, 12(1.6%) AUS, 37(4.8%) SFM and 252(33%) M. The ROM was, respectively, for each of the aforementioned categories, 57.1%, 23.9%, 50%, 76.2%, 100% in pleural effusions, 100%, 26.3%, 62.5%, 91.7%, 100% in peritoneal effusions and 0% for NFM, 0% for AUS and 100% for M in pericardial effusions. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were, respectively, 61.6%, 100%, 100%, 73.3%, 81.3% for pleural, 100%, 100%, 100%, 100%, 100% for pericardial and 61.2%, 100%, 100%, 70%, 79.7% for peritoneal effusion samples. CONCLUSION Serous effusion cytology has a high specificity and positive predictive value and a modest sensitivity and negative predictive value, supporting its role in confirming the diagnosis of malignancy. The ISRSFC will increase standardization and reproducibility in reporting, leading to improved clinical decision-making.
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Affiliation(s)
- Cláudia Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - João Costa
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Sara Petronilho
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Paula Monteiro
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Luís Leça
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of Porto University, Porto, Portugal.,Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
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Alshaikh S, Lapadat R, Atieh MK, Mehrotra S, Barkan GA, Wojcik EM, Pambuccian SE. The utilization and utility of immunostains in body fluid cytology. Cancer Cytopathol 2020; 128:384-391. [PMID: 32163239 DOI: 10.1002/cncy.22256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Body fluid cytology (BFC) is an important tool in the diagnosis and staging of malignancy and is aided by the judicious use of immunohistochemistry (IHC). The aim of this study was to determine the usage rates of IHC stains in BFC, their type and indications, and their diagnostic impact. We also attempted to estimate the optimal rate of IHC use in BFC by comparing the entire laboratory's and each individual cytopathologist's IHC use rates with their respective indeterminate and malignant diagnosis rates. METHODS We conducted a retrospective study of IHC stain use in BFC during a 5.5-year interval (2013-2018) and determined the laboratory's and each individual cytopathologist's IHC usage patterns according to the final diagnosis, site, and indications for their use. RESULTS A total of 477 out of 4144 (11.5%) BFC cases had 2128 individual immunostains performed, with an average of 4.5 immunostains per case. Individual cytopathologists used IHC stains on 6.7% to 22% of their BFC cases. Pathologists with higher rates of IHC stain use than the laboratory's mean were less experienced and had higher rates of indeterminate but not of malignant diagnoses. The most common indication for the use of IHC stains was differentiating mesothelial from malignant cells. MOC31, calretinin, Ber-EP4, CD68, and D2-40 were the most commonly used of the 67 different IHC stains used in BFC. CONCLUSIONS The laboratory's mean may represent the optimal IHC use rate, as higher IHC use rates did not lead to more diagnostic certainty or higher pickup rates of malignant cells.
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Affiliation(s)
| | - Razvan Lapadat
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Mohammed K Atieh
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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