Browsing by Subject "fine‐needle aspiration"

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    Application of the Milan System for Reporting Salivary Gland Cytopathology: A Retrospective 12-Year Bi-institutional Study
    (Oxford, 2019-06) Wu, Howard H.; Alruwaii, Fatimah; Zeng, Bao-Rung; Cramer, Harvey M.; Lai, Chiung-Ru; Hang, Jen-Fan; Pathology and Laboratory Medicine, School of Medicine
    Objectives Multi-institutional studies are required for the validation of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Methods A total of 1,560 fine-needle aspirations of the salivary glands were retrieved from two institutions for a 12-year period. The diagnoses were reclassified based on the MSRSGC. Risk of malignancy (ROM) for each category was calculated based on 694 histologic follow-up cases. Results The ROM for each category was: 18.3% for nondiagnostic, 8.9% for nonneoplastic, 37.5% for atypia of undetermined significance (AUS), 2.9% for benign neoplasm, 40.7% for salivary gland neoplasm of uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 98.3% for malignant. The sensitivity, specificity, positive predictive rate, and negative predictive rates were 89%, 99%, 98%, and 96%, respectively. Conclusions The results of the current study are in keeping with the MSRSGC. The indeterminate categories of AUS and SUMP showed intermediate ROMs at 37.5% and 40.7%, respectively.
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    Fine‐needle aspiration cytology of metastatic spindle cell follicular thyroid carcinoma: A case report
    (Wiley, 2019-06) Chen, Yu-Hsin; Perrino, Carmen M.; Cheng, Liang; Wu, Howard H.; Pathology and Laboratory Medicine, School of Medicine
    Follicular thyroid carcinoma, spindle cell variant is extremely rare. The tumor is predominantly composed of spindle cells with a fusiform appearance that are arranged in intersecting fascicles. Fine‐needle aspiration biopsy of this entity has not been previously described. We report a case of a 58‐year‐old woman who presented with metastasis to a left neck lymph node 15 years after the original diagnosis. Fine‐needle aspiration cytology showed numerous bland, spindled to epithelioid cells with thin, elongated, and plump nuclei with finely granular chromatin and inconspicuous nucleoli. The tumor cells had a moderate amount of cytoplasm with occasional elongated cytoplasmic tails. The cells were arranged in irregular aggregates with a fascicular pattern or singly dispersed. The tumor cells demonstrated positive staining for pan‐keratin, PAX8, thyroid transcription factor‐1, and thyroglobulin, which confirmed thyroid primary origin.
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    Subtyping salivary gland neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy
    (Wiley, 2018-11) Hang, Jen-Fan; Alruwaii, Fatimah; Zeng, Bao-Rung; Lai, Chiung-Ru; Wu, Howard H.; Pathology and Laboratory Medicine, School of Medicine
    BACKGROUND The newly unveiled Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has proposed salivary gland neoplasm of uncertain malignant potential (SUMP) as an indeterminate category. The category is reserved for fine‐needle aspiration (FNA) cases that are diagnostic of a salivary gland neoplasm but cannot be further designated as a specific tumor type. The objective of the current study was to evaluate the clinical utility of subtyping SUMP cases based on different cell types. METHODS A retrospective search of cytology databases at 2 institutions for salivary gland FNAs from 2006 through 2017 was conducted. The cytologic diagnosis of each case was reclassified according to the MSRSGC. Histologic follow‐up was retrieved for correlation. Cases reclassified as SUMP that had a follow‐up pathologic diagnosis were subject to cytology review and subtyping into oncocytic/squamoid, basaloid, or myoepithelial subtypes based on cytomorphology. The risk of malignancy (ROM) for each subtype was analyzed. RESULTS There were 92 SUMP cases, which comprised 5.9% of 1560 consecutive salivary gland FNAs within the 12‐year study period. Histologic follow‐up was available for 59 patients. After cytology review, there were 18 cases (30.5%) of oncocytic/squamoid subtype, 25 (42.4%) of basaloid subtype, and 16 (27.1%) of myoepithelial subtype. Pathologic correlation revealed an ROM of 61.1% (11 of 18 cases) for the oncocytic/squamoid subtype, 40.0% (10 of 25 cases) for the basaloid subtype, and 18.8% (3 of 16 cases) for the myoepithelial subtype. The differences in ROM among the 3 subtypes were statistically significant (P = .0476). CONCLUSIONS Subtyping SUMP cases into categories based on cell type demonstrated differential ROMs for better clinical stratification. Future prospective studies are mandatory to confirm this finding.
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    World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine‐needle aspiration biopsies of renal masses
    (Wiley, 2018-11) Perrino, Carmen M.; Cramer, Harvey M.; Chen, Shaoxiong; Idrees, Muhammad T.; Wu, Howard H.; Pathology and Laboratory Medicine, School of Medicine
    Background Utilization of fine‐needle aspiration (FNA) biopsy for the evaluation of renal masses has been increasing at our institution. At times diagnostic material on direct smears is superior to that in the cell block/core biopsy, therefore assigning an accurate nuclear grade in the cytopathology report would provide useful prognostic information. Methods Search of the pathology database identified renal FNAs performed during an 11‐year period (2006–2017). Corresponding core biopsies and resections were identified. Cases with a diagnosis of primary renal neoplasia on FNA, core biopsy, and/or resection were included. Two pathologists reviewed all cases and assigned a World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grade to each FNA, core biopsy, and resection case. Results A total of 162 kidney FNAs were identified. Primary renal neoplasia was diagnosed in 137 cases on core biopsy/resection. Among diagnostic FNAs of clear cell RCC and papillary RCC with core biopsy/resection specimens for re‐review (n = 52), reviewers assigned a concordant WHO/ISUP grade to 83% (43/52) of cases. Among 9 cases with discrepant scores, all had a discrepancy of 1 grade and were undergraded on FNA. Using a two tier grading system (low vs. high grade), reviewers assigned a concordant grade to 88% (46/52) of cases. Among 6 cases with discrepant scores, all were classified as low grade (WHO/ISUP grade 2) on FNA versus high grade (WHO/ISUP grade 3) on resection. Conclusion The WHO/ISUP grade assigned on FNA shows good concordance with subsequent resection/core specimens (83%), with all discrepant cases being undergraded by one grade.