The new Franseen tip FNB device provides histologically superior and cytologically comparable specimens to those obtained by FNA, but with fewer passes.

Intraductal papillary mucinous neoplasms (IPMN) have been considered difficult to diagnose by fine-needle aspiration (FNA) cytology. We identified 57 cases diagnosed as IPMN or consistent with IPMN by endoscopic ultrasound (EUS)-guided FNA over a 9-yr period. Histologic follow-up was available for 20 patients (35%). Pancreatic neoplasia was demonstrated in 18 of these cases (90%). The histologic diagnoses were IPMN (16 cases), pancreatic intraductal neoplasia (grade 1b, 1 case), invasive mucin-producing adenocarcinoma (1 case), and chronic pancreatitis with a pseudocyst (2 cases). Sixty-two cases of IPMN without coexisting adenocarcinoma were diagnosed by histology during this time period. Of these, 35 (56%) had a preceding EUS-guided FNA. The diagnosis made by EUS-guided FNA in these 35 cases was negative or nondiagnostic (6 cases), benign cyst (1 case), chronic pancreatitis (2 cases), atypical ductal cells (2 cases), adenocarcinoma or suspicious for adenocarcinoma (3 cases), consistent with mucinous cystic neoplasm (4 cases), and IPMN or consistent with IPMN (16 cases). An EUS FNA diagnosis of probable or definite neoplasia was, therefore, made in 71% of cases of histologically proven IPMN.

BACKGROUND The management of thyroid nodules with indeterminate cytology is challenging. Recently, molecular testing on fine‐needle aspirates (FNAs) has been advocated to determine whether clinical follow‐up or surgery is warranted for patients. Three different testing platforms were performed on aspirates from our institution (Afirma Thyroid FNA Analysis, RosettaGX Reveal, and Interpace ThyGenX/ThyraMIR). This study compares their diagnostic efficacy. METHODS We conducted a retrospective analysis of indeterminate thyroid FNAs with correlating molecular testing over 4 years (2015‐2018). The aspirates included diagnoses of follicular lesion of undetermined significance, follicular neoplasm, or suspicious for malignancy (SM). Based on cases that underwent surgical resection (Afirma, n = 37; Rosetta, n = 19; Interpace, n = 14), we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for risk of malignancy and neoplasia. RESULTS The three tests performed similarly when predicting risk of malignancy. They showed high sensitivity (80‐100%) and NPV (90‐100%) but lower specificity (10‐64%) and PPV (21‐44%). When assessing their value to predict neoplasia, each test had a high PPV (76‐89%) but low NPV (20‐33%). The sensitivity for neoplasm was intermediate to high (50‐93%), and the specificity remained extremely variable (11‐67%). CONCLUSION Overall, these molecular platforms performed similarly, displaying high NPV but low to intermediate PPV for malignancy and low NPV but high PPV for neoplasm. The risk of neoplasm is a good index for surgery, and we argue that many of the neoplasms are low‐risk tumors. We endorse conservative treatment with lobectomy for cases that are indeterminate at FNA but suspicious by molecular testing.

Background: Anaplastic lymphoma kinase (ALK) immunohistochemical staining on formalin-fixed paraffin-embedded tissue or cell blocks (CB) has been reported as an effective alternative to fluorescence hybridization in situ (FISH) for the detection of ALK gene rearrangement. However, CB frequently lack adequate cellularity even when the direct smears are cellular. This study aims to assess the utility of ALK immunocytochemical (ICC) staining on direct smears using the cell transfer (CT) technique for the detection of ALK rearrangement. Methods: Fine-needle aspiration (FNA) cases of lung adenocarcinoma in which the ALK status had been determined by FISH on CB or a concurrent biopsy were identified. ICC staining for ALK was performed on alcohol-fixed Papanicolaou-stained direct smears using the CT technique. ALK immunoreactivity was evaluated using a modified semiquantitative scale. Results were compared with those of FISH. Results: A total of 47 FNA specimens were included. Five of 7 FISH-positive cases showed positive ALK ICC staining (71.4%), and 39 of 40 FISH-negative cases were negative on ALK ICC staining (97.5%). The overall correlation between ALK ICC and FISH was 93.6%. Conclusion: ICC performed on FNA smears using the CT technique is an alternative method for the assessment of ALK rearrangement, especially when CB lack adequate cellularity.

The authors have developed an effective and inexpensive protocol for producing cell blocks that consistently yields abundant cellular material. The Cell-Gel method uses a hemolytic fixative and disposable base molds to produce adequate cell blocks. When the method was implemented, the cell block failure rate of the study laboratory decreased by approximately 67%. Cancer Cytopathol 2017;125:267-276. © 2016 American Cancer Society.

Cell-transfer technique has been proven useful for performing immunocytochemistry on fine-needle aspiration smears. However, its utility for EGFR and KRAS molecular testing has not been validated. Molecular testing was performed using the cell-transfer technique on both Papanicolaou-stained ethanol-fixed and Hema 3-stained air-dried smears from 32 fine-needle aspiration samples that had diagnoses of adenocarcinoma of the lung, and then was compared to the results of the corresponding formalin-fixed paraffin-embedded tissues. The molecular testing was successfully performed on 32 of 32 ethanol-fixed and 31 of 32 air-dried samples. The molecular results on ethanol-fixed and air-dried smears showed 100% agreement. There is 100% (32/32) agreement for the EGFR and 97% (31/32) agreement for the KRAS between the cell-transfer technique and formalin-fixed paraffin-embedded tissues. One discrepant case was due to low percentage of tumor cells on the smears. Cell-transfer technique is a reliable alternative method for EGFR and KRAS testing if the cell blocks lack adequate cellularity. Modern Pathology (2014) 27, 930-935; doi:10.1038/modpathol.2013.220; published online 13 December 2013Keywords: cell transfer; cytology; EGFR; fine-needle aspiration; KRAS Lung cancer exacts a considerable toll within the United States, each year claiming approximately 160 000 lives, a figure that represents more than 25% of total annual US cancer mortality. 1 Nonsmall-cell lung cancers, which account for 85% of all lung cancers, are often diagnosed at an advanced stage and have poor prognosis. 2,3 Adenocarcinoma represents the most common type of lung cancer, and understanding of its molecular pathogenesis has led to the development of several novel chemotherapeutic agents that offer potentially effective therapy on the basis of targeting specific genetic alterations such as mutations in the epidermal growth factor receptor (EGFR) and the Kristen-Rous sarcoma virus (KRAS). EGFR mutations are found in approximately 10-15% of non-small-cell lung cancers with the highest frequency occurring in adenocarcinoma. [4][5][6][7][8] Lung adenocarcinomas driven by EGFR mutations are sensitive to tyrosine kinase inhibitors such as gefitinib and erlotinib, and these patients will have longer progression-free survival than the patients whose tumors do not contain EGFR mutations. 9-12 KRAS represents a downstream effector of EGFR and lung adenocarcinomas with KRAS mutations are refractory to EGFR tyrosine kinase inhibitors. The occurrence of EGFR and KRAS mutations is mutually exclusive; hence performing both markers at the same time also serves an important quality control function. [13][14][15][16] Performing molecular testing on newly diagnosed advanced staged non-small-cell lung cancers in a timely fashion has become the standard of care. 17 Fine-needle aspiration is a safe, minimally invasive and relatively inexpensive diagnostic method, which may be used for the evaluation of both primary and metastatic lung cancer. 18 Although a diagnosis can often ...

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This study demonstrates that two molecular testing platforms performed equally well using our stained direct smears. Both molecular tests revealed a 100% negative predictive rate. RosettaGX showed a 75% positive predictive value in comparison to 60% for ThyGenX/ThyraMIR.