There was no significant difference in cytologic adequacy whether immediate cytologic analysis of aspirated material was performed or not. The procedure time was significantly shorter when immediate cytologic analysis was not performed.

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These data implicate CD103 as a homing receptor that targets graft-infiltrating CD8+ CTLs to the graft epithelium. Given the strong association of tubulitis with clinical rejection, these data are consistent with a role for the CD103+ CTL subset as an effector mechanism in renal allograft destruction.

We retrospectively determined the clinical impact of 1,000 randomly selected interinstitutional pathology consultations (IPCs). An IPC included all specimens from the patient. IPCs were classified as concordant or discordant with the original diagnosis. Discordant IPCs were classified as having a clinical impact or no impact. Discordant IPCs owing to interpretation differences were subclassified further. The IPCs included 1,522 specimens (1,204 histology, 318 cytology); 923 (92.3%) were concordant, 9 (0.9%) indeterminate, and 68 (6.8%) discordant (clinical impact, 37; no impact, 31). Reasons for discordant IPCs were interpretation differences, 45; additional sectioning, 7; ancillary testing, 1; clerical error, 5; or a combination, 10. Reasons for 26 discordant IPCs with clinical impact owing to interpretation differences were overdiagnosis, 11; tumor subtype change, 4; stage change, 4; underdiagnosis, 3; resection margin status change, 2; undergrading, 1; and understaging with resection margin status change, 1. IPC may identify diagnostic discrepancies that impact management for some patients. The prevalence of a clinical impact of IPC on management varies according to body site. Mandatory IPC does ensure identification of clinically significant diagnostic discrepancies; targeted IPC by body site or specimen type may represent an alternative strategy after further data accumulation. Discordant IPCs may be due to factors other than interpretation difference.

A b s t r a c tWe studied whether histologie criteriafor grading sarcomas could be applied to fine-needle aspiration biopsy (FNAB) Fine-needle aspiration biopsy (FNAB) is an effective tool for the diagnosis of primary and metastatic soft tissue tumors with reported high sensitivity and specificity rates. 1_5Exact subclassification of sarcomas, especially spindle cell sarcomas, can be difficult on FNAB and histologie examination without the use of ancillary studies, such as immunohistochemistry and électron microscopy.6 ' 8 However, several studies report that among spindle cell sarcomas and sarcomas in gênerai, the most important prognostic factor, which influences survival and récurrence rates, is the grade of the sarcoma, rather than the histologie subtype. 6- 910 In addition, some current treatment protocols for adults include preoperative radiation, chemotherapy, or both, for intermediate-and high-grade sarcomas regardless of the histologie subtype. The grading schemes of sarcomas reported in the literature, however, were developed from histologie spécimens and not FNAB spécimens. 6 ' 11_l6 We studied whether the criteria used in histologie grading can be applied to FNAB spécimens of spindle cell sarcomas in adults, without knowledge of the sarcoma subtype. Materials and MethodsThe FNAB spécimens of 36 consécutive spindle cell sarcomas from adults, which had a corresponding histologie spécimen, were reviewed without knowledge of the grade or histologie subtype. The grading scheme was adapted to FNAB material from a modification of the grading scheme applied to histologie spécimens of sarcomas at our institution ITable 11. FNAB cell groups and single cells were assessed for nuclear atypia (mild, moderate, or marked), présence of necrosis, and number of mitotic figures per 10 high-power fields (HPFs). Cell groups also were evaluated for nuclear overlap (minimal, moderate, or marked). The number of cell groups on each FNAB slide was classified as low (<20 groups per slide, 8 4Am J Clin Pathol 1999; 112:784-790

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