Collection and Handling of Thoracic Small Biopsy and Cytology Specimens for Ancillary Studies: Guideline From the College of American Pathologists in Collaboration With the American College of Chest Physicians, Association for Molecular Pathology, American Society of Cytopathology, American Thoracic Society, Pulmonary Pathology Society, Papanicolaou Society of Cytopathology, Society of Interventional Radiology, and Society of Thoracic Radiology

Abstract

Context.— The need for appropriate specimen use for ancillary testing has become more commonplace in the practice of pathology. This, coupled with improvements in technology, often provides less invasive methods of testing, but presents new challenges to appropriate specimen collection and handling of these small specimens, including thoracic small biopsy and cytology samples. Objective.— To develop a clinical practice guideline including recommendations on how to obtain, handle, and process thoracic small biopsy and cytology tissue specimens for diagnostic testing and ancillary studies. Methods.— The College of American Pathologists convened an expert panel to perform a systematic review of the literature and develop recommendations. Core needle biopsy, touch preparation, fine-needle aspiration, and effusion specimens with thoracic diseases including malignancy, granulomatous process/sarcoidosis, and infection (eg, tuberculosis) were deemed within scope. Ancillary studies included immunohistochemistry and immunocytochemistry, fluorescence in situ hybridization, mutational analysis, flow cytometry, cytogenetics, and microbiologic studies routinely performed in the clinical pathology laboratory. The use of rapid on-site evaluation was also covered. Results.— Sixteen guideline statements were developed to assist clinicians and pathologists in collecting and processing thoracic small biopsy and cytology tissue samples. Conclusions.— Based on the systematic review and expert panel consensus, thoracic small specimens can be handled and processed to perform downstream testing (eg, molecular markers, immunohistochemical biomarkers), core needle and fine-needle techniques can provide appropriate cytologic and histologic specimens for ancillary studies, and rapid on-site cytologic evaluation remains helpful in appropriate triage, handling, and processing of specimens.

Root cause analysis of indeterminate diagnoses in serous fluids cytopathology

“…Based on the survey conducted by ISRSFC working group, participants noted that a 50 to 100 mL of fluid was considered adequate for sensitivity of the malignant diagnosis in their practice 10 . The recently published Guideline from the College of American Pathologists did not recommend a minimal volume for diagnosis, and suggested the submission of maximum volume possible for an adequate evaluation of the effusions 22 . Based on these observations, 50 mL and below were considered low volume samples in our study, and were included as a root cause for ID 10 .…”

Optimising rapid on‐site evaluation‐assisted endobronchial ultrasound‐guided transbronchial needle aspiration of mediastinal lymph nodes: The real‐time cytopathology intervention process

“…Recent multidisciplinary consensuses have provided details and recommendations to obtain, handle and process cytology specimens and small thoracic biopsies to optimise tumour procurement 5,6,10 . When analysing EBUS‐TBNA sample adequacies in different clinical scenarios, several variables have the potential to impact quality and quantity of the specimen collection need to be considered 6,10 …”

A new guideline from the College of American Pathologists to improve the adequacy of thoracic small specimens for ancillary studies

“…With advancing technology in minimally invasive sampling techniques, pathology laboratories are receiving increasing numbers of small biopsy and cytology specimens on which to perform multiple ancillary studies to help in the diagnosis and management of pulmonary diseases. A recently published evidence‐based guideline from the College of American Pathologists (CAP), in collaboration with 8 other professional medical societies, provides recommendations to clinicians for collecting adequate material for diagnostic and ancillary testing and to pathologists and laboratory personnel for optimal handling in an attempt to prioritize ancillary testing 1 . An expert panel comprising practicing pathologists and a cytotechnologist, interventional pulmonologists, interventional radiologists, and a research methodologist from the CAP, American College of Chest Physicians, American Society of Cytopathology, American Thoracic Society, Association for Molecular Pathology, Papanicolaou Society of Cytopathology, Pulmonary Pathology Society, Society of Interventional Radiology, and Society of Thoracic Radiology performed a systematic review of the published literature and developed 16 recommendations.…”

“…An expert panel comprising practicing pathologists and a cytotechnologist, interventional pulmonologists, interventional radiologists, and a research methodologist from the CAP, American College of Chest Physicians, American Society of Cytopathology, American Thoracic Society, Association for Molecular Pathology, Papanicolaou Society of Cytopathology, Pulmonary Pathology Society, Society of Interventional Radiology, and Society of Thoracic Radiology performed a systematic review of the published literature and developed 16 recommendations. The guideline was developed to help pathologists and their clinical colleagues better collect and handle small thoracic pathology specimens 1 …”

“…Although the CAP expert panel recognizes the limitations of ROSE for all thoracic fine‐needle aspiration procedures because it may not be readily available, feasible, or practical in all situations, 3 guideline recommendations specifically focus on the use of ROSE in endobronchial ultrasound–guided transbronchial needle aspiration, transthoracic needle procedures, and bronchoscopic procedures to ensure the adequate collection and appropriate handling of these small specimens in all cases that require ancillary studies (Table 1). The guideline also has specific recommendations for situations in which ROSE is not available for adequacy assessment 1 …”