Cytotechnologist On-Site Evaluation of Pancreas Fine Needle Aspiration Adequacy: Comparison with Cytopathologists and Correlation with the Final Interpretation

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Background: Metastatic cancer infrequently involves the pancreas. When the pancreas hosts a metastatic tumor, cytopathological evaluation of fine-needle aspirate material is a crucial part of the diagnostic process. In this study, we show two institutions' experience with cytopathological diagnosis of pancreatic metastasis. Methods: Databases of institutional experience at The Johns Hopkins Hospital and Ohio State University Medical Center were queried for cases of metastatic tumors in the pancreas that underwent fine-needle aspiration. Demographic and pathological features were compiled and the cytomorphology was reviewed. Results: Forty-two cases of tumor metastasis to the pancreas were found. Over the time of this review, 5,495 aspirates were performed, and 43% (2,389/5,495) had malignant cytological findings. Thus, the 42 cases of metastatic disease to the pancreas comprised 0.8% of all pancreas aspirates and 1.8% of the malignant ones. Renal cell carcinoma was the most common metastasis, followed by melanoma and non-small cell lung carcinoma. Among the other tumors in this series, 2 cases each of rare metastases such as the fibrolamellar variant of hepatocellular carcinoma and solitary fibrous tumor were also seen. Conclusion: The pancreas is rarely involved with metastatic disease, but when it is involved the most common tumor is renal cell carcinoma followed by melanoma and non-small cell lung cancer. Clinical history and awareness of the primary pancreatic mimickers are necessary for arriving at the correct diagnosis. As conventional pancreatic adenocarcinoma is uncommon in children and young adults, history of other tumors - even ones that usually follow an indolent course - is essential.

Section: Methodsmentioning

confidence: 99%

Metastases to the Pancreas Diagnosed by Fine-Needle Aspiration

Olson¹,

Wakely²,

Ali³

2013

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“…Occasionally these lesions can present as purely cystic or purely solid lesions [16,17]. At our institution, duplicate smears are made in the endoscopy suite; one is stained with Romanowsky's stain for on-site evaluation of adequacy (OSEA) [18], and the other is fixed in 95% alcohol for Papanicolaou staining. Tissue from the needle rinse and dedicated passes are used to make a cell block for immunohistochemical labeling.…”

Section: Endoscopy and Fine-needle Aspirationmentioning

confidence: 99%

Solid-Pseudopapillary Neoplasm of the Pancreas: Cytomorphologic Findings and Literature Review

Bhatnagar

Olson²,

Fishman³

et al. 2014

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Background: Solid-pseudopapillary neoplasm (SPN) is a rare pancreatic malignancy with an excellent prognosis. It is most commonly diagnosed in young women. This article comprehensively reviews the clinical, pathological and radiological features of this neoplasm, as well as its clinical management. Methods: A literature review of SPN was performed of all articles published in the English language in PubMed prior to November 1, 2013. Cytomorphological features, histopathology, immunohistochemistry, patient general demographics, molecular studies, radiologic imaging and clinical management were reviewed. Results: SPN displays distinct cytomorphological features on fine-needle aspiration - thin, delicate, branching vessels in a ‘Chinese character' pattern lined by one to several layers of loosely cohesive neoplastic cells. Nuclear features include indented or grooved nuclei with an evenly distributed chromatin pattern and small inconspicuous nucleoli. SPN is characteristically immunoreactive for CD10, β-catenin (in an abnormal nuclear pattern), CD99 in a perinuclear dot-like pattern, α1-antitrypsin, and progesterone receptor. Almost all SPNs harbor an activating point mutation in exon 3 of the β-catenin gene (CTNNB1). Clinicopathological features generally do not correlate with prognosis, and most patients experience excellent long-term survival. Conclusions: SPN can mimic other neoplasms of the pancreas, which can lead to diagnostic challenges in a limited cytologic specimen. Distinct cytomorphological features can help distinguish SPNs from other pancreatic neoplasms. Complete surgical resection as well as resection of metastatic disease is preferred given a low rate of tumor recurrence and long periods of disease-free intervals.

“…the screening of nongynecological specimens, on-site evaluation of adequacy [1,2,3] and interfacing cytopathology with molecular methods [4]. Regulatory practices require quality performance measures for evaluating an individual's skill at interpreting Pap tests [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Cytotechnologist Performance for Detecting Nuclear Atypia in Indeterminate Thyroid Fine Needle Aspirates

VandenBussche

Adams

Ali³

et al. 2014

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Introduction: The thyroid gland is arguably the fastest growing anatomic site for fine needle aspiration (FNA). With the increase of thyroid cases, a reevaluation of cytotechnologist screening quality metrics in terms of thyroid FNA is called for. We present our institutional cytotechnologist performance at screening for nuclear atypia by applying established quality metrics. Materials and Methods: Information on 8,814 consecutive thyroid cytopathology cases over a 10-year period was retrieved from computerized records. A subsample of cases categorized either as atypia of uncertain significance with nuclear atypia or suspicious for malignancy with features suspicious for papillary thyroid carcinoma. The cytotechnologist and cytopathologist diagnoses were compared using step discrepancies and Δ-ratios. Results: Overall discrepancy between the cytotechnologist and cytopathologist diagnoses existed in <10% of all thyroid cases. One-category discrepancies were the most common (7.8%), while two-category discrepancies were rare (0.5%). The one-category discrepancy rate correlated with cytotechnologist experience. One-category undercalls were twice as common as overcalls (5.3 vs. 2.5%, p < 0.0001). Conclusions: We identified a high level of quality in the screening for nuclear atypia in thyroid FNA. The one-category discrepancy rate is suited to tracking individual cytotechnologist performance, identifies outliers and appears to correlate with cytotechnologist experience.