Depletion of Core Needle Biopsy Cellularity and DNA Content as a Result of Vigorous Touch Preparations

Rekhtman, Natasha; Kazi, Sofia; Yao, Jinjuan; Doğan, Snjezana; Yannes, Angela; Lin, Oscar; Silk, Mikhail; Silk, Tarik; Durack, Jeremy C.

doi:10.5858/arpa.2014-0392-oa

Cited by 36 publications

(32 citation statements)

References 29 publications

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“…In fact, the use of TPs from core biopsies of lung specimens can result in the deletion of cellularity and DNA content of the cores. 17 Because molecular analysis is vital to treatment in lung cancer, this study discourages the use of these preparations for subclassification of ADC and SqCC of the lung.…”

Section: Discussionmentioning

confidence: 99%

Morphologic Accuracy in Differentiating Primary Lung Adenocarcinoma From Squamous Cell Carcinoma in Cytology Specimens

Zakowski

Rekhtman²,

Auger³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context The National Cancer Care Network and the combined College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecular Pathology guidelines indicate that all lung adenocarcinomas (ADCs) should be tested for epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements. As the majority of patients present at a later stage, the subclassification and molecular analysis must be done on cytologic material. Objective To evaluate the accuracy and interobserver variability among cytopathologists in subtyping non–small cell lung carcinoma using cytologic preparations. Design Nine cytopathologists from different institutions submitted cases of non–small cell lung carcinoma with surgical follow-up. Cases were independently, blindly reviewed by each cytopathologist. A diagnosis of ADC or squamous cell carcinoma was rendered based on the Diff-Quik, Papanicolaou, and hematoxylin-eosin stains. The specimen types included fine-needle aspiration from lung, lymph node, and bone; touch preparations from lung core biopsies; bronchial washings; and bronchial brushes. A major disagreement was defined as a case being misclassified 3 or more times. Results Ninety-three cases (69 ADC, 24 squamous cell carcinoma) were examined. Of 818 chances (93 cases × 9 cytopathologists) to correctly identify all the cases, 753 correct diagnoses were made (92% overall accuracy). Twenty-five of 69 cases of ADC (36%) and 7 of 24 cases of squamous cell carcinoma (29%) had disagreement (P = .16). Touch preparations were more frequently misdiagnosed compared with other specimens. Diagnostic accuracy of each cytopathologist varied from 78.4% to 98.7% (mean, 91.7%). Conclusion Lung ADC can accurately be distinguished from squamous cell carcinoma by morphology in cytologic specimens with excellent interobserver concordance across multiple institutions and levels of cytology experience.

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Section: Discussionmentioning

confidence: 99%

Morphologic Accuracy in Differentiating Primary Lung Adenocarcinoma From Squamous Cell Carcinoma in Cytology Specimens

Zakowski

Rekhtman²,

Auger³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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“…The DNA content lost is directly related to each centimeter of imprint, thereby impacting the material available for molecular testing and other ancillary studies [11] . Rekhtman et al [12] described an imprint of a NCB as touching the CNB to the slide with minimal sliding along the slide surface and recommended the horizontal drag method. Other factors that can affect the quality and quantity of the NCB material include the type and location of the target lesion and the number and type of needle passes [12,13] .…”

Section: Nongynecologic Cytologymentioning

confidence: 99%

“…Rekhtman et al [12] described an imprint of a NCB as touching the CNB to the slide with minimal sliding along the slide surface and recommended the horizontal drag method. Other factors that can affect the quality and quantity of the NCB material include the type and location of the target lesion and the number and type of needle passes [12,13] . The shift to and preference for NCB over FNA is related to the ability of radiologists to provide multiple cores at the same time through the use of a coaxial NCB system and the flexibility for pathologists to triage the tissue adequately for ancillary studies including immunohistochemistry, histochemistry, microbiologic cultures, molecular studies, and flow cytometry [14,15] .…”

Section: Nongynecologic Cytologymentioning

confidence: 99%

Changing Trends and Practices in Cytopathology

González

Akhtar²,

Manucha³

2017

Acta Cytologica

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Objective: To explore the current and anticipated changes in the practice of cytopathology. Study Design: The present review is based on a review of recent literature and an evaluation of the authors' personal experiences. Results and Conclusion: In recent years the practice of cytopathology, nationwide and in our institute, has witnessed a major change affecting gynecologic and nongynecologic cytology. There has been a decline in the number of Papanicolaou tests which has affected the utilization of cytotechnologists and provoked a reorganization of their work flow. The “need to do more with less” in the era of targeted therapy/personalized medicine has resulted in an increasing preference for needle core biopsy when performing a rapid on-site evaluation. We feel that this change is unavoidable. It is pertinent that cytopathologists as a group recognize this change and prepare themselves and the trainees not only to become adapt but also to use this as an opportunity to discover the yet unexplored world of cytology.

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“…The current approach of frozen section analysis (FSA) for in-procedure histopathology is relatively time-consuming and damaging to the tissue and is not feasible for the immediate evaluation of small needle core biopsies [1]. Touch preparation of these specimens is currently the most effective method, but can frequently misrepresent tumor content and often needs a specialized cytopathologist for proper interpretation [2]. The labor-intensiveness and destructiveness of traditional histopathology preparations, like formalin-fixed, paraffin-embedded processing or frozen section analysis, is due to the need to deposit a thin section of hematoxylin and eosin (H&E) stained tissue on a slide to enable it to be evaluated by light-transmission microscopy.…”

Section: Introductionmentioning

confidence: 99%

DRAQ5 and Eosin (‘D&E’) as an Analog to Hematoxylin and Eosin for Rapid Fluorescence Histology of Fresh Tissues

et al. 2016

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Real-time on-site histopathology review of biopsy tissues at the point-of-procedure has great potential for significant clinical value and improved patient care. For instance, on-site review can aid in rapid screening of diagnostic biopsies to reduce false-negative results, or in quantitative assessment of biospecimen quality to increase the efficacy of downstream laboratory and histopathology analysis. However, the only currently available rapid pathology method, frozen section analysis (FSA), is too time- and labor-intensive for use in screening large quantities of biopsy tissues and is too destructive for maximum tissue conservation in multiple small needle core biopsies. In this work we demonstrate the spectrally-compatible combination of the nuclear stain DRAQ5 and the anionic counterstain eosin as a dual-component fluorescent staining analog to hematoxylin and eosin intended for use on fresh, unsectioned tissues. Combined with optical sectioning fluorescence microscopy and pseudo-coloring algorithms, DRAQ5 and eosin (“D&E”) enables very fast, non-destructive psuedohistological imaging of tissues at the point-of-acquisition with minimal tissue handling and processing. D&E was validated against H&E on a one-to-one basis on formalin-fixed paraffin-embedded and frozen section tissues of various human organs using standard epi-fluorescence microscopy, demonstrating high fidelity of the staining mechanism as an H&E analog. The method was then applied to fresh, whole 18G renal needle core biopsies and large needle core prostate biospecimen biopsies using fluorescence structured illumination optical sectioning microscopy. We demonstrate the ability to obtain high-resolution histology-like images of unsectioned, fresh tissues similar to subsequent H&E staining of the tissue. The application of D&E does not interfere with subsequent standard-of-care H&E staining and imaging, preserving the integrity of the tissue for thorough downstream analysis. These results indicate that this dual-stain pseudocoloring method could provide a real-time histology-like image at the time of acquisition and valuable objective tissue analysis for the clinician at the time of service.

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Depletion of Core Needle Biopsy Cellularity and DNA Content as a Result of Vigorous Touch Preparations

Cited by 36 publications

References 29 publications

Morphologic Accuracy in Differentiating Primary Lung Adenocarcinoma From Squamous Cell Carcinoma in Cytology Specimens

Morphologic Accuracy in Differentiating Primary Lung Adenocarcinoma From Squamous Cell Carcinoma in Cytology Specimens

Changing Trends and Practices in Cytopathology

DRAQ5 and Eosin (‘D&E’) as an Analog to Hematoxylin and Eosin for Rapid Fluorescence Histology of Fresh Tissues

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