Global Cytopathology-Hematopathology Practice Trends

Abstract

Objectives Small-volume biopsy—fine-needle aspiration biopsy (FNAB) with or without core biopsy—is in increasing use in diagnosis and management of lymphoma patients. Our objective was to survey the current practice in small-volume biopsy diagnosis of lymphoma, focusing on the interaction among hematopathologists and cytopathologists and the integration of FNAB, core biopsy, and flow cytometry studies at sign-out. Methods This study used a cross-sectional survey design employing the RedCap database distributed via nine pathology professional society email listservs. The survey consisted of 25 multiple-choice questions and several free text fields. In total, 128 pathologists participated. Results Most respondents indicated that FNAB specimens in which lymphoma is a diagnostic consideration (FNAB-L) are seen daily or weekly (68/116; 58.6%). However, most institutions have separate hematopathology and cytopathology services (72/116; 62.1%) with inconsistent communication. When communication occurred, respondents were frequently inclined to reconsider their original diagnoses. Barriers identified included lack of communication, inadequate access to diagnostic studies, no formal subspecialty training, and various opinions regarding FNAB in diagnosing lymphoma. Conclusions This survey showed that FNAB-L specimens are common, with a lack of uniformity in how complementary fine-needle aspiration and core biopsy specimens or flow immunophenotyping results are shared across hematopathology and cytopathology services.

Uses and limitations of small‐volume biopsies for the diagnosis of lymphoma

“…Zadeh et al. found that workflow and communication between cytopathology and hematopathology are inconsistent across different institutions, though when communication does occur, pathologists tend to reconsider original diagnoses 63 . The Re‐imagine Cytopathology Task Force has recently suggested that synchronous review and reporting of combined FNA and CNB specimens is superior to review of either alone by allowing for concurrent evaluation of cytology and histology and enabling tissue preservation for optimal ancillary testing triage 64 .…”

“…The use of FNA as a diagnostic adjunct has also been advocated, both as a means to provide additional material and cytologic assessment to a concurrently obtained CNB and to assist in the decision of whether a CNB should be performed. 63 The Re-imagine Cytopathology Task Force has recently suggested that synchronous review and reporting of combined FNA and CNB specimens is superior to review of either alone by allowing for concurrent evaluation of cytology and histology and enabling tissue preservation for optimal ancillary testing triage. 64 These studies suggest that communication across departments and integrated reporting are key in order to effectively and clearly provide patient biopsy results.…”

Diagnostic Discrepancies in Small-volume Biopsy for the Initial Diagnosis, Recurrence, and Transformation of Follicular Lymphoma

“…This is a retrospective exploratory study, and confounders are numerous, including unknown variations in practice patterns, reasons for repeat biopsy, and limited focus on the evaluation for FL. While this is a multi-institutional study, clinical practice varies between these institutions and could significantly impact the quality of the SVB analysis as well as the decisions to perform a subsequent biopsy across the various clinical scenarios 17. We therefore present cohort data to the pathology and oncology communities as a snapshot of the current state but do not provide P values or statistical analyses.…”

Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto‐Heme Interinstitutional Collaborative study

“…All institutions included in this study are large academic tertiary referral centers with an interest in hematopathology and/or cytology collaboration and with subspecialized pathologists. A recent study by Zadeh et al 32 . evaluating global practice differences in the evaluation of lymphoma on FNA specimens found that communication between cytopathologists and hematopathologists was inconsistent across different practices and also identified marked differences in access to ancillary testing.…”

“…All institutions included in this study are large academic tertiary referral centers with an interest in hematopathology and/or cytology collaboration and with subspecialized pathologists. A recent study by Zadeh et al 32 evaluating global practice differences in the evaluation of lymphoma on FNA specimens found that communication between cytopathologists and hematopathologists was inconsistent across different practices and also identified marked differences in access to ancillary testing. Therefore, the practices and resources available at the institutions participating in this study may differ from those of other clinical settings, and our findings may represent a best-case scenario in terms of expertise and interdepartmental communication.…”