Utilization of ancillary studies in the cytologic diagnosis of respiratory lesions: The papanicolaou society of cytopathology consensus recommendations for respiratory cytology

Abstract

The Papanicolaou Society of Cytopathology has developed a set of guidelines for respiratory cytology including indications for sputum examination, bronchial washings and brushings, CT-guided FNA and endobronchial ultrasound guided fine needle aspiration (EBUS-FNA), as well as recommendations for classification and criteria, ancillary testing and post-cytologic diagnosis management and follow-up. All recommendation documents are based on the expertise of committee members, an extensive literature review, and feedback from presentations at national and international conferences. The guideline documents selectively present the results of these discussions. The present document summarizes recommendations for ancillary testing of cytologic samples. Ancillary testing including microbiologic, immunocytochemical, flow cytometric, and molecular testing, including next-generation sequencing are discussed.

Diagnostic Accuracy of Fine-Needle Aspiration Cytology for Discrimination of Squamous Cell Carcinoma from Adenocarcinoma in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

“…Such separation is necessary in that adenocarcinomas may be treatable by a number of precision medicine protocols based on mutations present in a minority of adenocarcinomas of the lung [1, 5-7, 30]. These molecular tests are traditionally performed on histopathologic material but may be performed on a variety of cytology specimens [30, 38]. Endobronchial ultrasound-guided FNA (EBUS-FNA) is increasingly utilized for the initial diagnosis of pulmonary nodules and for the staging of pulmonary carcinomas.…”

A practical guide for ancillary studies in pulmonary cytologic specimens

“…The most common application of cytology in benign pulmonary lesions is for the detection of lung infections, especially for immunocompromised patients including HIV/AIDS patients, patients with known malignancies, and transplant patients. To increase the accuracy and sensitivity of the cytology specimens, typically bronchoalveolar lavages (BAL) or bronchial washings but occasionally induced sputa or more rarely lung FNAs, a multimodal assessment for infectious organisms, including cultures, various pathogen specific histochemical stains (eg, Ziehl‐Nielsen stain for mycobacterium), immunohistochemistry, and molecular detection, is recommended in addition to obtention of clinical history and correlation with corresponding tissue biopsies . In such specimens from immunosuppressed patients, one must look most particularly for fungi (including Pneumocystis jiroveci ) and for viral changes.…”

Committee II: Guidelines for cytologic sampling techniques of lung and mediastinal lymph nodes

“…In an effort to standardize respiratory cytology practice, the Papanicolaou Society of Cytopathology (PSC) developed a set of guidelines. The standardized terminology and nomenclature for respiratory cytology have recently been published, along with the consensus recommendations for the utilization of ancillary studies for diagnosis . The following is Committee II report on guidelines for techniques utilized for respiratory sampling that complements the previously published Committee I report on the guidelines for indications of such sampling techniques …”