Journal of the American Society of Cytopathology最新文献

{"title":"Primary tumor characteristics and immunohistochemical profile of renal cell carcinoma in serous fluid cytology","authors":"Mason Marshall DO ,&nbsp;Sigfred Lajara MD ,&nbsp;Gabriela Quiroga-Garza MD ,&nbsp;Dimitrios Korentzelos MD ,&nbsp;Maedeh Mohebnasab MD ,&nbsp;Samer Khader MD","doi":"10.1016/j.jasc.2024.11.002","DOIUrl":"10.1016/j.jasc.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Renal cell carcinoma (RCC) involves serosal surfaces in 2%-3% of cases, and thus few papers describe serous fluid cytology (SFC) involvement by RCC. This diagnosis is challenging, given its rarity, nondescript cytomorphologic features and infrequent expression of widely used epithelial markers MOC31 and BerEP4. We describe our institutional experience with RCC in SFC specimens.</div></div><div><h3>Materials and methods</h3><div>Our institutional laboratory information system was queried for SFC specimens from patients with RCC between 2013 and 2023. Cases signed out as “Suspicious for Malignant Cells” and “Positive for Malignant Cells” were included. Patient demographics, immunohistochemical results, primary tumor characteristics, and molecular data were recorded.</div></div><div><h3>Results</h3><div>Sixty-one cases, 50 pleural, and 11 peritoneal fluid specimens were identified. Fifty (50) were signed out as positive for malignancy and 11 were signed out as suspicious for malignancy. MOC31 and BerEP4 were positive in 59% and 55% of cases, respectively. PAX-8, CA9, CD10, and RCC were positive in 85%, 82%, 73%, and 29% of cases, respectively. Primary tumor histologic subtypes included 39 clear cell, 6 papillary, 1 chromophobe, and 15 were not further subclassified. Fifty-nine percent (59%) of cases had a nuclear grade of 4%, and 37% had sarcomatoid or rhabdoid differentiation. Seventy-one percent (71%) of cases had stage 3 or 4 disease.</div></div><div><h3>Conclusions</h3><div>RCC metastases to serosal surfaces are more likely to be seen in patients with higher disease stage, high nuclear grade, and sarcomatoid or rhabdoid differentiation. MOC31 and BerEP4 performed poorly in this setting. We recommend the addition of cytokeratins, PAX-8, CD10, and CA-9 to confirm metastatic involvement.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 2","pages":"Pages 123-131"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicoradiological Predictors of Malignancy in the Atypical Category by the Yokohama System for Reporting Breast Fine-Needle Aspiration Cytopathology","authors":"Possawat Peungkiatpairote MD ,&nbsp;Sayanan Chowsilpa MD","doi":"10.1016/j.jasc.2025.01.006","DOIUrl":"10.1016/j.jasc.2025.01.006","url":null,"abstract":"<div><h3>Introduction</h3><div>The atypical category (AC) by the Yokohama system is an indeterminate group characterized by predominantly benign cytomorphology of the lesions, with some uncommon features that may be seen in malignancy in breast fine-needle aspiration. The risk of malignancy (ROM) varies from 13% to 25%. Its management depends on the clinical and radiological findings. Since most cases are benign, selecting cases for further management may benefit patients. This study aims to determine the clinicoradiological predictors for malignancy in AC breast cytology.</div></div><div><h3>Materials and Methods</h3><div>All AC breast fine-needle aspirations at Chiang Mai University Hospital from 2015 to 2019 were selected from an electronic database for cyto-histological correlation and ROM calculation. The clinicoradiological factors calculated by ROM were analyzed using multivariable logistic regression for malignant prediction and screening scores.</div></div><div><h3>Results</h3><div>There were 218 aspirates from patients aged 15-77 years. The lesion size ranged from 0.2 to 9.2 cm. The ROM was 27.5%. The significant predictors were age ≥40 years (<em>P</em> = 0.03), lesion size ≥1 cm (<em>P</em>&lt; 0.01), and suspicious calcification on imaging (<em>P</em> &lt; 0.01). The ROM was numerically increased in Breast Imaging-Reporting and Data System 5. The screening score showed 88.3% sensitivity, 55.1% specificity, 42.7% positive predictive value, and 92.6% negative predictive value.</div></div><div><h3>Conclusions</h3><div>The AC diagnosis varies from benign to malignant. Age ≥40 years, a lesion size ≥1 cm, and suspicious calcification/Breast Imaging-Reporting and Data System 5 are useful predictors of malignancy. Selecting cases according to screening scores can reduce invasive procedures by up to 43.1%.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 3","pages":"Pages 170-181"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ROSE on small-cell lung carcinoma involvement of mediastinal lymph nodes: Performance evaluation at our institution","authors":"Xiaofeng Zhao MD, PhD,&nbsp;Suad Taraif MD, MBA,&nbsp;Aileen Grace Arriola MD","doi":"10.1016/j.jasc.2025.01.005","DOIUrl":"10.1016/j.jasc.2025.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Recognition of lymph node involvement by small-cell lung carcinoma (SCLC) is challenging, especially during rapid onsite evaluation (ROSE). This distinction might carry clinical significance especially for staging and potential therapy.</div></div><div><h3>Materials and methods</h3><div>Cases with ROSE of lymph nodes for assessment of involvement by SCLC between 2020 and 2024 at our institution were reviewed. Adequacy evaluation results were correlated with the final diagnosis. Smears used during ROSE from cases with diagnostic discrepancies between ROSE and final diagnosis were retrieved for additional review. Interpretation accuracy was measured, and useful features for recognizing SCLC and possible contributing factors for misrecognition were studied.</div></div><div><h3>Results</h3><div>The majority of the cases show concordance between ROSE interpretation and the final review. Most discrepancies are due to under-recognition of scant SCLC cells from background lymphocytes or abundant necrosis. Rapid Papanicolaou-stained smears showed better sensitivity and specificity for recognizing SCLC cells than Diff-Quick stain during ROSE. Pathologists in practice for a longer period (&gt;5 years) are more likely to accurately distinguish the carcinoma cells. Shorter time seems to have been spent onsite for evaluation of cases with under-recognized SCLC cells, but the association is not statistically significant.</div></div><div><h3>Conclusions</h3><div>Accurately recognizing lymph node involvement by SCLC during ROSE is important for timely diagnosis, triage, and management of cases. Several cytologic features should be utilized for accurately distinguishing SCLC cells from lymphocytes. Experience gained with practice increases diagnostic accuracy during ROSE, and rushing should be avoided. Knowledge of clinical impression and clear communication with clinicians should always be encouraged.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 3","pages":"Pages 191-198"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic FNA biopsies of palpable lesions without ultrasound guidance: a single-center study and narrative review of the literature","authors":"Bárbara Sepodes MD ,&nbsp;Vânia Almeida MD","doi":"10.1016/j.jasc.2025.01.004","DOIUrl":"10.1016/j.jasc.2025.01.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent studies suggest that ultrasound-guided fine-needle aspiration biopsy (iFNAb) enhances diagnostic accuracy for palpable lesions. This study evaluates the efficacy of palpation-guided FNAb (pFNAb) performed at Unidade Local de Saúde de Coimbra, Portugal, compares findings to existing literature, and identifies lesions that could benefit from ultrasound guidance.</div></div><div><h3>Materials and methods</h3><div>A retrospective review of 278 pFNAb cases from 2021 to 2023 was conducted, collecting data on lesion characteristics, procedural details, and operator expertise. Diagnostic accuracy was determined through concordance with histopathology, flow cytometry, or clinical follow-up. Statistical analyses included Fisher’s exact test, chi-square tests, and logistic regression. A Preferred Reporting Items for Systematic reviews and Meta-Analyses-guided literature review was also performed to contextualize findings.</div></div><div><h3>Results</h3><div>Diagnostic accuracy was achieved in 84% of pFNAb cases. Lesions less than 1 cm exhibited significantly lower diagnostic rates compared to larger lesions. Diagnostic accuracy improved with additional needle passes, reaching 87% with 3 attempts. Anatomical location significantly influenced outcomes, with scalp lesions having the lowest diagnostic rate (33%) compared to skin and soft tissue lesions (85.7%). Literature review findings corroborated the data, emphasizing the superior accuracy of iFNAb for smaller or anatomically challenging lesions.</div></div><div><h3>Conclusions</h3><div>pFNAb is effective for diagnosing most palpable lesions and provides a standard of care in settings without imaging resources. However, iFNAb is recommended for specific cases, such as small or scalp lesions, to enhance diagnostic accuracy. Tailoring biopsy approaches based on lesion characteristics can improve outcomes, reduce repeat procedures, and enhance patient care.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 3","pages":"Pages 152-158"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of the hologic genius digital diagnostics system for low-grade squamous intraepithelial lesion (LSIL) ThinPrep papanicolaou tests","authors":"Lakshmi Harinath MD, MPH ,&nbsp;Esther Elishaev MD ,&nbsp;Yuhong Ye MD, PhD ,&nbsp;Jonee Matsko SCT, MB ,&nbsp;Amy Colaizzi SCT ,&nbsp;Stephanie Wharton SCT ,&nbsp;Rohit Bhargava MD ,&nbsp;Matthew Hanna MD ,&nbsp;Sarah Harrington PhD ,&nbsp;Liron Pantanowitz MD, PhD, MHA ,&nbsp;Chengquan Zhao MD","doi":"10.1016/j.jasc.2025.01.003","DOIUrl":"10.1016/j.jasc.2025.01.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Advancements in digital imaging technology for Papanicolaou test slides, combined with artificial intelligence are driving the development and adoption of innovative computer-assisted screening methods for cervical cancer within the cytology community. Our study aimed to assess the performance of the Hologic Genius Digital Diagnostic System (HGDDS) in the interpretation of low-grade squamous intraepithelial lesions (LSIL) in ThinPrep Papanicolaou slides.</div></div><div><h3>Materials and methods</h3><div>As part of a validation study performed with 890 ThinPrep Papanicolaou slides using the HGDDS, a subset of 146 LSIL cases were included in this study. Performance characteristics for the detection of cervical intraepithelial neoplasia (CIN) and interobserver variability among 3 cytopathologists were assessed.</div></div><div><h3>Results</h3><div>On evaluation of the consensus results of the 3 cytopathologists, of the 146 LSIL Papanicolaou cases, 60.3% were interpreted as LSIL with the HGDDS. The remainder were interpreted as ASCUS (26%), ASC-H (10.3%), HSIL (2.7%), and NILM (0.7%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting CIN1+ lesions in the ASCUS + category with the HGDDS were 100%, 25%, 97.9%, and 100%, respectively. The sensitivity, specificity, PPV, and NPV for the detection of CIN1+ lesions in the LSIL + category with the HGDDS were 74.7%, 75%, 99.1%, and 7.7%, respectively. Kendall’s W coefficient was 0.792, indicating strong agreement among participating pathologists.</div></div><div><h3>Conclusions</h3><div>Our study demonstrated that ThinPrep Papanicolaou tests with LSIL could be interpreted with strong agreement among pathologists and with good performance indicators when utilizing the HGDDS.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 3","pages":"Pages 199-207"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving concepts in head and neck cytology","authors":"Brittany J. Holmes MD","doi":"10.1016/j.jasc.2025.01.002","DOIUrl":"10.1016/j.jasc.2025.01.002","url":null,"abstract":"<div><div>The head and neck region encompasses a variety of complex, intricate structures that can give rise to a plethora of epithelial tumors. As novel diagnostic entities and ancillary tests emerge in surgical pathology, translating this expanding knowledge to cytology can be challenging. This review will summarize key developments in diagnosing virus-associated squamous cell carcinomas and salivary gland lesions by fine needle aspiration (FNA). Despite collective efforts to define optimal thresholds for p16 positivity in cytologic material, the performance of p16 remains suboptimal for FNA specimens, with a lack of consensus on the best cutoff. Forthcoming guidelines are expected to recommend HPV-specific assays as first-line testing in FNAs of metastatic nonkeratinizing SCC due to their superior performance in limited material. In salivary cytology, the Milan System for Reporting Salivary Gland Cytopathology recently entered its second edition, retaining the original diagnostic categories. The risks of malignancy for each category have been refined based on published data. While the diagnostic categories are now familiar, several categories warrant special attention to their nuances and pitfalls to improve diagnostic accuracy. Finally, general principles gleaned from advances in both virus-associated squamous cell carcinoma and salivary neoplasia are highlighted, equipping the practicing cytopathologist to approach everyday cases strategically and confidently.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 3","pages":"Pages 143-151"},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of HER2-Low breast carcinoma in metastatic settings: a cytological approach to proliferation and survival","authors":"Alaa S. Hrizat MD ,&nbsp;Kelly A. Doxzon MBA, CT(ASCP) ,&nbsp;Raymond O'Neill BA ,&nbsp;Robert P. Post MD ,&nbsp;Elena F. Brachtel MD, PhD","doi":"10.1016/j.jasc.2025.01.001","DOIUrl":"10.1016/j.jasc.2025.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Human epidermal growth factor receptor 2 (HER2)-low breast cancer, defined by HER2 immunohistochemistry scores of 1+ or 2+ without gene amplification, represents a unique subgroup with emerging therapeutic implications. Limited data describe the behavior of HER2-low tumors, particularly in metastatic settings. This study evaluated the frequency of HER2-low expression, Ki-67 proliferation index, and survival outcomes across HER2 subtypes in metastatic breast carcinoma using cytology specimens.</div></div><div><h3>Materials and methods</h3><div>A 3-year retrospective analysis identified 43 patients with metastatic breast carcinoma diagnosed via fine-needle aspiration or exfoliative cytology. HER2, ER, PR, and Ki-67 status were determined by immunohistochemistry, with equivocal HER2 cases assessed by in situ hybridization. Survival outcomes were estimated using the Kaplan–Meier method, with Cox regression identifying predictors of survival.</div></div><div><h3>Results</h3><div>Among 43 cases, 31 (70.5%) were HER2-low, 6 (13.6%) HER2-positive, and 6 (13.6%) HER2-zero. HER2 discordance between primary and metastatic lesions occurred in 19%, mainly involving transitions to HER2-low status. Hormone receptor positivity was more frequent in HER2-low tumors (71%) than HER2-zero tumors (33%) (<em>P</em> &lt; 0.001). Mean Ki-67 was highest in HER2-low (45%) versus HER2-negative (34%) and HER2-positive (33%) cases (<em>P</em> = 0.549). Median survival was 13 months for HER2-low and 5 months for HER2-negative patients; survival differences were not significant (<em>P</em> = 0.225). Younger age (HR = 0.240, <em>P</em> = 0.048) and hormone receptor positivity (HR = 0.273, <em>P</em> = 0.011) were significant predictors of survival.</div></div><div><h3>Conclusion</h3><div>HER2-low expression is prevalent in metastatic breast carcinoma with a unique hormone receptor profile. Findings highlight the need for reassessment of HER2 status in metastatic settings, with potential therapeutic implications.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 3","pages":"Pages 182-190"},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tools, techniques, and challenges in preparing cytology specimens for ancillary studies: results of the ASC Optimizing Cytology and Small Biopsy Specimen Processing for Ancillary Studies task force survey","authors":"Jonas J. Heymann MD ,&nbsp;Cristiana M. Pineda MD, PhD ,&nbsp;Christine N. Booth MD ,&nbsp;Elizabeth Jenkins BBA, MSOL ,&nbsp;Joshua R. Menke MD ,&nbsp;Sara E. Monaco MD ,&nbsp;Ritu Nayar MD ,&nbsp;Michiya Nishino MD, PhD ,&nbsp;Sinchita Roy-Chowdhuri MD, PhD ,&nbsp;Roberto Ruiz-Cordero MD ,&nbsp;Donna K. Russell MEd, CT (ASCP) ,&nbsp;Anjali Saqi MD, MBA ,&nbsp;Kaitlin E. Sundling MD, PhD ,&nbsp;Michael J. Thrall MD ,&nbsp;Vanda F. Torous MD ,&nbsp;Christopher J. VandenBussche MD, PhD ,&nbsp;Paul A. VanderLaan MD, PhD ,&nbsp;M. Lisa Zhang MD ,&nbsp;Momin T. Siddiqui MD","doi":"10.1016/j.jasc.2024.10.001","DOIUrl":"10.1016/j.jasc.2024.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Ancillary testing on cytopathology and other small biopsy specimens is crucial for diagnosis and provides critical information to clinicians. Testing is dependent on preanalytic factors and would benefit from standardization of specimen collection protocols across laboratories. To assess institutional practices and areas of need for evidence-based standards, we surveyed current practices across cytopathology laboratories.</div></div><div><h3>Materials and methods</h3><div>A twelve-question electronic survey was distributed to American Society of Cytopathology (ASC) members through email, social media, and the ASC from January 8, 2024 to March 1, 2024. Survey responses were tabulated.</div></div><div><h3>Results</h3><div>Of 294 respondents, 257 (87%) completed at least 10/12 questions. Formalin-fixed, paraffin-embedded cell blocks (CBs) are utilized for immunohistochemistry, molecular testing, and <em>in situ</em> hybridization by 89%, 84%, and 71% of respondents, respectively. For fine needle aspirations, no collection medium is utilized by a majority of respondents. In contrast, 61% utilize no collection medium for fluids; 64% predominantly utilize liquid-based preservatives for other exfoliative specimens. For CB preparation, 58% of respondents use coagulating agent; 67% use no fixative before formalin. The two most significant factors limiting clinical utility of ancillary testing in cytology specimens are low cellularity and lack of validation (49% and 23% of respondents, respectively).</div></div><div><h3>Conclusions</h3><div>There is wide variation in current practices among laboratories, reflecting lack of consensus. Although laboratories utilize different collection media for different specimen types, for CB utilization, current survey results are similar to those reported previously. ASC has convened a task force to facilitate specimen standardization and minimize variability among preanalytic factors.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 1","pages":"Pages 55-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triage options for positive high-risk HPV results from HPV-based cervical cancer screening: a review of the potential alternatives to Papanicolaou test cytology","authors":"Michael J. Thrall MD ,&nbsp;Erin McCarthy MPH, CT (ASCP) ,&nbsp;Jeffrey K. Mito MD, PhD ,&nbsp;Jianyu Rao MD ,&nbsp;Clinical Practice Committee of the American Society of Cytopathology","doi":"10.1016/j.jasc.2024.09.003","DOIUrl":"10.1016/j.jasc.2024.09.003","url":null,"abstract":"<div><div>The American Cancer Society has recommended high-risk human papillomavirus (HPV) testing as the primary screening method for cervical cancer since 2020. Up to this point, the transition from Pap test cytology-based screening or co-testing with cytology and HPV testing has been slow and limited. However, more health systems in the United States are in the process of implementing this change. The transition to HPV-based screening requires a triage strategy for positive results. Genotyping to specifically detect HPV types 16 and 18 in conjunction with reflex cytology for the remaining high-risk HPV genotypes has been the recommended method. Testing options including Dual Stain for p16/Ki-67 and extended HPV genotyping are currently being incorporated into treatment algorithms as alternatives. Methylation testing is another promising method extensively investigated around the world. This review, performed by members of the Clinical Practice Committee of the American Society of Cytopathology, examines the rationale behind the switch away from reliance on Pap test cytology in the cervical cancer screening algorithm and the opportunities and problems associated with the most promising alternative approaches. Published studies that give insight into the performance characteristics of these newer tests are reviewed. At the present time, Pap test cytology remains a viable triage option for positive HPV screening results, but alternative tests have significant appeal and should be considered in tandem with the decision to offer primary HPV screening.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 1","pages":"Pages 11-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of the performance of urinary cytology with a focus on atypia, upper tract and updates on novel ancillary testing","authors":"Olisaemeka Chukwudebe MMBS, MPH ,&nbsp;Elizabeth Lynch MD ,&nbsp;Manish Vira MD ,&nbsp;Louis Vaickus MD ,&nbsp;Anam Khan MBBS ,&nbsp;Rubina Shaheen Cocker MD","doi":"10.1016/j.jasc.2024.09.001","DOIUrl":"10.1016/j.jasc.2024.09.001","url":null,"abstract":"<div><div>The Paris System for Reporting Urine Cytology (TPS) is remarkable for its high predictive value in the detection of high-grade urothelial carcinoma, especially of the bladder. However, universal compliance with TPS-recommended threshold for atypical call rates (15%) and TPS performance in the rarer upper tract urothelial carcinomas (UTUC) are challenging. UTUC diagnosis is compounded by instrumentation artifacts, degenerative changes superimposed on an ambiguous cytology, difficult-to-access location, lack of specific standardized criteria, and a limited number of UTUC-focused studies. We reviewed TPS-applied studies published since 2022, noting up to 50%, exceeding the suggested 15% threshold for atypia. Our examination of ancillary tests for UTUC explored novel approaches including DNA methylation analysis, the detection of overexpressed tumor-linked messenger RNAs, and immunohistochemistry on markers such as CK17. Preliminary evidence from our review suggests that ancillary tests display superior performance over cytology, including in voided samples and low-grade urothelial carcinoma. Importantly, voided samples obviate the risks of ureterorenoscopy. Finally, we explored the future opportunities offered by artificial intelligence and machine learning for a more objective application of TPS criteria on urine samples.</div></div>","PeriodicalId":38262,"journal":{"name":"Journal of the American Society of Cytopathology","volume":"14 1","pages":"Pages 23-35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}