Cancer Cytopathology最新文献

{"title":"Performance of a multigene genomic classifier and clinical parameters in predicting malignancy in a Southeast Asian cohort of patients with cytologically indeterminate thyroid nodules","authors":"Samantha Peiling Yang MBBS,&nbsp;Min En Nga MBBS,&nbsp;Manish Mahadeorao Bundele MBBS,&nbsp;Simion I. Chiosea MD,&nbsp;Sze Hwa Tan MBBS,&nbsp;Jeffrey H. Y. Lum MBBS,&nbsp;Rajeev Parameswaran MBBS,&nbsp;Ming Yann Lim MBBS,&nbsp;Hao Li MBBS,&nbsp;Wei Keat Cheah MBBS,&nbsp;Kathleen Su-Yen Sek MBBS,&nbsp;Andre Teck Huat Tan MBBS,&nbsp;Thomas Kwok Seng Loh MBBS,&nbsp;Kee Yuan Ngiam MBBS,&nbsp;Wee Boon Tan MBBS,&nbsp;Xinyong Huang MBBS,&nbsp;Thomas Wai Thong Ho MBBS,&nbsp;Keng Hua Lim MBBS,&nbsp;Chwee Ming Lim MBBS,&nbsp;Reyaz M. Singaporewalla MBBS,&nbsp;Anil Dinkar Rao MBBS,&nbsp;Nandini C. L. Rao MBBS,&nbsp;Dennis Yu Kim Chua MBBS,&nbsp;David Chao-Wu Chin MBBS,&nbsp;Abigail I. Wald PhD,&nbsp;Virginia A. LiVolsi MD,&nbsp;Yuri E. Nikiforov MD, PhD,&nbsp;E. Shyong Tai MBBS","doi":"10.1002/cncy.22796","DOIUrl":"10.1002/cncy.22796","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Most thyroid nodules are benign. It is important to determine the likelihood of malignancy in such nodules to avoid unnecessary surgery. The primary objective of this study was to characterize the genetic landscape and the performance of a multigene genomic classifier in fine-needle aspiration (FNA) biopsies of cytologically indeterminate thyroid nodules in a Southeast Asian cohort. The secondary objective was to assess the predictive contribution of clinical characteristics to thyroid malignancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, multicenter, blinded study included 132 patients with 134 nodules. Molecular testing (MT) with ThyroSeq v3 was performed on clinical or ex-vivo FNA samples. Centralized pathology review also was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 134 nodules, consisting of 61% Bethesda category III, 20% category IV, and 19% category V cytology, and 56% were histologically malignant. ThyroSeq yielded negative results in 37.3% of all FNA samples and in 42% of Bethesda category III–IV cytology nodules. Most positive samples had <i>RAS</i>-like (41.7%), followed by <i>BRAF</i>-like (22.6%), and high-risk (17.9%) alterations. Compared with North American patients, the authors observed a higher proportion of <i>RAS</i>-like mutations, specifically <i>NRAS</i>, in Bethesda categories III and IV and more <i>BRAF</i>-like mutations in Bethesda category III. The test had sensitivity, specificity, negative predictive value, and positive predictive value of 89.6%, 73.7%, 84.0%, and 82.1%, respectively. The risk of malignancy was predicted by positive MT and high-suspicion ultrasound characteristics according to American Thyroid Association criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Even in the current Southeast Asian cohort with nodules that had a high pretest cancer probability, MT could lead to potential avoidance of diagnostic surgery in 42% of patients with Bethesda category III–IV nodules. MT positivity was a stronger predictor of malignancy than clinical parameters.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 5","pages":"309-319"},"PeriodicalIF":3.4,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22796","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heightened but variable COVID-19 risks for patients with cancer","authors":"Bryn Nelson PhD,&nbsp;William Faquin MD, PhD","doi":"10.1002/cncy.22791","DOIUrl":"10.1002/cncy.22791","url":null,"abstract":"&lt;p&gt;Four years into the coronavirus disease 2019 (COVID-19) pandemic, multiple studies have agreed that patients with cancer are more susceptible to COVID-19 infection and have a higher risk of worse outcomes than the general population. Large cohort studies have revealed plenty of nuances, however, while raising additional questions in need of better answers.&lt;/p&gt;&lt;p&gt;Some cancer types, such as hematologic malignancies, have been associated with a higher risk of poor COVID-19 outcomes, as have some treatment types, such as recent cytotoxic chemotherapies, as well as a long list of other demographic factors and comorbidities. Researchers are just starting to investigate the added danger of long COVID-19.&lt;/p&gt;&lt;p&gt;The data, however, have also provided some reassurances, says Noha Sharafeldin, MD, PhD, MSc, an assistant professor of medicine at the University of Alabama at Birmingham and an associate scientist at the university’s O’Neal Comprehensive Cancer Center. One of the most notable findings is that vaccination against the SARS-CoV-2 virus can reduce the risk of severe infection even among those with hematologic malignancies.&lt;/p&gt;&lt;p&gt;“I think the thing we know for sure, if, God forbid, we’re hit with something similar again, is that this should be a group of people who should be at the forefront of protection efforts because of so many factors working against them,” Dr Sharafeldin says. “But the flip side of it is that vaccines work in those patients. We shouldn’t think that these patients might not benefit from these kinds of interventions.”&lt;/p&gt;&lt;p&gt;In a study that predated the first COVID-19 vaccines, Dr Sharafeldin and her colleagues found that COVID-19 positivity as significantly associated with an increased risk of all-cause mortality in adult patients with cancer.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Within the subset of patients who had cancer and were positive for COVID-19, multiple comorbidities, male gender, an age of 65 years or older, a hematologic malignancy, multiple tumor sites, and cytotoxic therapy received up to 30 days before the COVID-19 diagnosis were all associated with a higher risk of all-cause mortality. Recently administered immunotherapies or targeted therapies, however, did not increase the risk.&lt;/p&gt;&lt;p&gt;Dr Sharafeldin says that the assessment provided a kind of early natural history of COVID-19. The study drew on the medical records of nearly 4.4 million patients in the National COVID Cohort Collaborative. At the time, no one was sure of how to account for COVID-19 vulnerability or diagnosed infections in patients with cancer, particularly those in need of a bone marrow transplant. The study allowed the researchers to quantify the overall risk and identify the most vulnerable subset of patients with cancer. As expected, Dr Sharafeldin says, patients with hematologic malignancies had the highest risk of all-cause death, which was explainable by their predisposition for greater immunodeficiency.&lt;/p&gt;&lt;p&gt;“One thing we solidified is that this g","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 2","pages":"73-74"},"PeriodicalIF":3.4,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139674063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Droplet digital polymerase chain reaction detection of KRAS mutations in pancreatic FNA samples: Technical and practical aspects for routine clinical implementation","authors":"Yara Mansour MD,&nbsp;Mehdi Boubaddi MD,&nbsp;Typhaine Odion,&nbsp;Marion Marty MD,&nbsp;Geneviève Belleannée MD,&nbsp;Arthur Berger MD,&nbsp;Clément Subtil MD,&nbsp;Christophe Laurent MD, PhD,&nbsp;Sandrine Dabernat PhD,&nbsp;Samuel Amintas PharmD, PhD","doi":"10.1002/cncy.22795","DOIUrl":"10.1002/cncy.22795","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pancreatic adenocarcinoma (PDAC) is associated with a 5-year survival rate of less than 6%, and current treatments have limited efficacy. The diagnosis of PDAC is mainly based on a cytologic analysis of endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) samples. However, the collected specimens may prove noncontributory in a significant number of cases, delaying patient management and treatment. The combination of EUS-FNA sample examination and <i>KRAS</i> mutation detection can improve the sensitivity for diagnosis. In this context, the material used for molecular analysis may condition performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The authors prospectively compared the performance of cytologic analysis combined with a <i>KRAS</i> droplet digital polymerase chain reaction (ddPCR) assay for PDAC diagnosis using either conventional formalin-fixed, paraffin-embedded cytologic samples or needle-rinsing fluids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Molecular testing of formalin-fixed, paraffin-embedded cytologic samples was easier to set up, but the authors observed that the treatment of preanalytic samples, in particular the fixation process, drastically reduced ddPCR sensitivity, increasing the risk of false-negative results. Conversely, the analysis of dedicated, fresh needle-rinsing fluid samples appeared to be ideal for ddPCR analysis; it had greater sensitivity and was easily to implement in clinical use. In particular, fluid collection by the endoscopist, transportation to the laboratory, and subsequent freezing did not affect DNA quantity or quality. Moreover, the addition of <i>KRAS</i> mutation detection to cytologic examination improved diagnosis performance, regardless of the source of the sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Considering all of these aspects, the authors propose the use of an integrated flowchart for the <i>KRAS</i> molecular testing of EUS-FNA samples in clinical routine.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 5","pages":"274-284"},"PeriodicalIF":3.4,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139677819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytologic risk stratification of medullary thyroid carcinoma: Does it make the grade?","authors":"Michiya Nishino MD, PhD","doi":"10.1002/cncy.22799","DOIUrl":"10.1002/cncy.22799","url":null,"abstract":"<p>Recent efforts to develop a histologic grading system for medullary thyroid carcinoma is gaining broad acceptance. How well do these grading parameters translate to cytology specimens?</p>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 4","pages":"209-211"},"PeriodicalIF":3.4,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139674062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of The Paris System for Reporting Urine Cytology improves diagnostic accuracy of selective upper urinary tract cytology","authors":"Kosuke Miyai MD, PhD,&nbsp;Misaki Nakayama CT,&nbsp;Shinya Minabe CT,&nbsp;Sho Ogata MD, PhD,&nbsp;Keiichi Ito MD, PhD,&nbsp;Susumu Matsukuma MD, PhD","doi":"10.1002/cncy.22792","DOIUrl":"10.1002/cncy.22792","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Paris System for Reporting Urine Cytology (TPS) recommends diagnostic criteria for urinary tract cytology, focusing primarily on the detection of high-grade urothelial carcinoma (HGUC) in the lower urinary tract. The second edition of TPS (TPS 2.0), published in 2022, extends these recommendations to the upper urinary tract (UUT); however, there is a lack of comprehensive data on this subject.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In total, 223 consecutive UUT cytology specimens from 137 patients were retrieved and reclassified according to TPS 2.0 criteria and were compared with the original diagnosis based on the conventional system (CS). Histologic follow-up within a 3-month period was conducted for 43 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Histologic follow-up revealed 30 HGUCs, five low-grade urothelial carcinomas (LGUCs), and eight nonneoplastic fibrotic tissues. The risk of high-grade malignancy for each TPS diagnostic category was 16.7% for nondiagnostic/unsatisfactory, 2.3% for negative for HGUC (NHGUC), 42.1% for atypical urothelial cells, 50.0% for suspicious for HGUC (SHGUC), and 81.8% for HGUC. In all five cases of histologically diagnosed LGUC, the cytologic diagnosis was NHGUC. When SHGUC/HGUC was considered positive, the diagnostic accuracy of TPS had 63% sensitivity, 95% specificity, a 90% negative predictive value, and a 79% positive predictive value, which were better than those of CS. In addition, the TPS indices did not differ significantly between the specimens obtained before and after the application of contrast reagents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TPS implementation improved the accuracy of UUT cytology in predicting histologic HGUC, which was unaffected by the application of contrast reagents. These data indicate the usefulness of TPS for UUT cytology in routine clinical settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 4","pages":"242-249"},"PeriodicalIF":3.4,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fine-needle aspiration of amyloidoma: A critical analysis","authors":"Nisha S. Ramani MD,&nbsp;Bhuvaneswari Krishnan MD","doi":"10.1002/cncy.22784","DOIUrl":"10.1002/cncy.22784","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Amyloid, presenting as a mass, is termed amyloidoma. Among the reported cases, fine-needle aspiration (FNA) of amyloid is often misinterpreted as acellular nondiagnostic material.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A computer search of all FNAs was performed and cases diagnosed as amyloidoma were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 11,956 cases and 20,634 FNAs, there were six cases and 12 FNAs of amyloidoma. One case with mucin/myxoid matrix was misinterpreted as amyloid, which on our review was Congo red negative. All five other cases of amyloidoma were adequate for evaluation. The smears showed most of the aspirated contents in the middle of the slide and it did not spread when smeared. The amyloid was present as large chunks of waxy, smooth, orangophilic/cyanophilic fragments on Papanicolaou stain and as basophilic fragments on Diff-Quik stain in a clean background. In cases with lymphoma/myeloma, there were admixed lymphocytes and/or plasma cells. Unlike fibrous tissue, amyloid aspirates well and provides adequate material for interpretation. The clean background distinguishes it from mucin/myxoid matrix. Congo red stain was positive with apple green birefringence in all five cases. Further subtyping by mass spectrometry showed AL (κ) type in three patients and AIns (insulin) type in one patient. In one patient with lymphoma, the subtyping was not done.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>FNA of amyloidoma is rare (0.04%), but an optimal method for diagnosis and subtyping, avoiding unwanted surgical interventions. Although mistaken for fibrous tissue, which aspirates poorly, abundant acellular orangophilic/cyanophilic material on FNA should raise a suspicion for amyloid. Unlike mucin/myxoid matrix, amyloid does not smear the background.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 3","pages":"179-185"},"PeriodicalIF":3.4,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generic cancer drugs are still in short supply","authors":"Bryn Nelson PhD,&nbsp;William Faquin MD, PhD","doi":"10.1002/cncy.22788","DOIUrl":"10.1002/cncy.22788","url":null,"abstract":"&lt;p&gt;Generic carboplatin and cisplatin are inexpensive and indispensable. The platinum-based, injectable chemotherapeutic drugs have factored prominently in curative regimens and combination therapies that have significantly extended patients’ lives. By rights, they should be the poster children of cost-effective cancer care. Instead, they have become the focal points of a painful drug shortage in the United States that has dragged on since February 2023.&lt;/p&gt;&lt;p&gt;“This is the most critical chemotherapy shortage I’ve ever seen, and this is, certainly, a public health emergency,” says Angeles Alvarez Secord, MD, MHSc, director of gynecologic oncology clinical trials at Duke Cancer Institute in Durham, North Carolina. “It breaks my heart that you have cancer patients—or any patient for that matter—going through this.”&lt;/p&gt;&lt;p&gt;Drug shortages are a long-standing headache for hospitals, but the breadth and duration of the ongoing shortage in what another expert calls “bread-and-butter” oncology drugs have created an unusually acute crisis. The shortage has also renewed calls for government action that multiple providers and professional societies say is long overdue.&lt;/p&gt;&lt;p&gt;“It’s really mind blowing that we are here in 2023 dealing with pretty significant impacts on patients,” says Kirollos Hanna, PharmD, director of pharmacy at Minnesota Oncology and an assistant professor of pharmacy at the Mayo Clinic College of Medicine in Rochester, Minnesota. With cisplatin and carboplatin, he says, “We were at a point where we said, ‘No metastatic disease utilization.’ We said, ‘Find something else, even if the data are subpar.’ That’s all we had to work with, because we needed to be sure we were curing our bladder and testicular cancer patients.”&lt;/p&gt;&lt;p&gt;Stephen Colvill, MBA, assistant research director of the Duke–Margolis Center for Health Policy at Duke University, says that the severe impact of the cancer drug shortage has increased the visibility of what has been a “pretty consistent” problem. Among the root causes, he cites a lack of investment in modernized equipment, facilities, quality infrastructure, redundancy, and risk mitigation plans for generic drugs both within and beyond the United States.&lt;/p&gt;&lt;p&gt;In late 2022, a major production facility in Ahmedabad, India, owned by Intas Pharmaceuticals, failed a surprise Food and Drug Administration (FDA) inspection for a range of egregious safety and quality infractions. When the plant shut down, it knocked out an estimated half of all cisplatin and methotrexate production for the US market. Because the sterile, injectable form of cisplatin is complicated to make, other production facilities could not easily pick up the slack. Then, as demand spiked for alternatives, the ripple effect contributed to shortages of carboplatin as well.&lt;/p&gt;&lt;p&gt;By May 2023, 93% of academic cancer centers reported a shortage of carboplatin, while roughly 70% were short of cisplatin, according to a National Comprehensive Cancer Network (NCCN","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 1","pages":"5-6"},"PeriodicalIF":3.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging the concept of “risk of malignancy” in cytology","authors":"Ilias P. Nikas MD,&nbsp;Ricella Souza da Silva MD, PhD,&nbsp;Bernardo Sousa-Pinto MD, PhD,&nbsp;Fernando Schmitt MD, PhD, FIAC","doi":"10.1002/cncy.22787","DOIUrl":"10.1002/cncy.22787","url":null,"abstract":"<p>Several standardized systems for nongynecological cytopathology have been published following the successful implementation of The Bethesda System for Reporting Cervical Cytology. Each of these systems comprises a set of reporting categories accompanied by a risk of malignancy. However, in most cases, these risk of malignancy estimates have not been based on high-quality evidence and often may not be consider proper “risks” (because they have been estimated based on cross-sectional studies). This commentary discusses the problems related to the data used to generate these risks. To make nongynecological cytopathology reporting more evidence-based, large-scale prospective cohort studies and randomized trials, in addition to high-quality systematic reviews and meta-analyses, should be performed.</p>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 6","pages":"335-339"},"PeriodicalIF":3.4,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An uncertain balance: In search of the sweet spot for cancer screening","authors":"Bryn Nelson PhD,&nbsp;William Faquin MD, PhD","doi":"10.1002/cncy.22785","DOIUrl":"https://doi.org/10.1002/cncy.22785","url":null,"abstract":"&lt;p&gt;After decades of aggressive cancer treatments, multiple studies have forced a reckoning of overtreatment for low-risk prostate, cervical, breast, and other cancers. Some studies of patients with low-risk prostate cancer managed by active surveillance, for example, have reported 10-year prostate cancer-specific survival rates of nearly 100%. A 2015 study, by contrast, found that of roughly 3000 men who had a life expectancy of less than 10 years and were diagnosed with low-risk prostate cancer, 67% had been overtreated.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In addition to averting the harm of increased treatment-related genitourinary and gastrointestinal toxicity, the authors wrote that “the ability to avoid treating the 80% of men with lowgrade disease who will never die of prostate cancer would save $1.32 billion per year nationally.”&lt;/p&gt;&lt;p&gt;Just as costly preventive care can lead to potential undertreatment and poor patient outcomes by undermining screening access and follow-up, overtreatment without clear evidence of benefits can contribute to avoidable harms and unnecessary costs for the US health care system.&lt;/p&gt;&lt;p&gt;The studies documenting continued overtreatment, however, raise important questions about whether such care is necessarily inappropriate in all cases and whether researchers have the tools needed to make that distinction. Researchers who spoke with &lt;i&gt;CytoSource&lt;/i&gt; said that the decision-making often comes down to subjective judgment calls based in part on incomplete medical records, a lack of reliable risk stratification, limited high-quality imaging, conflicting guidelines, and strong patient preference. “This is the art of medicine, which is not very scientific,” says Sylvia L. Asa, MD, PhD, a professor of pathology at Case Western Reserve University in Cleveland, Ohio. “We’re not there yet.”&lt;/p&gt;&lt;p&gt;The ongoing controversy over how best to manage low-risk thyroid cancer offers one cautionary tale about the difficulty of finding the right balance. Dr Asa, for example, has found small incidental cancers in up to 24% of patients’ surgically resected thyroid glands. “They are very common,” she says. “They are readily accessible. People have palpation of their neck, we find something, they do an ultrasound, what we find clinically is probably completely irrelevant, but a small incidental cancer is identified and then panic ensues.”&lt;/p&gt;&lt;p&gt;On the basis of a diagnosis of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), patients routinely underwent total thyroidectomy and received radioactive iodine as treatments. The treatments can offer clear benefits to patients with aggressive cancers but not to patients with low-risk disease, and neither intervention is risk-free. “The problem I worry about is that this is a disease of young people,” Dr Asa says. “We’re giving radiation to young people, many of whom are still planning to have a family and we say it’s safe, but let’s just say if it were my daughter or my son, I really w","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"131 12","pages":"739-740"},"PeriodicalIF":3.4,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncy.22785","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138559110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grading medullary thyroid carcinoma on fine-needle aspiration cytology specimens with the International Medullary Thyroid Carcinoma Grading System: A cytologic–histologic correlation","authors":"Kartik Viswanathan MD PhD,&nbsp;D. Blake Behrman MD,&nbsp;Daniel J. Lubin MD","doi":"10.1002/cncy.22778","DOIUrl":"10.1002/cncy.22778","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medullary thyroid carcinoma (MTC) is a rare cancer of parafollicular C-cell origin. The International MTC Grading System (IMTCGS) incorporates mitotic activity, the presence of necrosis, and the Ki67 proliferation rate (PR) to classify MTCs as low or high grade. The ability to predict IMTCGS grade in cytology was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MTCs with cytology and subsequent surgical follow-up were reviewed. Cytology slides were reviewed for mitotic figures, apoptoses, and necrosis, and a Ki67 PR was calculated when possible. Findings were correlated with final IMTCGS grade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five MTC fine-needle aspirations (FNAs) were identified, with nine identified as high grade (36%). By using a PR cutoff of 5%, Ki67 on FNA material (Ki67FNA) showed 92% concordance (<i>n</i> = 22 of 24) with surgical Ki67 and a correlation coefficient (<i>R</i>²) of 0.72. Sensitivity and specificity of Ki67FNA for predicting high-grade MTC were 38% and 100%, respectively. Multiple mitotic figures were present in a single slide of 43% (<i>n</i> = 3 of 7) of evaluable high-grade MTCs, whereas only one of 16 low-grade MTCs showed a single mitotic figure. Definitive apoptoses were present in five of seven high-grade MTC FNAs but were absent in 16 low-grade MTCs. The sensitivity and specificity of apoptoses/necrosis on cytology for high-grade MTCs were 71% and 88%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ki67FNA ≥5% shows low sensitivity but high specificity for predicting high-grade MTC. The presence of multiple mitotic figures in a single slide or definitive apoptotic bodies are both highly suggestive of high-grade MTC, and should warrant a close examination for necrosis and a careful Ki67 PR count.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9410,"journal":{"name":"Cancer Cytopathology","volume":"132 4","pages":"224-232"},"PeriodicalIF":3.4,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138558330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}