Andrew A Renshaw

..Finally, patients with initially negative AFS results and thrombocytosis deserve to have additional evaluation of the AFS specimens...

..More restricted workloads (≤41 slides/d, ≤4.5 h/d) for manual screening may perform significantly better than automated screening devices as measured by histologic cervical intraepithelial neoplasia 2 and above...

..We conclude that for cases of dysplasia and atypia, NOS, review of the gross specimen and submission of up to 4 additional sections identify all significant lesions, and submission of the entire gallbladder is not justified...

..Laboratories using the TIS should restrict workload to seven ECA adjusted slides/day (maximum actual slides/day = 700/ECA percentage)...

..An additional 26 aspirates could be diagnosed as adequate without any false negative cases. Histologic follow-up suggests that the current criteria for adequacy can be lowered to improve specificity while retaining excellent sensitivity...

..For a laboratory with an ECA rate of 10%, this represents a total workload of 50-70 slides/day. We conclude that measuring the ECA-adjusted workload is a valuable method to assess workload for the ThinPrep Imaging System...

..While these results are preliminary and additional studies are warranted to confirm them, our results may be useful in monitoring workload limits in gynecologic cytology...

..Previous work has suggested that some types of "atypical follicular cells" have different risks of malignancy...

..Non-diagnostic rates for thyroid fine needle aspiration vary considerably, but reasons for this variation are poorly understood...

..The risk of malignancy for a benign diagnosis in a thyroid fine-needle aspiration is controversial because of lack of histologic follow-up...

..1 cm) of the breast is a well-known and well-characterized entity in excision specimens, the significance of small foci of invasion in breast core needle biopsies has not been well described...

..Although the cytologic features of papillary thyroid carcinoma in fine-needle aspiration specimens are well known, the correlation of these features with the ability of cytologists to identify this tumor has not been well studied...

..This laboratory sought to determine whether criteria for this diagnosis could be improved by subcategorizing cases into specific patterns, including the atrophic pattern, and determining their risk of malignancy...

..Nevertheless, additional information is becoming available to the cytologist, often from untraditional sources, and the best way to use that information to improve the quality of cytology is not yet known...

..The ASC/SIL ratio for CTs varies widely between and within laboratories, and may correlate with the use of location guided screening. Very low ASC/SIL ratios are unusual, and CTs with low ratios may warrant further evaluation...

..Tumors smaller than 0.5 cm and tumors larger than 3 cm may be more difficult to successfully aspirate on FNA, and the follicular variant may be more difficult to recognize as papillary...

..The author described 18 cases with a spectrum of cytologic appearances...

..The variance in these models is likely high reflecting a wide range of individual cytotechnologist performance. Strategies to most effectively incorporate this data in the management of workload in the laboratory are reviewed...

..However, the reliability of expert opinion alone in selecting slides of a specific cytodiagnosis that can be reproducibly and reliably identified by subsequent reviewers has not been determined...

..These results support the use of participant evaluation of cases to continually improve the quality of cases in this program...

....

....

..Whether this is true of cases of HSIL in ThinPrep Pap Test specimens is not known...

....

..CONCLUSION: Cases of specimens of leukemia/lymphoma in cerebrospinal fluid are more likely to be misdiagnosed as benign if they are Papanicolaou-stained or have 200 abnormal cells...

....

....

..These results have implications for the design of fair proficiency tests. Proficiency testing can be designed with the necessary number of reviews needed for slide validation...

..9% of cases and detected 88% of amendments. These data can be used to define material for directed blinded review that is relatively high in potential errors...

..Workload is extensively regulated in gynecologic cytology. However, sensitive monitors of excessive workload are not available...

..We review the cytologic findings from 16 aspirates of adenocarcinoma/metastatic carcinoma that were frequently misclassified as hepatocellular carcinomas and compare them with 17 cases that were rarely misclassified...

..Whether this is also true of cases of low-grade squamous intraepithelial lesion is not known...

..Participant performance on conventional mixed cases is distinctly different from performance on ThinPrep mixed cases...

....

..Awareness of these patterns may aid in avoiding misdiagnosis...

....

..To the authors' knowledge, the results of this method have not been previously published...

..CONCLUSION: These data from expert-referenced and biopsy-proven cases suggest that adenocarcinoma in situ is not as easily recognized or categorized as other serious diagnoses...

..In ThinPrep specimens, however, these groups are more likely to be labeled as glandular lesions, owing to their smooth contoured borders and small nuclei...

..Cytologic interpretations of LSIL are made with greater precision than those of HSIL and may represent a more appropriate endpoint to measure the precision performance of gynecologic cytology laboratories...

..Such data suggest that workload limits would have no effect at limiting or reducing error rates in surgical pathology or nongynecologic cytology...

..To the best of the authors' knowledge, longitudinal studies examining the effect of increasing workload on the performance of individual CTs have not been performed previously...

....

..These results suggest second review of surgical pathology is of value, but the best selection of cases to be reviewed remains to be defined...

..The relatively high rate of disagreement found with blinded review coupled with the very low rate of error highlights the substantial potential for bias in nonblinded reviews...

....

....

..Blinded review, performed so that errors can be corrected in a timely manner, and eventually integrated into an interlaboratory review process, represents a realistic and fair method to provide quantitative quality assurance information...

..Although the cytologic features of squamous cell carcinoma in ThinPrep specimens are well known, whether these features are different in cases that are easily identified than in cases that are more difficult to identify is not known...

..Methods for determining the statistical validity of this method were evaluated...

....

..The value of blinded review in surgical pathology is not known...

..Sending all slides is associated with a higher disagreement rate than sending only selected slides, but this disagreement comes from correcting and introducing error...

..The sensitivity of gynecologic cytology has been measured in several different ways. The current review summarizes the major sources of bias and the results of these efforts...

..In the current study, the authors sought to identify an appropriate measure for AUS use based on experience to date with TBS...

..Inking of breast core specimens is a simple, inexpensive, and effective way to help reduce the chance of specimen mix-up...

..Women in whom biopsy sites are excised are still at risk for subsequent DCIS and IC...

..Only a minority of these patients are found to have carcinoma at the time of resection. In the current study, an attempt was made to define criteria that were more specific for Hürthle cell carcinoma without a loss in sensitivity...

..Disagreement rates for interdepartmental consultation ranged from 5.9% to 10.7%, but only 33% to 79% represented errors. Additional consultation, tissue, and testing results can aid in distinguishing disagreements from errors...

..Because the published error rates are low, a relatively large number of cases need to be reviewed and a relatively great difference in error rate needs to exist to show a significant difference in performance in surgical pathology...

..Both gynecologic cytology and surgical pathology use similar methods to measure diagnostic error, but differences exist between how these methods have been applied in the 2 fields...

....

....

..0%; P = .03). Patients with 2 sequential nondiagnostic thyroid aspirates have a very low risk of malignancy. Cytologists should strive to better convey this risk in their reports...

..Routine measurement of radioactivity for all sentinel node specimens in the pathology laboratory is recommended...

..Using controls, however, requires significant alteration in the laboratory workflow, and much lower and variable workload limits for CTs, compared to those approved by FDA...

..08). The concentrated technique is as sensitive as routine direct smears for sampling sentinel nodes for breast carcinoma and may be associated with a lower screening error rate...

..Core needle biopsy has a higher adequacy rate than FNA but seems less sensitive, especially for papillary carcinoma. The combination of FNA with core needle biopsy seems to have the highest adequacy rate and sensitivity...

..48). Spray fixation results in 96% more follicular cells in scant thyroid aspirates than immersion fixation and a significant increase in adequate aspirates without a significant increase in the atypia rate related to preparation...

..Previous studies have shown that Gleason scores assigned by general pathologists have a low correlation with those assigned by urologic pathologists, and that general pathologists tend to undergrade prostate carcinoma...

..The only question that remains is, "How we will be able to escape?"..

....

..03). CONCLUSION: Patients with comedo ductal carcinoma in situ with a cribriform/papillary pattern or tumor involving more than 4 mm with lobular extension in breast core needle specimens are at increased risk for invasion at excision...

..0 cm often are termed incidental or occult tumors. In the current study, the author sought to determine the incidence of such tumors at his institution over a relatively short period...

..Patients with a benign diagnosis after an atypical diagnosis have a risk of malignancy between the risks of a single benign or atypical diagnosis. Cytologists should strive to better communicate this risk...

..Internal consultation has a significant and measurable impact on the practice of surgical pathology...

..The vast majority of mucinous lesions of the breast can be diagnosed accurately by core needle biopsy. Whether all such lesions require excision is not known at this time...

..In the current study, the authors investigated the impact of reducing and eliminating this category on the sensitivity and predictive values for detecting squamous intraepithelial lesions (SILs)...

..We use data from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology to evaluate the accuracy of fine-needle aspiration (FNA) biopsy for diagnosing pulmonary hamartoma (PH)...

..To compare prostate-specific antigen (PSA) outcome after radical prostatectomy (RP) for prostate cancer in African-American and white men using previously established risk groups...

..Consideration should be given to combining EBRT with hormonal therapy in these patients...

..2%, but was changed from intermediate or high risk to low risk in only 0.9%. Genitourinary pathology review would have changed management in approximately 10% of men, mainly in the direction of combined therapy over monotherapy...

..To identify an association between perineural invasion (PNI) and cancer-specific survival in patients with prostate cancer after standard-dose external beam radiation therapy (RT)...