Cancer Cytopathology

In this article, the authors discuss the advantages (“petals”) and disadvantages (“thorns”) of rapid on-site evaluation (ROSE) performed for minimally invasive procedures such as computed tomography (CT)-guided and endoscopic-guided fine-needle aspiration with a focus on deep-seated lymph nodes. One of the main advantages is increased diagnostic accuracy. Disadvantages include the need for highly trained professionals and a lack of adequate reimbursement.

The authors review the reporting systems that have been introduced in the literature for urinary cytology. Their review highlights the diagnostic categories and criterion for classification of each scheme and how they have evolved as histologic classification has changed and knowledge of the test has improved.

The authors describe a template for urologic cytology samples that is effective in targeting those patients who need to undergo cystoscopy. Greater than 66% of patients who have biopsy confirmation of high-grade urothelial carcinoma had a preceding cytologic diagnosis of atypical urothelial cells, favor high-grade carcinoma or high-grade urothelial carcinoma.

Urinary tract specimens that are diagnosed as highly suspicious for high-grade urothelial carcinoma often contain cells with hyperchromasia, irregular nuclear borders, an increased nucleus-to-cytoplasm ratio, and anisonucleosis. These features have a significant association with high-grade urothelial carcinoma when surveillance, but not hematuria, is an indication for the sample.

Cytology is an important component of the preoperative evaluation of patients with pancreatic cysts. The category of high-grade atypical epithelial cells, rather than “positive” (malignant) epithelial cells, is a sensitive, high-risk feature for malignancy with 85% accuracy for detecting pancreatic cysts that require resection.

The monoclonal antibody human pancreatic cancer fusion 2 (HPC2) 1-B3 immunostains pancreatic intraductal papillary mucinous neoplasms and ductal adenocarcinoma. This marker also appears to be secreted by dysplastic pancreatic cells, which may lead to a new rapid screening assay.

Compliance with practice guidelines for atypical glandular cells on cervical cytology has improved, but remains suboptimal, especially in women at high risk. Cytopathologist recommendations on cytology reports correlate with the types of evaluations women with atypical glandular cells receive.