Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh
-
Upload
mahra-nourbakhsh -
Category
Health & Medicine
-
view
365 -
download
3
Transcript of Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh
![Page 1: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/1.jpg)
Adequacy Criteria for Cytology Specimens
Mahra Nourbakhsh, MD, PhDResident Physician, PGY-3Anatomical Pathology
![Page 2: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/2.jpg)
What is an adequate sample?
Disappointing and Confusing!!
![Page 3: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/3.jpg)
• Technique (FNA, Brushing, Washing, Exfoliation, etc.)
• Operator (Clinician, Surgeon, Radiologist, Pathologist)
• Organ• Type of lesion (Solid, Cystic, Solid/Cystic)
• Pathology: (Non/Neoplastic, Malignant, Benign, inflammatory)
• Complexity of the pathology (Tumor with dual differentiation, carcinosarcoma, warthine tumor, etc.)
• Preparation, processing, staining• Patient’s condition (age, gender, history, clinical
findings)
There is no simple answer
![Page 4: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/4.jpg)
False Negative & False Positive
![Page 5: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/5.jpg)
Representative Sample
Normal Lesion
![Page 6: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/6.jpg)
• Webster’s Dictionary: sufficient in quality and/or quantity to satisfy one’s needs.
• Bethesda System: Appropriate labeling and identifying information; Relevant clinical information; Adequate numbers (a compilation from the literature) of well-preserved and well-visualized representative component cells
• My approach to adequacy: When there is discordance in clinical, radiologic and cytology findings, the adequacy of the specimen is questionable.
What is an adequate sample?
![Page 7: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/7.jpg)
Uterine Cervix
• A consensus on adequacy of cervical smear has been reached however the adequacy should still be considered case by case.
• Variable:1. Obscuring Element2. Minimum Squamous Cellularity3. Presence of Transformational Zone
(absence does not automatically indicates unsatisfactory specimen)
![Page 8: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/8.jpg)
Uterine Cervix Obscuring Elements
•Elements:– Blood– Inflammation– Necrotic artifacts
•If covers more than 75% of epithelial cells unsat
![Page 9: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/9.jpg)
Uterine CervixMinimum Squamous Cellularity
•Liquid Base– At least 5000 squamous cells– Metaplastic squamous cell are acceptable– Endocervical and Endometrial cells are not
included.
•Conventional– At least 8000-12000 squamous cells– Metaplastic squamous cell are acceptable– Endocervical and Endometrial cells are not
included.
![Page 10: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/10.jpg)
Uterine CervixPresence of T Zone
•T-Zone:– At least 10 well-preserved endocervical or
squamous metaplastic cells singly or in cluster
•Absence of T-Zone does not automatically classifies the specimen as unsatisfactory.
•Report if T-zone present or absent.
![Page 11: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/11.jpg)
Uterine Cervix
35F TAH 2°to a benign condition
Estimated cells of 5000-10000
Hysterectomy
![Page 12: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/12.jpg)
Uterine Cervix
56F TAH 2°to Endometrial CA Estimated cells of 5000-10000
Hysterectomy
![Page 13: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/13.jpg)
Uterine Cervix
56F with pelvic radiation Estimated cells of 5000-10000
Hysterectomy
![Page 14: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/14.jpg)
Uterine Cervix
46F with recent chemotherapy Estimated cells of 5000-10000
Hysterectomy
![Page 15: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/15.jpg)
Uterine CervixDoes reduction of cellularity from 8000 to 2000 is wise in post chemotherapy, post pelvic radiation or hysterectomy?
Lu Ch, et. Al. Cancer Cytopathol. 2010;118 (6):474-81
•7059 pap, 1361 had Hx of pelvic radiotherapy, chemotherapy and hysterectomy.
•Results:
•No increase in false-negative rate•Hysterectomy does not significantly correlates with unsatisfactory Pap
Unsat Criteria <8000 <2000Post Radiotherapy 17.9% 7.6%
Post Chemotherapy 19.6% 6%
![Page 16: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/16.jpg)
Respiratory Tract (Sputum)
• Guideline of Pap Society of Cytopathology Task Force
Mod Path. 1999; 12 (4): 427-436
1. Must contain alveolar macrophages2. No numerical cut point for macrophages,
but should be easily identifiable3. Should be large enough to prepare at least
2-4 slides. 4. Sensitivity to diagnose malignancy increase
from 42% with a single specimen to 91% with five specimen.
![Page 17: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/17.jpg)
Respiratory Tract (washing and brushing)
• Guideline of Pap Society of Cytopathology Task Force
Mod Path. 1999; 12 (4): 427-436
1. Large number of (not exactly defined), well-preserved, optimally stained ciliated bronchial epithelial cells and macrophages.
2. Should not be heavily contaminated with oral squamous cells or saprophytes
3. Absence of obscuring elements.
![Page 18: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/18.jpg)
Respiratory Tract (BAL)• Guideline of Pap Society of Cytopathology Task
ForceMod Path. 1999; 12 (4): 427-436
1. >5% of ciliated or squamous epithelial cells contamination of distal airways.
2. Chamberlain et.al criteria of inadequacy:Chamberline DW, et. Al. Acta Cytol 1987;31:599-605
• Less than 10 alveolar mac/ 10 hpf• Less than 25 alveolar mac/10hpf and one of the
followings:– Excessive epithelial cells with degenerative features or
exceeding number of macs– Mucopurulent exudate of PMN
• Numerous obscuring RBC• Degenerative changes or artifact obscuring cell
identity
![Page 19: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/19.jpg)
Respiratory Tract (FNA)
• Guideline of Pap Society of Cytopathology Task Force
Mod Path. 1999; 12 (4): 427-436
1. Complex issue2. No universally acceptable criteria in the
absence of abnormality.3. Depends on procedure, operator skills and
location and size of the lesion. 4. The findings are insufficient to account for
the lesion5. Use non-diagnostic rather than Unsat
![Page 20: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/20.jpg)
Respiratory Tract • 65 M smoker, 5 cm speculated mass, BAL
![Page 21: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/21.jpg)
Too Much Text
![Page 22: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/22.jpg)
Urine and Bladder
• Usefulness of the specimen to diagnose or broach the suspicion of urothelial carcinoma.
• Is determined by the interplay of: 1. Collection type2. Cellularity3. Volume4. Cytomorphological findings
![Page 23: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/23.jpg)
Urine and Bladder
• Limited publication on the role and and specific qualifiers of collection type, cellularity, and volume.
• Adequacy algorithm based on Paris system recommendation:
1. The communication between volume, collection type and cellularity.
2. Guide for individual labs in validating appropriate cut-offs for their own practice settings
3. Frame the future investigations dealing with adequacy of urine specimen
![Page 24: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/24.jpg)
Urine and Bladder
CellularityCollection Type
Volume
![Page 25: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/25.jpg)
Urine and Bladder: Cellularity
Instrumental Urinary Specimen1.Sat: 20 well-preserved, well-visualized. Urothelial cells per 10 high-power fields.2.Sat but limited by low cellularity: 10-20 cells3.Unsat: <10 cells
Prather J, Arville B, Chatt G, et al. J Am Soc Cytopathol. 2015;4:57-62
•1322 urothelial cells (10 per 10 hpfs) for diagnosis of atypical urothelial cells and above.
Prather J, et. al. J Am Soc Cytopathol. 2013; 2: S24-S25
1.2644 urothelial cells (20 per 10 hpfs) in the absence of atypical cells or higher to increase the positive predictive value of this test.
Prather J, Arville B, Chatt G, et al. J Am Soc Cytopathol. 2015;4:57-62
![Page 26: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/26.jpg)
Urine and Bladder: Cellularity
Voided Urine Specimen
1.No paper in literature review investigating the cellularity required for adequacy in voided urine specimen.
2.However two studies suggest cell counts for surveillance but are older studies (>80 urothelial cells/hpf?!).
Morse N, et. al. Acta Cytol 1974: 18:312–315Murphy WM, et. al. J Urol 1981:126:320–322.
![Page 27: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/27.jpg)
Urine and Bladder: Volume• At least 30 ml of urine is required in voided
urine samples.VandenBussche CJ, et. al. Cancer Cytopathol. 2016;124:174-180
1. Indication of voided urine cytology were not provided.
2. SurePath method.
• The Paris system recommendation shows two microscope-dependent nodes precede volume in the adequacy algorithm:
1. finding of atypical, suspicious, or malignant cells2. an adequate number of benign urothelial cells
![Page 28: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/28.jpg)
Fluids (Pleural, Pericardial, Peritoneal)
• Adequacy have no role in providing procurement information.
• Adequacy have a role in identifying processing problem.
• In the absence of abnormality or acellular fluid, no criteria has been indicated for adequacy.
Crothers, BA. Et al. Arch Pathol Lab Med. 2009 Nov;133(11):1743-56
![Page 29: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/29.jpg)
Peritoneal Wash
• In the absence of abnormal cells presence of mesothelial cells is recommended for reporting a specimen adequate.
McGowan L. et. Al. Obstet. Gynecol. 1989;73:136-137
• No consensus is reached for adequacy of washes.
![Page 30: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/30.jpg)
CSF
• Adequacy have no role in providing procurement information. It is based on how much the lesion exfoliates.
• No consensus has reached
My dog shed
![Page 31: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/31.jpg)
GI Tract (FNA)• An adequate is one that explain the
clinical/endoscopic findings.
• It is reasonable to consider a FNA adequate if there is sufficient cellularity to suggest limited DDX or explain the clinical/radiologic findings.
• Scant cellularity, obscuring elements, poorly preserved samples are the reasons for unsatisfactory aspirates
•
![Page 32: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/32.jpg)
GI Tract (Brushing)
• No consensus is reached regarding adequacy.
• An adequate brushing is one with 6-10 well-visualized and well-preserved epithelial cell groups (at least 6 cells/cluster).
• Too few cells, poor preservation, degenerated cells, obscuring elements render the specimen unsatisfactory
Moody Dr. CAP Today. August 2003, pp 68-70
![Page 33: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/33.jpg)
Breast
• Two opposite views toward the adequacy
• An epithelial cell cluster (ECC) cut off number for adequacy
• Non cellular features such as type of the lesion instead of ECC cut off number
![Page 34: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/34.jpg)
Breast
• Study #1: 4455 FNA, 51 false negative in MD Anderson Cancer Institute from 1985-1995.
Boerner S., and Sneige N. Cancer 1998; 84: pp. 344-348
– Criteria: 6 ECCs on all slides for a sample to be classified as adequate,
– Results: 50% of the false-negative was avoided.
presence ≥ 10 intact bipolar cells per 10 medium-power fields (×200),
![Page 35: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/35.jpg)
Breast• Study #2: 1779 FNA, 21 false negative
in Duke University Medical Center (1992-1995) and UCLA Center for the Health Sciences (1984-1990).
Boerner S., and Sneige N. Cancer 1998; 84: pp. 344-348
– Criteria: 6 ECCs or >10 bipolar cells in each of medium power field (X200) on all slides for a sample to be classified as adequate,
– Results: False negative rate 1.5% and unsat ratio of 20.2%.
Layfield L.J., Mooney E.E. et. al. Cancer 1997; 81: pp. 16-21
![Page 36: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/36.jpg)
Breast• F32 with no FHx of breast malignancy with a Cystic Lesion
at 10 O’clock, measuring 3.2 cm in largest dimensionpresence ≥ 10 intact bipolar cells per 10 medium-power fields (×200),
![Page 37: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/37.jpg)
Breast• F52 with a Solid mass at 7 O’clock, measuring 1.8 cm in
largest dimensionpresence ≥ 10 intact bipolar cells per 10 medium-power fields (×200)
![Page 38: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/38.jpg)
Breast (conclusion)• No consensus reached.
• For suspected epithelial lesion, 6 epithelial cell cluster of 5-10 cells each reduces the false negativity.
• For non-epithelial lesion no minimal cell group is proposed.
• Use of triple test is highly recommended.
• No consensus reached for nipple discharge cytology
![Page 39: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/39.jpg)
Thyroid • Minimum six group of well preserved , well
visualized follicular cells
• Each group contains a minimum of 10 cells.
• Preferably all six groups are on same slide
• Fewer follicular cell groups may be accepted if there is abundance of lymphocytes, granulomas or colloid.
![Page 40: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/40.jpg)
Thyroid
![Page 41: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/41.jpg)
Thyroid• F43 with a cystic nodule at inferior pole of Lt.
thyroid, measuring 2.8 cm presence ≥ 10 intact bipolar cells per 10 medium-power fields (×200)
![Page 42: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/42.jpg)
Thyroid• F39 with a cystic nodule at superior pole of Rt.
thyroid, measuring 2.9 cm presence ≥ 10 intact bipolar cells per 10 medium-power fields (×200)
![Page 43: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/43.jpg)
Thyroid• 6 months later
![Page 44: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/44.jpg)
Salivary Gland
• Adequacy criteria has not been established yet.
• The rate of false negative is related to type of lesion, the operator (Cytopathologist, vs. Radiologist vs. Surgeon).
• False negative results are most common with low-grade mucoepidermoid carcinoma, adenoid cystic carcinoma, and non-Hodgkin lymphoma
• False-positive diagnoses are seen with cystic lesions, particularly WT and pleomorphic adenoma (PA).
![Page 45: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/45.jpg)
Salivary Gland• Experience of UPMC: 294 case from 1999-
2012, with FNA and then surgical specimen obtained within 6 months.
Griffith CC, et. al, AM J Clin Pathol. 2015 Jun;143(6):839-53
• Adequacy Criteria: 4 hpf (×400) of epithelial cells
• Results: 28.2% inadequacy rate, including 38.6% non-neoplastic, 43.4% benign and 18.1% malignant including one case of high grade.
• Results: Specificity for pleomorphic adenoma 98.8% but sensitivity only 58.2%
![Page 46: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/46.jpg)
Lymph Node
• FNA of any lymph node: at least a moderate number of lymphocytes must be present.
• Well preserved, well visualized lymphocyte is required.
• Based on the location of the lymph node the adequate sample might be difficult to obtained.
![Page 47: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/47.jpg)
Lymph Node (mediastinum)
• Rapid On-Site Evaluation of FNA and Core Needle Biopsy
Choi, SM. et. Al. Ann Thorac Surg. 2016 Feb;101(2):444-50
• Using four sequential criteria, tissue core size, the presence of malignant cell, microscopic anthracotic pigments, and LD ‡40 cells/field, the sensitivity and accuracy rates increased from 64.4% to 98.6% and from 64.7% to 97.3%, respectively.
![Page 48: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/48.jpg)
Kidney
• Up to 30% of renal aspirates are non-diagnostic (inadequate)
• Repeat aspiration is helpful in 50% of case.
• Technical failure is number one reason for inadequacy.
• No consensus on adequacy criteria
![Page 49: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/49.jpg)
Kidney• Analysis of Results and Diagnostic Problem in 108 FNA of Renal
Masses in Adult.Truong, LD. et. Al. Diagnostic Cytopathol; 1999;20(6):339-349
Adequacy criteria in solid lesion:• Unsat:1. soft tissue and/or normal kidney tissue only2. Blood or necrotic material only3. Technically poor4. Scant cellularity: smear contains few cells or small cluster, the nature of which
cannot determined.
• Sat:1. Large number of well-preserved, isolated or cell clusters, which allow at least
limited DDX
![Page 50: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/50.jpg)
Kidney• Analysis of Results and Diagnostic Problem in 108
FNA of Renal Masses in Adult.Truong, LD. et. Al. Diagnostic Cytopathol; 1999;20(6):339-349
Adequacy criteria in cystic lesion:• Unsat:1. soft tissue and/or normal kidney tissue only2. Blood or necrotic material only
• Sat:1. Fluid regardless of cellularity
![Page 51: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/51.jpg)
Kidney• Analysis of Results and Diagnostic Problem in
108 FNA of Renal Masses in Adult.Truong, LD. et. Al. Diagnostic Cytopathol; 1999;20(6):339-349
Results:
1. The rate of unsat was 16% in lesion containing solid compartment and 0% in cystic lesion
2. Only one false negative case (out of 34) judged benign while later biopsy showed malignant RCC.
![Page 52: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/52.jpg)
Kidney• 72M with a cystic renal lesion
![Page 53: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/53.jpg)
Kidney
Current recommendation:
•No consensus, however it is reasonable to consider a FNA adequate if there is sufficient cellularity to suggest limited DDX.
•Specimen composed exclusively macrophages (typically cystic lesion) is best reported as non-diagnostic as cystic RCC can not be ruled out.
![Page 54: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/54.jpg)
Adrenal Gland, Ovary and Deep Solid Organs
• No Standard consensus.
• Similar to Kidney (and other deep solid organs), presence of sufficient cellularity to suggest limited DDXs.
• Scant cellularity, obscuring elements, poorly preserved samples are the reasons for unsatisfactory aspirates.
![Page 55: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/55.jpg)
Conclusion
• There is no simple/single criteria for adequacy
• Adequacy should remain in the discretion of cytopathologists even in the organ system with a defined adequacy criteria
• Clinical, radiologic and cytopathologic findings remain the most important factors for determining adequacy criteria
![Page 56: Adequacy criteria for cytology specimens by Dr. Mahra Nourbakhsh](https://reader036.fdocuments.in/reader036/viewer/2022081517/58acb2b51a28ab68608b59ff/html5/thumbnails/56.jpg)
Thank you!
Question/Discussion?!