Diagnostic dilemmas in pulmonary cytology

Crapanzano, John P.; Zakowski, Maureen F.

doi:10.1002/cncr.10136

Cited by 70 publications

(67 citation statements)

References 21 publications

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“…Difficulties distinguishing malignant cells from atypical reactive cells based on cytomorphology have long been recognized in the cytology literature and remain as diagnostic problems. [17][18][19][20] The importance of monitoring and sharing errors to improve the practice of pathology and the contribution that root-cause analysis can make in decreasing the incidence of future errors have been recognized by pathologists and endorsed by the Joint Commission and the Institute of Medicine. [21][22][23][24] The root-cause analysis process recognizes that diagnostic problems usually have multiple causes and helps to identify and delineate the components that contribute to medical errors.…”

Section: Clinical Impact Of Frozen Section Errors and Deferralsmentioning

confidence: 99%

Root Cause Analysis of Problems in the Frozen Section Diagnosis of In Situ, Minimally Invasive, and Invasive Adenocarcinoma of the Lung

Walts

Marchevsky

2012

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Frozen sections can help determine the extent of surgery by distinguishing in situ, minimally invasive, and invasive adenocarcinoma of the lung.Objective.-To evaluate our experience with the frozen section diagnosis of these lesions using root-cause analysis.Design. Results.-There were no false-positive diagnoses of malignancy. Frozen section errors and deferrals were identified in 12.1% (27 of 224) and 6.3% (14 of 224) of the cases, respectively. Significantly more errors occurred in the diagnosis of in situ and minimally invasive adenocarcinoma than in the diagnosis of invasive adenocarcinoma (P , .001). Frozen section errors and deferrals were twice as frequent in lesions smaller than 1.0 cm (P ¼ .09). Features significantly associated with errors and deferrals included intraoperative consultation by more than one pathologist (P ¼ .003) and more than one sample of frozen lung section (P ¼ .001). Inflammation with reactive atypia, fibrosis/scar, sampling problems, and suboptimal quality sections were identified in 51.2% (21 of 41), 36.6% (15 of 41), 26.8% (11 of 41), and 9.8% (4 of 41) of the errors and deferrals, respectively (more than one of these factors was identified in some cases). Frozen section errors and deferrals had significant clinical impact in only 4 patients (1.8%); each had to undergo completion video-assisted thoracoscopic lobectomy less than 90 days after the initial surgery.Conclusions.-The distinction of in situ from minimally invasive adenocarcinoma is difficult in both frozen and permanent sections. We identified several technical and interpretive features that likely contributed to frozen section errors and deferrals and suggest practice modifications that are likely to improve diagnostic accuracy.

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Section: Clinical Impact Of Frozen Section Errors and Deferralsmentioning

confidence: 99%

Root Cause Analysis of Problems in the Frozen Section Diagnosis of In Situ, Minimally Invasive, and Invasive Adenocarcinoma of the Lung

Walts

Marchevsky

2012

Archives of Pathology &Amp; Laboratory Medicine

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“…6 Sometimes benign and malignant lesions cannot be discriminated by morphology with certainty, and reactive changes of bronchial and alveolar epithelium, air-drying artifacts during smear preparation, and poorly preserved specimens sometimes impede or even render a distinct cytological diagnosis impossible. [7][8][9][10] Accordingly, cytology sometimes leaves an equivocal (2.9% of cases in a single institution; 8.6% from a single hospital during a 9-month period in our institution) or inconclusive result even in the hands of experienced observers. 5,11,12 To prevent repeated diagnostic efforts and potentially harmful invasive diagnostic procedures, it is essential to enhance diagnostic accuracy in these cases.…”

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confidence: 69%

Equivocal cytology in lung cancer diagnosis

Schramm

Wrobel

Born

et al. 2011

Cancer Cytopathology

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BACKGROUND:Sometimes, cytological lung cancer diagnosis is challenging because equivocal diagnoses are common. To enhance diagnostic accuracy, fluorescent in situ hybridization (FISH), DNA‐image cytometry, and quantitative promoter hypermethylation analysis have been proposed as adjuncts.METHODS:Bronchial washings and/or brushings or transbronchial fine‐needle aspiration biopsies were prospectively collected from patients who were clinically suspected of having lung carcinoma. After routine cytological diagnosis, 70 consecutive specimens, each cytologically diagnosed as negative, equivocal, or positive for cancer cells, were investigated with adjuvant methods. Suspicious areas on the smears were restained with the LAVysion multicolor FISH probe set (Abbott Molecular, Des Plaines, Illinois) or according to the Feulgen Staining Method for DNA‐image cytometry analysis. DNA was extracted from residual liquid material, and frequencies of aberrant methylation of APC, p16INK4A, and RASSF1A gene promoters were determined with quantitative methylation‐specific polymerase chain reaction (QMSP) after bisulfite conversion. Clinical and histological follow‐up according to a reference standard, defined in advance, were available for 198 of 210 patients.RESULTS:In the whole cohort, cytology, FISH, DNA‐image cytometry, and QMSP achieved sensitivities of 83.7%, 78%, 79%, and 49.6%, respectively (specificities of 69.8%, 98.2%, 98.2%, and 98.4%, respectively). Subsequent to cytologically equivocal diagnoses, FISH, DNA‐image cytometry, and QMSP definitely identified malignancy in 79%, 83%, and 49%, respectively. With QMSP, 4 of 22 cancer patients with cytologically negative diagnoses were correctly identified.CONCLUSIONS:Thus, adjuvant FISH or DNA‐image cytometry in cytologically equivocal diagnoses improves diagnostic accuracy at comparable rates. Adjuvant QMSP in cytologically negative cases with persistent suspicion of lung cancer would enhance sensitivity. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.

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“…1,6 Samples obtained by BB have traditionally been prepared as smears or CytoSpin preparations, followed by staining. An advantage of CytoSpin preparations relative to LBPs is that modified Giemsa-stained slides may be prepared in addition to Pap-stained slides.…”

Section: Resultsmentioning

confidence: 99%

Do Liquid-Based Preparations of Pulmonary Bronchial Brushing Specimens Perform Differently From Classically Prepared Cases for the Diagnosis of Malignancies? Observations From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology

Tabatabai

Auger

Kurtycz

et al. 2015

Archives of Pathology & Laboratory Medicine

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Context.-Pulmonary bronchial brushing specimens can be processed by liquid-based or conventional methods. The ability to accurately diagnose a pulmonary malignancy with a liquid-based preparation (LBP) versus a conventional preparation may differ.Objective.-To compare the performance of LBPs of malignant pulmonary bronchial brushing specimens with the performance of conventional preparations.Design.-Participant responses from 553 malignant pulmonary bronchial brushing samples were evaluated for concordance with the general diagnosis. The performance of LBPs was compared with that of classic preparations. A nonlinear mixed model was used to analyze the performance by reference diagnosis, preparation type, program years, participant type, and the interaction terms between these 4 factors.Results.-Concordance with the general category of malignant disease was observed in 95.2% of conventional Papanicolaou-stained, 90.9% of modified Giemsa-stained, and 96.9% of LBP (P , .001) samples. The results were significantly different between individual reference diagnoses (P , .001). The performance of LBPs was consistently higher for most diagnoses and was significantly better for squamous cell carcinoma (P ¼ .005), small cell carcinoma (P , .001), and metastatic carcinoma not otherwise specified (P , .001). All participant types performed significantly better with LBPs of small cell carcinoma. Pathologists and cytotechnologists performed significantly better with LBPs of squamous cell carcinoma. A significantly higher concordance was observed between the general diagnosis and program years 2007-2011 versus 2001-2006 (P ¼ .006).Conclusions.-Liquid-based preparations performed better than conventional methods, with significantly higher performance in squamous cell, small cell, and metastatic carcinomas. Improved performance over time may reflect more frequent use of LBP methods and increased familiarity with interpreting the morphologic findings.

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Diagnostic dilemmas in pulmonary cytology

Cited by 70 publications

References 21 publications

Root Cause Analysis of Problems in the Frozen Section Diagnosis of In Situ, Minimally Invasive, and Invasive Adenocarcinoma of the Lung

Root Cause Analysis of Problems in the Frozen Section Diagnosis of In Situ, Minimally Invasive, and Invasive Adenocarcinoma of the Lung

Equivocal cytology in lung cancer diagnosis

Do Liquid-Based Preparations of Pulmonary Bronchial Brushing Specimens Perform Differently From Classically Prepared Cases for the Diagnosis of Malignancies? Observations From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology

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