Should uncertainty concerning the risk of malignancy be included in diagnostic (nongynecologic) cytopathology reports?

Abstract

In diagnostic cytology, the known site‐specific false positive rates at various anatomical sites for the risk malignancy (ROM) when a confirmed malignant diagnosis is made are comparatively well documented. ROM figures for diagnostic cytology specimens may vary according to the anatomical site of the specimen, the exact nature of the specimen received, the staining method(s) used, and the use of additional laboratory techniques including molecular profiling; furthermore, they often differ to some extent from institution to institution, between differing cytologists within the same institution, and over time. A brief literature review for a selected group of routine diagnostic cytology specimens shows a published ROM for a confirmed malignant diagnosis as follows: bile duct brushings, ~99% (range, 97%‐100%); breast fine needle aspiration, 98.5% (range, 92%‐100%); serous effusion fluid, 98.9% (range, 90%‐100% although lower for squamous cell carcinoma, mesothelioma, and lymphoma), pulmonary endobronchial ultrasound cytology, ~99% (range, 86.6%‐100%); thyroid FNA, 98% (range, 97%‐99% if NIFTP tumors are excluded), salivary gland FNA, ~90%; (range 57%‐100%) and lateral neck cyst FNA, ~99% (range, 95.5%‐100%). Because most diagnostic cytology specimens have a small but accepted false‐positive rate, this information is vitally important for the clinical management of patients and for shared patient decision making. In our view, the known false‐positive rate for a given diagnostic cytology specimen could be included within the cytology report to assist in explaining the limitations of the diagnostic cytology interpretation and help facilitate the clinical decision‐making process.

Global impact of the COVID‐19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries

“…when the suspicious category also is taken into account (+6.95%), which is conceivable considering that the risk of malignancy of this category is not negligible, generally ranging from 50% to 100%. 17 The significance of this "relative" increase in the percentage of malignant and suspicious diagnoses should be investigated further, bearing in mind that the majority of laboratories had a dramatic decrease in the "absolute" volumes of many specimens.…”

The Contributory Role of Cell Blocks in Salivary Gland Neoplasms Fine Needle Aspirations Classified by the Milan System for Reporting Salivary Gland Cytology

“…To increase communication with clinicians, false-positive result rates were recently recommended to be part of cytopathology reporting. In general, the false-positive rate is 10% in salivary gland FNAs [39].…”

Risk of malignancy assessment of the International System for Reporting Serous Fluid Cytopathology: Experience in a community hospital setting and comparison with other studies

“…1,2 Diagnostic uncertainty may occur with almost any entity on cytology evaluation, depending on the quality and quantity of the provided sample. 3 There are essential practice questions to be considered for serous fluid cytopathology diagnoses, such as using volume and/or cellularity to determine adequacy, defining a true-negative sample, and setting criteria for atypia and suspicious categories. 4 In 2020, the International System for Reporting Serous Fluid Cytopathology (ISRSFC) was published as the first attempt to suggest a tiered structure to provide standard reporting terminology for serous fluid cytopathology, recommending the scenarios in which these terminologies are used, and proposing some diagnostic criteria and clinical management strategies.…”