The international system for reporting serous fluid cytopathology—diagnostic categories and clinical management

Gomes, D; Chandra, Ashish; Crothers, Barbara A.; Kurtycz, Daniel F.I.; Schmitt, Fernando

doi:10.1016/j.jasc.2020.05.015

Cited by 87 publications

(156 citation statements)

References 18 publications

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“…We also noted effusion in 85.5% of our cases, and 64.4% of effusion smears showed definite cytomorphology suggestive of MM but confirmation by IHC on cell block was done in only 35.6% cases and subsequently treatment was started without biopsy. Upcoming International System for Reporting Serous Fluid Cytopathology (TIS) 2020 also states that diagnosis of malignancy, that is, MM, can be given on effusions on the basis of cytomorphology and when combined with ancillary studies, cytological diagnosis of malignancy must be considered definitive and as actionable as histology [16]. Future GCDMM will update the expanding role of cytology in mesothelioma diagnosis and management [17].…”

Section: Discussionmentioning

confidence: 99%

Role of Cytology in the Current Guidelines for Malignant Mesothelioma: Largest Study from India

et al. 2020

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Introduction: Cytology provides crucial window for early diagnosis of malignant mesothelioma (MM) since it is often the first and easily available material for evaluation, resulting in early treatment. Still, its role is overlooked in the current treatment guidelines. The aim of this study is to determine the sensitivity of cytomorphology and role of subsequent ancillary techniques in diagnosing MM. Methods: This is a 5-year retrospective analysis of MM in the tertiary oncology center to determine sensitivity of cytomorphology and subsequent role of immunohistochemistry (IHC) in final diagnosis of MM according to the guidelines for cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma (GCDMM) laid by International Mesothelioma Interest Group. Cytomorphology and immunocytochemistry from effusions and fine needle aspirations were analyzed. Results: Sixty-two of 128 cases of MM had cytology and cytomorphological criteria described in GCDMM were fulfilled in 61.3% cases. Architectural atypia was useful in identifying cases with low cytological atypia. Overall sensitivity of cytomorphology was 73.01%. Sensitivity of effusion cytology was 77.8%. Subsequent IHC on cell blocks revealed the sensitivity as 100% for mesothelin, calretinin, and cytokeratin 5/6; 87.5% for thrombomodulin; and 50% for WT1, while CEA and TTF1 showed 100% specificity. Treatment was given based on final diagnosis of MM given after IHC on cytology material in only 25.8% cases. However, it was possible in additional 35.5% cases. Mean survival was 10 months when diagnosed by cytology, compared to 7 months by histology. Conclusions: Rather than ignoring the role of cytology in the diagnosis and treatment guidelines for MM, it is important to understand its strengths and limitations. Standardized guidelines in future can play an important role in more streamlined communication between cytopathologist and clinician.

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Section: Discussionmentioning

confidence: 99%

Role of Cytology in the Current Guidelines for Malignant Mesothelioma: Largest Study from India

et al. 2020

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“…According to the currently proposed International System for Reporting Serous Fluid Cytology, borderline tumours are designated the atypia of undetermined significance (AUS) category 10 . This seems contradictory to the aims of the system, as the main focus of the system is to minimise the indeterminate categories.…”

Section: Discussionmentioning

confidence: 99%

“…Advice to exclude neoplastic and preneoplastic conditions before applying the AUS category 10 also conflicts with a diagnosis of borderline lesions, as they are regarded as precursor lesions to low grade ovarian carcinoma. Effusions classified as AUS are usually expected to have a benign outcome with the aid of ICC, in contrast to suspicious for malignancy (SFM), where a malignant process is anticipated 10 . In our case, SFM would be the most suitable category for the choices currently available, albeit inaccurate.…”

Section: Discussionmentioning

confidence: 99%

“…This highlights the need to refine the indeterminate categories. Seeing that clinical management for SFM and malignant categories are similar, 10 broadening the SFM to incorporate neoplastic entities seems more plausible. Future case reports demonstrating similar issues are encouraged to assist in making the International System for Reporting Serous Fluid Cytology more inclusive.…”

Section: Discussionmentioning

confidence: 99%

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Effusion cytology of a mucinous borderline ovarian tumour: Pitfall or controversy? A case report with insight into the newly proposed International System for Reporting Serous Fluid Cytology

et al. 2020

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“…Each of these is characterized by strict diagnostic criteria and a well-defined risk of malignancy (ROM). The hope is that the implementation of this system will lead to better interobserver agreement and patient management [13]. In the context of TIS, ancillary techniques play an important role.…”

Section: Introductionmentioning

confidence: 99%

The International System for Reporting Serous Fluid Cytopathology: How to Incorporate Molecular Data in Cytopathology Reports

Pinto

Chandra

Schmitt

2021

JMP

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Serous effusion cytology is widely employed in the initial evaluation of the etiology of effusions with a high diagnostic sensitivity. To standardize practices, The International System for Reporting Serous Fluid Cytology (TIS) was developed following best international practices, the most up-to-date literature, and expert consensus. In the context of this system, ancillary techniques play an important role. Besides defining basic principles in laboratory specimen handling, adequacy criteria, and a standardized reporting terminology with five diagnostic categories, TIS provides an actionable framework for using immunohistochemical and molecular testing in effusion samples, namely, in atypical, suspicious of malignant samples. For diagnostic purposes, these tests may be employed to distinguish between a primary and secondary neoplasm, to confirm a diagnosis of malignant mesothelioma vs. reactive mesothelial hyperplasia, and to correctly classify and determine the primary location of a metastasis. Theranostic molecular tests may also be used for these samples to evaluate potential therapeutic targets. Pathologists play a central role in guiding this process by determining adequacy and selecting appropriate ancillary tests. The activity in this area of research should increase in the near future as new therapeutic targets are discovered and new drugs enter the clinical practice.

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The international system for reporting serous fluid cytopathology—diagnostic categories and clinical management

Cited by 87 publications

References 18 publications

Role of Cytology in the Current Guidelines for Malignant Mesothelioma: Largest Study from India

Role of Cytology in the Current Guidelines for Malignant Mesothelioma: Largest Study from India

Effusion cytology of a mucinous borderline ovarian tumour: Pitfall or controversy? A case report with insight into the newly proposed International System for Reporting Serous Fluid Cytology

The International System for Reporting Serous Fluid Cytopathology: How to Incorporate Molecular Data in Cytopathology Reports

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