This news section is written by a medical journalist and offers Cancer Cytopathology readers timely information on events, issues, and personalities of interest to the subspecialty.This edition explores the potential of noninvasive liquid biopsies for cancer screening and monitoring, as well as the challenges the tests must overcome before they are ready for widespread clinical use.
Abstract The recently published WHO Reporting System for Pancreaticobiliary Cytopathology (World Health Organization [WHO] System) is an international approach to the standardized reporting of pancreaticobiliary cytopathology, updating the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSC System). Significant changes were made to the categorization of benign neoplasms, intraductal neoplasms, mucinous cystic neoplasms, and malignant neoplasms considered low grade. Benign neoplasms, such as serous cystadenoma, categorized as Neoplastic: benign in the PSC system, are categorized as Benign/negative for malignancy in the WHO system. Pancreatic neuroendocrine tumor, solid‐pseudopapillary neoplasm, and gastrointestinal stromal tumor, categorized as Neoplastic: other in the PSC system, are categorized as Malignant in the WHO System in accord with their classification in the 5th edition WHO Classification of Digestive System Tumours (2019). The two new categories of Pancreaticobiliary Neoplasm Low‐risk/grade and Pancreaticobiliary Neoplasm High‐risk/grade are mostly limited to intraductal neoplasms and mucinous cystic neoplasms. Low‐risk/grade lesions are mucinous cysts, with or without low‐grade epithelial atypia. High‐risk/grade lesions contain neoplastic epithelium with high‐grade epithelial atypia. Correlation with clinical, imaging, and ancillary studies remains a key tenet. The sections for each entity are written to highlight key cytopathological features and cytopathological differential diagnoses with the pathologist working in low resource setting in mind. Each section also includes the most pertinent ancillary studies useful for the differential diagnosis. Sample reports are provided for each category. Finally, the book provides a separate section with risk of malignancy and management recommendations for each category to facilitate decision‐making for clinicians.
<b><i>Background:</i></b> The Wnt/β-catenin signaling pathway has been noted to be upregulated in head and neck cancers, including oropharyngeal squamous cell carcinoma (OSCC). This study compared the efficacy of β-catenin immunohistochemistry (IHC), p16 IHC and automated human papillomavirus (HPV) in situ hybridization (ISH) in OSCC. <b><i>Methods:</i></b> Sixty-eight OSCCs (48 surgical specimens and 20 fine-needle aspirations) were evaluated. Nuclear staining only of β-catenin was assessed as 0-3+ intensity (relative to controls of benign squamous mucosa). p16 was interpreted as positive if 70% of tumor cells showed brown nuclear and cytoplasmic staining. HPV ISH was interpreted as positive if a minimum of one tumor cell showed brown punctate dot-like nuclear positivity. p16 IHC and HPV ISH were then correlated with β-catenin staining. HPV ISH was used as the gold standard. <b><i>Results:</i></b> Twenty-five of 48 surgical specimens (52.1%) and 11 of 20 cell blocks (55%) stained positively for β-catenin, making a total of 36 of 68 (52.9%) staining positively for β-catenin, as compared to 61.7% positive for p16 IHC and 70.6% positive by automated HPV ISH, the gold standard method for OSCC diagnosis. χ<sup>2</sup> analysis revealed no significant correlation between β-catenin and HPV ISH (p > 0.05) and demonstrated a strong correlation between p16 and HPV ISH (p < 0.05). <b><i>Conclusion:</i></b> β-Catenin IHC is not a sensitive or specific marker of HPV and is unlikely to be a useful adjunct to p16 IHC or HPV ISH in the setting of advanced OSCC. However, as this study focused on samples of advanced OSCC, β-catenin IHC may still find some use in the diagnosis of early-stage OSCC.
THE AUTHORS’ REPLY We appreciate the interest expressed by Regauer and Reich regarding our study.1 They have formulated a conclusion based on the findings of our study that it is the thin high-grade squamous intraepithelial lesion (HSIL) that is usually underrecognized on the Papanicolaou (Pap) test. We agree that at least some cases in our study represent examples of thin HSIL, such as that represented in Image 2E. However, the key finding of our study was the identification of three main underrecognized patterns of HSIL on ThinPrep (Hologic) preparations—atypical metaplastic cells, atypical repair, and rare syncytial groups—and these cytologic patterns are not just restricted to thin HSILs, as evidenced by those biopsy specimens depicted in Image 1. The pattern of “atypical metaplastic cells,” in some instances, corresponds to atypical immature metaplasia on histology, and the pattern of “atypical repair” may mimic reactive changes/repair with a greater number of cell...
Cancer Cytopathology, a journal of the American Cancer Society, provides a unique forum for interaction and dissemination of original research and educational information relevant to the practice of cytopathology and its related oncologic disciplines.The journal strives to have a positive effect on cancer prevention, early detection, diagnosis, and cure by the publication of high-quality content.The mission of Cancer Cytopathology is to present and inform readers of new applications, technological advances, cutting-edge research, novel applications of molecular techniques, and relevant review articles related to cytopathology.
Cancer Cytopathology, a journal of the American Cancer Society, provides a unique forum for interaction and dissemination of original research and educational information relevant to the practice of cytopathology and its related oncologic disciplines.The journal strives to have a positive effect on cancer prevention, early detection, diagnosis, and cure by the publication of high-quality content.The mission of Cancer Cytopathology is to present and inform readers of new applications, technological advances, cutting-edge research, novel applications of molecular techniques, and relevant review articles related to cytopathology.
Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6‐tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine‐needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs. Methods Submandibular gland FNA cytology specimens from 15 international institutions (2013‐2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow‐up was performed, and the ROM was calculated for each MSRSGC diagnostic category. Results The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%‐50%); nonneoplastic, 24.2% (9.1%‐53.6%); AUS, 6.7% (0%‐14.3%); benign neoplasm, 18.3% (0%‐52.5%); SUMP, 12% (0%‐37.7%); SM, 3.5% (0%‐12.5%); and malignant, 13.9% (2%‐31.3%). The histopathologic follow‐up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. Conclusions This multi‐institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.
