Anatomic Abstracts
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August 2010 Editors:
Endobronchial ultrasound is a relatively new modality that can be used to guide transbronchial needle aspiration of mediastinal and hilar lymph nodes and peripheral lung lesions. Few studies have investigated the cytological profile of endobronchial ultrasound-transbronchial needle aspiration (EBUS--TBNA) specimens. The authors conducted a study in which they reviewed the cytological profile of 135 consecutive cases, including 71 lymph node cases, four lung cases, and 60 cases of both lymph node and lung sampling. The cytological specimens were collected using an ultrasound bronchofibervideoscope with a 22-gauge needle. Core biopsies were obtained with a 19-gauge needle. An experienced cytotechnologist performed an immediate on-site evaluation of adequacy. An immediate assessment was given to the clinician after each pass. In many patients, multiple sites were sampled. The average slides of each case were 9.9 (median, 12), with a range of two to 24. The authors found that of the 131 cases of lymph node sampling, 45 (34.6 percent) were diagnosed as malignant, 73 (55.7 percent) as benign process, five (3.8 percent) as suspicious for malignancy, and one (0.8 percent) as atypical cells. Of the 64 cases of lung lesion sampling, 21 (32.8 percent) were diagnosed as malignant, 35 (54.7 percent) as benign process, one (1.5 percent) as suspicious for malignancy, and four (6.3 percent) as atypical cells. The lymph node nondiagnostic rate was 5.3 percent and the nondiagnostic rate for lung lesions was 4.7 percent. Eighty-eight cases (65.2 percent) had corresponding core biopsies with a 19-gauge needle or followup surgery. When histology was considered the gold standard, the sensitivity, specificity, and positive and negative predictive values for EBUS-TBNA were 85 percent, 100 percent, 100 percent, and 89.7 percent, respectively. However, when histology and clinical followup were considered together, the overall sensitivity and negative predictive value were increased to 94.7 percent (P<.05) and 96.6 percent (P<.05), respectively. The authors concluded that EBUS-TBNA is an accurate and sensitive method for diagnosing and staging lung cancer. Feller-Kopman D, Yung RC, Burroughs F, et al. Cytology of endobronchial ultrasound-guided transbronchial needle aspiration; a retrospective study with histology correlation. Cancer Cytopathol. 2009;117(6):482–490. Correspondence: Dr. Qing Kay Li at qli23@jhmi.edu
Thyroid fine-needle aspiration samples that feature a follicular-patterned, monotonous Hurthle (oncocytic) cell population cannot be diagnosed reliably. The authors previously identified cyclin D3 overexpression on histologic sections of Hurthle cell carcinoma. For this study, they assessed the diagnostic value of cyclin D3 immunohistochemistry added to routine cytology. The authors examined 51 FNA samples that were suspicious for Hurthle cell neoplasia and that had histologic followup (19 malignant cases). They evaluated cyclin D3 expression levels in cell block preparations and compared them with levels of the closely related cyclin D1 protein. More than 25 percent positive cells were used as the cutoff point, as suggested by previous studies. Cyclin D1 and D3 were highly specific (100 percent for both) and fairly accurate (75 percent and 92 percent, respectively) in distinguishing between benign and malignant oncocytic lesions. The positive predictive value for each was 100 percent. However, both cyclins D1 and D3 had low sensitivity (32 percent and 79 percent, respectively) and low negative predictive value (71 percent and 89 percent, respectively). In contrast, by adopting balanced receiver operating characteristic-derived positive cutoff values, cyclin D1 of 6.5 percent or more and cyclin D3 of 7.5 percent or more were found to be highly sensitive (100 percent for both) and accurate (90 percent and 94 percent, respectively), and the negative predictive value was 100 percent for both. In contrast, cyclins D1 and D3 had low specificity (84 percent and 91 percent, respectively) and a low positive predictive value (79 percent and 86 percent, respectively). However, these values improved in samples that were positive for both cyclins (sensitivity, 100 percent; specificity, 94 percent; positive predictive value, 90 percent; negative predictive value, 100 percent; accuracy, 96 percent). The authors concluded that cyclin D3 increased the suspicion of malignancy in indeterminate oncocytic lesions. Its diagnostic performance depended on the cutoff point used and was enhanced further when combined with cyclin D1. Troncone G, Volante M, Iaccarino A, et al. Cyclin D1 and D3 overexpression predicts malignant behavior in thyroid fine-needle aspirates suspicious for Hurthle cell neoplasms. Cancer Cytopathol. 2009;117(6):522–529. Correspondence: Dr. Giancarlo Troncone at giancarlo.troncone@unina.it
HER2/neu status is critical for breast carcinoma therapy. Fluorescence in situ hybridization for gene amplification and immunohistochemical stains for protein expression are widely used methods to detect HER2/neu status. Multiple studies have shown that fluorescence in situ hybridization (FISH) and immunohistochemical stain results have high concordance rates. However, a comparison of FISH results for core needle biopsy and subsequent excisional biopsy specimens has not been conducted. The authors retrospectively evaluated FISH and immunohistochemical results in the breast core needle and excisional biopsies of 125 patients with invasive breast carcinoma between 2002 and 2005. They found complete concordance with respect to immunohistochemical and FISH results for core needle biopsy and excisional biopsy specimens in 87 percent of the patients evaluated. Comparing the FISH results of the 129 core needle biopsies with the 131 excisional biopsies of all 125 patients showed a concordance rate of 92 percent. The immunohistochemical stain results of the same core needle and excisional biopsies showed a concordance rate of 98 percent. Comparing the immunohistochemical stain results with the FISH results for all 260 cases examined showed 95 percent concordance. On the basis of this study, the authors concluded that repeating HER2/neu testing by immunohistochemical stain or FISH methods on excisional biopsy, or both, is not unreasonable, in particular for cases of intratumoral heterogeneity and indeterminate or borderline HER2/neu, as well as after neoadjuvant chemotherapy. Apple SK, Lowe AC, Rao PN, et al. Comparison of fluorescent in situ hybridization HER-2/neu results on core needle biopsy and excisional biopsy in primary breast cancer. Mod Pathol. 2009;22:1151–1159. Correspondence: Dr. S. K. Apple at sapple@mednet.ucla.edu Anatomic pathology abstracts editors: Michael Cibull, MD, professor and vice chair, Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington; Melissa Kesler, MD, and Rouzan Karabakhtsian, MD, assistant professors of pathology and laboratory medicine, University of Kentucky College of Medicine; and Megan Zhang, MD, visiting fellow, Division of Dermatopathology, University of California, San Francisco. |
