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Anal Cytology: Test Utilization Patterns and Outcomes, an Institutional Experience
S20 opposed to a diagnosis of a pancreatic primary neoplasm, highlighting the critical nature of a diagnosis rendered from EUS-FNA material. PST42 The Value of Elastography Scores in the Cytologic Diagnosis of Endoscopic Ultrasound-Guided Fine Needle Aspiration: The Experience of a Single Academic Center Anneliese Vélez-Pérez, MD1, Samreen Khowaja, MBBS2, Shruti Khurana, MBBS3, Erik Rahimi, MD4, Nirav Thosani, MD, MHA4, Songlin Zhang, MD PhD4. 1McGovern Medical School, Houston, TX; 2 Peoples University of Medical and Health Sciences for Women, Nawabshah, Sindh, Pakistan; 3Lady Hardinge Medical College, New Delhi, Delhi, India; 4The University of Texas Health Science Center at Houston, Houston, TX Introduction: Endoscopic Ultrasound Elastography (EUS-E) is a new ultrasound procedure that can assess tissue elasticity of tumors compared to surrounding tissue by qualitative and semi-quantitative methods to distinguish between malignant and benign lesions. Early studies have shown contradictory results of EUS-E in the diagnosis gastrointestinal (GI) and pancreatic tumors. Therefore, the accuracy of EUS-E on predicting the nature of these lesions is actively being researched. The aim of our study was to evaluate the correlation between EUS-E scores and the EUS fine-needle aspiration (EUS-FNA) diagnosis. Materials and Methods: A retrospective analysis of GI and pancreatic EUSFNA adult cases from 2014-2015 in a single academic center was performed (nZ156). Elastography data was available for 64 cases with 2 excluded unsatisfactory specimens (nZ62). Analyzed cases included 43 solid pancreatic lesions and 19 lesions from other GI tract sites. Based on the established guidelines of EUS-E score, a score of 0-2 designated a benign tumors and a score of 3-5 designated malignant tumors. Elastography results were compared with the final cytologic diagnosis of EUS-FNA. Results: Cytologic malignant and potentially malignant lesions had a significantly higher elastography scores compared to cytologic benign and atypical lesions (4.17 vs 3.19; pZ0.003). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of elastography were 94.3%, 37.0%, 66.0%, and 83.3%, respectively. For solid pancreatic lesions, cytologic malignant and neuroendocrine tumors have a significantly higher elastography scores than cytologic benign and atypical lesions (4.46 vs 3.67; pZ0.017). For pancreatic solid lesions, the sensitivity, specificity, PPV and NPV of elastography were 96.0%, 22.2%, 63.2%, and 80.0%. Conclusions: Elastography has a very high sensitivity, a good NPV, but a poor specificity and PPV for pancreatic and overall GI tract tumors. Elastography scores is a useful adjunct screening tool for EUS-FNA, although EUS-FNA cytology remains a necessary modality for diagnosis. PST43 Diagnosis of Gastrointestinal Stromal Tumors Using Endoscopic Ultrasound Guided Fine Needle Aspiration: The Value of Cellblock and Immunohistochemistry
Abstracts Materials and Methods: A retrospective analysis of adult EUS-FNA of submucosal lesions in the upper GI tract was performed (nZ8). Specimens were obtained using a 22-procore, or a 25-sharkcore needle from stomach (nZ6), duodenum (nZ1), and esophagus (nZ1). Results: All cases yielded sufficient material for cytologic and histological evaluation. Tumor size ranged from 1.3-6.4 cm. Three cases (37.5%) were diagnosed as GIST based on histologic and immunohistochemical findings (positive for CD117 and CD34, negative for desmin, smooth muscle actin, and S-100). One case was classified as high grade, high risk GIST based on mitotic rate (15/5mm2) and high Ki-67 proliferation index (25%). The subsequent resection confirmed the cytology impression. The remaining two cases were classified as low grade and low risk (Ki-67 <5%). The remaining 5 cases were diagnostic or suggestive of leiomyomas (nZ4, 50%) or normal smooth muscle cells (nZ1, 12.5%). Conclusions: In this limited sample, EUS-FNA of GI submucosal lesions yielded sufficient material for cellblock preparation and immunohistochemistry to establish the diagnosis of GIST and to perform the evaluation of tumor grade and risk, using either the procore or sharkcore needles. We use formalin as the fixative solution for all cellblock material, and we did not notice the discrepancy between the cytology and surgical specimens on CD117 and CD34. PST44 Anal Cytology: Test Utilization Patterns and Outcomes, an Institutional Experience Narjes Mousavi, CT(ASCP), Adele Kraft, MD. Virginia Commonwealth University Health, Richmond, VA Introduction: Anal cytology (AC) is used for anal squamous cell carcinoma screening in high-risk groups. Questions regarding screening strategies, appropriate intervals and management of abnormal tests results still remain. The New York State Department of Health AIDS Institute recommends AC at baseline and annually thereafter for high-risk patients. The aim of this study is to evaluate the utilization of anal cytology over a 6 year period in HIV+ patients. Materials and Methods: The electronic database was searched for all AC cases and corresponding surgical specimens collected up to 6 months after AC collection from 01/01/2010 to 12/31/2016. The cases were separated by diagnostic cytology category, correlated with surgical specimens. The number of AC studies performed over the study period was determined for each patient. Results: There were a total of 619 AC from 404 patients, all HIV+, being 98% male and 2% female, of which 14% were unsatisfactory (UNS), 43% were negative for dysplasia (NEG), 8% ASCUS, 33% LGSIL and 2% HGSIL. The number of AC performed varied from year to year (Table 1). Surgical follow-up was available for 27 patients (Table 2). Most patients (254) had one AC test performed during the study period; 102 were tested twice, 34 three times, 11 four times and only 5 had 3 AC (Table 3). Conclusions: The distribution of cases by cytology category correlates with the published statistics from larger institutions. One case of squamous cell carcinoma was detected. The number of AC tests varied widely from year
Anneliese Vélez-Pérez, MD1, Samreen Khowaja, MBBS2, Shruti Khurana, MBBS3, Erik Rahimi, MD4, Nirav Thosani, MD, MHA4, Songlin Zhang, MD PhD4. 1McGovern Medical School, Houston, TX; 2 Peoples University of Medical and Health Sciences for Women, Nawabshah, Sindh, Pakistan; 3Lady Hardinge Medical College, New Delhi, Delhi, India; 4The University of Texas Health Science Center at Houston, Houston, TX Introduction: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal (GI) tract. Their clinical management depends on their risk assessment based on tumor size, location, mitotic count, proliferation index, and histologic grade. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a common procedure for diagnosing GIST. A recent study reported a discrepancy of immunohistochemical results between the cytology and the surgical resection due to the cytolyte fixation of cytology material. The aim of this study was to analyze our experience on EUS-FNA for establishing diagnosis and malignant risk evaluation of GIST.
Table 1
Distribution of Cases by Cytology Category
Abstracts
S21
Table 2
Table 3
Cytology Histology Correlation
HIV-infected adults is about 30-fold higher than in the general population. In males having sex with males (MSM), the incidence of anal cancer in HIV-infected individuals is approximately five-fold that in HIV-uninfected individual. We explored differences in incidence and outcomes of intraepithelial lesions on anal Pap smears in MSM less than 20 yrs of age versus adults from the same community. Materials and Methods: An electronic medical database search for anal Pap smears received during 2010-2014 was carried out. The initial screening diagnoses and outcomes were tabulated. The patients were classified as less and greater than 20 years and compared. Results: Total number of smears reviewed: 398 (Pediatric <20 yrs: 49 and adult >20 yrs: 349. A comparison of pediatric and adult cytologic diagnoses was done. (Table 1). Cytohistologic correlation with follow-up biopsies was (Table 2 ) reviewed. Conclusions: Pediatric population had a slightly higher percentage of unsatisfactory and ASCUS and a lower percentage of LSIL and NILM smears. The majority of pediatric patients did not have follow up biopsies. The only significant biopsy result was AIN ½, most commonly preceded by ASCUS on screening cytology. In adults, AIN ½ was preceded by ASCUS, NILM, LSIL or unsatisfactory smears. Invasive carcinoma presented as ASCUS on screening in all the four cases. AIN3 presented as NILM, LSIL or ASCUS. In general, anal cytology evaluation yields intraepithelial lesions of lower grade, in comparison to cervical cytology.
Table 1
Anal Pap smear in pediatrics and adults
Table 2
Cytohistological correlation of anal Pap
Frequency of Anal Cytology Testing
to year. Most of the patients were screened once or twice during the study period. The possible reason for this decreased surveillance is the lack of consistent high-resolution anoscopy services at the institution, demonstrating that if anal cytology is to become an effective screening tool follow-up testing needs to be available.
PST45 Retrospective Review of Anal Pap Smears in HIV Positive Pediatric and Adult Population Amarpreet Bhalla, MD1, Manjula Garapati, MD2, Nora Frisch, MD3, Vinod Shidham, MD, FRCPath, FIAC4. 1Indiana University, Indianopolis, IN; 2University of Alabama, Birmingham, AL; 3University of Buffalo, Buffalo, NY; 4Wayne State University, Detroit, MI Introduction: Anal intraepithelial neoplasia is the most common non-AIDS defining malignancy in HIV infected adults. The incidence of anal cancer in
Abstracts Materials and Methods: A retrospective analysis of adult EUS-FNA of submucosal lesions in the upper GI tract was performed (nZ8). Specimens were obtained using a 22-procore, or a 25-sharkcore needle from stomach (nZ6), duodenum (nZ1), and esophagus (nZ1). Results: All cases yielded sufficient material for cytologic and histological evaluation. Tumor size ranged from 1.3-6.4 cm. Three cases (37.5%) were diagnosed as GIST based on histologic and immunohistochemical findings (positive for CD117 and CD34, negative for desmin, smooth muscle actin, and S-100). One case was classified as high grade, high risk GIST based on mitotic rate (15/5mm2) and high Ki-67 proliferation index (25%). The subsequent resection confirmed the cytology impression. The remaining two cases were classified as low grade and low risk (Ki-67 <5%). The remaining 5 cases were diagnostic or suggestive of leiomyomas (nZ4, 50%) or normal smooth muscle cells (nZ1, 12.5%). Conclusions: In this limited sample, EUS-FNA of GI submucosal lesions yielded sufficient material for cellblock preparation and immunohistochemistry to establish the diagnosis of GIST and to perform the evaluation of tumor grade and risk, using either the procore or sharkcore needles. We use formalin as the fixative solution for all cellblock material, and we did not notice the discrepancy between the cytology and surgical specimens on CD117 and CD34. PST44 Anal Cytology: Test Utilization Patterns and Outcomes, an Institutional Experience Narjes Mousavi, CT(ASCP), Adele Kraft, MD. Virginia Commonwealth University Health, Richmond, VA Introduction: Anal cytology (AC) is used for anal squamous cell carcinoma screening in high-risk groups. Questions regarding screening strategies, appropriate intervals and management of abnormal tests results still remain. The New York State Department of Health AIDS Institute recommends AC at baseline and annually thereafter for high-risk patients. The aim of this study is to evaluate the utilization of anal cytology over a 6 year period in HIV+ patients. Materials and Methods: The electronic database was searched for all AC cases and corresponding surgical specimens collected up to 6 months after AC collection from 01/01/2010 to 12/31/2016. The cases were separated by diagnostic cytology category, correlated with surgical specimens. The number of AC studies performed over the study period was determined for each patient. Results: There were a total of 619 AC from 404 patients, all HIV+, being 98% male and 2% female, of which 14% were unsatisfactory (UNS), 43% were negative for dysplasia (NEG), 8% ASCUS, 33% LGSIL and 2% HGSIL. The number of AC performed varied from year to year (Table 1). Surgical follow-up was available for 27 patients (Table 2). Most patients (254) had one AC test performed during the study period; 102 were tested twice, 34 three times, 11 four times and only 5 had 3 AC (Table 3). Conclusions: The distribution of cases by cytology category correlates with the published statistics from larger institutions. One case of squamous cell carcinoma was detected. The number of AC tests varied widely from year
Anneliese Vélez-Pérez, MD1, Samreen Khowaja, MBBS2, Shruti Khurana, MBBS3, Erik Rahimi, MD4, Nirav Thosani, MD, MHA4, Songlin Zhang, MD PhD4. 1McGovern Medical School, Houston, TX; 2 Peoples University of Medical and Health Sciences for Women, Nawabshah, Sindh, Pakistan; 3Lady Hardinge Medical College, New Delhi, Delhi, India; 4The University of Texas Health Science Center at Houston, Houston, TX Introduction: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal (GI) tract. Their clinical management depends on their risk assessment based on tumor size, location, mitotic count, proliferation index, and histologic grade. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a common procedure for diagnosing GIST. A recent study reported a discrepancy of immunohistochemical results between the cytology and the surgical resection due to the cytolyte fixation of cytology material. The aim of this study was to analyze our experience on EUS-FNA for establishing diagnosis and malignant risk evaluation of GIST.
Table 1
Distribution of Cases by Cytology Category
Abstracts
S21
Table 2
Table 3
Cytology Histology Correlation
HIV-infected adults is about 30-fold higher than in the general population. In males having sex with males (MSM), the incidence of anal cancer in HIV-infected individuals is approximately five-fold that in HIV-uninfected individual. We explored differences in incidence and outcomes of intraepithelial lesions on anal Pap smears in MSM less than 20 yrs of age versus adults from the same community. Materials and Methods: An electronic medical database search for anal Pap smears received during 2010-2014 was carried out. The initial screening diagnoses and outcomes were tabulated. The patients were classified as less and greater than 20 years and compared. Results: Total number of smears reviewed: 398 (Pediatric <20 yrs: 49 and adult >20 yrs: 349. A comparison of pediatric and adult cytologic diagnoses was done. (Table 1). Cytohistologic correlation with follow-up biopsies was (Table 2 ) reviewed. Conclusions: Pediatric population had a slightly higher percentage of unsatisfactory and ASCUS and a lower percentage of LSIL and NILM smears. The majority of pediatric patients did not have follow up biopsies. The only significant biopsy result was AIN ½, most commonly preceded by ASCUS on screening cytology. In adults, AIN ½ was preceded by ASCUS, NILM, LSIL or unsatisfactory smears. Invasive carcinoma presented as ASCUS on screening in all the four cases. AIN3 presented as NILM, LSIL or ASCUS. In general, anal cytology evaluation yields intraepithelial lesions of lower grade, in comparison to cervical cytology.
Table 1
Anal Pap smear in pediatrics and adults
Table 2
Cytohistological correlation of anal Pap
Frequency of Anal Cytology Testing
to year. Most of the patients were screened once or twice during the study period. The possible reason for this decreased surveillance is the lack of consistent high-resolution anoscopy services at the institution, demonstrating that if anal cytology is to become an effective screening tool follow-up testing needs to be available.
PST45 Retrospective Review of Anal Pap Smears in HIV Positive Pediatric and Adult Population Amarpreet Bhalla, MD1, Manjula Garapati, MD2, Nora Frisch, MD3, Vinod Shidham, MD, FRCPath, FIAC4. 1Indiana University, Indianopolis, IN; 2University of Alabama, Birmingham, AL; 3University of Buffalo, Buffalo, NY; 4Wayne State University, Detroit, MI Introduction: Anal intraepithelial neoplasia is the most common non-AIDS defining malignancy in HIV infected adults. The incidence of anal cancer in