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The Milan System for Reporting Salivary Gland Cytopathology: Analyses and Suggestions from Initial Survey
S82 PL07 Cytologic-histologic Correlation of Cystic Non-mucinous and Mucinous Salivary Gland Lesions Emilio Madrigal, DO1, David Chhieng, MD, MBA2, Manju Harshan, MD1. 1 Mount Sinai Health System, New York, NY; 2University of Washington, Seattle, WA Introduction: Although fine needle aspiration (FNA) biopsies reliably assess salivary gland enlargements, evaluation of cystic non-mucinous lesions or those with mucin only is challenging due to the lack of cellular material. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), a tiered classification scheme for reporting salivary gland cytology was recently established. According to the MSRSGC, cystic nonmucinous lesions and those with mucinous material are classified as nondiagnostic and atypia of undetermined significance (AUS), respectively. The object of the study is to establish the utility of the MSRSGC in assessing the risk of malignancy of these salivary gland lesions. Materials and Methods: We queried our laboratory information system from 2010 to 2016 for ultrasound-guided salivary gland FNA biopsies resulting in 1098 cases. Only cases with a subsequent histologic follow-up, devoid of an epithelial component and demonstrating a cystic nonmucinous or mucinous background, were included in the study. Direct smears were either air-dried and Diff-Quik stained or alcohol-fixed and Papanicolaou stained. Results: A total of 8 (0.73%) cases met inclusion criteria, and were categorized as non-diagnostic (nZ5) and AUS with a mucinous background (nZ3). Table 1 summarizes patient demographic details as well as cytologic and histologic interpretations. Based on subsequent surgical resection, non-diagnostic FNA cases were determined to be lymphoepithelial cysts (nZ2), and benign ductal cysts (nZ3). AUS cases were finalized as low-grade mucoepidermoid carcinoma (nZ1), pleomorphic adenoma (nZ1), and mucocele (nZ1). Conclusions: All non-diagnostic cases demonstrating cystic non-mucinous background were found to be benign on surgical follow-up with a risk of malignancy of 0%. The risk of malignancy for mucinous AUS cases without an epithelial component was 33%. Additional studies with more cases are necessary to assess the utility of the MSRGC in evaluating these challenging salivary gland lesions.
Abstracts differences, a 1-year retrospective quality assessment of anal cytology specimens was performed. Materials and Methods: The cytology database at a single academic medical center was searched for anal specimens collected in 2016. All available slides were reviewed for adequacy, and original reports were assessed for appropriate documentation of quality indicators, clinical management recommendations, and initiation of HPV testing. Results: 111 liquid-based anal cytology specimens were identified, predominantly from HIV+/- men who have sex with men. Adequacy/ Quality indicators: 100/111 samples (90.1%) were initially diagnosed as adequate, including 66 NILM, 33 ASC, and 1 LSIL cases, and the presence/absence of transformation zone was documented in 98% of adequate samples. On retrospective review, 4 specimens were reclassified as inadequate, and 8 were limited by adequate but scant cellularity. Clinical management recommendations: 9.7% of adequate, negative cases were reported with inappropriate recommendation to repeat testing for hyperkeratosis, prompting unnecessary repeat in 50% of instances. Recommendation to repeat testing at 6 months was inconsistently issued for cases with ASCUS (20/26, 77%). HPV testing: Reflex testing if abnormal was the most common order (67%), followed by cotesting (20%). HPV testing was performed in only 37/42 (88%) requested cases, leading to laboratory procedural changes. Conclusions: Inattention to unique aspects of anal cytology handling/ interpretation (e.g. different adequacy definition) may cause suboptimal screening or inappropriate follow-up. Our institution’s rates of abnormal (35% of adequate) and unsatisfactory (13.5%) specimens are similar to those in a recent large multicenter study. Absence of generally accepted management guidelines for ASC-US is reflected by non-uniform recommendations in cytopathology reports.
November 12, 2017, 8:00 am e 9:00 am MORNING PLATFORM PRESENTATIONS PL09 The Milan System for Reporting Salivary Gland Cytopathology: Analyses and Suggestions from Initial Survey Esther Diana Rossi, MD, PhD, MIAC1, William Faquin, MD, PhD2, Zubair Baloch, MD, PhD3, Guliz Barkan, MD4, Maria Foschini, MD, PhD5, Marc Pusztaszeri6, Phillippe Viehl, MD, PhD7, Daniel Kurtycz, MD8. 1Università Cattolica del Sacro Cuore, Rome, Italy; 2 Massachusetts General Hospital, Boston, MA; 3University of Pennsylvania, Philadelphia, PA; 4Loyola University, Maywood, IL; 5 University of Bologna, Bologna, Italy; 6Geneva University Hospital, Geneva, Switzerland; 7Laboratorie National de Sante, Luxembourg; 8 Wisconsin State Laboratory of Hygiene, Madison, WI
PL08 Retrospective Quality Assessment of Anal Cytology Specimens: A Single Institution Experience Highlighting Differences from Gynecologic Cytology Brock Martin, MD, Christina Kong, MD. Stanford University School of Medicine, Stanford, CA Introduction: Anal cytology was introduced into the Bethesda System in 2001 as screening for anal carcinoma and its precursors among high risk populations. The Bethesda recommendations are similar to those for gynecologic sites, with some notable exceptions. Emphasizing those
Introduction: An international panel in the field of salivary gland cytology, supported by the American Society of Cytopathology (ASC) and the International Academy of Cytology (IAC), conducted a survey to identify opinions, seek evidence, and practice patterns regarding salivary gland cytopathology. Results from this survey were used in the development of the proposed Milan System for Reporting Salivary Gland Cytopathology. Material and Methods: The Milan study group, formed during the 2015 European Congress of Cytology generated a survey that included 49 specific questions related to the taxonomy and practice of salivary gland cytology. QualtricsÒ software (Provo, Utah, USA) provided by the University of Wisconsin Division of Information Technology (DoIT) (Madison, Wisconsin, USA) was used as the study platform. The survey was available online from November 27th 2015 until February 1st 2016. Invitation to participants was accomplished through the websites and listserves of the professional societies. Results: A total of 515 participant responses were collected and reviewed. The survey included sets of questions pertaining to different diagnostic taxonomic schemes for salivary gland cytology. Three hundred and forty-
Abstracts seven participants provided information about their work setting. Responses reveal variation in diagnostic practice and subsequent management. Participants felt that the acceptable rate for non-diagnostic samples should be near 10%. Many would alter their interpretation based upon clinical (pain or paralysis) and radiologic evidence (mass lesion). Most would appreciate adoption of a tiered risk-based classification system. As expected, there were varied opinions regarding the approach to neoplastic lesions of uncertain biologic potential, those that may or may not exhibit local invasion and distant spread. Most already use the terms atypical and suspicious for malignancy, but the practice is not uniform. Conclusions: Results of the survey demonstrated a strong support for the development of a unified system for reporting salivary gland cytopathology among respondents. PL10 The Paris System for Urine Cytology in Upper Tract Urothelial Specimens: A Comparative Analysis with Biopsy and Surgical Resection Xiaoyong Zheng, MD, PhD1, Qiusheng Si, MD, PhD1, Diane Du, MD1, Manju Harshan, MD1, Zesong Zhang, MD, MS1, G. Kenneth Haines, MD1, David Chhieng, MD, MBA2. 1Mount Sinai Hospital, New York, NY; 2 University of Washington Medical Center, Seattle, WA Introduction: The Paris System (TPS) has recently been used in classification of urinary tract cytologic specimens. The majority of the studies have focused on urinary bladder specimens. Upper urinary tract (UUT) specimens are cytologically challenging due to limited tissue and other reactive atypia. Our objective is to investigate the utility of the TPS in evaluating UUT specimens and its correlation with subsequent histologic follow-up. Materials and Method: A total of 324 cytology cases of UUT from 179 patients from 2014-2017 were retrieved. Concurrent or subsequent biopsy or resection within 2-month period was available in 125 (38.6%) cases from 74 (41.3%) patients. Interpretations were recorded as per TPS. Descriptive diagnoses from cases evaluated before the implementation of TPS were placed into the best overall categories by 2 reviewers. Result: Table 1 showed the distribution of the cytologic diagnoses of the 324 cytology cases. Table 2 summarizes the cytologic and histologic correlation of the 125 cytologic cases including the risk of HGUC for each cytologic diagnostic category. None of the cases with a cytologic of LGUN was found to have a HGUC on biopsy. Among the 19 AUC cytology cases, the histology is heterogeneous (3 ND/U, 7 benign, 1 atypia, 5 low grade lesion, and 6 HGUC). When we considered cytology cases with SHGUC or HGUC interpretations as positive, the performance of TPS in predicting high grade urothelial carcinoma on hisotlogy were: sensitivity 78.6%, specificity 86%, PPV 80.5%, and NPV 84.5%. Conclusion: More than 1/3 of the UUT cytologic cases were AUC and approximately 1/15 were SHGUC or HGUC. Based on UUT cytology
S83 specimens, the risk of malignancy of each cytologic diagnostic category of TPS was similar to that reported in the literature. The adoption of TPS in evaluating UUT cytology specimens is useful and effective in identifying patients with HGUC on histology. PL11 A Preliminary Study of SP70 as a Marker to Enrich Tumor Cells from Body Fluid Samples Jianyu Rao, MD1, Li Xia Zhang, MD2, Shiyang Pan, MD, PhD2, Marc Renz Minas, BS1, Yong Ying, MD1, Yusheng Jin, MB1, Weibo Yu, MD1. 1UCLA Medical Center, Los Angeles, CA; 2Jiangsu Provincial People’s Hospital/Nanjing Medical University, Nanjing, China Introduction: Cytological diagnosis of body fluid samples plays an important role in managing cancer. However, the sensitivity of detecting malignant cells by cytology is low. SP70 is a newly identified marker for adenocarcinoma of lung, breast and colon. A reagent kit with the antibody against SP70 conjugated to microbeads was developed. The goal of this project was to preliminarily test the efficacy of SP70 as a marker to detect metastatic adenocarcinoma in body fluid samples. Materials and Method: In this study, remnants of 30 body fluid samples (including 15 pleural fluid samples and 15 ascetic fluid samples) were obtained from cytology laboratory after routine cytological evaluation. For each sample, 50 ml samples were processed by centrifuging at 1500 rpm for 10 minutes. The pellet was re-suspended with 2mL NaCl solution mixed with 10mL working bead solution, inverted 5 times, and incubated for an hour. The mixture was washed multiple times with PBST, fixed with 95% ethanol, smeared on the slide, and then stained with DiffQuick. The slides were reviewed independently without the knowledge of cytological diagnosis. Results: Total 30 cases, consisting of 7 males and 23 females with an average age of 70 years old, were analyzed. Among which 18 were positive by SP70 test, and 12 were negative. All 10 cases with positive cytological diagnosis were positive by SP70 test. In 20 cytology negative samples, 8
Table 1
Table 2
Figure 1
Representative Image of SP70-beads Coa
Abstracts differences, a 1-year retrospective quality assessment of anal cytology specimens was performed. Materials and Methods: The cytology database at a single academic medical center was searched for anal specimens collected in 2016. All available slides were reviewed for adequacy, and original reports were assessed for appropriate documentation of quality indicators, clinical management recommendations, and initiation of HPV testing. Results: 111 liquid-based anal cytology specimens were identified, predominantly from HIV+/- men who have sex with men. Adequacy/ Quality indicators: 100/111 samples (90.1%) were initially diagnosed as adequate, including 66 NILM, 33 ASC, and 1 LSIL cases, and the presence/absence of transformation zone was documented in 98% of adequate samples. On retrospective review, 4 specimens were reclassified as inadequate, and 8 were limited by adequate but scant cellularity. Clinical management recommendations: 9.7% of adequate, negative cases were reported with inappropriate recommendation to repeat testing for hyperkeratosis, prompting unnecessary repeat in 50% of instances. Recommendation to repeat testing at 6 months was inconsistently issued for cases with ASCUS (20/26, 77%). HPV testing: Reflex testing if abnormal was the most common order (67%), followed by cotesting (20%). HPV testing was performed in only 37/42 (88%) requested cases, leading to laboratory procedural changes. Conclusions: Inattention to unique aspects of anal cytology handling/ interpretation (e.g. different adequacy definition) may cause suboptimal screening or inappropriate follow-up. Our institution’s rates of abnormal (35% of adequate) and unsatisfactory (13.5%) specimens are similar to those in a recent large multicenter study. Absence of generally accepted management guidelines for ASC-US is reflected by non-uniform recommendations in cytopathology reports.
November 12, 2017, 8:00 am e 9:00 am MORNING PLATFORM PRESENTATIONS PL09 The Milan System for Reporting Salivary Gland Cytopathology: Analyses and Suggestions from Initial Survey Esther Diana Rossi, MD, PhD, MIAC1, William Faquin, MD, PhD2, Zubair Baloch, MD, PhD3, Guliz Barkan, MD4, Maria Foschini, MD, PhD5, Marc Pusztaszeri6, Phillippe Viehl, MD, PhD7, Daniel Kurtycz, MD8. 1Università Cattolica del Sacro Cuore, Rome, Italy; 2 Massachusetts General Hospital, Boston, MA; 3University of Pennsylvania, Philadelphia, PA; 4Loyola University, Maywood, IL; 5 University of Bologna, Bologna, Italy; 6Geneva University Hospital, Geneva, Switzerland; 7Laboratorie National de Sante, Luxembourg; 8 Wisconsin State Laboratory of Hygiene, Madison, WI
PL08 Retrospective Quality Assessment of Anal Cytology Specimens: A Single Institution Experience Highlighting Differences from Gynecologic Cytology Brock Martin, MD, Christina Kong, MD. Stanford University School of Medicine, Stanford, CA Introduction: Anal cytology was introduced into the Bethesda System in 2001 as screening for anal carcinoma and its precursors among high risk populations. The Bethesda recommendations are similar to those for gynecologic sites, with some notable exceptions. Emphasizing those
Introduction: An international panel in the field of salivary gland cytology, supported by the American Society of Cytopathology (ASC) and the International Academy of Cytology (IAC), conducted a survey to identify opinions, seek evidence, and practice patterns regarding salivary gland cytopathology. Results from this survey were used in the development of the proposed Milan System for Reporting Salivary Gland Cytopathology. Material and Methods: The Milan study group, formed during the 2015 European Congress of Cytology generated a survey that included 49 specific questions related to the taxonomy and practice of salivary gland cytology. QualtricsÒ software (Provo, Utah, USA) provided by the University of Wisconsin Division of Information Technology (DoIT) (Madison, Wisconsin, USA) was used as the study platform. The survey was available online from November 27th 2015 until February 1st 2016. Invitation to participants was accomplished through the websites and listserves of the professional societies. Results: A total of 515 participant responses were collected and reviewed. The survey included sets of questions pertaining to different diagnostic taxonomic schemes for salivary gland cytology. Three hundred and forty-
Abstracts seven participants provided information about their work setting. Responses reveal variation in diagnostic practice and subsequent management. Participants felt that the acceptable rate for non-diagnostic samples should be near 10%. Many would alter their interpretation based upon clinical (pain or paralysis) and radiologic evidence (mass lesion). Most would appreciate adoption of a tiered risk-based classification system. As expected, there were varied opinions regarding the approach to neoplastic lesions of uncertain biologic potential, those that may or may not exhibit local invasion and distant spread. Most already use the terms atypical and suspicious for malignancy, but the practice is not uniform. Conclusions: Results of the survey demonstrated a strong support for the development of a unified system for reporting salivary gland cytopathology among respondents. PL10 The Paris System for Urine Cytology in Upper Tract Urothelial Specimens: A Comparative Analysis with Biopsy and Surgical Resection Xiaoyong Zheng, MD, PhD1, Qiusheng Si, MD, PhD1, Diane Du, MD1, Manju Harshan, MD1, Zesong Zhang, MD, MS1, G. Kenneth Haines, MD1, David Chhieng, MD, MBA2. 1Mount Sinai Hospital, New York, NY; 2 University of Washington Medical Center, Seattle, WA Introduction: The Paris System (TPS) has recently been used in classification of urinary tract cytologic specimens. The majority of the studies have focused on urinary bladder specimens. Upper urinary tract (UUT) specimens are cytologically challenging due to limited tissue and other reactive atypia. Our objective is to investigate the utility of the TPS in evaluating UUT specimens and its correlation with subsequent histologic follow-up. Materials and Method: A total of 324 cytology cases of UUT from 179 patients from 2014-2017 were retrieved. Concurrent or subsequent biopsy or resection within 2-month period was available in 125 (38.6%) cases from 74 (41.3%) patients. Interpretations were recorded as per TPS. Descriptive diagnoses from cases evaluated before the implementation of TPS were placed into the best overall categories by 2 reviewers. Result: Table 1 showed the distribution of the cytologic diagnoses of the 324 cytology cases. Table 2 summarizes the cytologic and histologic correlation of the 125 cytologic cases including the risk of HGUC for each cytologic diagnostic category. None of the cases with a cytologic of LGUN was found to have a HGUC on biopsy. Among the 19 AUC cytology cases, the histology is heterogeneous (3 ND/U, 7 benign, 1 atypia, 5 low grade lesion, and 6 HGUC). When we considered cytology cases with SHGUC or HGUC interpretations as positive, the performance of TPS in predicting high grade urothelial carcinoma on hisotlogy were: sensitivity 78.6%, specificity 86%, PPV 80.5%, and NPV 84.5%. Conclusion: More than 1/3 of the UUT cytologic cases were AUC and approximately 1/15 were SHGUC or HGUC. Based on UUT cytology
S83 specimens, the risk of malignancy of each cytologic diagnostic category of TPS was similar to that reported in the literature. The adoption of TPS in evaluating UUT cytology specimens is useful and effective in identifying patients with HGUC on histology. PL11 A Preliminary Study of SP70 as a Marker to Enrich Tumor Cells from Body Fluid Samples Jianyu Rao, MD1, Li Xia Zhang, MD2, Shiyang Pan, MD, PhD2, Marc Renz Minas, BS1, Yong Ying, MD1, Yusheng Jin, MB1, Weibo Yu, MD1. 1UCLA Medical Center, Los Angeles, CA; 2Jiangsu Provincial People’s Hospital/Nanjing Medical University, Nanjing, China Introduction: Cytological diagnosis of body fluid samples plays an important role in managing cancer. However, the sensitivity of detecting malignant cells by cytology is low. SP70 is a newly identified marker for adenocarcinoma of lung, breast and colon. A reagent kit with the antibody against SP70 conjugated to microbeads was developed. The goal of this project was to preliminarily test the efficacy of SP70 as a marker to detect metastatic adenocarcinoma in body fluid samples. Materials and Method: In this study, remnants of 30 body fluid samples (including 15 pleural fluid samples and 15 ascetic fluid samples) were obtained from cytology laboratory after routine cytological evaluation. For each sample, 50 ml samples were processed by centrifuging at 1500 rpm for 10 minutes. The pellet was re-suspended with 2mL NaCl solution mixed with 10mL working bead solution, inverted 5 times, and incubated for an hour. The mixture was washed multiple times with PBST, fixed with 95% ethanol, smeared on the slide, and then stained with DiffQuick. The slides were reviewed independently without the knowledge of cytological diagnosis. Results: Total 30 cases, consisting of 7 males and 23 females with an average age of 70 years old, were analyzed. Among which 18 were positive by SP70 test, and 12 were negative. All 10 cases with positive cytological diagnosis were positive by SP70 test. In 20 cytology negative samples, 8
Table 1
Table 2
Figure 1
Representative Image of SP70-beads Coa