World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine-needle aspiration biopsies of renal masses

Objectives: Biological behavior of pancreatic neuroendocrine tumors (Pan NETs) is difficult to predict on morphology alone. The assessment of proliferation by the Ki-67 proliferation index (PI) is considered to be an important prognostic parameter in these tumors and has been endorsed by the 2017 World Health Organization (WHO) grading system for Pan NETs. Although widely accepted on surgical specimens, there is varied opinion on grading of these tumors on cytology samples. This study aimed at classification and grading of Pan NETs on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using the recent 2017 WHO criteria and assess the reliability of Ki-67 grading by comparing it with histology samples wherever available. Material and Methods: Search of cytopathology lab records over a 3-year period (June 2015–May 2018) revealed 33 cases of pancreatic NETs diagnosed on EUS-FNA specimens. Using the guidelines of 2017 WHO classification and grading of Pan NETs, retrospective grading of these Pan NETs was done. They were graded as Grades 1, 2, and 3 well differentiated Pan NETs and poorly differentiated Grade 3 neoplasms based on Ki-67 PI and cytomorphology. Cytomorphological features were compared across the three grades. The cytological grading was then compared with the histological grading where available. Results: Ki-67 grading on cytology was done in 32 cases (22 on cell block and 10 on smears), of which 19 (59.4%) were Grade 1, 8 (25%) were Grade 2, and 5 (15.6%) were Grade 3 tumors. The most common cytomorphological features observed in Grade 1 tumors were small round uniform cells with granular chromatin and prominent plasmacytoid morphology. As the grade increased, tumor cells showed increased pleomorphism, angulated nuclei, and less frequent plasmacytoid cells. Histopathology (biopsy/resected specimens) was available in 11 of the 32 cases. Comparison of grading on cytology and histology showed concordance in ten of the 11 cases (k value = 0.862). Conclusion: Our data suggest that grading of Pan NETs by assessing Ki-67 PI on cytology samples collected by EUS-FNA shows good agreement with that measured on histology samples.

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Gallbladder carcinoma: An attempt of WHO histological classification on fine needle aspiration material

CytoJournal ◽

10.4103/1742-6413.113627 ◽

2013 ◽

Vol 10 ◽

pp. 12 ◽

Cited By ~ 27

Author(s):

Rajni Yadav ◽

Deepali Jain ◽

Sandeep R. Mathur ◽

Atul Sharma ◽

Venkateswaran K. Iyer

Keyword(s):

Fine Needle Aspiration ◽

Who Classification ◽

Giant Cells ◽

Needle Aspiration ◽

Undifferentiated Carcinoma ◽

World Health ◽

Fine Needle ◽

Signet Ring ◽

Needle Aspiration Cytology ◽

Health Organization

Background: Carcinoma of the gallbladder (CaGB) is common in India and its prognosis depends primarily on the extent of the disease and histological type. We aim to study the role of guided fine needle aspiration cytology (FNAC) for diagnosis of CaGB and to evaluate the feasibility of applying world health organization (WHO) classification on fine needle aspiration (FNA) material to predict the outcome of the tumor. Materials and Methods: Retrospective cytomorphologic analysis was performed in all cases of CaGB diagnosed by ultrasound (US) guided FNAC over a period of 2 years. A specific subtype was assigned according to WHO classification based on characteristic cytologic features. These included papillary or acinar arrangement, intra and extracellular mucin, keratin, rosettes and columnar, signet ring, atypical squamous, small, clear, spindle and giant cells. Correlation with histopathology was performed when available. Results: A total of 541 aspirations with clinical or radiological suspicion of primary CaGB were studied. Of these, 54 aspirates were unsatisfactory. Fifty cases were negative for malignancy. Remaining 437 aspirates were positive for carcinoma. Histopathologic diagnosis was available in 32 cases. Adenocarcinoma was the most frequent diagnosis in 86.7% of cases. Mucinous, signet ring, adenosquamous, squamous, small cell, mixed adenoneuroendocrine and undifferentiated carcinoma including spindle and giant cell subtypes were diagnosed identifying specific features on FNAC. Correlation with histopathology was present in all, but one case giving rise to sensitivity of 96.8%. No post-FNA complications were recorded. Conclusions: US guided FNAC is a safe and effective method to diagnose CaGB. Although, rare, clinically and prognostically significant variants described in WHO classification can be detected on cytology.

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Accuracy of Subclassification and Grading of Renal Tumors on Fine Needle Aspiration Cytology Alone

Acta Cytologica ◽

10.1159/000513065 ◽

2021 ◽

pp. 1-10

Author(s):

Heather I.-Hsuan Chen ◽

Razvan Lapadat ◽

Ricardo R. Lastra ◽

Anna Biernacka ◽

Ward Reeves ◽

...

Keyword(s):

Fine Needle Aspiration ◽

Correct Diagnosis ◽

Needle Aspiration ◽

World Health ◽

Renal Tumors ◽

Malignant Neoplasms ◽

Renal Masses ◽

Fine Needle ◽

Percent Correct ◽

Rater Variability

Background: Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73–94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. Design: Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss’ Kappa and Cohen’s Kappa equations were used to look at inter-rater variability. Results: When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss’ Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. Conclusions: Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.

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Huge pelvic parachordoma: fine needle aspiration cytology and histological differential diagnosis

Rare Tumors ◽

10.4081/rt.2012.e53 ◽

2012 ◽

Vol 4 (4) ◽

pp. 172-174 ◽

Cited By ~ 4

Author(s):

Rehab M. Samaka ◽

Mona A. Kandil

Keyword(s):

Fine Needle Aspiration ◽

Fine Needle Aspiration Cytology ◽

Soft Tissues ◽

Pelvic Mass ◽

Needle Aspiration ◽

World Health ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology ◽

Health Organization

Parachordoma is an extremely rare soft tissue tumor of unknown lineage. Parachordoma develops most often on the extremities. Only 2 cases have been reported as pelvic parachordoma. A 46-year old Egyptian woman with a huge painful pelvic mass was found to have a parachordoma with ectopic pelvic right kidney. There is only one report in the literature of fine needle aspiration cytology in this setting. The microscopic picture of parachordoma is not new to pathologists but the gross picture of this rare tumor has not previously been published; not even in the World Health Organization classification of soft tissues tumors. Diagnosis was confirmed by immunohistochemistry. The patient is in good clinical condition without any evidence of recurrence or metastasis after 84 months of follow up.

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Role of Fine-Needle Aspiration in the Surgical Management of Pancreatic Neuroendocrine Tumors: Utility and Limitations in Light of the New World Health Organization Classification

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2013-0300-oa ◽

2014 ◽

Vol 138 (7) ◽

pp. 896-902 ◽

Cited By ~ 8

Author(s):

Terence N. Moyana ◽

Wayne S. Kendal ◽

Avijit Chatterjee ◽

Derek J. Jonker ◽

Jean A. Maroun ◽

...

Keyword(s):

Minimally Invasive ◽

Fine Needle Aspiration ◽

New World ◽

Preoperative Evaluation ◽

Needle Aspiration ◽

World Health ◽

Pancreatic Neuroendocrine Tumors ◽

World Health Organization Classification ◽

Fine Needle ◽

Health Organization

Context.—Pancreatic neuroendocrine tumors (Panc-NETs) are rare and tend to get overshadowed by their more prevalent and aggressive ductal adenocarcinoma counterparts. The biological behavior of PancNETs is unpredictable, and thus management is controversial. However, the new World Health Organization classification has significantly contributed to the prognostic stratification of these patients. Concurrently, there have been advances in surgical techniques for benign or low-grade pancreatic tumors. These procedures include minimally invasive and parenchyma-sparing operations such as laparoscopy and enucleation. Objective.—To report on the utility and limitations of fine-needle aspiration in the preoperative evaluation and management of PancNETs. Design.—This was a retrospective review of our institutional tumor database from 2002 to 2012. There were 25 cases of PancNETs that were localized and staged by medical imaging and diagnosed by fine-needle aspiration. Results.—Fourteen patients underwent laparotomy, with some requiring only limited surgery; 4 had laparoscopic resections; 4 were serially observed without surgical intervention; and another 3 were inoperable. After a mean follow-up of 37 months, more than half of the patients had no evidence of disease, including most of those who underwent minimally invasive surgery. Conclusions.—Fine-needle aspiration is a useful diagnostic adjunct to medical imaging in the preoperative evaluation and management of PancNETs. However, there are limitations with regard to grading PancNETs using this technique.

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Association between Fine-needle Aspiration Cytological Features and CD4 Level in Human Immunodeficiency Virus-Associated Tuberculous Lymphadenitis Patients Admitted to Haji Adam Malik Hospital in 2017

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.449 ◽

2019 ◽

Vol 7 (20) ◽

pp. 3475-3477

Author(s):

Delyuzar Delyuzar ◽

Agri Borneos Sinulingga ◽

Dedy Suryadi

Keyword(s):

Fine Needle Aspiration ◽

Extrapulmonary Tuberculosis ◽

Needle Aspiration ◽

World Health ◽

P Value ◽

Tuberculous Lymphadenitis ◽

Cross Sectional ◽

Fine Needle ◽

Cytological Features ◽

Health Organization

BACKGROUND: World Health Organization stated that one-third of the world's population has tuberculosis with one infected person in every second. In 2015 there were 330,910 tuberculosis cases in Indonesia. This number increased compared to 2014, which amounted to 324,539 cases. HIV-positive patients with extrapulmonary tuberculosis accounted for 50% of TB cases, of which 35% were lymphadenitis. Lymph node fine-needle aspiration (FNA) is considered effective in determining the early diagnosis of lymphadenopathy. AIM: This study aims to evaluate the association between cytological features and CD4 level in HIV-associated tuberculous lymphadenitis patients in Haji Adam Malik Hospital in 2017. METHODS: This is an analytical study with a cross-sectional approach involving 42 samples. Cytological features were obtained by slide reviewed and CD4 level were obtained from the medical record. RESULTS: Analysis of the association of cytological features with CD4 level association revealed p-value of 0.353. CONCLUSION: This indicates that there is no significant association between FNA cytological features and CD4 level in HIV-associated tuberculous lymphadenitis patients.

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Fine Needle Aspiration Cytology and Flow Cytometry in the Diagnosis and Subclassification of Non-Hodgkin’s Lymphoma Based on the World Health Organization Classification

Acta Cytologica ◽

10.1159/000325753 ◽

2007 ◽

Vol 51 (3) ◽

pp. 390-398 ◽

Cited By ~ 37

Author(s):

Markus Bangerter ◽

Olaf Brudler ◽

Bernhard Heinrich ◽

Martin Griesshammer

Keyword(s):

Flow Cytometry ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

World Health ◽

World Health Organization Classification ◽

Aspiration Cytology ◽

Fine Needle ◽

The World ◽

Needle Aspiration Cytology ◽

Health Organization

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Classification of Breast Cancer Malignancy Using Cytological Images of Fine Needle Aspiration Biopsies

International Journal of Applied Mathematics and Computer Science ◽

10.2478/v10006-008-0007-x ◽

2008 ◽

Vol 18 (1) ◽

pp. 75-83 ◽

Cited By ~ 42

Author(s):

Łukasz Jeleń ◽

Thomas Fevens ◽

Adam Krzyżak

Keyword(s):

Breast Cancer ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

World Health ◽

Support Vector ◽

Fine Needle ◽

Malignancy Grade ◽

Precise Diagnosis ◽

Health Organization

Classification of Breast Cancer Malignancy Using Cytological Images of Fine Needle Aspiration BiopsiesAccording to the World Health Organization (WHO), breast cancer (BC) is one of the most deadly cancers diagnosed among middle-aged women. Precise diagnosis and prognosis are crucial to reduce the high death rate. In this paper we present a framework for automatic malignancy grading of fine needle aspiration biopsy tissue. The malignancy grade is one of the most important factors taken into consideration during the prediction of cancer behavior after the treatment. Our framework is based on a classification using Support Vector Machines (SVM). The SVMs presented here are able to assign a malignancy grade based on preextracted features with the accuracy up to 94.24%. We also show that SVMs performed best out of four tested classifiers.

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