scholarly journals Routine Use of Adjunctive p16 Immunohistochemistry Improves Diagnostic Agreement of Cervical Biopsy Interpretation

2018 ◽  
Vol 42 (8) ◽  
pp. 1001-1009 ◽  
Author(s):  
Mark H. Stoler ◽  
Thomas C. Wright ◽  
Alex Ferenczy ◽  
James Ranger-Moore ◽  
Qijun Fang ◽  
...  
Keyword(s):  
Diagnostic Agreement ◽  
Cervical Biopsy ◽  
P16 Immunohistochemistry ◽  
Biopsy Interpretation

Estimating the Benefits and Harms of p16 Utilization on Cervical Biopsy Interpretation in Routine Clinical Practice

2018 ◽  
Author(s):  
Salina M. Torres ◽  
Nicolas Wentzensen ◽  
Mark H. Stoler ◽  
Teresa M. Darragh ◽  
Patti E. Gravitt ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Routine Clinical Practice ◽  
Cervical Biopsy ◽  
Biopsy Interpretation

Do Deeper Levels of Cervical Biopsies Preceded by a Pap Smear Diagnosis of LSIL, ASCUS, or NILM/HPV+ Increase the Yield of Identifying Clinically Significant Lesions?

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
K G Manjee ◽  
W G Watkin
Keyword(s):  
Pap Smear ◽  
Past History ◽  
Prior History ◽  
Cervical Biopsy ◽  
P16 Immunohistochemistry ◽  
Hpv Status ◽  
Significant Difference ◽  
History Of ◽  
Clinically Significant ◽  
Almost All

Abstract Introduction/Objective Cervical biopsy is performed following an abnormal pap smear or positive HPV testing in an attempt to uncover clinically significant lesions [HSIL/invasive carcinoma (HSIL+)]. An excisional procedure is considered if biopsy confirms HSIL+. When preceded by pap smear of LSIL, ASCUS, NILM/HPV+ or persistent HPV, continued surveillance is recommended for biopsies showing no SIL or LSIL. In our laboratory, cervical biopsies are routinely sectioned at 3 levels. Deeper levels are often ordered when initial sections are non-diagnostic. p16 immunohistochemistry, with or without deeper levels, is often ordered to confirm HSIL, or to differentiate HSIL from mimics. In this study, we examine whether and in what clinical situations does obtaining additional levels uncover clinically significant lesions. Methods 430 cervical biopsies between January-May 2018, with recent cytology of LSIL, ASCUS or NILM/HPV+ were identified in the pathology database. HPV status (if known), final biopsy diagnosis and past history of LSIL/HSIL were recorded. For each biopsy, orders for additional levels and/or p16 immunohistochemistry were recorded resulting in 4 categories: C1-no additional levels or p16, C2-deeper only, C3-deeper+p16 and C4-p16 only. Final diagnoses were divided into HSIL+, LSIL and no SIL. Results There was no significant difference in prior history of LSIL/HSIL and HPV status between all categories. Biopsy results were as follows: HSIL+: 11/222 (5%) C1; 1/78 (1%) C2; 7/43 (16%) C3; 15/87 (17%) C4 LSIL: 91/222 (41%) C1; 7/78 (9%) C2; 16/43 (37%) C3; 35/87 (40%) C4 No SIL: 120/222 (54%) C1; 70/78 (90%) C2; 20/43 (46%) C3; 37/87 (42%) C4 The average number of additional levels in C2 and C3 was 3.8 and 1.8, respectively. Conclusion Deeper levels alone did not enhance the detection of HSIL+. Almost all LSIL/HSIL were detected when initial levels were diagnostic or suspicious and supported by p16 immunohistochemistry. 3 levels are adequate to detect clinically significant lesions.

scholarly journals Prospective Consensus Reporting by Gynecologic Pathology and Dermatopathology Improves Diagnosis of Vulvar Biopsies

2020 ◽  
Vol 144 (12) ◽  
pp. 000-000
Author(s):  
Susanne K. Jeffus ◽  
Charles M. Quick ◽  
Chien Chen ◽  
Jerad M. Gardner ◽  
Jennifer R. Kaley ◽  
...  
Keyword(s):  
Diagnostic Category ◽  
Clinical History ◽  
Daily Practice ◽  
Diagnostic Agreement ◽  
Diagnostic Confidence ◽  
Multiple Data ◽  
Biopsy Interpretation ◽  
Diagnostic Concordance ◽  
Data Elements ◽  
Consensus Diagnosis

Context.— Vulvar biopsy interpretation and reporting, particularly of vulvar dermatoses, can be challenging in daily practice for both surgical pathologists (SPs) and dermatopathologists (DPs). Objective.— To investigate whether prospective consensus reporting of vulvar biopsies by SPs and DPs would provide value and improve overall diagnostic concordance. Design.— Consecutive vulvar biopsies during a 6-month period were reviewed prospectively by both gynecologic SPs and DPs. Preliminary, independently generated diagnoses were recorded and then shared in consensus review (SPs+DPs). A third pathologist adjudicated cases without consensus. Multiple data elements were collected for each case: division (SP/DP), age, site, clinical history, diagnostic category, preliminary and final (consensus) diagnosis, need for adjudication, ancillary tests, and diagnostic discrepancy. Results.— Eighty-four biopsies (48 SP, 36 DP) from 70 patients were reviewed. Forty-two of 84 cases (50%) were neoplastic, 38 of 84 (45%) were reactive/inflammatory, with the remaining (5%) showing both or other features. Independent diagnoses were discrepant in 22 of 84 cases (26%), but consensus review resulted in an agreed-upon diagnosis in all cases, with adjudication required in 6 cases. Independent diagnostic agreement increased over time with a reduction in major and minor discrepancies between the first and second half of the study period. Conclusions.— Prospective review of vulvar biopsies by both SPs and DPs can improve overall reporting. Consensus review allows pathologists to gain diagnostic confidence in interpretation of inflammatory (for SPs) and neoplastic (for DPs) vulvar biopsies; therefore, intradepartmental consultation is of value, particularly in select cases.

Overdiagnosis of HSIL on cervical biopsy: errors in p16 immunohistochemistry implementation

2016 ◽  
Vol 55 ◽  
pp. 51-56 ◽  
Author(s):  
Jennifer L. Clark ◽  
Dan Lu ◽  
Tamara Kalir ◽  
Yuxin Liu
Keyword(s):  
Cervical Biopsy ◽  
P16 Immunohistochemistry

Forced coughing versus local anesthesia and pain associated with cervical biopsy: A randomized trial

2008 ◽  
Vol 68 (04) ◽  
Author(s):  
BC Schmid ◽  
S Pils ◽  
G Heinze ◽  
L Hefler ◽  
A Reinthaller ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Local Anesthesia ◽  
Cervical Biopsy

Utilization of P16 in Head and Neck Cytology and Surgical Specimens After the Release of CAP Guidelines

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S22-S22
Author(s):  
H Laharwani ◽  
V Manucha ◽  
G Jefferson ◽  
L Jackson
Keyword(s):  
Head And Neck ◽  
Squamous Cell ◽  
Squamous Cell Carcinomas ◽  
Common Reason ◽  
Unknown Primary ◽  
Hpv Testing ◽  
Neck Masses ◽  
P16 Immunohistochemistry ◽  
Hpv Status ◽  
Wrong Site

Abstract Introduction/Objective HPV-positive oropharyngeal squamous cell carcinoma is biologically and clinically unique and has a survival advantage over other head and neck squamous cell carcinomas. In December 2017 College of American Pathologist published guidelines for testing HPV status in head and neck cancer. It was recommended that pathologists perform HR-HPV testing on head and neck squamous cell carcinomas from all patients with known oropharyngeal SCC not previously tested for HR-HPV, with suspected oropharyngeal SCC, or with metastatic SCC of unknown primary. The aim of this study was to determine the compliance of pathologists following the CAP guidelines. Methods Cases that underwent HPV testing using p16 immunohistochemistry for the years 2017 and 2019 were retrieved. Based on the guidelines, p16 testing was designated as “indicated” or “not indicated”. Results There were 196 cases in which p16 testing was performed in a period of 3 consecutive years. Of these, 175 were FNA/ biopsies and 21 were surgical resections. In 69 cases (56 FNAs and 13 biopsies) the biopsy was performed on neck masses with unknown primary. The compliance for p16 testing in OPC and Lymph nodes with metastatic SCC of unknown primary was 100%. In 34 (17.3%) cases p16 testing was not indicated, the most common reason being wrong site (85%) including the larynx, oral tongue, the floor of the mouth, buccal mucosa, and nasal mass. Of the unindicated p16s, 20 (58%) were received in consultation for continuity of care. Conclusion Not being clear about the site of the tumor is the most common reason for unindicated p16 testing. A clear designation of biopsy site and proper communication between pathologist and surgeon can improve utilization of p16 testing in head and neck carcinomas.

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