Application of the International System for Reporting Serous Fluid Cytopathology with Cytohistological Correlation and Risk of Malignancy Assessment

The International System for Reporting Serous Fluid Cytopathology (TIS) classifies serous effusions into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM) and malignant (MAL). The main objectives of this classification comprise the establishment of a universal code of communication between cytopathologists and clinicians and histopathologists, as well as between different laboratories worldwide, paving the way for the setting of clinical management guidelines based on the risk of malignancy assessment for each diagnostic category. We retrieved the total number of pleural and peritoneal effusion cases of our department for the three-year time period between 2018 and 2020, yielding a total of 528 and 500 cases, respectively. We then proceeded to reclassify each specimen according to TIS guidelines and calculate the risk of malignancy (ROM) for each category by searching each patients’ histology records, medical history and clinical follow-up. For pleural effusions, 3 (0.57%) cases were classified as ND, 430 (81.44%) cases as NFM, 15 (2.84%) as AUS, 15 (2.84%) as SFM and 65 (12.31%) as MAL. ROM amounted to 0%, 5.3%, 33.33%, 93.33% and 100% for each category, respectively. As far as peritoneal effusions are concerned, 6 (1.2%) were categorized as ND with ROM estimated at 16.66%, 347 (69.4%) as NFM (ROM = 9%), 13 (2.6%) as AUS (ROM = 38.46%), 12 (2.4%) as SFM (ROM = 83.33%) and 122 (24.4%) as MAL (ROM = 100%). Our results underline the utility of the current classification, both as a means of communication between doctors of different specialties and as general guidelines for the further clinical management of patients.

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Pleureaergüsse: Zytohistologie als wesentliche Option zum Ausschluss oder zur Bestätigung einer bösartigen Ursache

Karger Kompass Pneumologie ◽

10.1159/000520116 ◽

2021 ◽

pp. 1-3

Author(s):

Franz Stanzel

Keyword(s):

International System ◽

The Body ◽

Future Research ◽

Pleural Effusions ◽

Serous Fluid ◽

Pleural Biopsy ◽

Diagnostic Categories ◽

Unknown Significance ◽

Risk Of Malignancy ◽

Fluid Cytology

The International System for Reporting Serous Fluid Cytology (TIS) was recently developed. Given its novelty, most studies looking into the risk of malignancy (ROM) of serous effusion diagnostic categories were published before the development of TIS. We searched the database of our department for pleural effusions diagnosed in the last five years, excluding those without a corresponding pleural biopsy. Cases were reviewed and reclassified according to the TIS. A cytohistological correlation was performed. In total, 350 pleural effusion specimens with one or more corresponding pleural biopsies were included. After reclassification, 5 (1.43%) were nondiagnostic (ND), 253 (72.29%) were negative for malignancy (NFM), 7 (2.00%) had atypia of unknown significance (AUS), 14 (4.00%) were suspicious for malignancy (SFM), and 71 (20.57%) were malignant (MAL). Calculated ROM was 40% for ND, 20.16% for NFM, 42.86% for AUS, 78.57% for SFM, and 100% for MAL. Effusion cytology sensitivity and specificity were 60.29% and 98.56%, respectively. This is the first publication looking into the cytohistological correlation of a retrospective cohort of pleural effusions based on the TIS. We add to the body of data regarding the ROM for TIS categories, highlighting areas of potential future research.

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Cytohistological Correlation in Pleural Effusions Based on the International System for Reporting Serous Fluid Cytopathology

Diagnostics ◽

10.3390/diagnostics11061126 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1126

Author(s):

Daniel Pinto ◽

Eduardo Cruz ◽

Diamantina Branco ◽

Cláudia Linares ◽

Conceição Carvalho ◽

...

Keyword(s):

International System ◽

The Body ◽

Future Research ◽

Pleural Effusions ◽

Serous Fluid ◽

Pleural Biopsy ◽

Diagnostic Categories ◽

Unknown Significance ◽

Risk Of Malignancy ◽

Fluid Cytology

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Application of the International System for Reporting Serous Fluid Cytopathology in routine reporting of pleural effusion and assessment of the risk of malignancy

Diagnostic Cytopathology ◽

10.1002/dc.24837 ◽

2021 ◽

Author(s):

Shilpy Jha ◽

Madhusmita Sethy ◽

Amit Kumar Adhya

Keyword(s):

Pleural Effusion ◽

International System ◽

Serous Fluid ◽

Risk Of Malignancy

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Correlation study of thyroid nodule cytopathology and histopathology at two institutions in Jordan

CytoJournal ◽

10.4103/cytojournal.cytojournal_53_17 ◽

2018 ◽

Vol 15 ◽

pp. 24 ◽

Cited By ~ 1

Author(s):

Niveen Abdullah ◽

Manar Hajeer ◽

Loay Abudalu ◽

Maher Sughayer

Keyword(s):

Test Performance ◽

Predictive Value ◽

Diagnostic Category ◽

Needle Aspiration ◽

Correlation Study ◽

Follicular Neoplasm ◽

Risk Of Malignancy ◽

Thyroid Fna ◽

Undetermined Significance

Background: Fine-needle aspiration (FNA) plays a fundamental role in determining the appropriate management for patients presenting with thyroid nodules. Aims: The aims of this study are to evaluate thyroid FNA test performance parameters through a cytohistological correlation. Materials and Methods: A retrospective analysis of all thyroid FNAs received over a period of 18 months was carried out. The findings were compared to their subsequent definite diagnoses on surgical specimens as well as to their follow-up repeat FNA results. A total of 499 thyroid FNAs were collected and reviewed against The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The percentage of each diagnostic category was calculated, and the implied risk of malignancy was determined by comparing the cytology results to their definite diagnoses obtained on the resection specimens. Analytical procedures were performed using Microsoft Excel. Results: Out of 499 thyroid FNAs, a benign interpretation was found in 273 patients (54.7%), atypia of undetermined significance in 81 (16.2%), follicular neoplasm in 20 (4%), suspicious for malignancy in 36 (7.2%), malignant in 32 (6.4%) and were nondiagnostic in 57 patients (11.4%). Only 101 patients (20.2%) underwent surgical resection and 47 (9.4%) underwent a follow-up FNA. After cytohistological correlation, FNA test performance, calculated by excluding the inadequate and undetermined categories revealed test sensitivity, specificity, and diagnostic accuracy of 95.6%, 54.8%, and 78.9%, respectively. The positive predictive value was 75.4%, and the negative predictive value was 89.5%. Conclusions: Our results are comparable to those previously published figures. The rate of atypia of undetermined significance/follicular lesion of undetermined significance is higher than what is currently recommended in TBSRTC.

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Risk of Malignancy of Pelvic and Peritoneal Fluid Cytology with Histological Correlation Using the International System for Reporting Serous Fluid Cytopathology: Experience of a Large Healthcare System

Journal of the American Society of Cytopathology ◽

10.1016/j.jasc.2021.07.023 ◽

2021 ◽

Vol 10 (5) ◽

pp. S20

Author(s):

Deepika Savant ◽

Karen Chau ◽

Sujata Sajjan ◽

Hector Chavarria ◽

Nidhi Kataria ◽

...

Keyword(s):

Healthcare System ◽

Peritoneal Fluid ◽

International System ◽

Serous Fluid ◽

Risk Of Malignancy ◽

Fluid Cytology

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Application of the Milan System for Reporting Salivary Gland Cytopathology: A 10-Year Experience in a Single Japanese Institution

Acta Cytologica ◽

10.1159/000510990 ◽

2020 ◽

pp. 1-9

Author(s):

Yukiya Hirata ◽

Kayoko Higuchi ◽

Koichi Tamashiro ◽

Keisuke Koja ◽

Yuiko Yasutomi ◽

...

Keyword(s):

Salivary Gland ◽

Predictive Value ◽

Diagnostic Category ◽

Needle Aspiration ◽

Salivary Gland Neoplasm ◽

Published Evidence ◽

Risk Of Malignancy ◽

Categorization System ◽

Sensitivity Specificity

Objective: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a recently published evidence-based categorization system for salivary gland fine-needle aspiration (FNA). We applied MSRSGC to Japanese cases and evaluated its utility. Study Design: A total of 480 FNA cases were reviewed. We recategorized each case into one of the MSRSGC categories. The risk of neoplasm (RON) and the risk of malignancy (ROM) for each diagnostic category in MSRSGC, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for malignancy and for neoplasms were calculated for cases with histological follow-up. In addition, the overall ROM (O-ROM) was calculated for all FNA cases. Results: RON, ROM, and O-ROM rates were as follows – non-diagnostic: 51.3, 5.1, and 1.0%; non-neoplastic: 0, 0, and 0%; atypia of undetermined significance: 83.9, 12.9, and 7.3%; neoplasm, benign: 100, 0, and 0%; salivary gland neoplasm of uncertain malignant potential: 100, 32.1, and 23.7%; suspicious for malignancy: 100, 85.7, and 60%; and malignant: 100, 100, 81.8%. The sensitivity, specificity, and accuracy with (without) indeterminate cases for malignancy were 65 (100), 99 (99), 92% (99%) and PPV and NPV were 96 and 100%, respectively, and those for neoplasms were 84 (100), 100 (100), 85% (100%), and PPV and NPV were 100 and 100%, respectively. Conclusions: The MSRSGC is useful for stratification of ROM and for promoting the performance of salivary gland FNA. The MSRSGC could be easily introduced in Japan and may improve the Japanese salivary gland FNA status.

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A Retrospective Analysis of Serous Effusions Based on the Newly Proposed International System for Reporting Serous Fluid Cytopathology: A Report of 3633 Cases in an Oncological Center

10.21203/rs.3.rs-1234200/v1 ◽

2022 ◽

Author(s):

Yan-li Zhu ◽

Wen-hao Ren ◽

Qian Wang ◽

Hai-zhu Jin ◽

Yi-yi Guo ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

International System ◽

High Specificity ◽

Serous Effusion ◽

Serous Fluid ◽

Preparation Methods ◽

Cytologic Examination ◽

Risk Of Malignancy ◽

The Difference

Abstract Background: The International System for Reporting Serous Fluid Cytopathology (TIS) was recently proposed. We retrospectively applied TIS recommendations for reporting the cytological diagnosis of serous effusions and reported our experience.Methods: All the serous effusions from January 2018 to September 2021 were retrieved from the database. Recategorization was performed using the TIS classification, the risk of malignancy (ROM) was calculated for each TIS category, and the performance evaluation was carried out among different samples (pleural, peritoneal and pericardial effusions) and preparation methods (conventional smears, liquid-based preparations and cell-blocks). Results: A total of 3633 cases were studied, 17 (0.5%) were diagnosed as ND, 1100 (30.3%) as NFM, 101 (2.8%) as AUS, 677 (18.6%) as SFM, and 1738 (47.8%) as MAL. The ROM for the categories were found to be 38.5%, 28.6%, 52.1%, 99.4% and 100%, respectively. The ROM for SFM was significantly higher than that for AUS (P < 0.001), while the difference between the ROMs for the IVa and IVb was insignificant. The sensitivity, negative predictive value(NPV) and diagnostic accuracy of liquid-based preparations were all superior to conventional smears and cell-blocks in detecting abnormalities. Using three preparation methods simultaneously had the highest sensitivity, NPV and diagnostic accuracy.Conclusion: Serous effusion cytology has a high specificity and positive predictive value(PPV), and the TIS is a user-friendly reporting system. Liquid-based preparations could improve the sensitivity of diagnosis, and it is best to use three different preparation methods simultaneously for serous effusion cytologic examination.

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Incidental Thyroid Nodules Found During Acute Stroke Angiography: Prevalence, Outcomes, and Suggested Management Guidelines

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211018459 ◽

2021 ◽

pp. 875647932110184

Author(s):

Diana M. Lin ◽

Yurany A. Arevalo ◽

Chen Lin

Keyword(s):

Thyroid Cancer ◽

Acute Stroke ◽

Thyroid Nodules ◽

Study Cohort ◽

Stroke Work ◽

Management Guidelines ◽

Risk Of Malignancy ◽

Thyroid Cancer Risk ◽

Work Up

Objective: In stroke patients, extensive interventions for incidental thyroid nodules can be burdensome and costly. It appears that the risk of malignancy has not been reported in angiographically detected nodules and outcomes have not yet been described in patients, receiving acute stroke work-up. Materials and Methods: Incidental thyroid nodules were found on neck computerized tomography angiography or magnetic resonance angiography performed during inpatient stroke workup (January 2017 to September 2019). These patient cases were reviewed based on sonography reports, diagnosis, and follow-up care. Results: Of the 13 563 patients, 192 had incidental thyroid nodules (prevalence 1.4%). Twenty-six died from comorbidities and 22 received thyroid sonography. Twelve nodules from 10 patients had sonographic characteristics for biopsy: 10 benign, 1 indeterminate, and 1 papillary thyroid cancer (risk of malignancy: 8%). The cancer patient underwent hemithyroidectomy and is disease-free. Follow-up of the remaining patients showed no worsening or suspicious nodules. The American College of Radiology (ACR) guidelines would have prevented 8 unnecessary sonograms and 1 biopsy without missing malignancy. Conclusion: Although a small risk of malignancy was noted, 95% of patients undergoing additional diagnostic thyroid testing had clinically insignificant results. The ACR guidelines can prevent unnecessary interventions. Given the 14% mortality rate in the study cohort, it is proposed that a clinical evaluation of patients is important before undergoing further diagnostics, as comorbidities may be worse than a thyroid cancer.

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