and non-clinical applications. This book accordingly incorporates several relevant chapters including computer-assisted Pap test screening by Pantanowitz and Bui [6], telecytology for rapid on-site evaluation by Hanna et al. [7], whole-slide imaging by Li et al. [8], and image analysis by Pantanowitz and Bui [9]. The final chapter by Pantanowitz et al. [10] encompasses a potpourri of exciting topics, including clinical trials in cytology and cytobanking. However, it does not matter in which order the chapters of this book are read as each chapter represents a stand-alone contemporary review of emerging topics in cytopathology. We hope that you will find this monograph to be thought-provoking and a valuable reference for your practice.
Acknowledgements
The editors are thankful to all of the contributors for their expertise and effort. Special thanks are extended to Dr. Philippe Vielh, who envisioned and propelled this project. We also express our gratitude to our family for their unwavering support of our academic work.
Disclosure Statement
The editors have no conflicts of interest to declare.
Marilyn M. Bui, Tampa, FL, USA
Liron Pantanowitz, Pittsburgh, PA, USA
References
1Rollins SD: The interventional cytopathologist and ultrasound-guided fine-needle aspiration; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455781.
2Saqi A, Balassanian R: Cell Blocks: Evolution, modernization, and assimilation into emerging technologies; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455772.
3Monaco SE, Dacic S: Fluorescence in situ hybridization in cytopathology; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455777.
4Roy-Chowdhuri S, Somak R, Pantanowitz L: Next-generation sequencing in cytopathology; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455779.
5Katz RL, Zaidi TM, Xiaohui N: Liquid biopsy: recent advances in the detection of circulating tumor cells and their clinical application; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455780.
6Pantanowitz L, Bui MM: Computer-assisted Pap test screening; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455774.
7Hanna MG, Lin O, Sirintrapun SJ, Pantanowitz L: Telecytology for rapid on-site evaluation; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000496525.
8Li Z, Quick M, Pantanowitz L: Whole-slide imaging in cytopathology; in Bui MM, Pantanowitz L (eds): Modern techniques in cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455775.
9Pantanowitz L, Bui MM: Image analysis in cytopathology; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455776.
10Pantanowitz L, Monaco SE, da Cunha Santos G: Other cytology applications: clinical trials, checkpoint inhibitors, and cytobanking; in Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology. Monogr Clin Cytol. Basel, Karger, 2020, vol 25. DOI: 10.1159/000455773.
Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology.
Monogr Clin Cytol. Basel, Karger, 2020, vol 25, pp 1–5 (DOI: 10.1159/000455781)
______________________
The Interventional Cytopathologist and Ultrasound-Guided Fine-Needle Aspiration
Susan D. Rollins
ETSU Department of Pathology, Outpatient Cytopathology Center, Johnson City, TN, USA
______________________
Abstract
Ultrasound-guided fine-needle aspiration (FNA) biopsy allows for accurate sampling of mass lesions. The diagnostic information from this procedure is maximized when the pathologist is intimately involved with specimen procurement, specimen triage, and interpretation. This chapter discusses the role of the interventional cytopathologist, training opportunities, and basic information for starting a pathologist ultrasound-guided FNA clinic.
© 2020 S. Karger AG, Basel
In 2009, the College of American Pathologists began offering a course to cytologists in ultrasound-guided fine-needle aspiration (USFNA) biopsy entitled Ultrasound-Guided Fine-Needle Aspiration Advanced Practical Pathology Program (USFNA AP3). Prior to this, only a handful of cytopathologists were performing their own USFNA biopsies. In less than a decade, cytopathologists have realized the utility of learning and practicing USFNA. The technique is now taught in residency and fellowship programs. Highlighting the importance of USFNA in cytopathology training programs, the July 2015 ACGME and ABP Cytopathology Milestone Project (PC2) cited this skill as a level 4 milestone in cytopathology training. According to this milestone the cytology trainee should have the following competency: “Describes and discusses indications and/or performs ultrasound-guided FNAB and core-needle biopsy” [1].
The scope of practice for clinical cytologists is markedly expanded when USFNA is added to their repertoire. In addition to palpable masses, cytologists have the opportunity to sample non-palpable superficial targets. Sampling of palpable masses is also improved. The cytologist has control over needle gauge, number of passes, area of lesion sampled, and, based on rapid on-site cytologic evaluation (ROSE), specimens can be appropriately triaged for ancillary studies such as cell block, immunocytochemical stains, cultures, flow cytometry, molecular studies, and/or core-needle biopsy. With experience, the cytologist can learn how to correlate ultrasound (US) features of a mass with the cytologic findings and can integrate this information into the cytology report to better guide clinicians in appropriate follow-up care and specialist referral. The ability to link the cytology procedure and report to patient management algorithms is immensely valuable for the patient and can be personally gratifying for the clinical cytopathologist. Cytologist-centered USFNA offers patients streamlined, cost-effective, and personalized care.
ROSE of FNA biopsy specimens