physician to choose a needle gauge based on the lesion being sampled, patient coagulation status, and Doppler vascularity of the mass. Use of a syringe holder (gun) is at the discretion of the aspirating physician; several styles are commercially available. A needle-only technique can be used to sample many masses. Some clinicians like using an adaptor between the needle and the syringe so that the needle-only technique can be used for needle placement, while an assistant can apply suction on an attached syringe.
Fig. 2. Cutaneous anesthesia options.
Reporting
In September 1996, the National Cancer Institute (NCI) sponsored a consensus conference to define a uniform approach for reporting breast FNA biopsy cytology. Twenty years later, the executive of the International Academy of Cytology (IAC) named a Breast Group including cytopathologists, surgical pathologists, radiologists, surgeons, and oncologists to draft a standardized reporting system for breast FNA that could be employed widely in both developed and underdeveloped countries. The structured report includes management recommendations to enhance the clinicians’ use of breast FNAB and use of cells blocks, immunohistochemistry, in-situ hybridization, and other prognostic and diagnostic markers [7].
In 2007, the NCI sponsored the “Thyroid Fine-Needle Aspiration State of the Science Conference,” and in 2010 “The Bethesda System for Reporting Thyroid Cytopathology” (TBSRTC) monograph was published. Since then, there have been significant developments in molecular studies for thyroid lesions as well as changes in clinical management as reflected in the 2015 American Thyroid Association (ATA) guidelines and the introduction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) [8, 9]. These revised reporting systems are important for the promotion of cytopathologist USFNA. They reflect the importance of integration of clinical, imaging, and cytologic findings, and integration of ancillary studies which enhance the role of the clinical cytopathologist in the future practice of medicine.
Looking Forward: Elastography
Diagnostic US creates morphologic images of organs. US elastography is a non-invasive test that images tissue stiffness. This imaging modality may be able to generate additional clinically relevant information since pathological processes can alter the elastic properties of tissue. Emerging uses of elastography that could be relevant to the clinical cytopathologists performing USFNA include breast lymph node and thyroid masses. If so, an additional skill can be learned by the clinical cytopathologist and integrated into the cytology report [10, 11].
Disclosure Statement
The author has no conflicts of interest to disclose.
References
1The Cytopathology Milestone Project: A Joint Initiative of The Accreditation Council for Graduate Medical Education and The American Board of Pathology, July 2015.
2Schmidt RL, Walker BS, Cohen MB: When is rapid on-site evaluation cost-effective for fine-needle aspiration biopsy? PLoS One 2015;10:e0135466.
3Layfield LJ, Bentz JS, Gopez EV: Immediate on-site interpretation of fine-needle aspiration smears: a cost and compensation analysis. Cancer 2001;93:319–322.
4Ljung BM, Drejet A, Chiampi N, et al: Diagnostic accuracy of FNAB is determined by physician training in sampling technique. Cancer 2001;93:263–268.
5Monaco SE, Xing J, Pantanowitz L: Credentialing criteria for pathologists to obtain privileges to perform ultrasound guided fine needle aspiration. Poster; ASC Meeting, New Orleans, 2016.
6Ljung BM, Langer J, Mazzaferri EL: Training, credentialing and re-credentialing for the performance of a thyroid FNA: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008;36:400–406.
7Field AS, Schmitt F, Vielh P: IAC standardized reporting of breast fine-needle aspiration biopsy cytology. Acta Cytol 2017;61:3–6.
8Haugen B, Alexander E, Bible KC, et al; American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer: 2015 American Thyroid Association management guideline for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1–133.
9Baloch ZW, Seethala RR, Faquin WC, et al: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): a changing paradigm in thyroid surgical pathology and implications for thyroid cytopathology. September 2016;124:616–620.
10Gennisson JL, Deffieux T, Fink M, et al: Ultrasound elastography: principles and techniques. Diagn Interv Imaging 2013;94:487–495.
11Massat MB: Ultrasound elastography gaining clinical use. Appl Radiol 2016;45:44–47.
Prof. Susan D. Rollins
ETSU Department of Pathology
Outpatient Cytopathology Center
2400 Susannah Street, Johnson City TN 37601 (USA)
E-Mail [email protected]
Bui MM, Pantanowitz L (eds): Modern Techniques in Cytopathology.
Monogr Clin Cytol. Basel, Karger, 2020, vol 25, pp 6–18 (DOI: 10.1159/000455772)
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Cell Blocks: Evolution, Modernization, and Assimilation into Emerging Technologies
Anjali Saqia Ronald Balassanianb
aDepartment of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA; bDepartment of Pathology, University of California, San Francisco, CA, USA
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Abstract
Cell blocks represent the convergence of cytology and histology. Processed as a formalin-fixed paraffin-embedded histology sample, the cell block is composed of cells and small tissue fragments condensed into a pellet. Unlike histology specimens, which have relatively consistent standard operating procedures, the protocols for cell blocks vary among laboratories. The reasons may be 2-fold. First, there is unavailability of an ideal