Evaluation of cytopathology fellow performance for rapid on-site evaluations of fine-needle aspirates over a 6-year period (original) (raw)
Related papers
Indian Journal of Surgical Oncology, 2019
Fine needle aspiration (FNA) cytology is a basic diagnostic technique used to investigate superficial and deep swellings. Rapid on-site evaluation (ROSE) using toluidine blue (TB) is easily available, cheap, cost-effective, can be used both for testing adequacy and giving provisional diagnosis. To evaluate the role of ROSE using toluidine blue staining in arriving at a diagnosis in comparison to routine stains. A total of 1500 cases of FNA of palpable swellings from sites like salivary gland, breast, thyroid, lymph node, and soft tissue lesions [non-image guided] during a 9-month period were studied. All the cases were evaluated by ROSE using toluidine blue stain and routine Giemsa/PAP staining. The results were compared in each case. Only 2% cases proved inadequate on TB, Giemsa and PAP combination, commonest site of inadequacy being lymph node. Adequate sample was obtained within two passes in 92.5% cases. The turnaround time (TAT) was 1 day in 96.4% of cases. The average time for making a provisional diagnosis on TB was 3 minutes. There was 99.2% concordance between TB and final cyto-diagnosis. Validity parameters: sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 99.8%, efficacy 99.2% and false negative 1.94%. ROSE using toluidine blue is a reliable means of demonstrating sample adequacy, for making a provisional diagnosis and guiding collection of diagnostic material for microbiology, immunocytochemistry (ICC), cell block and molecular testing etc. The technique is easy enough for general laboratories to incorporate into their routine practice. ROSE can be called as the "frozen section of cytology".
Rapid onsite evaluation: A comparison of cytopathologist and pulmonologist performance
Cancer cytopathology, 2015
Rapid onsite evaluation (ROSE) has several potential benefits but also can prolong procedures if one must wait for a cytopathologist, and it can involve a considerable time commitment on the part of the cytopathologist. At the University of Arkansas for Medical Sciences, interventional pulmonologists have routinely reviewed cytology specimens. This study was performed to determine prospectively how accurately pulmonologists could perform ROSE and whether they could contribute to the efficiency of the process. For sequential cases, the procedural pulmonologist documented a ROSE reading before the reading by the cytopathologist. Readings were compared between the two for agreement and for accuracy. The time commitment for the cytopathologist was also recorded. One hundred sixty-four sites were biopsied in 102 patients. With respect to onsite adequacy, there was a high level of concordance between pulmonology and cytopathology as evidenced by the κ score ( ± standard error) of 0.72 ± 0...
Improving the Quality of Cytology Diagnosis
American Journal of Clinical Pathology, 2005
Detailed root cause analysis to determine causes of pulmonary cytology errors has not been used to design specific practice changes. We performed root cause analysis of all false-negative bronchial brushing and washing specimen errors (n = 32) detected by the cytologic-histologic correlation process in 2002. Medical records and all slides were reviewed. Based on the correlation process, 10 errors were interpretive, 16 sampling, and 6 combined interpretive/sampling. Root cause analysis showed that the lesion was not accessible in 8 cases and tumor was readily identified on the slides in only 1 case. In 11 cases, the malignant cells were few and not recognized, and in 13 cases, obscuring artifacts (eg, cellular crushing and air drying) limited interpretation. Sampling issues had a major role in the misdiagnosis in 31 cases (97%), and recommendations for error reduction include immediate interpretation and the use of transmucosal fine-needle aspiration. Anatomic pathology errors are estimated to occur in approximately 1% to 5% of all specimens, and the majority of these errors do not lead to patient harm. 1-12 Error frequencies depend on the method of detection, and commonly used methods are secondary review for cytologic-histologic (CH) correlation, hospital or departmental conferences, clinician-directed concerns, extradepartmental consultation, and other quality assurance practices. 1-12 Although error frequencies, based on these detection methods, have been published in the medical literature, little study on how to reduce these errors has occurred. 1 Six institutions are participating in an Agency for Healthcare Research and Quality (AHRQ; Rockville, MD) project focused on developing quality improvement programs to reduce pathology-detected errors that occur more frequently and/or are associated with greater clinical severity. 1 Based on the CH correlation error-detection process, Clary et al 8 reported that errors related to pulmonary specimens were the most frequent organ-specific errors, partly because lung specimens are of high volume. In pulmonary specimens, Clary et al 8 reported that 90.9% of errors were false-negative diagnoses and 9.1% of errors were false-positive diagnoses. In the pathology literature, informal root cause analysis has focused on determining diagnostic pitfalls or on documenting the findings in unusual cases that led to misdiagnosis. 1 This approach implies that errors are related to failures in diagnostic ability rather than to system flaws that might lead to individuals performing poorly. Formal root cause analysis has not been performed and is a method that systematically examines for all sources of error and provides information that may be used to target errors at their source. 13-16 This study represents a second step in our project that uses pathology-detected errors to redesign systems to improve
Archives of Pathology & Laboratory Medicine, 2016
Context Additional reviews of diagnostic surgical and cytology cases have been shown to detect diagnostic discrepancies. Objective To develop, through a systematic review of the literature, recommendations for the review of pathology cases to detect or prevent interpretive diagnostic errors. Design The College of American Pathologists Pathology and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology convened an expert panel to develop an evidence-based guideline to help define the role of case reviews in surgical pathology and cytology. A literature search was conducted to gather data on the review of cases in surgical pathology and cytology. Results The panel drafted 5 recommendations, with strong agreement from open comment period participants ranging from 87% to 93%. The recommendations are: (1) anatomic pathologists should develop procedures for the review of selected pathology cases to detect disagreements and potential ...
CytoJournal, 2006
On-site rapid interpretation (RI) of fine needle aspiration (FNA) has been shown to increase the diagnostic yield of FNA and decrease the need for repeat diagnostic procedures. Because the pathologist interprets only a fraction of the sample and has limited resources available at such times, an occasional RI diagnosis will be changed at the time of the final diagnosis. We investigated how often these changes in diagnoses occur and the possible reasons for the changes. All cytology reports from 1/1/02 to 12/31/03 from a single institution were reviewed. Cases with RI with discrepant final diagnoses were noted. The discrepant diagnoses were categorized depending on how they were changed. Possible sources for changed diagnoses were noted. Between 1/1/02 and 12/31/03 there were 1368 RIs of FNAs. Of these 80 (5.8%) had discrepancies between the RIs and final diagnoses. Seventy-eight cases had additional slides and/or cell block at time of final diagnosis. 16 cases had ancillary studies a...
Issues in Cytologic Screening and Evaluation
Surgical Oncology Clinics of North America, 1999
The key to getting helpful results from cytologic specimens is to know your laboratory and pathologist(s). Specimen submission requirements, processing, and terminology vary among laboratory settings. Similar to other anatomic pathology disciplines, there is also interobserver variability in diagnostic assessment, especially for low-grade malignancies, precancers, and proliferative disorders.24 In this sense, cytologic evaluation differs from most clinical laboratory tests because the final diagnosis is the result of human judgment and the application of criteria that are almost never "black and white." Surgeons should call the laboratory in advance with questions concerning specimen submission. Correcting problems later may be difficult, especially because cytologic specimens are often small and may be difficult to replace. If estrogen receptors or other special stains are desired, the laboratory may need to make special cell preparations at the time of initial processing. Flow cytometry for lymphoma markers requires unfixed specimens, preferably submitted in cell culture media. Surgical oncologists may be required to use a number of cytology laboratories because of insurance or managed care coverage. A manual that includes specimen instructions, submission requirements, pathology telephone numbers, and cytology requisitions should be accessible to physicians and office staff. Clinical history is critical for proper interpretation. Prior chemotherapy or radiation may induce changes that mimic malignancy. Similarly,
Virchows Archiv, 2015
Double reading may be a valuable tool for improving the quality of patient care by restoring diagnostic errors before final sign-out, but standard double reading would significantly increase costs of pathology. The aim of this study was to assess the added value of routine double reading of defined categories of clinical cytology specimens by specialized cytopathologists. Specialized cytopathologists routinely re-diagnosed blinded defined categories of clinical cytology specimens that had been signed out by routine pathologists from January 2012 up to December 2013. Major and minor discordance rates between initial and expert diagnoses were determined, and both diagnoses were validated by comparison with same-site histological follow-up. Initial and expert diagnoses were concordant in 131/218 specimens (60.1 %). Major and minor discordances were present in 28 (12.8 %) and 59 (27.1 %) specimens, respectively. Pleural fluid, thyroid and urine specimens showed the highest major discordance rates (19.4, 19.2 and 16.7 %, respectively). Histological follow-up (where possible) supported the expert diagnosis in 95.5 % of specimens. Our implemented double reading strategy of defined categories of cytology specimens showed major discordance in 12.8 % of specimens. The expert diagnosis was sup-ported in 95.5 % of discordant cases where histological follow-up was available. This indicates that this double reading strategy is worthwhile and contributes to better cytodiagnostics and quality of patient care, especially for suspicious pleural fluid, thyroid and urine specimens. Our results emphasize that cytopathology is a subspecialization of pathology and requires specialized cytopathologists.
Journal of the American Society of Cytopathology, 2019
Introduction Rapid on-site evaluation (ROSE) is a service provided by cytologists that helps ensure specimen adequacy and appropriate triage for ancillary testing. However, data on the current usage patterns across different practice settings have been lacking. Materials and methods To obtain an accurate and timely assessment of the current state of practice of ROSE, a 14-question online survey was constructed by the Clinical Practice Committee of the American Society for Cytopathology. The survey was available to the membership of the American Society for Cytopathology for a 3-week period in early 2019. Results A total of 541 responses were received, including from 255 cytopathologists/pathologists, 261 cytotechnologists, 19 cytology resident/fellow trainees, and 6 others. ROSE was offered as a clinical service by 95.4% of the respondents, with telecytology for ROSE used in 21.9% of the practices. Endobronchial ultrasound-guided transbronchial needle aspiration was the procedure most frequently reported to use ROSE (mean, 59.1%; median, 70%). Cytotechnologists were involved in ROSE in most practices. The number of daily ROSE procedures correlated with the annual nongynecologic cytology volumes. Approximately 70% of ROSE procedures were reported to require >30 minutes, on average, for the cytologist. Conclusions The results from our survey of cytologists have shown that the reported practice patterns for the usage of ROSE vary considerably. The presented data can help inform future guideline recommendations and the implementation of ROSE in different clinical settings.