Yeh-Han Wang | NYMU - Academia.edu (original) (raw)
Papers by Yeh-Han Wang
Diagnostic cytopathology, Jan 26, 2016
Granular cell tumor (GCT) of the breast is a rare but usually benign mesenchymal tumor. It is rep... more Granular cell tumor (GCT) of the breast is a rare but usually benign mesenchymal tumor. It is reported more commonly in middle-aged premenopausal women, especially in African Americans. 1 However, only rare cases in male patients have been reported. 2-5 The ratio of men to women in document accounts from 1:9 to 1:15. 6 GCT of the breast simulates malignancy clinically 3,7 and mammographically, 5,8 which may lead to unnecessary mastectomy, especially in subareolar cases. We therefore describe a rare case of a middle-aged man with subareolar GCT of the breast. The initial fine needle aspiration cytology (FNAC) received a preliminary diagnosis of atypical apocrine proliferation, after which GCT is diagnosed in the core biopsy. We herein discuss the differential diagnosis of GCT in FNAC and compare with their key cytomorphological features.
International Journal of Molecular Sciences
As tumor mutational burden (TMB) has been approved as a predictive biomarker for immune checkpoin... more As tumor mutational burden (TMB) has been approved as a predictive biomarker for immune checkpoint inhibitors (ICIs), next-generation sequencing (NGS) TMB panels are being increasingly used clinically. However, only a few of them have been validated in clinical trials or authorized by administration. The harmonization and standardization of TMB panels are thus essential for clinical implementation. In this review, preanalytic, sequencing, bioinformatics and interpretative factors are summarized to provide a comprehensive picture of how the different factors affect the estimation of panel-based TMB. Among the factors, poor DNA quality, improper formalin fixation and residual germline variants after filtration may overestimate TMB, while low tumor purity may decrease the sensitivity of the TMB panel. In addition, a small panel size leads to more variability when comparing with true TMB values detected by whole-exome sequencing (WES). A panel covering a genomic region of more than 1Mb ...
Cancer Cytopathology
BACKGROUND: The purpose of the current study was to examine the impact of coronavirus disease 201... more BACKGROUND: The purpose of the current study was to examine the impact of coronavirus disease 2019 (COVID-19) on various aspects of cytology practice in the Asia-Pacific region. METHODS: An online questionnaire was distributed to cytopathology laboratories in 24 Asia-Pacific countries to explore the impact of restrictive measures on access to health care, use of general and personal protective equipment (PPE), and changes in cytology workflow and workload from February to April 2020. RESULTS: A total of 167 cytopathology laboratories from 24 countries responded to the survey; the majority reported that restrictive measures that limited the accessibility of health care services had been implemented in their cities and/or countries (80.8%) and their hospitals (83.8%). The respondents noted that COVID-19 had an impact on the cytologic workflow as well as the workload. Approximately one-half of the participants reported the implementation of new biosafety protocols (54.5%) as well as improvements in laboratory facilities (47.3%). Rearrangement or redeployment of the workforce was reported in 53.3% and 34.1% of laboratories, respectively. The majority of the respondents reported a significant reduction (>10%) in caseload associated with both gynecological (82.0%) and nongynecological specimens (78.4%). Most laboratories reported no significant change in the malignancy rates of both gynecological (67.7%) and nongynecological specimens (58.7%) compared with the same period in 2019. CONCLUSIONS: The results of the survey demonstrated that the COVID-19 pandemic resulted in a significant reduction in the number of cytology specimens examined along with the need to implement new biosafety protocols. These findings underscore the need for the worldwide standardization of biosafety protocols and cytology practice. Cancer Cytopathol 2020;0:1-10. © 2020 American Cancer Society. KEY WORDS: biosafety; coronavirus; coronavirus disease 2019 (COVID-19); cytology; laboratories; pathology.
Journal of Clinical Pathology
AimsAlthough Ki67 labelling index (LI) is a prognostic and predictive marker in breast cancer, it... more AimsAlthough Ki67 labelling index (LI) is a prognostic and predictive marker in breast cancer, its accuracy and reproducibility must be validated before its clinical application. We aimed to evaluate the agreement of Ki67 LI in clinical practice in Taiwan.MethodsWe conducted a Ki67 immunohistochemistry (IHC) proficiency test. The participants performed the Ki67 IHC test and measured the Ki67 LI of 10 cases of breast cancer tissue on a microarray slide. The staining quality was centrally reviewed based on the Ki67 staining of the tonsil surface epithelium.ResultsKi67 staining and counting methods are diverse in Taiwan. The reproducibility of Ki67 LI was poor to good (intraclass correlation coefficient: 0.581, 95% CI 0.354 to 0.802). The reproducibility and agreement in the high staining quality group were significantly higher than those in the low staining quality group. The majority of the Ki67 LIs derived from the low staining quality group were underestimated. Different counting m...
Journal of Pathology and Translational Medicine
Fine-needle aspiration (FNA) is minimally invasive and widely used for assessing thyroid nodules ... more Fine-needle aspiration (FNA) is minimally invasive and widely used for assessing thyroid nodules [1]. It is also a decisive procedure for evaluating thyroid nodules that require surgery or conservative management [2,3]. Although the Bethesda System is the most widely accepted diagnostic system for thyroid cytology, there are significant deviations in practices in different countries [4,5]. Our previous review summarized the history and the evolution of the thyroid FNA practice in Taiwan [6]. The aims of this article are to provide an overview of the current thyroid FNA practice in Taiwan, particularly data from our nationwide survey, describe the changes due to the new World Health Organization (WHO) classification, and the advances of novel technologies. CURRENT THYROID CYTOPATHOLOGY IN TAIWAN In Taiwan, the majority of thyroid FNA cases are now performed with ultrasound guidance, since ultrasound-guided FNA provides better sampling of smaller or multiple nodules compared to palpation-guided FNA. High-resolution neck ultrasonography provides a simple, real-time, and noninvasive method to assess thyroid nodules. The accuracy of neck ultrasonography
Cancers
In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were... more In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were proposed for reporting urine cytology. To evaluate the diagnostic agreement and interobserver concordance for assessing TPS criteria, the Taiwan Society of Clinical Cytology organized an online survey with 10 atypical urine cytology cases. A total of 137 participants completed the survey. The mean agreement of diagnosis was 51.2%, ranging from 34.3% to 83.2% for each case. For 60% (6/10) of cases, the agreement was <50%. The interobserver concordance of diagnosis and cytological criteria assessment showed poor agreement. The nuclear-to-cytoplasmic (N/C) ratio had the highest kappa value of 0.386, indicating a significantly higher interobserver concordance and reproducibility than the other three TPS criteria. The correct rate of assessing the N/C ratio increased as the N/C ratio increased (correlation coefficient: 0.891, p < 0.01). Three cases with an N/C ratio near 0.5 were overe...
Diagnostic cytopathology, Jan 26, 2016
Granular cell tumor (GCT) of the breast is a rare but usually benign mesenchymal tumor. It is rep... more Granular cell tumor (GCT) of the breast is a rare but usually benign mesenchymal tumor. It is reported more commonly in middle-aged premenopausal women, especially in African Americans. 1 However, only rare cases in male patients have been reported. 2-5 The ratio of men to women in document accounts from 1:9 to 1:15. 6 GCT of the breast simulates malignancy clinically 3,7 and mammographically, 5,8 which may lead to unnecessary mastectomy, especially in subareolar cases. We therefore describe a rare case of a middle-aged man with subareolar GCT of the breast. The initial fine needle aspiration cytology (FNAC) received a preliminary diagnosis of atypical apocrine proliferation, after which GCT is diagnosed in the core biopsy. We herein discuss the differential diagnosis of GCT in FNAC and compare with their key cytomorphological features.
International Journal of Molecular Sciences
As tumor mutational burden (TMB) has been approved as a predictive biomarker for immune checkpoin... more As tumor mutational burden (TMB) has been approved as a predictive biomarker for immune checkpoint inhibitors (ICIs), next-generation sequencing (NGS) TMB panels are being increasingly used clinically. However, only a few of them have been validated in clinical trials or authorized by administration. The harmonization and standardization of TMB panels are thus essential for clinical implementation. In this review, preanalytic, sequencing, bioinformatics and interpretative factors are summarized to provide a comprehensive picture of how the different factors affect the estimation of panel-based TMB. Among the factors, poor DNA quality, improper formalin fixation and residual germline variants after filtration may overestimate TMB, while low tumor purity may decrease the sensitivity of the TMB panel. In addition, a small panel size leads to more variability when comparing with true TMB values detected by whole-exome sequencing (WES). A panel covering a genomic region of more than 1Mb ...
Cancer Cytopathology
BACKGROUND: The purpose of the current study was to examine the impact of coronavirus disease 201... more BACKGROUND: The purpose of the current study was to examine the impact of coronavirus disease 2019 (COVID-19) on various aspects of cytology practice in the Asia-Pacific region. METHODS: An online questionnaire was distributed to cytopathology laboratories in 24 Asia-Pacific countries to explore the impact of restrictive measures on access to health care, use of general and personal protective equipment (PPE), and changes in cytology workflow and workload from February to April 2020. RESULTS: A total of 167 cytopathology laboratories from 24 countries responded to the survey; the majority reported that restrictive measures that limited the accessibility of health care services had been implemented in their cities and/or countries (80.8%) and their hospitals (83.8%). The respondents noted that COVID-19 had an impact on the cytologic workflow as well as the workload. Approximately one-half of the participants reported the implementation of new biosafety protocols (54.5%) as well as improvements in laboratory facilities (47.3%). Rearrangement or redeployment of the workforce was reported in 53.3% and 34.1% of laboratories, respectively. The majority of the respondents reported a significant reduction (>10%) in caseload associated with both gynecological (82.0%) and nongynecological specimens (78.4%). Most laboratories reported no significant change in the malignancy rates of both gynecological (67.7%) and nongynecological specimens (58.7%) compared with the same period in 2019. CONCLUSIONS: The results of the survey demonstrated that the COVID-19 pandemic resulted in a significant reduction in the number of cytology specimens examined along with the need to implement new biosafety protocols. These findings underscore the need for the worldwide standardization of biosafety protocols and cytology practice. Cancer Cytopathol 2020;0:1-10. © 2020 American Cancer Society. KEY WORDS: biosafety; coronavirus; coronavirus disease 2019 (COVID-19); cytology; laboratories; pathology.
Journal of Clinical Pathology
AimsAlthough Ki67 labelling index (LI) is a prognostic and predictive marker in breast cancer, it... more AimsAlthough Ki67 labelling index (LI) is a prognostic and predictive marker in breast cancer, its accuracy and reproducibility must be validated before its clinical application. We aimed to evaluate the agreement of Ki67 LI in clinical practice in Taiwan.MethodsWe conducted a Ki67 immunohistochemistry (IHC) proficiency test. The participants performed the Ki67 IHC test and measured the Ki67 LI of 10 cases of breast cancer tissue on a microarray slide. The staining quality was centrally reviewed based on the Ki67 staining of the tonsil surface epithelium.ResultsKi67 staining and counting methods are diverse in Taiwan. The reproducibility of Ki67 LI was poor to good (intraclass correlation coefficient: 0.581, 95% CI 0.354 to 0.802). The reproducibility and agreement in the high staining quality group were significantly higher than those in the low staining quality group. The majority of the Ki67 LIs derived from the low staining quality group were underestimated. Different counting m...
Journal of Pathology and Translational Medicine
Fine-needle aspiration (FNA) is minimally invasive and widely used for assessing thyroid nodules ... more Fine-needle aspiration (FNA) is minimally invasive and widely used for assessing thyroid nodules [1]. It is also a decisive procedure for evaluating thyroid nodules that require surgery or conservative management [2,3]. Although the Bethesda System is the most widely accepted diagnostic system for thyroid cytology, there are significant deviations in practices in different countries [4,5]. Our previous review summarized the history and the evolution of the thyroid FNA practice in Taiwan [6]. The aims of this article are to provide an overview of the current thyroid FNA practice in Taiwan, particularly data from our nationwide survey, describe the changes due to the new World Health Organization (WHO) classification, and the advances of novel technologies. CURRENT THYROID CYTOPATHOLOGY IN TAIWAN In Taiwan, the majority of thyroid FNA cases are now performed with ultrasound guidance, since ultrasound-guided FNA provides better sampling of smaller or multiple nodules compared to palpation-guided FNA. High-resolution neck ultrasonography provides a simple, real-time, and noninvasive method to assess thyroid nodules. The accuracy of neck ultrasonography
Cancers
In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were... more In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were proposed for reporting urine cytology. To evaluate the diagnostic agreement and interobserver concordance for assessing TPS criteria, the Taiwan Society of Clinical Cytology organized an online survey with 10 atypical urine cytology cases. A total of 137 participants completed the survey. The mean agreement of diagnosis was 51.2%, ranging from 34.3% to 83.2% for each case. For 60% (6/10) of cases, the agreement was <50%. The interobserver concordance of diagnosis and cytological criteria assessment showed poor agreement. The nuclear-to-cytoplasmic (N/C) ratio had the highest kappa value of 0.386, indicating a significantly higher interobserver concordance and reproducibility than the other three TPS criteria. The correct rate of assessing the N/C ratio increased as the N/C ratio increased (correlation coefficient: 0.891, p < 0.01). Three cases with an N/C ratio near 0.5 were overe...