12 hours ago The process of cytologic-histologic correlation is highly valuable to the fields of both cytopathology and surgical pathology, because correlation provides a wealth of data that may be used to improve diagnostic testing and screening processes. In this study, overall improvement appeared to be drive … >> Go To The Portal
Cytologic-histologic correlation may be performed real time or retrospectively or both. Real-time correlation implies that available cytology slides are reviewed in conjunction with the surgical biopsy or relatively soon after the surgical biopsy is evaluated, but before a surgical biopsy report is issued.
A cytology report recorded as suspicious is not considered as diagnostic of cancer and unless supported by a positive biopsy (as reported on a pathology report) or by a clinical impression of cancer, these cases should not be abstracted.
For pathologists with limited experience in cytopathology, it is a great educator and feedback mechanism: You get the answer (a biopsy) to your cytologic impression. There are lessons to be learned from both specimens and information to be gained about processes.
Although the review focused on gynecologic cytology specimens, the principles for improving current quality assurance practices apply to all cytologic-histologic correlations (CHC). Cytologic-histologic correlation is a powerful cytopathology quality assurance tool that may be overlooked and underused.
Cytologic-histologic (CH) correlation is a method of medical error detection1 that is used most frequently by cytopathology personnel to evaluate failures in cytologic screening or diagnostic tests.
Cytologic evaluation is the analysis of cells from the body under a microscope. This is done to determine what the cells look like, and how they form and function. The test is usually used to look for cancers and precancerous changes. It may also be used to look for viral infections in cells.
What is cytology? Cytology (also known as cytopathology) involves examining cells from bodily tissues or fluids to determine a diagnosis. A certain kind of scientist called a pathologist will look at the cells in the tissue sample under a microscope and look for characteristics or abnormalities in the cells.
Cytology is the exam of a single cell type, as often found in fluid specimens. It's mainly used to diagnose or screen for cancer. It's also used to screen for fetal abnormalities, for pap smears, to diagnose infectious organisms, and in other screening and diagnostic areas.
It has a 10% to 50% accuracy rate for low-grade (the cancer cells grow and spread slowly) carcinoma and has a significant false-negative rate for this condition, meaning the urine cytology results are negative for low-grade carcinoma, but other tests show that the person does, in fact, have low-grade carcinoma.
An abnormal cervical screening test result means that you have changes in the cells covering the neck of your womb (cervix). These changes are not cancer. The cells often go back to normal by themselves. But in some women, if not treated, these changes could develop into cancer in the future.
Routine biopsy and cytology results may be ready as soon as 1or 2 days after the sample gets to the lab. But there are many reasons some take much longer to complete.
It's much more common than you might have thought. The false-positive rate of endoscopic ultrasound fine-needle aspiration (EUS-FNA) cytology is thought not to exceed 1%.
A urine cytology test requires a urine sample, which you provide by urinating into a sterile container. In some cases, a urine sample is collected using a thin, hollow tube (catheter) that's inserted into your urethra and moved up to your bladder.
Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer. Screening includes cervical cytology (also called the Pap test or Pap smear), testing for human papillomavirus (HPV), or both. Most women should have cervical cancer screening on a regular basis.
The Pap test (also called a Pap smear or cervical cytology) collects cervical cells and looks at them for changes caused by HPV that may—if left untreated—turn into cervical cancer. It can also detect cervical cancer cells.
Cytology Report. A cytology report recorded as suspicious is not considered as diagnostic of cancer and unless supported by a positive biopsy (as reported on a pathology report) or by a clinical impression of cancer, these cases should not be abstracted. The Papanicolaou classification of cells for the detection of malignancy ("Pap" smear) ...
Conclusive evidence of malignant neoplasm. Some medical records will contain more than one cytology report. If there are multiple reports on the same type and source of specimen, record the findings on the first positive report.
No evidence of a malignant neoplasm, no atypical cells. Atypical cells present but no evidence of malignant neoplasm. Cells present causing suspicion of malignant neoplasm. Fairly conclusive evidence of malignant neoplasm. Conclusive evidence of malignant neoplasm. Some medical records will contain more than one cytology report.
This is highly relevant when comparing the value of cytology to biopsy because, in most investigations, the exclusion of inconclusive cytologic diagnoses markedly improves the determination of diagnostic accuracy.
Diagnostic accuracy is the frequency a test correctly identifies a patient as having, or not having, the disease of interest; a test with high diagnostic accuracy reveals relatively few false positive (highly specific) and few false negative (highly sensitive) results. Since an index test is often performed to identify more than one disease ...
This is self-evident when the sample is acellular or consists of only peripheral blood elements; however, in more cellular specimens a clinical pathologist may identify distinct cytologic findings, which are negative for specific disease, yet fails to suggest that the results may be inconclusive. This is highly relevant when comparing the value ...
A cytology finding that does not confirm tumor, or any other definitive diagnosis, should not necessarily be considered a negative result if it is performed on, or identified as, a non-representative specimen. Other limitations in cytologic evaluation include the distribution and accessibility of the lesion in question.
Although pathology reports are written by physicians for physicians, you may be able to decipher some of the medical jargon provided by the report. The structure and information provided in your pathology report may vary, but the following sections are usually included.
Your primary doctor should be able to address specific questions you have about your pathology report; however, it is helpful to have a basic understanding of what the pathologist is looking for. The structure and information provided in your pathology report may vary, but the following sections are usually included.
The pathologist then writes a pathology report summarizing his or her findings.
Most cancer patients will undergo a biopsy or other procedure to remove a sample of tissue for examination by a pathologist in order to diagnose their disease. There are a variety of methods used to obtain samples, including a typical biopsy, fine needle aspiration, or a biopsy with the use of an endoscope.
A pathologist is a physician specializing in the diagnosis of disease based on examination of tissues and fluids removed from the body. Upon examination, the pathologist determines if the tissue sample contains normal, pre-cancerous or cancerous cells and then writes a report with his or her findings.
The method used to gain a tissue sample depends on the type of mass and location in the body. Doctors are increasingly using "liquid" biopsies to evaluate cancer which are easily collected from the blood and are non-invasive. Liquid biopsies are replacing the need to collect tissue in many situations.
What you need to know about liquid biopsies. A typical biopsy involves the surgical removal of a mass of abnormal cells. Fine needle aspiration involves guiding a thin needle into the cancer and gently sucking out cells for microscopic evaluation.
During a clinical correlation, the healthcare provider compares and contrasts the patient's clinical findings. Such findings may include signs or symptoms of a certain disease or condition, such as swollen lymph nodes.
Clinical correlation is recommended when results from a diagnostic test, including biopsies, x-rays or MRIs, are abnormal . In this instance, the physician uses a combination of results from the diagnostic test and an individual's age, previous medical history, clinical test and other relevant results to make a definitive diagnosis.
Smaller test volumes may spur increased consolidation of Pap testing to specific laboratories. Consolidation may be further potentiated by the diminishing cytotechnology workforce 23 if laboratories are unable to hire cytotechnologists. Pap test consolidation would threaten the ability to obtain cervical biopsy slides and results for correlation from other laboratories that do not perform Pap tests on those patients, and this would effectively make CHC a paper drill without slide reviews of discrepancies. Diminishing cervical biopsies due to fewer referrals, colposcopic see‐and‐treat procedures, and clinical observation of LSILs also decrease the robustness of CHC data.
The simplest definition of a positive gynecologic CHC correlation and the one with least interobserver variability 18, 19 is the combination of any Pap test interpretation of a SIL, AIS, or cancer with any biopsy interpretation of a SIL, cervical intraepithelial neoplasia (CIN), AIS, or cancer. Binary approaches to interpretation (positive or negative) result in the highest concordance rates in pathology. This avoids the problem of determining how many degrees of variance are allowed before a pair correlates in laboratories that use different steps of interpretation, including atypical cases. A negative correlation is any positive Pap test interpretation as defined previously with any negative, reactive, or inflammatory cervical specimen or vice versa. This is the minimum parameter of CHC: it serves primarily to provide a statistical analysis of the PPV of a Pap test for laboratory comparison. The PPV is calculated as follows:
CHC performed at the time of biopsy interpretation (real‐time or concurrent correlation) is ideal for affecting patient management but may be logistically impossible and fail to capture CHC data for monitoring. In addition, confirmation bias is possible, and the pathologist interpreting a biopsy as negative may be more inclined to downgrade a Pap test called HSIL if few cells are present, despite their diagnostic features. Real‐time correlation provides immediate feedback to the pathologist interpreting the biopsy and allows the contributing health care provider to act on the mismatch by obtaining further biopsies (in the case of an HSIL Pap test and negative biopsies) or preventing unnecessary procedures (in the case of an overcalled HSIL Pap test and negative biopsies). It also allows the pathologist to perform measures to resolve a discrepancy before reporting, such as obtaining additional levels, reorienting the tissue in the block, or obtaining a second opinion; these are important options when the Pap test shows HSIL and biopsies are negative. Large laboratories and those that have separate facilities performing cytology and histology may have difficulty getting cytology slides to the sign‐out pathologist in a timely manner so that the review can be concurrent. Laboratory information systems may not have the capability to record concordant review results as a separate quality document, and this can complicate correlation statistic compilation and reporting. CHC is not recompensed and can require considerable personnel time for finding slides and tabulating results; this creates a challenge for smaller practices.
Cytopathology practices continue to struggle with the performance of cytologic‐histologic correlation (CHC) and what to do with the results. For practices in the United States, the Clinical Laboratory Improvement Amendments (CLIA) require “laboratory comparison of clinical information, when available, with cytology reports and comparison of all gynecologic cytology reports with a diagnosis of high‐grade squamous intraepithelial lesion (HSIL), adenocarcinoma, or other malignant neoplasms with the histopathology report, if available in the laboratory (either on‐site or in storage), and determination of the causes of any discrepancies.” 1 In 2015, the failure to comply with this directive was one of the top 10 cytopathology deficiency citations for laboratories inspected by the College of American Pathologists (unpublished data, College of American Pathologists, 2015). There is no standardized method for performing this comparison or reporting results. Despite the lack of detailed regulatory directives, many practices extend CHC beyond the constraints of CLIA to perform a more complete analysis of gynecologic cytology discrepancies and to include nongynecologic cytology specimens for their quality assurance program.
Perhaps the major flaw of many CHC programs is the failure to make appropriate use of data collected to implement change. Most laboratories will notify providers of discrepancies and resolutions that affect current patient care. 2 There is no regulatory guidance on how to use the data, and this allows laboratories to design quality programs to target problem areas. One of the most powerful and popular courses of action implemented is to perform a group review of discrepant slides and discuss the reasons for the discrepancy. 22 This activity exposes participants to nuances of specific interpretations, facilitates interpretive agreement, highlights potential quality problems that lead individuals to interpretive errors, and generates discussion on how to correct for confounding variables. When performed anonymously, it removes the stress associated with discrepant cases. A targeted CHC review of cases such as atypical glandular cells can enlighten participants about the many cytologic and histologic appearances of glandular lesions. Collecting data on tissue variables such as the orientation in the block, the presence or absence of a transformation zone, the number of biopsies, the size of the biopsy, the performance of additional steps or levels to detect a lesion, the thickness of the section, and the quality of the stain provides metrics that target specific, remediable system problems. Laboratories can modify or change methods and procedures as a course of action. For example, laboratories might establish a policy of performing 6 steps on all cervical biopsies with unstained slides in between to enhance the identification of lesions deeper in blocks and allow for p16 immunohistochemical analysis on unstained slides. This may prevent the loss of lesional tissue when blocks are being cut for immunohistochemical studies. An evaluation of reports, including whether a clinical history is provided, the use of standardized terminology or report templates, and the inclusion of appropriate notes, can be included in correlation statistics. These monitors may be applied periodically for information gathering, until the deficiency is corrected, or continuously with each CHC interval. Regardless of the changes implemented or proposed, it is important to document the analytic findings and record the implemented changes. To close the loop, monitoring the same variables after implemented changes will determine whether the change had an impact on the overall performance of the system.