Limits...
The Utilization of Cytologic Fine-Needle Aspirates of Lung Cancer for Molecular Diagnostic Testing.

Roh MH - J Pathol Transl Med (2015)

Bottom Line: In this era of precision medicine, our understanding and knowledge of the molecular landscape associated with lung cancer pathogenesis continues to evolve.During the management of these patients, minimally invasive procedures to obtain samples for tissue diagnoses are desirable.Thus, cytologic fine-needle aspirates must be utilized and triaged judiciously to achieve both objectives.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT
In this era of precision medicine, our understanding and knowledge of the molecular landscape associated with lung cancer pathogenesis continues to evolve. This information is being increasingly exploited to treat advanced stage lung cancer patients with tailored, targeted therapy. During the management of these patients, minimally invasive procedures to obtain samples for tissue diagnoses are desirable. Cytologic fine-needle aspirates are often utilized for this purpose and are important not only for rendering diagnoses to subtype patients' lung cancers, but also for ascertaining molecular diagnostic information for treatment purposes. Thus, cytologic fine-needle aspirates must be utilized and triaged judiciously to achieve both objectives. In this review, strategies in utilizing fine-needle aspirates will be discussed in the context of our current understanding of the clinically actionable molecular aberrations underlying non-small cell lung cancer and the molecular assays applied to these samples in order to obtain treatment-relevant molecular diagnostic information.

No MeSH data available.


Related in: MedlinePlus

Example of fine-needle aspiration (FNA) processing workflow. The contents of a needle pass, obtained during an FNA procedure, are expelled onto a slide to prepare smears. Typically, a pair of smears (one Diff-Quik stained and one Papanicolaou stained) is prepared per needle pass. However, additional smears can be prepared from a single needle pass by distributing the cellular material across more than two slides. The additional smears can be directly triaged for ancillary studies. For instance, an unstained smear can be sent to the Immunohistochemistry Laboratory for immunostaining (e.g., thyroid transcription factor-1 [TTF-1] immunocytochemistry). Also, a stained smear can be directly triaged to the Molecular Diagnostics Laboratory for tumor cell macro- or microdissection, nucleic acid isolation, and subsequent molecular testing (e.g., epidermal growth factor receptor [EGFR] mutation analysis).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4508567&req=5

f1-jptm-49-4-300: Example of fine-needle aspiration (FNA) processing workflow. The contents of a needle pass, obtained during an FNA procedure, are expelled onto a slide to prepare smears. Typically, a pair of smears (one Diff-Quik stained and one Papanicolaou stained) is prepared per needle pass. However, additional smears can be prepared from a single needle pass by distributing the cellular material across more than two slides. The additional smears can be directly triaged for ancillary studies. For instance, an unstained smear can be sent to the Immunohistochemistry Laboratory for immunostaining (e.g., thyroid transcription factor-1 [TTF-1] immunocytochemistry). Also, a stained smear can be directly triaged to the Molecular Diagnostics Laboratory for tumor cell macro- or microdissection, nucleic acid isolation, and subsequent molecular testing (e.g., epidermal growth factor receptor [EGFR] mutation analysis).

Mentions: For patients afflicted with lung cancer at our institution, we perform ROSE for cytopathologist-performed FNAs and for EBUS-guided FNAs, performed by our clinical colleagues. The contents of each needle pass are expelled onto a slide which is utilized to prepare direct smears. The needle is then rinsed into buffered media; we utilize RPMI media for this purpose. Commonly, a pair of direct smears is prepared per needle pass; one is air-dried and the other is immediately alcohol-fixed. The air-dried smear is stained on-site with the Diff-Quik (Romanowsky) stain and the stained slide can be examined under the microscope immediately thereafter. The alcohol-fixed smear is stained later in the cytopathology laboratory with the Papanicolaou stain. Alternatively, the needle contents can be distributed over multiple smears allowing for flexibility in the utilization of direct smears for cytomorphologic evaluation and ancillary studies (Fig. 1) [4,5]. Based on the findings in the Diff-Quik stained smears, the determination can be made to perform additional needle passes to obtain more tumor cells for diagnosis and/or anticipated ancillary studies while the patient is still accessible. For instance, additional direct smears can be prepared and/or dedicated needle passes for the rinse solution (i.e., the needle contents are rinsed in the RPMI solution without the preparation of smears for those needle passes) obtained for the cell block preparation. This overall approach is flexible, forgiving, and engages the cytopathology team in maximizing the chance of success in obtaining adequate cellular material for diagnosis and ancillary studies. This approach can help minimize the chances of encountering the scenario in which diagnostic cellular material is present on only one smear; microdissection of the cells for molecular studies can result in sacrificing this only diagnostic slide in this context, which can have medico-legal consequences [6]. If this scenario is encountered, however, this risk can be mitigated by digital archiving prior to microdissection either via digital slide scanning and/or obtaining photomicrographs [7]. After immediate assessment of the cytomorphologic findings on the Diff-Quik stained smears, a preliminary diagnosis can be rendered by the cytopathologist and communicated to the clinical care providers.


The Utilization of Cytologic Fine-Needle Aspirates of Lung Cancer for Molecular Diagnostic Testing.

Roh MH - J Pathol Transl Med (2015)

Example of fine-needle aspiration (FNA) processing workflow. The contents of a needle pass, obtained during an FNA procedure, are expelled onto a slide to prepare smears. Typically, a pair of smears (one Diff-Quik stained and one Papanicolaou stained) is prepared per needle pass. However, additional smears can be prepared from a single needle pass by distributing the cellular material across more than two slides. The additional smears can be directly triaged for ancillary studies. For instance, an unstained smear can be sent to the Immunohistochemistry Laboratory for immunostaining (e.g., thyroid transcription factor-1 [TTF-1] immunocytochemistry). Also, a stained smear can be directly triaged to the Molecular Diagnostics Laboratory for tumor cell macro- or microdissection, nucleic acid isolation, and subsequent molecular testing (e.g., epidermal growth factor receptor [EGFR] mutation analysis).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508567&req=5

f1-jptm-49-4-300: Example of fine-needle aspiration (FNA) processing workflow. The contents of a needle pass, obtained during an FNA procedure, are expelled onto a slide to prepare smears. Typically, a pair of smears (one Diff-Quik stained and one Papanicolaou stained) is prepared per needle pass. However, additional smears can be prepared from a single needle pass by distributing the cellular material across more than two slides. The additional smears can be directly triaged for ancillary studies. For instance, an unstained smear can be sent to the Immunohistochemistry Laboratory for immunostaining (e.g., thyroid transcription factor-1 [TTF-1] immunocytochemistry). Also, a stained smear can be directly triaged to the Molecular Diagnostics Laboratory for tumor cell macro- or microdissection, nucleic acid isolation, and subsequent molecular testing (e.g., epidermal growth factor receptor [EGFR] mutation analysis).
Mentions: For patients afflicted with lung cancer at our institution, we perform ROSE for cytopathologist-performed FNAs and for EBUS-guided FNAs, performed by our clinical colleagues. The contents of each needle pass are expelled onto a slide which is utilized to prepare direct smears. The needle is then rinsed into buffered media; we utilize RPMI media for this purpose. Commonly, a pair of direct smears is prepared per needle pass; one is air-dried and the other is immediately alcohol-fixed. The air-dried smear is stained on-site with the Diff-Quik (Romanowsky) stain and the stained slide can be examined under the microscope immediately thereafter. The alcohol-fixed smear is stained later in the cytopathology laboratory with the Papanicolaou stain. Alternatively, the needle contents can be distributed over multiple smears allowing for flexibility in the utilization of direct smears for cytomorphologic evaluation and ancillary studies (Fig. 1) [4,5]. Based on the findings in the Diff-Quik stained smears, the determination can be made to perform additional needle passes to obtain more tumor cells for diagnosis and/or anticipated ancillary studies while the patient is still accessible. For instance, additional direct smears can be prepared and/or dedicated needle passes for the rinse solution (i.e., the needle contents are rinsed in the RPMI solution without the preparation of smears for those needle passes) obtained for the cell block preparation. This overall approach is flexible, forgiving, and engages the cytopathology team in maximizing the chance of success in obtaining adequate cellular material for diagnosis and ancillary studies. This approach can help minimize the chances of encountering the scenario in which diagnostic cellular material is present on only one smear; microdissection of the cells for molecular studies can result in sacrificing this only diagnostic slide in this context, which can have medico-legal consequences [6]. If this scenario is encountered, however, this risk can be mitigated by digital archiving prior to microdissection either via digital slide scanning and/or obtaining photomicrographs [7]. After immediate assessment of the cytomorphologic findings on the Diff-Quik stained smears, a preliminary diagnosis can be rendered by the cytopathologist and communicated to the clinical care providers.

Bottom Line: In this era of precision medicine, our understanding and knowledge of the molecular landscape associated with lung cancer pathogenesis continues to evolve.During the management of these patients, minimally invasive procedures to obtain samples for tissue diagnoses are desirable.Thus, cytologic fine-needle aspirates must be utilized and triaged judiciously to achieve both objectives.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA.

ABSTRACT
In this era of precision medicine, our understanding and knowledge of the molecular landscape associated with lung cancer pathogenesis continues to evolve. This information is being increasingly exploited to treat advanced stage lung cancer patients with tailored, targeted therapy. During the management of these patients, minimally invasive procedures to obtain samples for tissue diagnoses are desirable. Cytologic fine-needle aspirates are often utilized for this purpose and are important not only for rendering diagnoses to subtype patients' lung cancers, but also for ascertaining molecular diagnostic information for treatment purposes. Thus, cytologic fine-needle aspirates must be utilized and triaged judiciously to achieve both objectives. In this review, strategies in utilizing fine-needle aspirates will be discussed in the context of our current understanding of the clinically actionable molecular aberrations underlying non-small cell lung cancer and the molecular assays applied to these samples in order to obtain treatment-relevant molecular diagnostic information.

No MeSH data available.


Related in: MedlinePlus