Fri, 11/8: 4:00 PM - 5:30 PM
Hyatt Regency Orlando
Room: Windemere Y-Z
CEU Credits: 1.5
This study investigates the cytomorphological and molecular characteristics of thyroid nodules in patients who underwent radioactive iodine (RAI) treatment for hyperthyroidism.
Materials
We analyzed thyroid fine needle aspiration (FNA) cases from RAI-treated patients from 2015-2024. Selected cytological slides were meticulously assessed by two board certified cytopathologists to evaluate the cytomorphological features of the nodules. Subsequently, the data derived from these cases were compared to that of general in-house thyroid FNA cases collected during 2022 and 2023. Furthermore, we compared the surgical resection outcomes between patients who had received RAI treatment and those who had not, in order to gain a comprehensive understanding of the impact of RAI treatment.
45 thyroid FNA reports from 24 patients, predominantly female, were reviewed. FNA biopsies occurred, on average, 16.9 years post-RAI treatment (Table 1). There is a higher malignancy rate in surgically resected nodules following RAI treatment (11/18, 61%) comparing to cases of Graves' disease that had not been treated with RAI (128/375, 34.1%, p=0.03, Table 1).
Additionally, thyroid nodules that developed post-RAI exhibited a significantly higher rate of Bethesda I (17.8%) and indeterminate nodules (28.9% for Bethesda III and 11.1% for Bethesda IV), than the general population (2.2% for Bethesda I, 9.1% for Bethesda III and 1.7% for Bethesda IV, p<0.01, Table 2).
On cytopathology, the thyroid nodules post RAI showed frequently exhibited oncocytic cells, anisonucleosis, nuclear enlargement, metachromatic stroma, and atrophic follicles (Table 3, Figure 1). Metachromatic stroma was more frequently present in indeterminate nodules (p<0.05, Table 3).
Co-Presenter(s)
Insoo Suh, MD, NYU Langone Health
Sruthi Ramesh, BS, NYU Langone Health
Fang Zhou, MD, NYU Langone Health
Cheng Liu, MD, NYU Langone Health
Brendan Belovarac, MD, NYU Langone Health
Kepal Patel, MD, NYU Langone Health
Aylin Simsir, MD, NYU Langone Medical Center
Wei Sun, Cytopathologist, NYU Grossman School of Medicine
Presenter
Rong Xia, MD PhD, NYU Langone Medical Center
The Bethesda System for Reporting Thyroid Cytopathology recommends an "Atypia of Undetermined Significance" (AUS) rate of 10% or less. In the past, our institution has consistently exceeded this benchmark, prompting an in-depth Quality Improvement (QI) initiative in 2023. This initiative focused on analyzing patterns of AUS usage among pathologists and correlating these with molecular test results (MRT) to identify potential AUS overuse. Feedback on AUS rates was subsequently provided to pathologists and intradepartmental second opinions for AUS cases were encouraged. The present study evaluates the impact of this QI initiative on AUS rates one year later.
Materials
Board-certified cytopathologists were labeled P1 through P5. The proportion of diagnoses across Bethesda categories was calculated for each pathologist (Table 1). Comparative analysis of AUS usage among 5 pathologists was conducted, spanning the years 2021-2022 and focusing on changes in 2023 (one year post QI project) (Figure 1). We also evaluated the use of intradepartmental second reviews for AUS cases.
AUS usage decreased significantly in 2023 (16.9%) compared to the combined 2021-2022 period (22.6%), with a relative risk reduction (RRR) of 25.2%. This decrease was statistically significant (chi-square test, p<0.05). P1 (10.4% in 2023 versus 18.4% in 2021-2022, RRR of 43%) and P5 (15.4% in 2023 versus 28% in 2021-2022, RRR of 45%) also showed significant decreases in AUS usage (chi-square test, p<0.05). These two pathologists combined reviewed 52.2% of their AUS cases with at least one other colleague in 2023, compared to 33% of total AUS cases.
Co-Presenter(s)
Jonathan Marotti, MD, Dartmouth Hitchcock Medical Center
Xiaoying Liu, MD, MS, FIAC, Dartmouth Hitchcock Medical Center
Presenter
Abdol Aziz Ould Ismail, MD, Dartmouth Hitchcock Medical Center
ASCCP guidelines state that unsatisfactory cytology with negative or not available HPV testing should undergo repeat screening in 2-4 months as a negative HPV result could reflect an inadequate sample. We examined the rate of HPV detection in unsatisfactory cytology in the setting of frequent co-testing to explore the theoretical impact of inadequate collections in an HPV primary screening program.
Materials
Pap smear cytology that underwent glacial acetic acid reprocessing (GAA) for initial blood-related inadequacy was analyzed over a one-year period. HPV testing was performed using the Roche cobas® assay.
709 of 781 initially unsatisfactory paps treated with GAA converted to adequate (91%, Figure 1). 479 of these (68%) had an accompanying HPV testing, with an HPV positivity rate of 16.1% (77/479) (Figure 2). This was not significantly different than the lab-wide positivity rate (15.7%). However, for the 56 of the 72 paps that remained unsatisfactory and had an accompanying HPV testing (77%), there was a significantly lower HPV positivity rate of 1.8% (1/56) (p = 0.004).
Co-Presenter
Christopher O'Conor, MD, PhD, Vanderbilt University Medical Center
Presenter
Madison Swaney, M.D., Vanderbilt University Medical Center
Revolutionary artificial intelligence (AI)-based systems are transforming cytopathology practice. The Hologic Genius Digital Diagnostic System (GDDS) combines AI algorithmic analysis with volumetric imaging technology in the interpretation of ThinPrep Pap slides. Our study determines the sensitivity of HSIL interpretation by the GDDS and evaluates interobserver variability amongst cytopathologists.
Materials
A validation study was performed with 890 ThinPrep Paps where a cytotechnologist and three cytopathologists reviewed all of the cases on GDDS independently. A total of 183 cases originally interpreted as HSIL with histologic diagnosis of CIN2+ lesions confirmed by biopsy were included in this study. Sensitivity for detecting HSIL by three cytopathologists was calculated. Kendall's W coefficient was applied to calculate consistency of their interpretations.
Most of the HSIL cases were classified as AGC/ASC-H and above by all cytopathologists. 11.5% of the cases were classified as LSIL by Pathologist A (PA), 6% by Pathologist B (PB) and 5.5 % by Pathologist C (PC). 3.8%, 2.7% and 1.6% cases were classified as ASCUS by PA, PB and PC respectively (Table 1). The sensitivity for detection of CIN2+ lesion was 100% if ASCUS and above lesions were counted amongst all three pathologists. The sensitivity for detection of CIN2+ lesions was 84.7%, 91.3%, and 92.9% by PA, PB and PC respectively, for ASC-H and above lesions (Table 2). Kendall's W coefficient was 0.722, indicating strong agreement between all pathologists.
Co-Presenter(s)
Esther Elishaev, MD, University of Pittsburgh School of Medine and UPMC
Yuhong Ye, MD, PhD, Department of Pathology, the first affiliated Hospital, Fujian Medical University
Jonee Matsko, SCT, MB(ASCP), UPMC Magee Womens Hospital
Amy Colaizzi, SCT, UPMC Magee Women's Hospital
Stephanie Wharton, BS, SCT (ASCP), UPMC Magee Women's Hospital
Liron Pantanowitz, MD, PhD, MHA, UPMCPitt
Chengquan Zhao, MD, Magee Womens Hospital of UPMC
Presenter
Lakshmi Harinath, MD MPH, UPMC
Despite cancer incidence rising in sub-Saharan Africa, cancer screening services are still limited. Fine needle aspiration (FNA) of superficial masses is a cost-effective, minimally invasive procedure that helps guide physicians to the correct treatment. In Rwanda, FNAs are only offered at referral hospitals, which are disproportionately located in the central and northern provinces. The University Teaching Hospital of Butare (CHUB) is the referral hospital for 4 million patients, some of whom live over 100 km away. While all Rwandans have national health insurance, they have to visit a local sector health center, then be referred to a district hospital, and finally travel to CHUB before they can receive a cancer diagnosis. These multiple barriers deter patients from following up until the patient's cancer becomes late stage, leading to a poor prognosis. We proposed creating mobile cytology clinics at health centers in the Huye district to bring FNA procedures directly to patients.
Materials
We partnered with a local non-governmental organization, Innovation for Perfection in Health (IPH), to help deploy these clinics. The $10,000 American Society of Cytopathology's Patient Advocacy Grant covered the cost of FNA materials, training, personnel, transportation, and travel fare for patients to go to CHUB if an FNA was positive for malignancy. After seeking approval from the Huye Mayor, community awareness was achieved by advertising the clinics on the radio. A training session with health center personnel and community health workers, and scheduling the clinics was also performed. A team of one pathologist, one technician, and one nurse would travel to each of the health centers to bring the FNA supplies. Immediate adequacy assessment was performed, and patients were followed up at the visit or by telephone for results. Data collected included the patient demographics, as well as number of clinics deployed, patients seen, and patients referred for tissue biopsy.
From the time IPH received the grant funding, it took six months to complete the entire project including training, advertising and deployment. All 16 clinics were completed in the Huye district within six weeks. A total of 459 patients were seen, resulting in an average of 28 patients per clinic. After excluding patients under 18 years of age, 376 answered our demographic survey. The majority were female (234, 63%) and between the age of 40-60 years old (106, 45%) (Table 1). Fifteen patients were provided round trip travel fare to go to CHUB to receive a tissue biopsy for definitive diagnosis.
Co-Presenter(s)
Elisee Hategekimana, MD, University Teaching Hospital of Butare
Theoneste Nizeyimana, MD, MMed, CHUB
Mbarushimana Djibril, MD, MMed, University Teaching Hospital of Butare
Daniel Rosen, MD, MEd, Baylor College of Medicine
Presenter
Kelsey Hummel, DO, M.D. Anderson Cancer Center
Rapid On-Site Evaluation (ROSE) has led to an increased diagnostic yield and a reduction in complication rates across different organ types. However, many clinical sites do not offer ROSE due to (i) limited availability of cytologists and (ii) the length/complexity of the process. Due to the limited availability of suitable cells (< 10%) on a glass slide, the cytologist may spend a lot of time scanning an entire slide to provide adequacy feedback. In this preliminary study, we report developing an artificial intelligence (AI) algorithm applied to a digital slide to aid the cytologist in identifying the diagnostic cells.
Materials
We first utilized the ASP Health's ROSE Prep™ system to automatically prepare specimen slides from patients undergoing bronchoscopic procedures (n = 165 patients, 225 specimen slides). Second, the individual specimen slide was digitized and segmented into ~ 1200 tiles (1 tile = 500 um x 500 um area). Each tile was assigned a rank of either containing a diagnostic cell (e.g., tumor cell, lymphocyte, etc.) or not having a diagnostic cell (e.g., blood, bronchial cell, etc.) by a certified cytologist. The ranked tiles within each specimen slide were split into a training (75%) and an independent validation (25%) set before being fed into the AI algorithm.
The AI algorithm showed 90% accuracy on the training set. Importantly, on the independent validation set, the AI algorithm identified the presence of diagnostic cells with 80% accuracy.
Co-Presenter(s)
Nathan Oleari, B.S., ASP-Health
Alex Bluestone, BS, ASP-Health
JOANNA DANCZUK, CT(ASCP), ASP-Health
Melissa Randolph, SCT(ASCP) CM, Indiana University Health
Mark Costaldi, MD, MS, Crouse Health
Presenter
Hariharan Subramanian, PhD, MBA, ASP Health