Rapid on-site evaluation using telecytology: Quality assurance study at a high-volume cancer center

Abstract

Background: Telecytology-assisted rapid on-site evaluation (ROSE) offers a cost-effective method to enhance minimally invasive biopsies like fine needle aspiration and core biopsies with touch preparation. By reducing nondiagnostic sampling and the need for repeat procedures, ROSE via telecytology facilitates prompt triage for ancillary tests, improving patient management. This study examines cases initially deemed adequate for diagnosis during telecytology-assisted ROSE but later categorized as nondiagnostic at final evaluation (NDIS).

Design: We performed a retrospective analysis of telecytology-assisted ROSE cases over 7 years at a major cancer center, focusing on fine needle aspiration and touch preparation of core biopsies. Each case was thoroughly reviewed, correlating with clinical data and concurrent core biopsies or subsequent excisions. The study identified leading factors contributing to NDIS.

Results: The average NDIS rate was 0.06% (42/70,612). Misinterpretation of benign or reactive cells as neoplastic was the leading cause (76.2%) of discrepancies between original ROSE and final diagnosis. Kidney biopsies had the highest NDIS rate (0.90%), primarily because of misinterpreting nonneoplastic cells. Thyroid biopsies were linked to quantitative threshold issues (0.10%). NDIS events were most associated with misinterpretation in kidney, pancreas, gastrointestinal tract, and lung biopsies.

Conclusion: In conclusion, the NDIS rate in telecytology-assisted ROSE is low, but quality assurance identified areas for improvement. Recognizing site-specific pitfalls during telecytology-assisted ROSE can enhance diagnostic accuracy and optimize patient care.

Keywords: cytology; nondiagnostic interpretation of specimens; quality assurance; rapid on‐site evaluation; telecytology.

Figure 1.

Workflow and Final QA Categories for Telecytology Assisted ROSE

Figure 2.. MISINTERPRETATION IN RENAL BIOPSY

A: CT guided core biopsy of right renal upper pole mass. B, D & E: Touch Prep cytology, Renal tubules and renal tubular cells. (DQ, 40X ) F: Touch Prep cytology, Renal glomerulus (DQ, 20X ) C: Concurrent core biopsy, representative histology: benign renal parenchyma. No tumor seen. (H&E) G & H: Touch Prep of repeat core biopsy of the same right renal upper pole mass shows renal cortical oncocytic neoplasm. (DQ, 10X and 40X) In this case, the benign tubular cells were misinterpreted as oncocytic neoplasm.

Figure 3.. ADEQUACY THRESHOLD DISCREPANCY

FNA of a 3.8 × 2.7 × 2.0 cm hypoechoic to isoechoic nodule with peripheral and internal vascularity in the right thyroid lobe (A, B). ROSE slide shows a very paucicellular sample at low power (C ). and at higher power rare clusters of follicular cells, initially thought to be enough to deem the specimen adequate for evaluation (D, E, F). It was considered non-diagnostic by a second pathologists as less than 6 clusters of well preserved follicular cells were identified..

Figure 4.. MISINTERPRETATION OF BRONCHIAL CELLS AS LYMPHOCYTES

83 y/o man diagnosed with right lung non-small cell carcinoma, for which he underwent EBUS mediastinal lymph nodes FNA for staging. This photo depicted FNA material of mediastinal level 7 lymph node. The sample was considered adequate for lymph node sampling, however, final review of the slides revealed that the small blue cells were in fact the nuclei of bronchial cells.

Figure 5. Case 4. MISINTERPRETATION IN SOFT TISSUE LESION

US-guided core biopsy of a rim-enhancing lesion on CT in the left thigh of a patient who was s/p resection of left thigh leiomyosarcoma and prothesis implantation. A and B : imaging findings of the lesion. TP shows tissue fragments containing a few cellular clusters with gland-like architecture (C, thin arrow, and D). These findings were considered adequate for lesional cells during ROSE. However, the concurrent core biopsy shows atrophic skeletal muscle only (E). The atrophic skeletal muscle cells with peripherally located nuclei collapsed together, mimicking glands, therefore led to NDIS. Noted that the striation in an atrophic muscle fiber was still recognizable. (C, block arrow)