The unsatisfactory percentage for ThinPrep Pap Tests (TPPT) at our institution reached the 75th percentile (2.7%) benchmark established by the College of American Pathologists (CAP). Our aim was to identify outliers by analysis of data, provide education and feedback, and establish a system to monitor outcomes. The laboratory information system (LIS) was queried for TPPT cases diagnosed as 'Non-diagnostic' between April and June 2022. Two hundred and thirty-two cases were identified and reviewed by 2 cytopathologists and 1 cytotechnologist to identify limiting factors, including cellularity, blood, lubricant, inflammation, and mucus. The percentage of unsatisfactory TPPT was evaluated for both clinicians and clinics and stratified into peer groups based on total TPPT collected. The two clinics with the highest unsatisfactory percentage in a peer group of > 500 TPPT collected were identified. A LIS report was created to improve efficiency in future data collection. Low cellularity was a limiting factor in 100% of cases, blood in 51.7% (n = 120), lubricant in 18.5% (n = 43), inflammation in 13.8% (n = 32), and mucus in 3.9% (n = 9), with multiple factors possible per case. Twenty clinics collected > 500 TPPT for FY2022. Two clinics (1 resident-led clinic) had an unsatisfactory percentage > 3%, for which to target interventions. Clinic 1 had an unsatisfactory percentage of 6.1% (62/1018), and clinic 2 was 3.5% (21/608). To address limiting factors, a laboratory bulletin with best practices for TPPT collection and a list of Hologic TPPT approved lubricants was sent to each clinic. Statistics of unsatisfactory TPPT were provided. The highest unsatisfactory TPPT clinics received Hologic educational materials and an educational session. The resolution of laboratory quality issues requires investigations, often laborious in nature. In an era of staffing shortages, an effective LIS is essential to efficiently investigate and resolve quality variances. TPPT data via LIS reports were reviewed at 3 months and 1-year post-intervention implementation to evaluate outcomes.

Pancreatic adenocarcinoma (PDAC) is characterized by its poor prognosis. Cytology is essential for diagnostic confirmation and ancillary studies. The endoscopic ultrasound (EUS) set a precedent, facilitating cytological sampling through fine-needle aspiration (FNA), with a sensitivity of 93% and a specificity of 95%. In this work, we analyzed all EUS-guided pancreatic FNAs performed at our center over 2014-2025 and compared the cytological findings with the corresponding surgical specimen results. Observational, descriptive, and retrospective study of all EUS-guided pancreatic FNAs performed at our center (2014-January 2025) in patients ≥ 18 years and their corresponding surgical specimens. Samples were obtained using a linear echoendoscope and 25G needles, processed with Romanowsky and Papanicolaou stains, and cell blocks prepared for immunohistochemistry. Cytological diagnoses followed WHO criteria; histology from surgical specimens served as the reference standard. Statistical analysis was performed using SPSS v.22 with p < 0.05 considered significant. One hundred and sixty-three EUS-guided pancreatic FNAs were performed and 34 patients underwent surgical treatment (20.8%), 31 of them (91.2%) with a cytological diagnosis of malignancy. Thirty-three patients had malignant lesions (97%) in the surgical specimen. Cytology showed a sensitivity of 96.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. Cyto-histological correlation was 91.2% with a κ = 0.654 (p < 0.001). Cytopathologists' expertise was statistically significant (p < 0.001). Cytology is highly reliable for confirming malignancy. Final management will be multidisciplinary.

Basaloid squamous cell carcinoma of the cervix (BSCC) is an extremely rare subtype. In the 2020 WHO classification, BSCC is considered a subtype within HPV-associated squamous cell carcinoma. We report a case wherein liquid-based cytology (LBC) initially suggested a high-grade squamous intraepithelial lesion (HSIL). Retrospective review, prompted by the histologic diagnosis of BSCC, revealed diffuse sheets of monotonous basaloid and parabasaloid cells. Key cytologic features included three-dimensional clusters with occasional papillary architecture, palisading, and cord-like arrangements-findings that can be misleading. This case underscored that BSCC's deceptively bland cytology often overlaps with HSIL, contributing to diagnostic under-call. Increased awareness of these subtle yet distinctive patterns is crucial for accurate identification and appropriate clinical management of this rare variant.

Serous cystadenoma (SCA), pancreas is a rare benign neoplasm comprising < 1% of primary pancreatic lesions. Although preoperative imaging and biochemical cyst fluid analysis have been described for SCA, the pathognomic features are appreciable only in a handful of cases. Endoscopic ultrasound guided fine needle aspiration/Biopsy (EUS FNA/B) and cell block of SCA suffers from low cellular yield and nonspecific diagnosis. This was a combined retrospective and prospective study conducted during a period of 6 years (January 2017-December 2023) at a tertiary care referral centre. Clinical history, primary imaging and EUS characteristics were noted. Immunohistochemical (IHC) expression of alpha inhibin, Calponin, Glucose transporter 1 (GLUT 1), Synaptophysin and Chromogranin was evaluated in the cases of SCA and compared with expression of these immunomarkers in 20 cases of neuroendocrine tumour, pancreas (Grades I and II). Fourteen cases of indeterminate SCA were identified over a period of 6 years (January 2017-December 2023). Cell block supplemented with immunohistochemistry(IHC) was able to provide a definitive diagnosis in 92.3% (12/13) cases in this series. Thus, diagnostic certainty improved from 30.8% on the basis of morphology alone to 92.3% with FNA/B and cell block and IHC. Thus, EUS FNA/B supplemented with cell block and IHC can provide an unequivocal preoperative diagnosis of SCA. IHC panel comprising alpha inhibin, GLUT 1, synaptophysin and chromogranin can provide a sufficient level of evidence to categorize the lesion as SCA.

Although core needle biopsy is widely preferred for evaluating renal lesions, fine needle aspiration (FNA) combined with rapid on-site evaluation (ROSE) remains a valuable diagnostic method in selected cases. This study aims to assess the diagnostic efficacy of renal FNA and highlight the impact of ROSE on achieving definitive diagnoses. This retrospective study included 273 patients who underwent ultrasound- or CT-guided FNA for renal lesions between 2010 and 2018 at Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine. Lesions were evaluated based on size, radiologic features, localization, ROSE status, and number of smears. Cytopathological results were categorized as nondiagnostic, limited, non-neoplastic, or neoplastic. Histopathological correlation was assessed in available cases. Statistical analyses were performed using SPSS v25.0, with p < 0.05 considered significant. Of the 273 cases, 218 (79.8%) yielded diagnostic results. Definitive diagnosis rates increased with lesion size and were significantly higher in solid (86.3%) and mixed (91.4%) lesions compared to cystic lesions (60%) (p = 0.001). ROSE was performed in 177 cases, significantly improving diagnostic yield compared to cases without ROSE (85.8% vs. 68.7%, p = 0.001). Histopathological follow-up was available in 119 cases, with an overall cytological-histological concordance of 84%, reaching 98% in cases with adequate material. Renal FNA remains a reliable and accurate diagnostic method when combined with ROSE, especially in well-sampled cases. It aids in identifying both primary and metastatic tumors and can guide clinical decision-making, particularly when surgery is not feasible.

Folate receptor-⍺ (FR-⍺) is an attractive target for targeted therapy. Mirvetuximab soravtansine (MIRV) has been approved by the United States Food and Drug Administration (FDA) for treating adult patients with FR-⍺ positive, platinum-resistant epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. Therefore, identifying and detecting FR-⍺ has become an essential part of precision medicine. This study aimed to evaluate the feasibility of detecting FR-⍺ protein expression in serous cavity effusions using cell blocks (CBs) and compare the results with surgical pathology biopsy or resection specimens. Furthermore, we investigated potential variations in FR-⍺ expression pre- and post-chemotherapy. Immunohistochemical (IHC) staining of FR-⍺ was performed on the serous cavity effusion specimens from 35 patients with epithelial ovarian cancer, along with matched surgical pathological (SP) biopsy or resection specimens, following the manufacturer's guidelines for IHC analysis. Positive staining was observed in 30 (85.7%) and 32 (91.4%) serous cavity effusion CB and tissue samples, respectively. A total of 31 (88.5%) tissue and 28 (80%) effusion CB samples exhibited moderate-to-strong FR-⍺ expression in at least 25% of tumor cells. A cutoff of 25% for FR-⍺ expression positivity was used to demonstrate high concordance (96.4%) between cytology CBs and tissue specimens. We recommend a cutoff of 75% viable tumor cells with moderate-to-strong membrane staining as "positive" in CBs for greater reliability, which aligns with FDA-approved criteria. A reasonable consistency was observed in FR-⍺ expression between the pre-treatment serous cavity effusion CB specimens and the new biopsy specimens obtained after multiline treatment. We demonstrated that serous effusion CB specimens may be effective for FR-⍺ biomarker detection; FR-⍺ maintains stable expression pre- and post-chemotherapy, and patients can benefit from MIRV.

Fine-needle aspiration cytology (FNAC) remains widely used for the evaluation of palpable breast lesions, particularly in resource-limited settings, though histopathology is the gold standard. The International Academy of Cytology (IAC) Yokohama System provides a standardized five-tier reporting framework with defined risk of malignancy (ROM). This study aimed to evaluate its diagnostic performance, reproducibility, and applicability in a tertiary care setting. A total of 548 breast FNACs from 533 patients were reclassified both prospectively and retrospectively according to the IAC Yokohama categories. Histological correlation was available in 228 cases. Interobserver agreement was assessed among two senior cytopathologists and one junior pathologist using unweighted and weighted kappa statistics. Diagnostic performance was calculated against histology using three definitions of test positivity (Cat-5 only; Cat-4 & 5; Cat-3-5). A total of 548 FNACs from 533 patients were reclassified using the IAC Yokohama system: Cat-1 (36, 6.6%), Cat-2 (318, 58.0%), Cat-3 (14, 2.6%), Cat-4 (25, 4.6%), and Cat-5 (155, 28.3%). Histological correlation was available in 228 cases. The observed ROM was 50% for Cat-1, 7.9% for Cat-2, 45.5% for Cat-3, 93.8% for Cat-4, and 100% for Cat-5. Diagnostic accuracy improved with reclassification: in Group A (Cat-5 positive), sensitivity increased to 78.4% and specificity was 100%; in Group B (Cat-4 & 5 positive), sensitivity was 90.9% and specificity was 97.9%; and in Group C (Cat-3-5 positive), sensitivity reached 94.7% with a specificity of 89.6%. ROC analysis confirmed superior discrimination for the Yokohama system (AUC 0.94 vs. 0.88 for the original). Interobserver reproducibility was excellent, with weighted kappa values of 0.954 (P1 vs. P2), 0.942 (consensus vs. P3), and 0.939 (P2 vs. P3). Agreement was highest in benign and malignant categories and lowest in atypical and suspicious groups. The IAC Yokohama System showed high diagnostic accuracy, excellent reproducibility, and reliable risk stratification. By reducing false negatives and minimizing equivocal reporting, it improved alignment with histology compared with the conventional descriptive system, supporting its routine use in breast cytology practice.

Fine needle aspiration cytology (FNAC) is widely used to evaluate various lesions. Rapid on-site evaluation (ROSE) can be incorporated into cytology procedures. Our study aims to determine the efficacy of ROSE on the specimen adequacy of FNAC as compared to non-ROSE cases. We conducted a prospective study that included consecutive FNAC cases from various sites between January 10th, 2025, and April 9th, 2025. All cases performed in our laboratory's FNAC clinic had undergone ROSE using a Diff-Quik stain, whereas all FNAC cases in which the glass slides were received from other institutions for cytological evaluation were not subjected to ROSE. The specimen adequacy of ROSE-performed FNAC cases was compared with that of the non-ROSE group. This study included 350 patients. ROSE-performed cases constituted 30.8% (n = 108), while non-ROSE cases accounted for the remaining 69.2% (n = 242). The thyroid was the most frequently sampled site overall (38.86%, n = 136), followed by lymph nodes (31.14%, n = 109), breast (16.58%, n = 58), salivary gland (9.14%, n = 32), and soft tissue (3.14%, n = 11). Cell block preparations were performed in 22.85% (n = 80) of cases, of which 88.75% (n = 71) belonged to the ROSE group. Among the 286 overall adequate cases (81.7%), ROSE was performed in 106 cases (98.14% specimen adequacy, p < 0.001), while 180 out of 242 cases in the non-ROSE group were adequate (74.38% specimen adequacy, p < 0.001). The current study validates ROSE as a relevant and beneficial method that can be used as an adjunct to FNAC to improve the specimen adequacy.

Fine-needle aspiration cytology (FNAC) is a vital first-line diagnostic tool in evaluating lymphadenopathy, particularly in the head and neck region, where malignancies often present with nodal enlargement. Historically, the lack of a standardised reporting system for lymph node cytology has resulted in interobserver variability and inconsistent diagnoses. The Sydney System, introduced in 2019, provided a structured five-tier framework, which was further refined by the newly proposed World Health Organisation (WHO) Reporting System for Lymph Node, Spleen, and Thymus Cytopathology (2024). This study aims to assess the diagnostic performance of the proposed Sydney system in the context of head and neck lymphadenopathy and determine the associated risk of malignancy (ROM) for each diagnostic category. A retrospective-prospective study was conducted on 295 cases of cervical and supraclavicular lymphadenopathy evaluated through FNAC, with or without ultrasound guidance, after institutional ethical clearance. ROM values were calculated and compared with those previously published in the literature for the years 2024 and 2025. Ancillary techniques, such as ROSE and cell block preparations, as well as immunohistochemistry, were employed as necessary. The study demonstrated high sensitivity (89.9%), specificity (92.9%) and diagnostic accuracy (90.47%). The ROM varied across diagnostic categories, with the highest in malignant cases and the lowest in benign cases. No cases were reported as atypia of undetermined significance (AUS), reflecting effective clinicoradiological correlation. When plotted as an ROC curve, the present study demonstrates a strong diagnostic ability (AUC≈0.91). FNAC, when interpreted using a standardised system like the WHO or Sydney framework, remains an effective, minimally invasive and cost-efficient diagnostic tool. It enhances communication, reduces diagnostic ambiguity and facilitates streamlined treatment planning, particularly in resource-limited settings.

A 51-year-old man with no significant past medical history presented with worsening epigastric pain radiating to the back, exacerbated by inspiration.