Tools, techniques, and challenges in preparing cytology specimens for ancillary studies: results of the ASC Optimizing Cytology and Small Biopsy Specimen Processing for Ancillary Studies task force survey

Jonas J Heymann; Cristiana M Pineda; Christine N Booth; Elizabeth Jenkins; Joshua R Menke; Sara E Monaco; Ritu Nayar; Michiya Nishino; Sinchita Roy-Chowdhuri; Roberto Ruiz-Cordero; Donna K Russell; Anjali Saqi; Kaitlin E Sundling; Michael J Thrall; Vanda F Torous; Christopher J VandenBussche; Paul A VanderLaan; M Lisa Zhang; Momin T Siddiqui

doi:10.1016/j.jasc.2024.10.001

Tools, techniques, and challenges in preparing cytology specimens for ancillary studies: results of the ASC Optimizing Cytology and Small Biopsy Specimen Processing for Ancillary Studies task force survey

J Am Soc Cytopathol. 2024 Oct 16:S2213-2945(24)00215-1. doi: 10.1016/j.jasc.2024.10.001. Online ahead of print.

Authors

Jonas J Heymann¹, Cristiana M Pineda², Christine N Booth³, Elizabeth Jenkins⁴, Joshua R Menke⁵, Sara E Monaco⁶, Ritu Nayar⁷, Michiya Nishino², Sinchita Roy-Chowdhuri⁸, Roberto Ruiz-Cordero⁹, Donna K Russell¹⁰, Anjali Saqi¹¹, Kaitlin E Sundling¹², Michael J Thrall¹³, Vanda F Torous¹⁴, Christopher J VandenBussche¹⁵, Paul A VanderLaan², M Lisa Zhang¹⁴, Momin T Siddiqui¹⁶

Affiliations

¹ Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York. Electronic address: [email protected].
² Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
³ Department of Pathology, Cleveland Clinic, Cleveland, Ohio.
⁴ American Society of Cytopathology, Wilmington, Delaware.
⁵ Department of Pathology, Stanford University, Stanford, California.
⁶ Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania.
⁷ Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
⁸ Division of Pathology and Laboratory Medicine, Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁹ Department of Pathology and Laboratory Medicine, Miller School of Medicine, University of Miami, Miami, Florida.
¹⁰ University of Rochester Medical Center, Rochester, New York.
¹¹ Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.
¹² Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
¹³ Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
¹⁴ Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
¹⁵ Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁶ Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York.

PMID: 39547835
DOI: 10.1016/j.jasc.2024.10.001

Abstract

Introduction: Ancillary testing on cytopathology and other small biopsy specimens is crucial for diagnosis and provides critical information to clinicians. Testing is dependent on preanalytic factors and would benefit from standardization of specimen collection protocols across laboratories. To assess institutional practices and areas of need for evidence-based standards, we surveyed current practices across cytopathology laboratories.

Materials and methods: A twelve-question electronic survey was distributed to American Society of Cytopathology (ASC) members through email, social media, and the ASC from January 8, 2024 to March 1, 2024. Survey responses were tabulated.

Results: Of 294 respondents, 257 (87%) completed at least 10/12 questions. Formalin-fixed, paraffin-embedded cell blocks (CBs) are utilized for immunohistochemistry, molecular testing, and in situ hybridization by 89%, 84%, and 71% of respondents, respectively. For fine needle aspirations, no collection medium is utilized by a majority of respondents. In contrast, 61% utilize no collection medium for fluids; 64% predominantly utilize liquid-based preservatives for other exfoliative specimens. For CB preparation, 58% of respondents use coagulating agent; 67% use no fixative before formalin. The two most significant factors limiting clinical utility of ancillary testing in cytology specimens are low cellularity and lack of validation (49% and 23% of respondents, respectively).

Conclusions: There is wide variation in current practices among laboratories, reflecting lack of consensus. Although laboratories utilize different collection media for different specimen types, for CB utilization, current survey results are similar to those reported previously. ASC has convened a task force to facilitate specimen standardization and minimize variability among preanalytic factors.

Keywords: Ancillary studies; Cell block; Fixation; Immunohistochemistry; Molecular diagnostic techniques; Preanalytic factors.