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Article: Islet cell tumor of the pancreas: increasing diagnosis after instituting ultrasonography-guided fine needle aspiration.

Caudill, Jill L / Humphrey, Sandra K / Salomão, Diva R

2008 Volume 52, Issue 1, Page(s) 45–51

Abstract: Objective: To review the clinical and cytomorphologic features of pancreatic islet cell tumors (ICT).: Study design: Computer search identified patients with pancreatic ICT diagnosed by fine needle aspiration biopsy (FNAB) between January 1995 and ... ...

Abstract	Objective: To review the clinical and cytomorphologic features of pancreatic islet cell tumors (ICT). Study design: Computer search identified patients with pancreatic ICT diagnosed by fine needle aspiration biopsy (FNAB) between January 1995 and December 2003. Clinical, radiographic, and cytomorphologic findings were reviewed. Results: Thirty-eight patients (19 men, 19 women; median age 60 years, range 30-82) with ICT were identified; 30 were diagnosed through endoscopic ultrasonography (EUS)-FNAB and 8 through computed tomography (CT)-guided FNAB. Smears of 37 specimens had adequate cellularity. Most were highly cellular with bloody backgrounds. No major differences were observed between specimens obtained by EUS-FNAB or CT-FNAB. Radiographically, 20 tumors measured 1-5 cm, 7 were > 5 cm and 4 < 1 cm. Twenty-two patients underwent tumor resection. Conclusion: Newer radiography and biopsy techniques to detect and examine smaller pancreatic masses have increased the number of pancreatic ICT diagnoses at our institution. The distinctive cytomorphologic features of pancreatic ICT make it reliably diagnosable by FNAB.
MeSH term(s)	Adenoma, Islet Cell/diagnosis ; Adenoma, Islet Cell/pathology ; Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Endosonography ; Female ; Humans ; Islets of Langerhans/diagnostic imaging ; Islets of Langerhans/pathology ; Male ; Middle Aged ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/pathology ; Tomography, X-Ray Computed
Language	English
Publishing date	2008-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	80003-x
ISSN	1938-2650 ; 0001-5547
ISSN (online)	1938-2650
ISSN	0001-5547
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Article: Islet Cell Tumor of the Pancreas

Caudill, Jill L. / Humphrey, Sandra K. / Salomão, Diva R.

Acta Cytologica

2011 Volume 52, Issue 1, Page(s) 45–51

Institution	From the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, U.S.A
Language	English
Publishing date	2011-02-15
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Fine Needle Aspiration
ZDB-ID	80003-x
ISSN	1938-2650 ; 0001-5547
ISSN (online)	1938-2650
ISSN	0001-5547
DOI	10.1159/000325433
Database	Karger publisher's database

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Article: Cervicovaginal (Papanicolaou) smear findings in patients with malignant mixed Müllerian tumors.

Casey, Mary B / Caudill, Jill L / Salomão, Diva R

Diagnostic cytopathology

2003 Volume 28, Issue 5, Page(s) 245–249

Abstract: Malignant mixed Müllerian tumor is a rare neoplasm that occurs most frequently in elderly patients. It is characterized by a mixture of malignant epithelial and sarcomatous components. Little has been published about Papanicolaou smear findings ... ...

Abstract	Malignant mixed Müllerian tumor is a rare neoplasm that occurs most frequently in elderly patients. It is characterized by a mixture of malignant epithelial and sarcomatous components. Little has been published about Papanicolaou smear findings pertaining to malignant mixed Müllerian tumors. We present our experience, with an emphasis on cytologic detail. Nine patients (median age, 65 yr) met our study criteria. All available smears and surgical specimens were reviewed. Four smears were positive for malignancy, with a sensitivity of 44% (3 adenocarcinoma, and 1 squamous-cell carcinoma, small-cell type). The results of our study showed that Papanicolaou smear findings pertaining to malignant mixed Müllerian tumors are seen in patients with advanced-stage disease with involvement of the lower uterine segment or cervix. The usual finding is large numbers of high-grade epithelial malignant cells in a necrotic background. The mesenchymal component rarely sheds cells visible on Papanicolaou smear.
MeSH term(s)	Aged ; Aged, 80 and over ; False Negative Reactions ; Female ; Humans ; Middle Aged ; Mixed Tumor, Mullerian/pathology ; Papanicolaou Test ; Uterine Neoplasms/pathology ; Vaginal Smears
Language	English
Publishing date	2003-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	632710-2
ISSN	8755-1039
ISSN	8755-1039
DOI	10.1002/dc.10276
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Molecular diagnostics, personalized medicine, and the evolving role of the cytotechnologist: an institutional experience.

Kane, Lindsey E / Root, Renee R / Voss, Jesse S / Caudill, Jill L / Sorenson, Angela M / Colborn, Lisa K / Halling, Kevin C / Henry, Michael R / Clayton, Amy C / Kipp, Benjamin R

Acta cytologica

2012 Volume 56, Issue 6, Page(s) 678–685

Abstract: The role of cytotechnologists has focused primarily on the microscopic examination of cytologic specimens for diagnosing disease. Cytotechnologists currently evaluate a wide assortment of both gynecological and nongynecological cytology specimens. ... ...

Abstract	The role of cytotechnologists has focused primarily on the microscopic examination of cytologic specimens for diagnosing disease. Cytotechnologists currently evaluate a wide assortment of both gynecological and nongynecological cytology specimens. However, the Pap test remains the primary test for most cytology laboratories. Recently, human papillomavirus testing and newer cervical cancer screening guidelines have reduced the number of Pap tests, resulting in some anxiety and concern among the cytology community. However, as Pap test volumes continue to decrease, molecular oncology and ancillary testing volumes continue to increase with the advent of new biomarkers and associated personalized therapies. This change in clinical practice has resulted in evolving roles for many cytotechnologists. Cytotechnologists have skills based not only in morphology but also in understanding concepts of disease including neoplasia. These skills allow cytotechnologists to excel in many other types of laboratory testing. This article discusses how the roles of the cytotechnologist have recently expanded at our institution to include involvement in DNA ploidy analysis, quantitative immunohistochemistry, fluorescence in situ hybridization, circulating tumor cells, and molecular oncology testing. Lastly, this article discusses how these newer roles benefit both the cytotechnologist and the clinical laboratory.
MeSH term(s)	Biomarkers, Tumor/analysis ; Cytodiagnosis ; Humans ; Molecular Diagnostic Techniques ; Neoplasms/diagnosis ; Precision Medicine
Chemical Substances	Biomarkers, Tumor
Language	English
Publishing date	2012
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	80003-x
ISSN	1938-2650 ; 0001-5547
ISSN (online)	1938-2650
ISSN	0001-5547
DOI	10.1159/000341169
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Identification of malignant cytologic criteria in pancreatobiliary brushings with corresponding positive fluorescence in situ hybridization results.

Barr Fritcher, Emily G / Caudill, Jill L / Blue, Joshua E / Djuric, Kris / Feipel, Lesley / Maritim, Benard K / Ragheb, Ameera A / Halling, Kevin C / Henry, Michael R / Clayton, Amy C

American journal of clinical pathology

2011 Volume 136, Issue 3, Page(s) 442–449

Abstract: Cytologic evaluation of pancreatobiliary brushings is specific but poorly sensitive for malignancy. Detection of polysomic cells by fluorescence in situ hybridization (FISH) is significantly more sensitive than routine cytology with similar specificity. ... ...

Abstract	Cytologic evaluation of pancreatobiliary brushings is specific but poorly sensitive for malignancy. Detection of polysomic cells by fluorescence in situ hybridization (FISH) is significantly more sensitive than routine cytology with similar specificity. The purpose of this study was to identify cytologic criteria most associated with malignancy in specimens unaffected by sample failure. Endoscopic brushings were split equally for routine cytologic and FISH analyses per clinical practice. We retrospectively evaluated 16 cytologic criteria on Papanicolaou-stained slides. We assumed that the presence of polysomic cells by FISH indicated successful tumor sampling in specimens from patients with pathologic evidence of malignancy on follow-up. We compared cytologic criteria of malignant brushings with corresponding positive FISH results (positive control, n = 39) with those without evidence of malignancy and corresponding negative FISH results (negative control, n = 30). The presence of single abnormal cells, irregular nuclear membranes, and enlarged nuclei were independent predictors of malignancy by logistic regression (P < .05).
MeSH term(s)	Adenocarcinoma/pathology ; Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/pathology ; Cholangiocarcinoma/pathology ; Cholangitis, Sclerosing/pathology ; Cytodiagnosis/methods ; Female ; Humans ; In Situ Hybridization, Fluorescence/methods ; Male ; Middle Aged ; Pancreatic Neoplasms/pathology ; Retrospective Studies ; Sensitivity and Specificity
Language	English
Publishing date	2011-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2944-0
ISSN	1943-7722 ; 0002-9173
ISSN (online)	1943-7722
ISSN	0002-9173
DOI	10.1309/AJCPDULIOEOTUZ5H
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Article ; Online: False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors.

Gleeson, Ferga C / Kipp, Benjamin R / Caudill, Jill L / Clain, Jonathan E / Clayton, Amy C / Halling, Kevin C / Henry, Michael R / Rajan, Elizabeth / Topazian, Mark D / Wang, Kenneth K / Wiersema, Maurits J / Zhang, Jun / Levy, Michael J

Gut

2010 Volume 59, Issue 5, Page(s) 586–593

Abstract: Objective: It is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0-1%. It was hypothesised that the FP and false suspicious (FS) rates for EUS FNA are greater than reported. A study was ... ...

Abstract	Objective: It is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0-1%. It was hypothesised that the FP and false suspicious (FS) rates for EUS FNA are greater than reported. A study was undertaken to establish the rate and root cause of discordant interpretation. Design: Using a prospectively maintained endoscopic database, cytohistological discordant EUS FNA examinations from 30 July 1996 to 31 December 2008 were identified retrospectively. Setting: Tertiary referral centre. Main outcome measures: Discordant FNA was defined by positive or suspicious FNA cytology in the absence of malignancy or neoplasm in the subsequent surgical pathology specimen, specifically in the absence of neoadjuvant therapy. Three cytopathologists conducted a blinded review of randomised discordant and matched specimens. Results: FNA was performed in 5667/18 066 (31.4%) patients undergoing EUS, of whom 2547 had cytology results interpreted as 'positive' or 'suspicious' or 'atypical' for malignancy or neoplasm. Subsequent surgical resection without prior neoadjuvant therapy was performed in 377 patients with positive or suspicious cytology. The FP rate was 20/377 (5.3%) and increased to 27/377 (7.2%) when FS cases were included. The incidence of discordance was consistent over time (1996-2002: 10/118 (8.6%) vs 2003-2008: 17/259 (6.6%); p=0.5) and was higher in non-pancreatic FNA (15%) than pancreatic FNA (2.2%; p=0.0001). Two-thirds of the non-pancreatic FP cases involved sampling of perioesophageal or perirectal nodes in patients with luminal neoplasms or Barrett's oesophagus. Following pathological re-review, discordance was attributed to translocated cell contamination/sampling error (50%) or cytopathologist interpretive error (50%). Conclusions: These findings refute the accepted paradigm that FP cytology rarely occurs with EUS FNA. Further investigation revealed that FP FNA developed secondary to endosonographer technique or initial cytological misinterpretation, and is particularly likely when perioesophageal or perirectal nodes are aspirated in the setting of a luminal neoplasm or Barrett's oesophagus. Further study is needed to determine the significance of these findings and potential impact on the performance of FNA and patient outcomes.
MeSH term(s)	Biopsy, Fine-Needle/standards ; Biopsy, Fine-Needle/statistics & numerical data ; Digestive System Neoplasms/diagnostic imaging ; Digestive System Neoplasms/pathology ; Digestive System Neoplasms/surgery ; Endosonography/standards ; Endosonography/statistics & numerical data ; Epidemiologic Methods ; False Positive Reactions ; Humans ; Minnesota ; Pancreatic Neoplasms/pathology ; Ultrasonography, Interventional/standards ; Ultrasonography, Interventional/statistics & numerical data ; Workload
Language	English
Publishing date	2010-05
Publishing country	England
Document type	Journal Article
ZDB-ID	80128-8
ISSN	1468-3288 ; 0017-5749
ISSN (online)	1468-3288
ISSN	0017-5749
DOI	10.1136/gut.2009.187765
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Article ; Online: Prospective cytological assessment of gastrointestinal luminal fluid acquired during EUS: a potential source of false-positive FNA and needle tract seeding.

Levy, Michael J / Gleeson, Ferga C / Campion, Michael B / Caudill, Jill L / Clain, Jonathan E / Halling, Kevin / Rajan, Elizabeth / Topazian, Mark D / Wang, Kenneth K / Wiersema, Maurits J / Clayton, Amy

The American journal of gastroenterology

2010 Volume 105, Issue 6, Page(s) 1311–1318

Abstract: Objectives: Endoscopic ultrasound (EUS) fine needle aspiration (FNA) can result in false-positive cytology and can also cause needle tract seeding. Our goal was to evaluate a potential cause, namely, the presence of malignant cells within ... ...

Abstract	Objectives: Endoscopic ultrasound (EUS) fine needle aspiration (FNA) can result in false-positive cytology and can also cause needle tract seeding. Our goal was to evaluate a potential cause, namely, the presence of malignant cells within gastrointestinal (GI) luminal fluid, either as a result of tumor sloughing from luminal cancers or secondary to FNA of extraluminal sites. Methods: During EUS, luminal fluid that is usually aspirated through the echoendoscope suction channel and discarded was instead submitted for cytological analysis among patients with cancer and benign disease. Pre- and post-FNA luminal fluid samples were collected to discern the role of FNA in inducing a positive cytology. When not performing FNA, one sample was collected for the entire examination. The final diagnosis was based on strict clinicopathological criteria and >or=2-year follow-up. This study was conducted in a tertiary referral center. Results: We assessed the prevalence of luminal fluid-positive cytology among patients with luminal (e.g., esophageal), extraluminal (e.g., pancreatic), and benign disease. Among the 140 patients prospectively enrolled with sufficient sampling and follow-up, an examination of luminal fluid cytology showed positive results for malignancy in luminal and extraluminal cancer patients, 48 and 10%, respectively. This included 8 out of 23 esophageal, 4 of 5 gastric, and 9 of 15 rectal cancers. The positive luminal fluid cytology rate with luminal cancers was not affected by performing FNA. Post-FNA luminal fluid cytology was positive in 3 out of 26 with pancreatic cancers. Cytological examination of luminal fluid aspirates did not demonstrate malignant cells in any patient with nonmalignant disease. Conclusions: Malignant cells are commonly present in the GI luminal fluid of patients with luminal cancers and can also be found in patients with pancreatic cancer after EUS FNA. Further study is needed to determine the impact of these findings on cytological interpretation, staging, risk of needle tract seeding, and patient care and outcomes.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle/adverse effects ; Endosonography ; Female ; Gastrointestinal Contents ; Gastrointestinal Tract/diagnostic imaging ; Gastrointestinal Tract/pathology ; Humans ; Male ; Middle Aged ; Neoplasm Seeding ; Neoplasms/pathology ; Prospective Studies
Language	English
Publishing date	2010-06
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	390122-1
ISSN	1572-0241 ; 0002-9270
ISSN (online)	1572-0241
ISSN	0002-9270
DOI	10.1038/ajg.2010.80
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Article ; Online: Molecular Diagnostics, Personalized Medicine, and the Evolving Role of the Cytotechnologist: An Institutional Experience

Kane, Lindsey E. / Root, Renee R. / Voss, Jesse S. / Caudill, Jill L. / Sorenson, Angela M. / Colborn, Lisa K. / Halling, Kevin C. / Henry, Michael R. / Clayton, Amy C. / Kipp, Benjamin R.

Acta Cytologica - The Journal of Clinical Cytology and Cytopathology

2012 Volume 56, Issue 6, Page(s) 678–685

Abstract	The role of cytotechnologists has focused primarily on the microscopic examination of cytologic specimens for diagnosing disease. Cytotechnologists currently evaluate a wide assortment of both gynecological and nongynecological cytology specimens. However, the Pap test remains the primary test for most cytology laboratories. Recently, human papillomavirus testing and newer cervical cancer screening guidelines have reduced the number of Pap tests, resulting in some anxiety and concern among the cytology community. However, as Pap test volumes continue to decrease, molecular oncology and ancillary testing volumes continue to increase with the advent of new biomarkers and associated personalized therapies. This change in clinical practice has resulted in evolving roles for many cytotechnologists. Cytotechnologists have skills based not only in morphology but also in understanding concepts of disease including neoplasia. These skills allow cytotechnologists to excel in many other types of laboratory testing. This article discusses how the roles of the cytotechnologist have recently expanded at our institution to include involvement in DNA ploidy analysis, quantitative immunohistochemistry, fluorescence in situ hybridization, circulating tumor cells, and molecular oncology testing. Lastly, this article discusses how these newer roles benefit both the cytotechnologist and the clinical laboratory.
Keywords	Cytology ; Molecular diagnostics ; Molecular pathology ; Ancillary testing
Language	English
Publisher	S. Karger AG
Publishing place	Basel
Publishing country	Switzerland
Document type	Article ; Online
ISSN	1938-2650 ; 0001-5547 ; 0001-5547
ISSN (online)	1938-2650
ISSN	0001-5547
DOI	10.1159/000341169
Database	Karger publisher's database

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Article ; Online: Novel breast tissue feature strongly associated with risk of breast cancer.

McKian, Kevin P / Reynolds, Carol A / Visscher, Daniel W / Nassar, Aziza / Radisky, Derek C / Vierkant, Robert A / Degnim, Amy C / Boughey, Judy C / Ghosh, Karthik / Anderson, Stephanie S / Minot, Douglas / Caudill, Jill L / Vachon, Celine M / Frost, Marlene H / Pankratz, V Shane / Hartmann, Lynn C

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

2009 Volume 27, Issue 35, Page(s) 5893–5898

Abstract: Purpose: Accurate, individualized risk prediction for breast cancer is lacking. Tissue-based features may help to stratify women into different risk levels. Breast lobules are the anatomic sites of origin of breast cancer. As women age, these lobular ... ...

Abstract	Purpose: Accurate, individualized risk prediction for breast cancer is lacking. Tissue-based features may help to stratify women into different risk levels. Breast lobules are the anatomic sites of origin of breast cancer. As women age, these lobular structures should regress, which results in reduced breast cancer risk. However, this does not occur in all women. Methods: We have quantified the extent of lobule regression on a benign breast biopsy in 85 patients who developed breast cancer and 142 age-matched controls from the Mayo Benign Breast Disease Cohort, by determining number of acini per lobule and lobular area. We also calculated Gail model 5-year predicted risks for these women. Results: There is a step-wise increase in breast cancer risk with increasing numbers of acini per lobule (P = .0004). Adjusting for Gail model score, parity, histology, and family history did not attenuate this association. Lobular area was similarly associated with risk. The Gail model estimates were associated with risk of breast cancer (P = .03). We examined the individual accuracy of these measures using the concordance (c) statistic. The Gail model c statistic was 0.60 (95% CI, 0.50 to 0.70); the acinar count c statistic was 0.65 (95% CI, 0.54 to 0.75). Combining acinar count and lobular area, the c statistic was 0.68 (95% CI, 0.58 to 0.78). Adding the Gail model to these measures did not improve the c statistic. Conclusion: Novel, tissue-based features that reflect the status of a woman's normal breast lobules are associated with breast cancer risk. These features may offer a novel strategy for risk prediction.
MeSH term(s)	Adult ; Age Factors ; Biopsy ; Breast/pathology ; Breast Neoplasms/genetics ; Breast Neoplasms/pathology ; Case-Control Studies ; Cell Proliferation ; Female ; Genetic Predisposition to Disease ; Humans ; Hyperplasia ; Logistic Models ; Middle Aged ; Parity ; Pedigree ; Precancerous Conditions/genetics ; Precancerous Conditions/pathology ; Predictive Value of Tests ; Pregnancy ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Time Factors
Language	English
Publishing date	2009-10-05
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	604914-x
ISSN	1527-7755 ; 0732-183X
ISSN (online)	1527-7755
ISSN	0732-183X
DOI	10.1200/JCO.2008.21.5079
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