Sabato 27 ottobre 2012 - Pacini Editore

COmuNiCaziONi ORali
Conclusions. Specular FFPE blocks, which are easy to store and
to cut into sections and offer optimal morphological detail, can
provide plenty of useful information about the corresponding
frozen samples and can therefore be used for biobanking QC
procedures. However, because of the intrinsic heterogeneity possessed
by neoplastic lesions, specular blocks may not accurately
represent the tissue composition and the biological attributes
of each single frozen aliquot. On the other hand, for the same
reason a single frozen aliquot may not be fully representative of
the whole lesion, as evaluated on specular FFPE blocks. All this
must be taken into account when planning and performing frozen
sample QC procedures involving the use of matching FFPE material.
Particular care must be exercised in choosing the discrepancy
thresholds, as they can greatly affect the outcome of the process.
references
1 Botti G, et al. Sample conservation: freezing, fixation and quality
control. Pathologica 2008.
2 Mager SR, et al. Standard operating procedure for the collection of
fresh frozen tissue samples. Eur J Cancer 2007.
3 Morente MM, et al. TuBaFrost 2: Standardising tissue collection and
quality control procedures for a European virtual frozen tissue bank
network. Eur J Cancer 2006.
4 ISBER. Best Practices for Repositories – Collection, Storage, Retrieval
and Distribution of Biological Materials for Research. Cell Preserv
Tech 2008.
FnA: who must perform this procedure?
S. Negri, L. Gaetti, G. Calabrese, G. Granchelli, R. Fante, D. Azzolini
* , A. Bellomi
Azienda Ospedaliera C. Poma, Mantova, Servizio di Anatomia Patologica,
* Servizio di Diagnostica per immagini
Preface. The Pathologic Anatomy Unit at Mantova Hospital has
been equipped with a FNA laboratory since 1984.
At first, this Unit dealt with palpable nodules only, and then with
instrumentally-detected lesions in close collaboration with radi
ologists.
The diagnostic quality of our work enabled us to treat 2000 cases
per year by 1990 and this figure has gone up to 3000 since 2000,
with an ever increasing number of FNA on echographic guidance.
The reliability of this diagnostic procedure has led to a very high
number of requests for instrumentally-guided exams also in relation
to other organs, both deep and superficial.
This increase, not supported by an adequate number of pathologists,
often compels other professional figures such echographists
or clinicians to perform the exam.
The high number of requests and the decision of the Head of the
Radiology Unit no longer to perform FNA in collaboration with
pathologists, have caused pathologists to provide themselves
with the necessary equipment and staff (surgery, echograph and
nurse) in order to be able to perform this exam without help from
a radiologist.
Materials and methods. After an adequate training period in
which a radiologist instructed a pathologist in the use of the
ecograph, this technique was employed simultaneously by two
pathologists, one detecting the lesion, and the other positioning
the needle and collecting the specimen.
Once the training period of the 5 pathologists forming the team
was over, we moved to the last stage in which a single pathologist
used the ecograph with one hand, while he used the other to
position the needle and collect the specimen. No FNA have been
carried out without a preceding radiologic diagnosis or adequate
imaging.
Results. In the period of five years (from 2007 to 2011) in which
the procedure described above was employed, 3399 FNA were
performed, of which 1985 on the thyroid, 567 on the breast, 61
on the salivary glands, 299 on lymph nodes and 487 on nodules
detected at various locations (see tab- I).
297
The percentage of inadequates depends on the location of the
nodule to be examined and varies from 7.3% in the case of nodules
detected at various locations, to 2,2% for mammary ones,
with an average value of 4.53 % (see table 2).
The values of sensitivity and specificity VPP and VPN will be
considered later on.
The methods and results of FNA performed by pathologists will
be compared with those of FNA carried out by radiologists and
with those reported in the literature.
Discussion. FNA on echographic guidance is the most widespread
procedure in the field of oncological diagnostics. However,
its nationwide use is hampered by the lack of professional figures
to be entrusted with the preparation of the material. What’s
more, the need to integrate the professional skills of the cytologist
with those of the radiologist is hindered by the fact that these two
figures work in two different departments.
The lack of collaboration between pathologists and radiologists
may lead to poor results, which makes it necessary to use more
expensive and invasive methodologies with an increase in discomfort
for patients.
The Pathologist and radiologist must collaborate blending their
professional skills with the purpose of providing patients with a
quick, reliable diagnosis essential for effective treatment.
“Siapec” and its own Cytology committee should address the
issue of FNA with proposals, based on their competence, to organise
training courses which must find new ways of enhancing
effective interaction between radiologists and cytopathologists.
In 2011 with the help of the “ Servizio di Sviluppo Organizzativo
e Formazione Aziendale” we organized two editions of a training
course called “Instrumentally-guided FNA. From theory to
practice”.
The aim of the project was to uniform and optimize the instructions
and methodology of FNA on echographic guidance in dealing
with both palpable and non palpable lesions.
The expected changes were: