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• W1484321763 abstract "Alternative methods of cytology have been on the rise, as emphasized in several articles.1-10 There is debate in the literature about the possible advantages and limits of each cytological method. Focusing on extragynecological cytology, fine-needle aspiration biopsy (FNAB) was introduced in 1930 but was not recognized as an invaluable diagnostic tool until the 1950s, when it was regarded for its simplicity, safety, and ability to be repeated.1-3 Conventional cytology (CC), which may be considered the pioneering cytological diagnostic tool, has been the cornerstone of cytological methods, including those recently gaining attention for their ability to diagnose thyroid nodular lesions. In addition, in 1995, liquid-based cytology (LBC) gained consensus as an alternative and valid method for both gynecological and nongynecological cytology.1, 2, 10 Since then, several authors have compared and emphasized the differences among CC, LBC, and cell block–derived slides. There has been a surge in the literature reporting alternative cytological methods, especially LBC, and their potential to serve as reasonable solutions for some of the problems with cytology. However, the question remains if the cytological method itself is more important than the cytopathologist who interprets the sample. As an analogy, were the specific sailing ships more critical than Columbus' navigational experience in reaching the new world? If he had steered the Pinta rather than the Santa Maria, would the result have been different? Similarly, the same kind of discussion can be applied to cytology. Hence, the controversy surrounding LBC and other alternative methods might be explained by a reluctance to look for possible advantages that might be offered. However, criticisms are generally made after careful evaluation, especially in institutions where new methods might increase technical workloads and economic costs. These concerns might justify the reluctance with which many laboratories treat the LBC method or other alternative cytological approaches. In our institution, we have been working with LBC since 2001, although we initially applied a split sample method. Our numerous articles, which cover all cytological specimens, but mainly thyroid cytology, show excellent results that were obtained with a simple shift to LBC.1, 8, 10, 11 Our results indicate that our rates of diagnostic categories were identical to those of the pre-LBC era, which led us to conclude that the cytopathologist's experience represents the most critical factor in cytological accuracy. This is not found universally, as Jo et al determined that institutional differences in the distribution of diagnostic categories may be attributable to differences in slide preparation (conventional versus LBC slides).12 Articles from Biscotti et al, Mesonero et al, and Scurry et al underline a similar diagnostic accuracy between CC and LBC (more than 90% correlation) and, furthermore, the absence of statistical differences.2-4 We are aware that several parameters, including different methanol fixative, shrunken morphological features, and the concentration of cells into a 2-cm round area can change the physical look of cytology slides, especially at the beginning of the application.1, 2, 5 In agreement with the literature, we clearly demonstrated in a series of 10,360 thyroid FNABs that 3 arbitrary parameters of efficacy (characterized by “inadequate samples,” “indeterminate proliferations,” and “positive for malignancy”) resulted in similar diagnostic value on both CC and LBC.8 Furthermore, a series of 2587 patients with thyroid nodules processed with LBC, proposed by Yassa et al, resulted in 97% positivity for malignancy and 99% accuracy for negative predictive value.13 Our 12 years of experience with LBC has indicated that a dedicated cytopathologist is, after a short initial learning period, undoubtedly able to define the exact cytological features and even the challenging “gray zone” of follicular proliferation, which is difficult regardless of the cytological method used.8 The new application of ancillary techniques (immunocytochemistry and molecular panels) that could be easily applied on LBC would be of great interest to cytopathologists in their search for LBC alternatives.9-11, 14-16 Several authors, including our group, and seminal articles by Leung et al and Dabbs et al have highlighted the excellent results in terms of quality and quantity of cytologic material for immunocytochemical and molecular purposes.6, 7, 9-11, 14-16 Of course, this might raise the eyebrows of supporters of conventional cytology for several reasons that we acknowledge. For instance, the application of immunocytochemistry and molecular analysis is allowed on conventional smears with good results, although it may be a time-consuming and laborious investigation.17-21 From the perspective we propose, the morphological evaluation of cells is still the same regardless of the cytological method employed because the most important aspect is the expertise of the cytopathologist. Would Columbus have reached the Americas with another ship? Most would say “yes.” Similarly, the cytological diagnosis is mainly attributed to the expertise of cytopathologist who is able to discriminate which cases need further investigation. In conclusion, the LBC method is a powerful diagnostic tool when the cytopathologist is skilled and aware of the morphologic differences in respect to CC. The experience of the cytopathologist holds more weight than the method applied. It was the courage and skill of Columbus, and not merely the specific ship used, that was responsible for reaching the Americas! The author made no disclosures." @default.
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• W1484321763 date "2014-03-03" @default.
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• W1484321763 title "Who was responsible for reaching the Americas—Columbus or his ships?: Focusing on the side of liquid‐based cytology: The importance and role of the cytopathologist as opposed to the cytological method used" @default.
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