Cytopathology Journal Club

#CytoJC
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[Cytopathology Journal Club @CytoJC]

Great discussion tonight by author @MikeLandauMD on NR4A3 #CytoJC !

Some polls will remain active for 24hrs so you can see how other institutions/hospitals tackle these tests!

Good night everyone and once again thanks so much @MikeLandauMD and everyone that participated!

[Michael Landau @MikeLandauMD]

@CytoJC The case u refer to was the 1 AcCC that was neg for NR4A3 IHC on both FNA & resection. We don't have a definite explanation for why. It was also neg for MSANTD3 FISH. We hypothesized that maybe NR4A2 was involved in this case - but we didn't stain for it so did not prove it.

[Cytopathology Journal Club @CytoJC]

#CytoJC

Last question of the night!!!

@MikeLandauMD

Although it was only in one case, do you think staining for NR4A2 as well as NR4A3 would catch more cases of AcCC?

[Swikrity U Baskota,MD, FCAP,FASCP @Baskotacytopath]

NR4A3 IHC #CytoJC

[Swikrity U Baskota,MD, FCAP,FASCP @Baskotacytopath]

NR4A3 FISH #CytoJC #ENTPath

[Michael Landau @MikeLandauMD]

@CytoJC It certainly would be nice, since IHC is cheaper & faster. But NR4A3 works better than other IHC stains for H&N tumors we have tried in our lab. For instance, we have not found great success w/ PLAG1 & HMGA2 IHC.

[Cytopathology Journal Club @CytoJC]

#CytoJC

@MikeLandauMD
Do you foresee this practice of performing IHC instead of FISH will become a trend throughout head and neck pathology?

[Michael Landau @MikeLandauMD]

@CytoJC Oddly, the FNA of the primary showed only 1+ positivity (weak staining) while the LN met showed 3+ positivity (strong staining). I don't remember if there were low-grade areas in the primary resection - would have to check.

[Cytopathology Journal Club @CytoJC]

#CytoJC

Does your institution do NR4A3 FISH in house?

[Cytopathology Journal Club @CytoJC]

#CytoJC

Will your institution adopt NR4A3 IHC as an in-house test in the near future?

[Cytopathology Journal Club @CytoJC]

#CytoJC

Q4: Were there any qualitative differences in DOG1 / NR4A3 staining between the low grade AcCC and the high grade transformation areas seen in one case?

@MikeLandauMD

[Michael Landau @MikeLandauMD]

@CytoJC We wanted to give DOG1 a fighting chance, so we scored it using 2 different thresholds (any memb/cytopl staining vs. circumferential). Since it shows different patterns, we weren't sure which threshold was best and assessed both.

[Liza Quintana, MD @LizaMQuintana]

@MikeLandauMD @CytoJC In a study presented at USCAP 2020, 13/13 acinic cell carcinomas of the breast were neg for NR4A3 #cytojc

[Michael Landau @MikeLandauMD]

@VarshaManuchaMD @CytoJC I would add that normal acini & AcCC cells can be intermixed, so the tumor cells can be missed if u are only relying on DOG1. The apical or circumferential staining can be weak and not obvious.

[Varsha Manucha, MD @VarshaManuchaMD]

@CytoJC @MikeLandauMD Important to know the fidelity of a stain esp. in cytology.
#cytoJC

[Cytopathology Journal Club @CytoJC]

#CytoJC

@MikeLandauMD
Q3: Do you think standardizing reporting of DOG1 (“complete membranous” vs “any staining”) as done in your study eliminated interobserver variability somewhat? And do you think this approach should be encouraged for other IHC-based studies moving forward?

[Liza Quintana, MD @LizaMQuintana]

@VarshaManuchaMD @CytoJC @MikeLandauMD same! i also prefer a nuclear stain in CBs #cytojc

[Varsha Manucha, MD @VarshaManuchaMD]

@MikeLandauMD @CytoJC Besides interpretation of DOG1 can be challenging on hypocellular specimens or even otherwise. #CytoJC

[Cytopathology Journal Club @CytoJC]

.@MikeLandauMD

Q2: Will NR4A3 also be present in breast and other organ systems? There are a couple of abstracts that have pushed this idea forward.

#CytoJC

[Cytopathology Journal Club @CytoJC]

Great! It looks like more folks are tuning in!

Today's #CytoJC is led by author @MikeLandauMD from @UPMC
on the paper "Evaluation of NR4A3 Immunohistochemistry (IHC) and Fluorescence In Situ Hybridization and Comparison With DOG1 IHC for FNA Diagnosis of Acinic Cell Carcinoma"