Karen Villar‐Zarra

Introduction: Pathology requires the integration of macroscopic and microscopic findings for an accurate diagnosis. Fine needle aspiration biopsy (FNA) traditionally became the domain of radiologists with the introduction of ultrasound; however, its increased accessibility has allowed other specialists, including pathologists, to incorporate it into their daily practice. Both ultrasound-guided FNA and core needle biopsy (CNB) performed by interventional pathologists have proven valuable tools in the diagnosis of lymph node lesions. Materials and Methods: An observational, descriptive, retrospective study was conducted at Hospital Universitario del Henares, analysing 134 FNABs and 31 CNBs of lymph node lesions between 2023 and 2024. The diagnostic yield of both techniques and their correlation were evaluated. Results: Ultrasound facilitated better lesion characterization. FNA demonstrated a diagnostic yield of 98%, with a 94% correlation with CNB results. The Sydney system 2020 was applied to FNA reporting in lymphatic node. An equivalent classification system for CNB is proposed. Conclusion: The performance of FNA and CNB by pathologists optimizes diagnosis, reduces time and costs, and strengthens their role in minimally invasive diagnostics. Adoption of a unified classification system for CNB lesions would facilitate communication between specialists.

Background: The growing demand for specialised healthcare often results in prolonged waiting times for diagnostic procedures, particularly in oncological pathology. Interventional pathology, wherein pathologists perform sample collection and diagnosis, offers a potential solution through same‐day diagnostic services.Objectives: This study aims to describe the operational framework of a One‐Stop interventional pathology consultation and analyse its outcomes, focusing on response times and diagnostic performance for patients with superficial nodules.Methods: This retrospective study was conducted in a tertiary hospital from 2016 to 2023. The consultation involved ultrasound‐guided fine needle aspiration (USFNA) and core needle biopsy (USCNB) performed by an interventional pathologist. Data on procedure adequacy, response times, and diagnostic outcomes were collected and analysed.Results: A total of 877 procedures (718 USFNA, 159 USCNB) were performed. The median time from specialist request to definitive diagnosis was 2 days (interquartile range 1–4), with 18% of patients receiving a diagnosis on the same day. Adequacy rates were 98.6% for USFNA and 100% for USCNB, with low non‐diagnostic rates (USFNA: 3.2%; USCNB: 0.6%). Lymph nodes were the most commonly sampled organ, and head‐and‐neck areas were the predominant anatomical sites.Conclusions: The One‐Stop interventional pathology model significantly reduced diagnostic times and improved patient experience. This efficient, patient‐centred approach demonstrates high diagnostic accuracy and low non‐diagnostic rates, supporting its viability for broader adoption. Further multicentre studies are needed to validate findings and optimise implementation.

Interventional pathology has emerged as a pivotal force in modern healthcare, heralding a paradigm shift from traditional diagnostic approaches to patient‐centered care. This innovative field bridges the gap between pathology and cytopathology, empowering pathologists to streamline diagnoses and reduce waiting times for patients. Collaborative mentorship and knowledge sharing ensure a lasting legacy of diagnostic excellence for future generations. Interventional pathology stands as a symbol of innovation and patient empowerment, offering a unified approach to diagnostics and improved care in the era of personalized medicine. This narrative chronicles the evolution of interventional pathologists from behind‐the‐scenes diagnostic specialists to frontline innovators. This is the story of the rise of the interventional pathologist: a testament to innovation, dedication, and an unwavering commitment to patient well‐being.

Cytopathology is the official journal of the British Association for Cytopathology publishing research to increase our knowledge and management of human disease.

This paper delves into the integral role of cytotechnologists (CTs) and biomedical scientists (BMSs) in interventional pathology, emphasizing their multifaceted responsibilities. From meticulous pre‐procedural preparations to real‐time decision‐making and post‐procedural care, CTs/BMSs significantly contribute to diagnostic efficiency. Their involvement is critical in optimizing patient outcomes.

Introduction: Despite the established role of the interventional pathologist, their diagnostic performance is difficult to establish. At least in Spain training of pathology residents in ultrasound‐guided interventional procedures for specimen collection is limited or absent in most institutions. We present our teaching experience in the instruction of ultrasound‐guided fine‐needle aspiration (FNA) to pathology residents in a tertiary‐level hospital.Materials and Methods: The training of pathology residents who rotated through the interventional unit of the pathology department and the application of ultrasound‐guided FNA and rapid on‐site evaluation (U‐ROSE) was documented over 5 years. The training period was broken down into learning phases and included the number of ultrasound‐guided FNA performed, anatomical location, and their diagnostic performance, among other aspects.Results: Nineteen (19) pathology residents were trained in U‐ROSE, and performed a total of 4003 procedures, with a mean of 211 per resident. In 53% of cases only one pass was required for an adequated sample. The specimen was diagnostic in more than 97% of cases. The most frequently sampled anatomical sites were the thyroid gland (n = 2347), followed by lymph node (n = 667), soft tissues (n = 663) and salivary glands (n = 322).Conclusion: The results support the training programme followed by pathology residents in learning U‐ROSE, which is essential to lay the foundations for the future interventional pathologist.

Background: After a series of standardized reporting systems in cytopathology, the Sydney system was recently introduced to address the need for reproducibility and standardization in lymph node cytopathology. Since then, the risk of malignancy for the categories of the Sydney system has been explored by several studies, but no studies have yet examined the interobserver reproducibility of the Sydney system.Methods: The authors assessed interobserver reproducibility of the Sydney system on 85 lymph node fine‐needle aspiration cytology cases reviewed by 15 cytopathologists from 12 institutions in eight different countries, resulting in 1275 diagnoses. In total, 186 slides stained with Diff‐Quik, Papanicolaou, and immunocytochemistry were scanned. A subset of the cases included clinical data and results from ultrasound examinations, flow cytometry immunophenotyping, and fluorescence in situ hybridization analysis. The study participants assessed the cases digitally using whole‐slide images.Results: Overall, the authors observed an almost perfect agreement of cytopathologists with the ground truth (median weighted Cohen κ = 0.887; interquartile range, κ = 0.210) and moderate overall interobserver concordance (Fleiss κ = 0.476). There was substantial agreement for the inadequate and malignant categories (κ = 0.794 and κ = 0.729, respectively), moderate agreement for the benign category (κ = 0.490), and very slight agreement for the suspicious (κ = 0.104) and atypical (κ = 0.075) categories.Conclusions: The Sydney system for reporting lymph node cytopathology shows adequate interobserver concordance. Digital microscopy is an adequate means to assess lymph node cytopathology specimens.