Cytology Primer for Endosonographers

This chapter provides a roadmap of opportunities, which could be tapped in building a successful multidisciplinary program of obtaining samples utilizing endosonography at its base. No other book on the subject of endosonography has highlighted very critical steps from preanalytic steps that are needed to make any endosonography program successful in its endeavors. The chapter highlights important discussion on how the type of needles, sample preparation, sample transport, algorithmic cytologic evaluation, and ancillary testing are critical not only for providing cytologic diagnosis but also for triaging samples for any additional studies including molecular studies that may help additional therapeutic interventions. Assessment of pancreatic FNA samples obtained under endosonography guidance is very challenging even for experienced pathologists. One of the unique features highlighted in this chapter is delineation of “Jhala algorithm” for evaluation of solid pancreatic lesions. This algorithm provides a lucid and solid framework to assess solid pancreatic lesions and avoid unforced errors in assessment of this challenging specimen type. The chapter also highlights pitfalls to avoid in evaluation of endosonographically obtained samples. In addition, the chapter provides a salient roadmap for assessment cytology smears from various sites including lymph nodes, mediastinum, gastrointestinal tract, liver, and adrenal glands.