Abstract
Initial evaluation of patients presenting with a suspected malignancy without a clear clinical or radiologic impression of a primary site (so-called cancer of unknown primary, or CUP) frequently includes fine needle aspiration (FNA) to both establish a diagnosis and procure tissue for additional studies. Careful management of limited specimen material is especially important in the modern era, when molecular studies may take precedence over a more definitive tissue diagnosis. This review summarizes our practice habits when encountering a CUP. Broadly, key morphologic patterns in context of patient history and clinical-radiologic impression should guide the selection of a limited panel of IPOX stains to establish first a broad lineage. Subsequently 1–2 site-specific markers may be used to confirm the diagnosis. In difficult cases, it is helpful to convey the situation to the treating physicians, who may prefer to prioritize molecular testing over pursuit of a more definitive diagnosis. Prudent choice of immunoperoxidase (IPOX) studies, based on both key cytomorphologic criteria and continued communications with the clinical team regarding their needs for treatment planning, is critical in CUP cases.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 724-737 |
| Number of pages | 14 |
| Journal | Cancer cytopathology |
| Volume | 126 |
| DOIs | |
| State | Published - Aug 1 2018 |
Fingerprint
Keywords
- cancer of unknown primary
- carcinoma of unknown primary
- fine needle aspiration
- unknown origin
ASJC Scopus subject areas
- Oncology
- Cancer Research
Cite this
cancer of unknown primary : Ancillary testing of cytologic and small biopsy specimens in the era of targeted therapy. / Cowan, Morgan L.; VandenBussche, Christopher.
In: Cancer cytopathology, Vol. 126, 01.08.2018, p. 724-737.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - cancer of unknown primary
T2 - Ancillary testing of cytologic and small biopsy specimens in the era of targeted therapy
AU - Cowan, Morgan L.
AU - VandenBussche, Christopher
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Initial evaluation of patients presenting with a suspected malignancy without a clear clinical or radiologic impression of a primary site (so-called cancer of unknown primary, or CUP) frequently includes fine needle aspiration (FNA) to both establish a diagnosis and procure tissue for additional studies. Careful management of limited specimen material is especially important in the modern era, when molecular studies may take precedence over a more definitive tissue diagnosis. This review summarizes our practice habits when encountering a CUP. Broadly, key morphologic patterns in context of patient history and clinical-radiologic impression should guide the selection of a limited panel of IPOX stains to establish first a broad lineage. Subsequently 1–2 site-specific markers may be used to confirm the diagnosis. In difficult cases, it is helpful to convey the situation to the treating physicians, who may prefer to prioritize molecular testing over pursuit of a more definitive diagnosis. Prudent choice of immunoperoxidase (IPOX) studies, based on both key cytomorphologic criteria and continued communications with the clinical team regarding their needs for treatment planning, is critical in CUP cases.
AB - Initial evaluation of patients presenting with a suspected malignancy without a clear clinical or radiologic impression of a primary site (so-called cancer of unknown primary, or CUP) frequently includes fine needle aspiration (FNA) to both establish a diagnosis and procure tissue for additional studies. Careful management of limited specimen material is especially important in the modern era, when molecular studies may take precedence over a more definitive tissue diagnosis. This review summarizes our practice habits when encountering a CUP. Broadly, key morphologic patterns in context of patient history and clinical-radiologic impression should guide the selection of a limited panel of IPOX stains to establish first a broad lineage. Subsequently 1–2 site-specific markers may be used to confirm the diagnosis. In difficult cases, it is helpful to convey the situation to the treating physicians, who may prefer to prioritize molecular testing over pursuit of a more definitive diagnosis. Prudent choice of immunoperoxidase (IPOX) studies, based on both key cytomorphologic criteria and continued communications with the clinical team regarding their needs for treatment planning, is critical in CUP cases.
KW - cancer of unknown primary
KW - carcinoma of unknown primary
KW - fine needle aspiration
KW - unknown origin
UR - http://www.scopus.com/inward/record.url?scp=85052531969&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052531969&partnerID=8YFLogxK
U2 - 10.1002/cncy.22014
DO - 10.1002/cncy.22014
M3 - Review article
C2 - 30156769
AN - SCOPUS:85052531969
VL - 126
SP - 724
EP - 737
JO - Cancer cytopathology
JF - Cancer cytopathology
SN - 1934-662X
ER -