Nadeem Zafar, Farhan Akhtar, Tariq Masood Malik, Saqib Qayyum Ahmad, Saemah Nuzhat Zafar.
Inter-observer concurrence (or lack thereof) on conventionally - stained smears aspirated from patients of Rosai - Dorfman disease.
Pak J Pathol Jan ;27(2):49-54.

Objective: To determine the degree of inter-observer reproducibility of results in fine-needle aspirated material in patients with Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy (SHML).Study design: Case Series. Place & duration of study: Departments of Pathology of eleven Armed Forces medical institutions, inland and abroad, April 25, 2004 through April 30, 2016.Materials and Methods: Three qualified cytopathologists independently opined on all aspirates from all RDD patients in fine-needle aspirate (FNA) clinics of their respective canters. All smears examined by any one worker were circulated amongst both the other. These were all followed by confirmation on biopsy (the `gold standard`). Those that were diagnosed SHML, on examination of either aspiration smears or on histopathology sections, were selected for this project. As a routine, all our fine-needle aspirates are: (1) subjected to fixation in absolute alcohol, to be stained with Papanicolaou method as well as haematoxylin-and-eosin (H&E) and (2) dried in air, to be dyed with Romanovsky stains. After the diagnosis was histologically confirmed, comparisons were drawn between the cytology verdicts of all three assessors. Results: A total number of 13 patients formed the size of our sample. Out of these, 11 (85%) were diagnosed correctly by all three workers. Of the remainder, 1 (8%) case had been missed by all three examiners, while two of them overlooked another separate case each. Hence the overall agreement in diagnosis turned out to be 92% between the first author and either of the second and third, whereas it was 85% between the second and third as well as between all three. The dearth or absolute lack of emperipolesis (earlier thought of as lymphophagocytosis) was found to be the most important `confounding` factor.Conclusion: For a large examiner-to-sample ratio (3:13) as this, the agreement in cytological diagnosis of RDD is strong. With a greater number of cases and the application of immunohistochemical tools, FNA diagnosis is expected to bring in a higher degree of agreement. With fully-developed emperipolesis, FNA can be relied on for an accurate diagnosis of SHML.

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