Educational Objectives:
1. To review select examples of molecular techniques routinely requested on cytologic specimens, and consider additional techniques likely to be increasingly utilized in the future
2. To discuss the advantages and disadvantages of various platforms (e.g., cell blocks, direct smears, Whatman cards, frozen specimens) with which ancillary studies are performed
3. To discuss optimal triage of limited cytologic specimens for performing diagnostic and prognostic ancillary studies by leveraging the available diversity of cytologic material

We plan to discuss scenarios where molecular analytic tools play vital roles in rendering specific cytologic diagnoses as well as providing key therapeutic and prognostic information. Information provided will be based on interactions with oncologists, a large state of the art pathology molecular testing facility, as well as extensive literature review. Examples include subclassification of non-small cell carcinoma, EGFR mutational analysis in pulmonary adenocarcinoma, mutational analysis of thyroid neoplasms, cytogenetic analysis of small round blue cell tumors, and optimal identification of lymphoid neoplasms. We will then poll the audience as to the platforms used for these ancillary studies in their routine practices. Results from the poll will provide a segue into discussing advantages and disadvantages of these platforms, incorporating personal laboratory and research experience, recent publications, and a thorough up-to-date literature review. Finally, we will present a holistic, integrated approach for triaging limited cytologic tissue in the laboratory aimed at optimizing both cytologic diagnoses as well as the performance of clinically relevant ancillary studies. Optimal triage will be predicated on the appropriate clinico-pathologic contexts and ensuing molecular techniques to be performed (e.g., PCR-based mutational analysis, fluorescence in situ hybridization, signal amplification techniques, chromogenic in situ hybridization) as well as the necessity of traditional immunocytochemistry. The advantages and disadvantages of immunocytochemical techniques performed on cell blocks and direct smears will also be discussed.