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Biomedical subjects

C R Laverty

Publications and source records attributed to C R Laverty.

At least 19 recordsLinked to original sources
PubMed2000

Subdividing atypical glandular cells of undetermined significance according to the Australian modified Bethesda, system: analysis of outcomes.

BACKGROUND: The Australian modification of the Bethesda system (TBS) for reporting endocervical cellular abnormalities differs from TBS in having a "high grade" category for prediction of adenocarcinoma in situ (AIS), an "inconclusive" category requiring that AIS be excluded (AISEX), and a "low grade" category (Enatyp) for when only minor changes are seen in endocervical cells. METHODS: From subsequent follow-up, the authors evaluated the proportion of histologically confirmed high grade lesions (squamous, glandular, or endometrial) in each cytologic reporting category, for cases in which no concurrent squamous abnormality was also predicted. RESULTS: From information was available for 95.9% of 172 AIS predictions, 81.5% of 119 AISEX predictions, and 89.0% of 237 reports of Enatyp. The histologic positive predictive values for high grade lesions were 95.7% for AIS, 71.1% for AISEX, and 7.1% for Enatyp. In the first 2 categories, a minority of lesions proved to be purely squamous (3.8% for AIS and 33.3% for AISEX), whereas in the Enatyp category 87.0% were squamous only. CONCLUSIONS: Compared with TBS, the Australian terminology for reporting of endocervical abnormalities better reflects the risk of underlying high grade abnormalities and may result in more appropriate management recommendations. For Enatyp reports, which constitute over 85% of reported endocervical abnormalities, repeat cytology should be considered appropriate management. However, cone biopsy should be the investigative method of choice for women with reports of AIS and AISEX.

Adenocarcinoma↗
PubMed1997

Evaluation of the ThinPrep Pap test as an adjunct to the conventional Pap smear.

OBJECTIVE: To evaluate the ThinPrep Pap test as an adjunct to the conventional Pap smear. DESIGN AND SETTING: Prospectively collected cervical samples were split for independent screening at a large specialised private gynaecological pathology practice in Sydney. MAIN OUTCOME MEASURES: Detection of additional significant abnormalities (cervical intraepithelial neoplasia 1, or more severe); changed management recommendations from "repeat smear in 12 months" or "...six months" to "colposcopy", a reduction in unsatisfactory reports. RESULTS: 35,560 paired (split-sample) conventional and ThinPrep slides were prepared. Significant abnormalities were detected in 724 conventional smears (2%). Additional significant abnormalities were found in 85 ThinPrep slides whose corresponding conventional smear was negative or unsatisfactory even after review, representing a 12% increase in the detection of significant abnormalities. As a result of the addition of ThinPrep, management recommendations were changed from "repeat smear in 12 months" or "...six months" to "colposcopy" for 89 of 1669 women whose conventional Pap smears showed minor non-specific changes or papillomavirus. There were 1258 conventional smears (3.5%) that were unsatisfactory compared with 235 ThinPrep slides (0.7%); for only 74 samples (0.2%) were both slides unsatisfactory. CONCLUSIONS: The addition of the ThinPrep Pap test improves detection and clinical management of cervical abnormalities, and reduces the number of unsatisfactory samples which would otherwise require repeat tests.

Colposcopy↗
PubMed1997

Evaluation of the CytoRich slide preparation process.

OBJECTIVE: To compare the quality and sensitivity of CytoRich slides with conventional cytologic smears and to evaluate the benefits of using this technology as an add-on procedure. STUDY DESIGN: The study design consisted of non-randomized, paired cervical samples. The subjects were 2,125 Sydney women who were routine patients of 13 gynecologists and 8 general practitioners and had cytologic smears taken between January and June 1995. All smears were taken using the Cervex brush. After preparing the conventional cytologic smear slide, the head of the sampler was detached and placed in a vial of fluid fixative. Paired slides were then prepared in the laboratory from the cells in the fluid fixative, using the CytoRich processing machine. The CytoRich and conventional cytologic smear slides were compared for quality, ease of screening, presence of endocervical cells, recognition of infections, and detection of squamous and glandular abnormalities. RESULTS: CytoRich slides were of much better quality, were easier to screen, had substantially fewer unsatisfactory results (0.3% vs. 2.6%) but lacked endocervical cells more often (16.1% vs. 10.6%). As regards abnormalities, the CytoRich slides showed fewer abnormalities, particularly in the low grade category. However, as a result of screening the paired CytoRich slide, some additional abnormalities were detected and a number of abnormalities reported on the conventional slide were reclassified (some to higher grades but more to negative). CONCLUSION: As an add-on technology, the CytoRich process has much to offer, in particular in the virtual elimination of unsatisfactory smears and in helping to resolve the difficult dichotomy between normal and low grade categories. Examining additional cellular material on a CytoRich slide enhances the sensitivity and accuracy of the combined results.

Cytodiagnosis↗
PubMed1995

Anxiolytic-like effects of yohimbine in the murine plus-maze: strain independence and evidence against alpha 2-adrenoceptor mediation.

The influence of alpha 2-adrenoceptor antagonists in animal models of anxiety is quite inconsistent, with results spanning the full range of effect from anxiogenesis to anxiolysis. In the present study, an ethological technique was used to examine the effects of yohimbine (0.5-4.0 mg/kg) on plus-maze behaviour in DBA/2 mice. Results indicated significant anxiolytic-like effects on standard spatiotemporal measures at 2.0-4.0 mg/kg, and on risk assessment measures across the entire dose range. Full-scale follow-up studies with T1 and BALB/c strains confirmed that this action of yohimbine in the murine plus-maze is not peculiar to DBA/2 mice. The more selective alpha 2-adrenoceptor antagonist, idazoxan (0.63-5.0 mg/kg), exerted much weaker behavioural effects in the maze while the alpha 2-adrenoceptor agonist, clonidine (0.01-0.1 mg/kg), produced a profile consistent with non-specific behavioural disruption. Data are discussed in relation to the possible involvement of 5-HT1A receptor mechanisms in the observed anxiolytic-like effects of yohimbine in the murine plus-maze.

Animals↗
PubMed1995

An Australian trial of ThinPrep: a new cytopreparatory technique.

To evaluate the sensitivity and suitability of ThinPrep, a new slide preparation technique, 2026 paired cervical cytology slides were examined. After conventional Papanicolaou smears were prepared, the sampling instruments were rinsed in a fluid fixative. ThinPrep slides were then prepared in the laboratory from the surplus cells in the fixative. Compared with the Pap smears, ThinPrep slides were easier and quicker to screen, were inconclusive less often, and had similar rates for detecting abnormalities and infection. There were more unsatisfactory ThinPrep slides and more ThinPrep slides lacked endocervical cells. Both of these shortcomings were found to be linked to the choice of sampling implements. This study, in which a variety of sampling instruments was used, fails to confirm some of the previous claims made for the new technique.

Australia↗
PubMed1991

Should cervical cytologic testing be augmented by cervicography or human papillomavirus deoxyribonucleic acid detection?

Criticism of the Papanicolaou smear in the lay press and recent federal legislation regulating cytology laboratories indicate a need to reappraise cervical cancer screening programs. This study directly compares three potential screening tests, used alone or in combination. A total of 1012 women aged 18 to 35 years were screened by cytologic testing, cervicography, and hybridization for human papillomavirus deoxyribonucleic acid, with discrepancies being referred by the last two authors. After findings from the entire lower genital tract were combined, 116 women (11.5%) showed definite clinical abnormalities (either exophytic vulvovaginal condylomas or cervical squamous intraepithelial lesions). Another 72 (7.2%) had positive Southern blot hybridizations without accompanying viral expression, yielding a cumulative frequency for established disease or latent infection of 18.6%. When associated vulvovaginal condylomas are disregarded, final groupings with regard to cervical pathologic classification were: 23 high-grade and 71 low-grade squamous intraepithelial lesions, 164 cases of equivocal atypia (34 of which had detectable human papillomavirus deoxyribonucleic acid), and 754 cases with negative results (38 of which had detectable human papillomavirus deoxyribonucleic acid). Cervical screening tests were compared principally by plotting increasingly liberal recall criteria onto receiver operating characteristic curves (i.e., graphs of true-positive results on the Y axis versus false-positive results on the X axis). Used individually, each screening test was valid, but none was substantially better than the others. No matter how liberal the recall criteria, no single test was able to detect all of the 23 definite precursors in this sample. Applying conventional recall criteria (i.e., high- or low-grade lesion suspected), cytologic testing alone detected 12 high-grade squamous intraepithelial lesions (52.2%), at a cost of having to perform colposcopy in 8.7% of the sample. Combining all three tests and setting the end point as just a high-positive result by at least one test, 19 high-grade squamous intraepithelial lesions (83%) were detected, with a recall of 7%. Optimal test performance (96% sensitivity, 4% recall) would have been attained by recalling all patients with high-grade cytologic results or positive cervicography results, plus any patients with low-grade morphologic atypia in which hybridization detected an oncogenic human papillomavirus type. Our conclusions are as follows: (1) Cytologic detection rates are markedly improved by a second or third test; (2) increased screening costs could be offset by not recalling patients with minor lesions with no apparent potential for progression.

Adolescent↗
PubMed1990

Office hysteroscopy and curettage--a safe diagnostic procedure.

In a series of 50 patients investigated by office hysteroscopy and curettage, satisfactory direct inspection of the cervical canal and uterine cavity was possible in all patients. In addition satisfactory endometrial specimens suitable for reliable histological evaluation were obtained in 98% of patients. No endometrium was obtained in 1 postmenopausal patient. Patients chosen for this form of investigation are those with an indication for diagnostic curettage who have no serious cardiovascular disease, are not bleeding or have light bleeding, and are willing to have an office procedure. Currently office curettage is done with a 5mm Karman catheter with an attached 10ml syringe for suction. Local analgesia is rarely used.

Adenocarcinoma↗
PubMed1989

The importance of the cell sample in cervical cytology: a controlled trial of a new sampling device.

The provision of a truly-representative cellular sample is the major prerequisite for reliable cervical cytology. We performed a trial with a cervical-sampling implement of innovative design, the Cervex Sampler. By means of the parameters of patient and doctor acceptability, the quality of the smear, the presence of endocervical cells, and the rate of squamous-cell atypia, the Cervex Sampler was compared with a modified Ayre spatula. One hundred samplers were distributed to each of 10 doctors. The parameters were assessed before, during and after the trial period. The consensus was that the Cervex Sampler was easier to use and did not cause patients any problems. Assessment of the smears that were made with the Cervex Sampler showed a significant improvement in the quantity and evenness of the distribution of the cellular sample. During the trial, statistically-significant increases occurred in the percentage of smears that contained endocervical cells (P = 0.0001) and atypical squamous cells (P = 0.028). At the end of the trial, when the doctors again used the modified Ayre spatula, these rates reverted to the same levels as before.

Equipment Design↗
PubMed1988

The reliability of a cytological prediction of cervical adenocarcinoma in situ.

A spectrum of changes precedes clinical invasive adenocarcinoma of the cervix. Cytological and histological criteria for the diagnosis of adenocarcinoma in situ (ACIS) are becoming more clearly defined. A 5-year prospective study was undertaken to test the accuracy of a cytological prediction of ACIS. From a total of 290,000 cervical smears 54 predictions of ACIS were made: 33 (61%) alone and 21 (39%) with associated squamous carcinoma in situ (SCIS). The rate of reporting ACIS was compared to the rates for intraepithelial and invasive squamous lesions and for frank invasive adenocarcinoma. The findings suggest that ACIS is being underdiagnosed. Forty-seven patients were adequately investigated; 46 had intraepithelial or invasive malignancy. There were 10 cases of ACIS, 10 ACIS with SCIS, 9 microinvasive adenocarcinoma, 5 invasive adenocarcinoma, 2 microinvasive adenosquamous carcinomas, 1 invasive adenosquamous carcinoma, 8 SCIS and 1 endometrial carcinoma. There was one true false positive report. Thus cervical glandular neoplasia was confirmed in 37 patients (79%), 13 of these having adenosquamous tumours. Because 98% of patients had in situ or invasive malignancy and because 36% of cases were invasive (though mostly microinvasive) prompt investigation, by cone biopsy, must follow a cytological report of ACIS.

Adenocarcinoma↗
PubMed1980

Noncondylomatous cervical wart virus infection.

Human papillomavirus (HPV) infections of the genital tract frequently involve cervical epithelium and produce a macroscopically flat lesion that the authors have called noncondylomatous cervical wart virus infection (NCWVI). Over a 6-month period, 92 of 7281 routine cervical smears (1.3%) and 46 of 183 colposcopically directed punch biopsies (25%) showed morphologic evidence of wart virus infection. The etiologic role of HPV was confirmed by the demonstration of virus particles in 24 of 53 cases (45%) examined by electron microscopy. The colposcopic features of NCWVI consist principally of epithelial opacity and vascular atypia, leading to frequent confusion with cervical intraepithelial neoplasia. Differences in surface contour, color, vascular patterns, and topography generally permit colposcopic differentiation. These 2 conditions sometimes coexist; whether the association is causal or casual in not presently known.

Colposcopy↗
PubMed1979

Extrauterine mesodermal (müllerian) adenosarcoma. A case report.

Extrauterine mesodermal (müllerian) adenosarcomas have only recently been described, and this is the first reported case from Australia. These tumours fall within the category of common epithelial tumours' in the World Health Organisation (W.H.O.) classification of ovarian tumours and comprise benign looking epithelial structures (glands, papillae) in association with sarcomatous stroma. They are thus distinct from malignant mesodermal mixed tumours in which both epithelial and stromal elements are cytologically malignant.

Adult↗
PubMed1977

Malignant melanoma metastases in the placenta: a case report.

Although the coincidence of pregnancy and maternal malignancy is not rare, only 29 cases of metastases to the products of conception have been previously reported and of these, 14 have been of malignant melanoma. The present case of widespread maternal malignant melanoma metastasizing to the placenta further emphasizes this trend. The mother died of malanomatosis two weeks after induced labour at 36 weeks gestation. The infant, despite widespread placental involvement including apparent foetal vascular invasion, is well and without clinical evidence of disease five months after delivery.

Adult↗