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David C Wilbur

Publications and source records attributed to David C Wilbur.

25 records · Page 2Linked to original sources
PubMed2004

Fluids--good and bad actors: observations from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology.

CONTEXT: Body cavity fluid examination presents a common and sometimes difficult diagnostic challenge in daily cytology practice. Separating benign from malignant cellular changes may require meticulous screening, careful scrutiny of cellular features, and an understanding of the range of reactive changes. We use the data from the College of American Pathologists (CAP) Interlaboratory Comparison Program in Nongynecologic Cytology (NGC) to identify characteristics of fluids that place them at opposite ends of the diagnostic spectrum. OBJECTIVE: To assess the features of individual body cavity fluid slides that demonstrated good performance characteristics and compare them to slides that were poor performers. DESIGN: A databank of 10 396 laboratory responses, including a variety of malignant and benign cases obtained from 1997 through 2001, was used to select cases. A cumulative slide history was used to identify slides that performed well or poorly in each reference diagnosis. Cases were confirmed by consensus of 4 CAP Cytopathology Resource Committee members. Observations and characterizations of good and bad performers in each category were recorded and summarized. RESULTS: Percentage of concordance of poor performers ranged from 0% to 58%. Conversely, good performers were identified with high concordance of laboratory diagnosis in each reference category (>80%). Several patterns emerged. Poorly performing cases of adenocarcinoma consisted of slides with rare tumor cells, hypercellular malignant cases without 2 cell populations, and cases with single cells. Poor performance in confirmed squamous cell carcinoma cases related to rare cells without keratinization. Small cell carcinoma and melanoma cases performed poorly when there were few malignant cells. Lymphoma cases demonstrated poor performance when there were abundant pleomorphic lymphoid cells or when rare Reed- Sternberg-like cells were present. Reactive or negative slides performed best with a polymorphous population; poor performers were those with a predominant lymphocyte population mistaken for a hematopoietic neoplasm. CONCLUSION: Close attention to classic cytologic criteria and careful examination of slides may enhance the educational experience of participants and the performance characteristics of body cavity fluid specimens in the CAP NGC program. Lessons from bad actors in the CAP NGC program may increase awareness of potential diagnostic problems in daily practice or help identify areas for laboratory quality improvement.

Adenocarcinoma↗
PubMed2003

The many faces of atrophy in gynecologic cytology.

As more attention is paid to cervical cancer screening in the postmenopausal population, increased numbers of atrophic specimens will be evaluated in the cytology laboratory. In addition, specimens that have cell patterns that mimic the nonestrogen or partially estrogen-stimulated state occur in a variety of situations, including pregnancy, the postpartum period, and in individuals who are treated with progesterone. A firm understanding of the cellular changes that are within the range of normal in such circumstances is critical to ensure the specificity of interpretation. This article has detailed the conditions under which nonestrogen stimulated patterns occur and addressed the cytologic changes that are noted. Hints to avoid pitfalls have been offered. There is no substitute for a thorough evaluation of each case, and with continued experience and understanding of these principles, the correct interpretations, and, ultimately, correct management of patients, can be optimized.

Atrophy↗
PubMed2003

Cervical cytology automation: an update for 2003. The end of the quest nears?

The field of cytology automation, through long investigation, trial and error, and finally, commercial success and failure, has arrived at the first levels of the "grail" of improvements in accuracy and productivity in cervical cytology screening. It remains to be seen how much further the road will lead toward so-called "diagnostic" instrumentation that would actually provide us with a fully automated system of "specimen in-diagnosis out" with little, or no, human input. Will commercial ventures or academic institutions continue to support investigations to further the applications that have been developed to date? This remains to be seen and is directly dependent on parallel processes that are detailed elsewhere in this issue. Will HPV vaccines eliminate the need for screening? Possibly, but probably not for many years [70]. Will more sensitive and specific genetic or protein markers (or combinations thereof) be found to be more accurate and cost-effective? Certainly the possibility of mass screening by high-risk HPV DNA testing, as a viable alternative, is being discussed at present. Despite all of these uncertainties, the present (or nearly available) technology has the potential to improve the practice of cervical cytology. Improvements in accuracy that are necessary to provide the highest possible level of patient care and to protect practitioners from unreasonable levels of medico-legal risk are a reality. Improvements in productivity that are necessary to help in the impending labor shortage in the field of cytotechnology are also a reality. Automation is clearly the short-term solution to the most difficult of the challenges that we face.

Cell Biology↗
PubMed2002

The primary screening clinical trials of the TriPath AutoPap System.

The AutoPap Primary Screening System has been approved recently by the United States Food and Drug Administration for the initial screening and quality control of non-"high-risk" conventional cervical cytology slides. A prospective clinical trial using the device compared its performance in terms of sensitivity and specificity for abnormality detection with the current standard of practice, which is represented by initial manual screening and 10% random quality control rescreening. The study showed statistically superior abnormality detection sensitivity by the AutoPap System. In addition, specificity of diagnosis was also improved. Equivalent performance was noted for categorization of slide adequacy and detection of infectious organisms and benign cellular changes. Use of the AutoPap System therefore has the potential to improve the accuracy of cervical cytologic examinations as well as to make a positive impact on the productivity of cytology laboratory personnel.

Automation↗
PubMed2002

Location-guided screening of liquid-based cervical cytology specimens: a potential improvement in accuracy and productivity is demonstrated in a preclinical feasibility trial.

A 2-armed, masked study was performed on 1,275 AutoCyte PREP (TriPath, Burlington, NC) slides. Manual screening (current practice [CP]) was compared with automated screening with location-guided screening (LGS) using the AutoPap system with the SlideWizard 2 automated review microscopy station (TriPath). Cytologic adjudication determined "truth" for each slide. LGS identified more abnormal cases at all interpretive levels and classified abnormalities more specifically. For high-grade squamous intraepithelial lesions and above, the overall sensitivity of appropriate triage to pathologist review was 98.4% for LGS and 91.1% for CP. The appropriate triage for all abnormal cases was 92.1% for LGS and 87.9% for CP. The potential exists for more accurate and productive cytologic interpretation using this system, which requires no manual screening of a portion of slides and only limited review of another portion of "predotted" slides.

Automation↗