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PubMed2007

Adequacy of urine cytology specimens: an assessment of collection techniques.

The objective of this study was to determine whether the method of urine collection impacts the adequacy and cell counts of cytology specimens in a low-risk population. Voided, post-cystometrogram (CMG), and bladder irrigant specimens were collected and evaluated for cytologic adequacy and average cell count by a single cytopathologist masked to the source of each sample. Data were analyzed to detect differences in specimen adequacy and cell counts based on method of collection. Both the voided and post-CMG specimens (97.3%, 93.7% respectively) were significantly more likely to be adequate compared to the bladder irrigant specimen (11.7%, p < 0.0001). The spontaneously voided specimen (211.4 +/- 100.1) had significantly higher cell counts than both the post-CMG specimen (85.9 +/- 86.6) and the cystoscopy specimen (6.4 +/- 19.6, p < 0.0001). In a multivariate linear model, collection method and specimen adequacy were associated with increased cell count/hpf (p < 0.001), as was the presence of hematuria on urine dipstick (p = 0.03). No cytologic abnormalities were diagnosed. Whereas both spontaneously voided and post-CMG specimens were consistently adequate for interpretation, spontaneous voided specimens were optimal with regard to maximizing cell count/hpf.

Adult↗
PubMed2003

Contribution of second stool specimen to increased sensitivity of poliovirus detection in India, 1998-2000.

Acute flaccid paralysis (AFP) surveillance data from India were analysed to examine sensitivity of poliovirus isolation from stool specimens and the added sensitivity obtained from collection of a second stool specimen. Analysis was restricted to Indian AFP cases, 1998-2000, with two adequate stool specimens. The proportion of cases confirmed with wild poliovirus isolation by the second specimen only was calculated, regardless of specimen quality. Overall specimen sensitivity (1998-2000) was 81% using the first specimen, 78% using the second, and 96% using both. Sensitivity increased from 1998 to 2000, with slightly higher sensitivity each year for the first specimen. The second specimen increased sensitivity by 15% overall and contributed more when the first specimen was collected late or was in poor condition. As wild poliovirus disappears, increased sensitivity provided by a second stool specimen may reduce the risk of missing circulating virus.

Feces↗
PubMed1998

Cross-contamination of specimens with Mycobacterium tuberculosis: clinical significance, causes, and prevention.

At the Veterans Affairs Lakeside Medical Center, two episodes of specimen cross-contamination with Mycobacterium tuberculosis were detected during a 54-month period by molecular strain typing using DNA restriction fragment length polymorphism for 3 patients without clinical or radiologic signs of tuberculosis (TB). A cross-contaminated specimen was the only culture-positive specimen for each of the 3 patients. Laboratory features of cross-contamination included acid-fast smear negativity, growth only in broth or solid medium, and growth in solid medium with 5 or fewer colonies. Retrospective analysis demonstrated identical features for occasional culture-positive specimens from 54 patients with TB during the same period. However, productive cough, pleural pain, weight loss, night sweats, chest radiograph results suggestive of TB, positive tuberculin skin testing, and/or multiple culture-positive specimens were invariably present in patients with TB with such specimens. Most patients with TB (50/54; 93%) had multiple specimens positive in culture for M. tuberculosis, and the few patients with TB with single culture-positive specimens were symptomatic. These results indicate that correlation with clinical manifestations is necessary to determine the significance of isolated, acid-fast smear negative, and/or low-yield culture-positive specimens. Although the prevalence of specimen cross-contamination is low (0.1%), possible sources (especially the use of single-reagent delivery systems for multiple specimens) should be eliminated by mycobacteriology laboratories.

Adult↗
PubMed1982

Comparison of six different criteria for judging the acceptability of sputum specimens.

A series of 391 unselected expectorated sputum specimens was examined microscopically, and six different published criteria for judging the acceptability of the specimens were applied. Of the 391 specimens, 234 were found to be acceptable or unacceptable by all six criteria; 157 specimens were discrepant. By the criteria of Murray and Washington and of Barry, 25 and 23% of the specimens, respectively, were rejected; only 19 of 143 specimens which contained potential pathogens as part of their predominant microbial flora were rejected by both sets of criteria. The criteria described by Geckler et al. and Bartlett missed fewer potential pathogens; only 9 or 17% of the specimens, respectively, were found unacceptable. The criteria of Heineman and Radano and of Van Scoy resulted in the greatest percentages of specimens judged unacceptable (28 and 29%, respectively), including 19 and 24% of specimens containing potential pathogens. The reproducibility of sputum screening results was also assessed, comparing the method of Murray and Washington with that of Barry. Six separate slides were prepared from each of 45 different specimens: three samples with purulent or bloody flecks and three samples in which the specimens had been mixed with an applicator swab. Satisfactory reproducibility was observed with both criteria and both sampling methods; no significant differences in reproducibility could be documented in this limited series.

Bacteria↗
PubMed1986

Use of the Bac-T-Screen to predict bacteriuria from urine specimens held at room temperature.

Results from the Bac-T-Screen (BTS) of fresh urine specimens were compared with the BTS results obtained when the same urine specimens had been held at room temperature for 24 h. Of the 246 specimens studied, 43 were initially BTS positive, 11 were false-negative, and 39 had greater than or equal to 10(5) CFU/ml. After 24 h at room temperature an additional 60 specimens had greater than or equal to 10(5) CFU/ml, of which only 16 were BTS positive; 10 specimens still gave false-negative results, and the number of false-positive specimens increased by only 6.5% of all specimens. For significant specimens (containing greater than or equal to 10(5) CFU of probable pathogens per ml), the predictive value of a negative test changed by only 0.1% (99.5 to 99.4%), whereas the sensitivity of the test remained at 96.4% for incubated specimens. Of those specimens that developed greater than or equal to 10(5) CFU/ml in vitro, 85% contained gram-negative bacilli. Neither bacteria grown in vitro nor urine specimens from normal females containing greater than or equal to 10(5) CFU/ml were positive with the BTS. For reasons not entirely understood, the BTS system may be unique in its ability to discriminate between bacteria which represent true bacteriuria and those which are present because of contamination, possibly due to other cellular elements present in infection-related bacteriuria, namely leukocytes and sloughed bladder epithelial cells.

Bacteriological Techniques↗
PubMed1987

Comparison of nasopharyngeal aspirate and nasopharyngeal swab specimens for respiratory syncytial virus diagnosis by cell culture, indirect immunofluorescence assay, and enzyme-linked immunosorbent assay.

Paired nasopharyngeal aspirate (NPA) and nasopharyngeal swab (NPS) specimens obtained from each of 32 hospitalized infants with X-ray-confirmed pneumonia (91%) or bronchiolitis were tested for respiratory syncytial virus (RSV) infection by virus culture, the indirect immunofluorescent-antibody (IFA) technique, enzyme-linked immunosorbent assay (ELISA; Ortho Diagnostic Systems, Inc.), and spot hybridization with a human genomic probe to quantitate cellular DNA. RSV was isolated in cell cultures from 72% (23 of 32) of patients by using NPA specimens compared with 47% (15 of 32) by using NPS specimens. With tissue culture positivity as the reference test, the sensitivities of the ELISA on NPA and NPS specimens were found to be 69% (16 of 23) and 61% (14 of 23), respectively, with a specificity and a positive predictive value from both sites of 100%. The sensitivities of the IFA technique compared with the cell culture on NPA and NPS specimens were 61% (14 of 23) and 52% (12 of 23) with specificities of 89 and 78% and positive predictive values of 96 and 92%, respectively. Despite the recovery of significantly more cells (as shown by detection of more cellular DNA by using NPA specimens), virus was detected by the IFA technique or ELISA at similar frequencies in paired specimens. However, virus was recovered more often from NPA than NPS specimens by cell culture, and ELISA optical density readings and the number of RSV-positive fluorescing cells were greater for NPA specimens. NPA specimen collection was less traumatic for the patient, was an easier procedure for the physician to perform, and provided a superior laboratory specimen for RSV diagnosis than the NPS technique.

Animals↗
PubMed2002

Evaluation of Gen-Probe amplified mycobacterium tuberculosis direct test by using respiratory and nonrespiratory specimens in a tertiary care center laboratory.

The performance of the Amplified Mycobacterium Tuberculosis Direct (AMTD) test (Gen-Probe Inc., San Diego, Calif.) was assessed in a large tertiary care mycobacteriology laboratory. Both acid-fast smear-positive and smear-negative respiratory and nonrespiratory clinical specimens were analyzed. From February 1998 to 4 October 2001, AMTD assays were performed on 391 respiratory specimens and 164 nonrespiratory specimens. The AMTD assay was compared to the "gold standard" of combined culture and clinical diagnosis. The overall sensitivity for all specimens, including those for which no smear result was available, was 91.2%. The overall sensitivities of the assay, including acid-fast smear-positive and -negative specimens, were 97.8 and 77.3% for respiratory and nonrespiratory specimens, respectively. The corresponding specificities for respiratory and nonrespiratory specimens were 99.1 and 98.5%, respectively. The overall specificity for all specimens was 98.9%. Positive and negative predictive values were 93.9 and 99.7% and 91.7 and 96.4% for respiratory and nonrespiratory specimens, respectively. The time saved by using the AMTD test for making a diagnosis of tuberculosis instead of using culture was 8.99 days. Inhibitors to the AMTD assay were found in 3.1% of respiratory specimens and 3.1% of nonrespiratory specimens. The assay, used in a general mycobacteriology laboratory setting, represents an important advance in improving the speed and accuracy of diagnosis in the management of patients with tuberculosis.

Bronchoalveolar Lavage Fluid↗
PubMed2000

Evaluation of a new amplified enzyme immunoassay (EIA) for the detection of Chlamydia trachomatis in male urine, female endocervical swab, and patient obtained vaginal swab specimens.

AIMS: To compare the performance of a new generation dual amplified enzyme immunoassay (EIA) with a molecular method for the diagnosis of Chlamydia trachomatis, using a range of urogenital samples, and to assess the reliability of testing self collected vaginal specimens compared with clinician collected vaginal specimens. METHODS: Two population groups were tested. For the first population group, first void urine samples were collected from 193 male patients with urethritis, and endocervical swabs were collected from 187 high risk commercial sex workers. All urine and endocervical specimens were tested by a conventional assay (IDEIA chlamydia), a new generation amplified immunoassay (IDEIA PCE chlamydia), and the Amplicor polymerase chain reaction (PCR). Discrepant results obtained among the three sample types were confirmed using a nested PCR test with a different plasmid target region. For the second population group, four swab specimens, including one patient obtained vaginal swab, two clinician obtained endocervical swabs, and one clinician obtained vaginal swab, were collected from 91 high risk sex workers. Self collected and clinician collected vaginal swabs were tested by IDEIA PCE chlamydia. Clinician obtained endocervical swabs were assayed by IDEIA PCE chlamydia and Amplicor PCR. RESULTS: The performance of the IDEIA PCE chlamydia test was comparable to that of the Amplicor PCR test when male urine and female endocervical swab specimens were analysed. The relative sensitivities of IDEIA, IDEIA PCE, and Amplicor PCR on male first void urine specimens were 79.3%, 91.4%, and 100%, respectively. The relative sensitivities of the three tests on female endocervical specimens were 85.0%, 95.0%, and 100%, respectively. The positivity rates for patient collected vaginal specimens and clinician collected vaginal specimens by IDEIA PCE were 25.2% and 23.1%, respectively, whereas those for clinician collected endocervical swabs by PCR and IDEIA PCE were both 27.5%. CONCLUSIONS: IDEIA PCE chlamydia is a lower cost but sensitive alternative test to PCR for testing male urine samples and female endocervical swabs. In addition, self collected or clinician collected vaginal specimens tested by IDEIA PCE chlamydia are a reliable alternative to analysing endocervical specimens.

Chlamydia Infections↗
PubMed1998

Pooling of urine specimens for PCR testing: a cost saving strategy for Chlamydia trachomatis control programmes.

OBJECTIVES: To evaluate pooling of first catch urine (FCU) specimens as a cost effective strategy for chlamydia testing. METHODS: Mock specimens were pooled with and without dilution to determine optimal pool size and ease of work flow. The performance of the Amplicor Chlamydia trachomatis PCR assay on pooled specimens was compared with individual testing using 370 FCU specimens from asymptomatic men presenting to an STD clinic. Cost savings associated with pooling were estimated. RESULTS: Using mock specimens, the sensitivity and specificity of the Amplicor PCR assay were not affected by pool sizes of two and five, but at a pool size of 10 decreased sensitivity due to inhibition was observed in one of five mock pools when the pooling method which involved no dilution was used. Archived FCU specimens from a study of 370 asymptomatic men were combined consecutively into 74 pools of five and tested by PCR. Of the 18 pools that contained positive specimens, 17 were PCR positive. Compared with testing FCU specimens individually, pooling resulted in a sensitivity of 95%, specificity of 100%, and a cost savings of 57% based on reduced number of tests required. CONCLUSION: Depending on the prevalence of infection, pooling of FCU specimens for PCR testing may result in cost savings compared with testing specimens individually. Further evaluations to validate this strategy using fresh FCU specimens are needed.

Bacteriological Techniques↗
PubMed2006

Assessing the requirement for the 6-hour interval between specimens in the American Heart Association Classification of Myocardial Infarction in Epidemiology and Clinical Research Studies.

BACKGROUND: The American Heart Association (AHA) case definition for acute myocardial infarction (AMI) requires an "adequate set" of biomarkers: 2 measurements of the same marker at least 6 h apart. A sensitive troponin assay might detect significant changes in concentration earlier. We determined AMI prevalence, using protocols with shorter intervals between measurements, with and without incorporating the time from onset of symptoms. METHODS: The AHA case definition was used to retrospectively assign a diagnosis in 258 patients presenting to the emergency department with symptoms of cardiac ischemia. AMI was diagnosed if either specimen in an adequate set had a cardiac troponin I (cTnI) above the 99th percentile (AccuTnI >0.04 microg/L; Beckman Coulter) with a > or =20% change in concentration between specimens. We assessed positivity for AMI after progressively decreasing the time interval between specimens in specimen sets. In addition, for each patient, 2 additional specimen pairs were selected: pairs collected at least 1 h apart with 1 specimen being either > or =3 h after onset or > or =6 h after onset. RESULTS: When we used the AHA definition, the AMI prevalence was 35.7%. Prevalence was not significantly diminished when the interval between specimens was > or =5, > or =4, or > or= 3 h (36.4%, 34.5%, and 33.7%, respectively) compared with the AHA > or =6 h interval. When the time from onset of symptoms was included in the specimen selection algorithm, a 1-h interval was sufficient provided that at least one specimen was collected > or =6 h after onset (prevalence, 34.1%; P = 0.48 vs AHA definition). CONCLUSION: A sensitive cTnI assay in specimen sets with time intervals > or =3 h, or having one specimen > or =6 h after onset, gave an AMI prevalence equivalent to the AHA definition.

American Heart Association↗
PubMed2006

Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors.

CONTEXT: Patient safety is an increasingly visible and important mission for clinical laboratories. Attention to improving processes related to patient identification and specimen labeling is being paid by accreditation and regulatory organizations because errors in these areas that jeopardize patient safety are common and avoidable through improvement in the total testing process. OBJECTIVE: To assess patient identification and specimen labeling improvement after multiple implementation projects using longitudinal statistical tools. DESIGN: Specimen errors were categorized by a multidisciplinary health care team. Patient identification errors were grouped into 3 categories: (1) specimen/requisition mismatch, (2) unlabeled specimens, and (3) mislabeled specimens. Specimens with these types of identification errors were compared preimplementation and postimplementation for 3 patient safety projects: (1) reorganization of phlebotomy (4 months); (2) introduction of an electronic event reporting system (10 months); and (3) activation of an automated processing system (14 months) for a 24-month period, using trend analysis and Student t test statistics. RESULTS: Of 16,632 total specimen errors, mislabeled specimens, requisition mismatches, and unlabeled specimens represented 1.0%, 6.3%, and 4.6% of errors, respectively. Student t test showed a significant decrease in the most serious error, mislabeled specimens (P < .001) when compared to before implementation of the 3 patient safety projects. Trend analysis demonstrated decreases in all 3 error types for 26 months. CONCLUSIONS: Applying performance-improvement strategies that focus longitudinally on specimen labeling errors can significantly reduce errors, therefore improving patient safety. This is an important area in which laboratory professionals, working in interdisciplinary teams, can improve safety and outcomes of care.

Clinical Laboratory Techniques↗
PubMed1995

Complete blood count specimen acceptability. A College of American Pathologists Q-Probes study of 703 laboratories.

OBJECTIVE: to determine the frequency and reasons for rejection of specimens submitted to the laboratory for complete blood count studies. DESIGN AND SETTING: College of American Pathologists' Q-Probes laboratory quality improvement study prospective recording of rejected complete blood count specimens and associated factors in 703 laboratories. MAIN OUTCOME MEASURE: Percentage of submitted specimens rejected for testing. RESULTS: Of 7,894,882 complete blood count specimens submitted for testing to the participating laboratories during the data collection period, 35,347 (0.45%) were rejected. The most frequent reason for rejection was a clotted specimen, which occurred about six times more frequently than the second most cited reason, insufficient specimen quantity. Compared with their respective frequency of use for specimen collection, significantly more rejected specimens were collected in microtubes than in other containers. Compared with the respective frequency with which they collect specimens, laboratory personnel had significantly fewer rejected specimens than the other personnel groups. The poorest performance was exhibited by other in-hospital nonlaboratory personnel. Hospital bedsize was also a significant performance factor; smaller hospitals demonstrated lower rejection percentages. CONCLUSIONS: Specimen rejection should be monitored on a regular basis, identifying institution-specific factors that are associated with rejection. Monitoring of sufficient significant variables will help narrow the focus of corrective action. Action thresholds should be set sufficiently low to assure ongoing efforts toward improvement.

Blood Cell Count↗
PubMed1997

Chemistry specimen acceptability: a College of American Pathologists Q-Probes study of 453 laboratories.

OBJECTIVE: To determine the frequency and reasons for rejection of chemistry specimens. DESIGN AND SETTING: College of American Pathologists Q-Probes laboratory quality improvement study prospectively recording rejected chemistry specimens in 453 laboratories. MAIN OUTCOME MEASURE: Percentage of submitted specimens rejected for testing. RESULTS: Of 10,709,701 chemistry specimens submitted to the participating laboratories during the data collection period, 37,208 (0.35%) were rejected prior to testing. The institutional 10th, 50th (median), and 90th percentiles were 1.35%, 0.31%, and 0.06%, respectively. The most frequent reason for rejection was hemolysis, which occurred five times more frequently than the second most cited reason, insufficient specimen quantity to perform the test. When examined with their respective frequency of use, a higher percentage of rejected specimens were collected in microcollection tubes than in other containers. When compared with the respective frequency with which they collect specimens, laboratory personnel submitted significantly fewer rejected specimens than other in-hospital personnel groups and slightly more than out-of-hospital nonlaboratory personnel. The poorest performance was demonstrated by other in-hospital nonlaboratory personnel. Serum and plasma oxalate/fluoride specimens exhibited significantly lower rejection rates when compared with the other specimen types. Relative rejection rates were higher for nongel tubes and lower for syringes when compared with gel tubes. CONCLUSION: Specimen rejection should be monitored on a regular basis. Institution-specific factors that are associated with rejection should be identified and targeted for improvement efforts. Action thresholds should be set sufficiently low to assure that continuous improvement is effected.

Blood Preservation↗
PubMed1994

Prediction of pathologic stage and postprostatectomy disease recurrence by DNA ploidy analysis of initial needle biopsy specimens of prostate cancer.

BACKGROUND: DNA ploidy determination of carcinomas in radical prostatectomy specimens has shown significant correlation with patient outcome, but the predictive value of ploidy status of cancers obtained by transrectal ultrasound-guided needle biopsies has not been studied extensively. METHODS: Eighty-nine paired needle biopsy specimens (NBX) and radical prostatectomy (RPX) specimens from patients with early clinical stage (A2-B2) prostate cancer were evaluated for DNA content by image analysis of Feulgen stained tissue sections. Findings were compared with Gleason grading on the same specimens by univariate and multivariate analyses for prediction of local tumor invasion, metastasis, disease recurrence, and serum prostate specific antigen concentration during a 0.9-6.0 year clinical follow-up period. RESULTS: There was excellent correlation of ploidy status between NBX and RPX specimens (P < 0.0001); NBX and RPX grades did not correlate. On RPX specimens, aneuploid status correlated with high tumor grade (P < 0.0005). Aneuploidy in NBX specimens was associated with a twofold higher rate of extracapsular spread (ECS) (P = 0.04). Aneuploid NBX tumors featured a tenfold greater frequency of metastasis than did diploid NBX tumors (P < 0.005). Radical prostatectomy grade correlated with ECS (P < 0.001) and presence of metastatic disease (P = 0.04). On multivariate logistic regression analysis, aneuploidy in both NBX and RPX specimens was the most significant variable and independently predicted the presence of metastasis (P = 0.006 for NBX; P = 0.028 for RPX). Tumor grade of NBX and RPX specimens did not independently predict metastatic disease or disease recurrence, but RPX grade was associated independently with ECS (P = 0.005). Aneuploid NBX tumors recurred after RPX three times more often than did diploid cases, which was significant on univariate (P < 0.001) and multivariate (P = 0.018) analyses using the Cox proportional hazards model. There was no correlation with NBX or RPX Gleason score and disease recurrence. Preoperative serum PSA concentration did not correlate with tumor grade or ploidy status, but on multivariate analysis, when paired with ploidy status, independently contributed to the propensity for ECS, metastasis, and disease recurrence. CONCLUSIONS: DNA content analysis of early clinical stage prostate carcinoma needle biopsy specimens by image analysis directly correlates with radical prostatectomy specimen ploidy status and is associated independently, with the presence of metastasis, postprostatectomy disease recurrence, and ECS. Needle biopsy tumor grading did not correlate with prostatectomy grade and did not predict disease outcome accurately.

Aged↗
PubMed2004

Laser scanning cytometry for the detection of neoplasia in urologic cytology specimens.

BACKGROUND: The objective of the current pilot project was to assess the efficacy of laser scanning cytometry (LSC) for DNA ploidy analysis of atypical urologic cytology specimens to enhance the distinction between benign and malignant changes. METHODS: Forty selected urologic cytology specimens that previously had been categorized as normal, atypical, or malignant were studied. Nuclear propidium iodide and fluorescence intensity measurements were converted to pixel values, which were used to create scattergrams that excluded debris and cell clusters from ploidy analysis, creating a gated (isolated) region of predominantly single cells for LSC ploidy analysis. Integral histograms then were created to show the number of cells present in diploid, tetraploid, and aneuploid peaks; these histograms also were used to assess DNA ploidy. RESULTS: Ten normal specimens, 10 malignant specimens, and 20 atypical specimens were examined to assess the efficacy of LSC ploidy analysis. Normal and malignant specimens generated reference histograms for comparison with the atypical specimens and exhibited 90% specificity and 100% sensitivity. Ten atypical aneuploid specimens had histogram and scattergram patterns similar to those produced by malignant specimens and, using the cytometer's relocation feature, the presence of atypical cells was confirmed in the aneuploid regions. CONCLUSIONS: The authors determined that DNA ploidy analysis of atypical urologic cytology specimens using LSC is a useful adjunct tool for identifying malignant specimens that lack sufficient cytologic criteria for diagnosis by light microscopy alone. However, LSC is time consuming and requires expensive equipment.

Aneuploidy↗
PubMed2006

Analysis of cytological specimens from mediastinal lesions obtained by endoscopic ultrasound-guided fine-needle aspiration.

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) seems to be a powerful tool to obtain cytologic specimens from mediastinal and celiac lymph nodes, enlarged left adrenal glands, and intrapulmonary tumors with mediastinal extension. The diagnostic yield of EUS-FNA and the accuracy of cytologic specimens was evaluated. METHODS: Cytologic assessment of EUS-FNA specimens was performed and specimens were classified as positive, negative, suspicious for malignancy, or unsatisfactory for diagnosis. Cytology was compared with histologic and clinical (> or = 6 months) follow-up. RESULTS: Cytologic specimens were collected from 155 lymph nodes, 10 left adrenal glands, and 9 intrapulmonary tumor masses. For lymph nodes, the diagnostic yield was 0.65. After exclusion of unsatisfactory specimens, sensitivity, specificity, accuracy, and positive (PPV) and negative (NPV) predictive values of cytologic specimens were 0.92, 1.00, 0.93, 1.00, and 0.63, respectively. Subgroup analysis of lymph nodes with a dimension of > or = 10 mm showed similar results. With EUS imaging only, lymph node diameter and a round or irregular shape were significant predictors of malignancy at multiple logistic regression analysis, but their clinical usefulness is very limited (PPV = 0.78 and NPV = 0.45). For left adrenal gland specimens, sensitivity and specificity were 0.89 and 1.00, respectively. From intrapulmonary masses, 8 true-positive and 1 true-negative specimens were obtained. CONCLUSIONS: Cytologic specimens from mediastinal or celiac lymph nodes obtained with EUS-FNA were reliable and accurate. Specimens from left adrenal glands and intrapulmonary tumor masses showed promising results.

Adrenal Glands↗
PubMed1989

Mites in pulmonary cytology specimens.

Mites were observed in 55 pulmonary specimens examined routinely over a 4.5-yr period. The 55 specimens included 33 spontaneous and 12 aerosol-induced sputum samples, nine bronchial washings, and one fine-needle aspirate. Two specimens contained only fragments of mites; however, in most cases the mites were relatively intact. Many were identified as Tyrophagus sp, but a few were definitely not Tyrophagus sp. Although only a single mite was noted in most instances, eight specimens contained more than one, with the maximum being six. No patient was found to have a mite in more than one specimen. Mite eggs were found in five of the specimens containing mites. One specimen contained adults and a larval form. Mites appeared to be surrounded by acute inflammatory cells in 13 cases. Specimens were processed by the Saccomanno blending technique with smears prepared by pipetting a portion directly onto a slide or by utilizing a cytocentrifuge. No mites were found in nonpulmonary specimens. Both a seasonal variation and an interobserver variability were found. Mites often resemble specimen contaminants, such as food, and may be overlooked on routine screening. Mites are known to represent or produce a respiratory allergen, but the significance of their presence in pulmonary cytology specimens has not been determined.

Adult↗
PubMed1993

Cytogenetic analysis of 1375 amniotic fluid specimens from pregnancies with gestational age less than 14 weeks.

Our laboratory has received 1375 early amniotic fluid (EA) specimens during the past 5-year period for cytogenetics analysis. The gestational ages of the EA specimens were less than 14 weeks as estimated by ultrasound. The average volume of specimen received was 16 ml. Specimens were typically received in two collection tubes and cultured in Chang A and in supplemented MEM media using the in situ technique. Of the 1375 EA specimens received, 1356 were successfully cultured and yielded results. Abnormal results were found in 67 (4.9 per cent) of the cases. Nineteen specimens (1.4 per cent) failed to yield a result. The mean turn-around time (TAT) for all EA specimens was 8.28 days. In 1991, the average TAT for the EA specimens was 8.00 days compared with a TAT of 6.59 days for all specimens received over 14 weeks gestational age. The number of EA specimens received has increased from 1.5 per month in 1986 to 57 per month in 1991. In summary, our experience with EA specimens for cytogenetic analysis has demonstrated that the success rate is 98.6 per cent and that an increasing number of obstetricians are performing early amniocentesis as they seek to provide their patients with earlier results and an alternative to chorionic villus sampling.

Amniocentesis↗