[Cytodiagnosis from the surgical viewpoint. C. Technical problems of cytodiagnosis in breast aspiration biopsies].
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Registration of slide-movements in conventional gynecological smears - its relevance for automated cytology - The information contained in conventional cytologic smears can only be obtained by means of a very scrutinizing scanning of the slide. This is one of the reasons, why people are interested in automated cytology. In the present study slide movements during 216 visual screenings of conventional gynecologic smears were graphically and electronically recorded. The recordings show alternating movements and stops. The time of stops shows a high variation with a mean value of about 0,3 seconds. The moving times are mostly below 0,2 seconds. The relation of total stop times to total movement times is in most cases between two and three. The percentage of total stop times, the total screening time, the relation of stop times to movement times and the number of microscopic fields evaluated while standing rise in difficult specimens. There are obvious differences between the screening patterns of different cytotechnologists. An analysis of the recordings concerning the number of stops shows that even in smears which are screened very carefully a considerable percentage of the smear is not seen during the stops. The pattern of mechanical slide movements allows conclusions about the "data acquisition" by the human cytoscreener.
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AIM: To combine ultrasound-guided fine-needle aspiration (US-FNA) and Liu (Riu) stain to make a quick study on liver tumor lesions. METHODS: Two hundred and twenty-eight aspirations from 232 patients were completely studied. The operator himself made the quick cytodiagnosis of US-FNA smear stained by Liu method within thirty minutes. The US-FNA specimen was also sent to the pathological department for cytological study and cellblock histology. The result of our Liu-stain quick cytodiagnosis in each patient was confirmed by the final cytopathological diagnosis from pathological report. RESULTS: Among 228 samples, the quick cytodiagnosis revealed 146 malignancies, 81 benign lesions and one inadequate specimen. Cytopathological diagnosis from the pathological department revealed 150 malignancies, and 78 benign lesions. Four well-differentiated hepatocellular carcinomas (HCCs) were under-diagnosed by quick cytodiagnosis as benign and 3 benign lesions were over-diagnosed as well-differentiated HCCs. Compared with cytopathological diagnosis, quick cytodiagnosis correctly diagnosed 143 malignancies and 77 benign lesions. Except for the one inadequate specimen in quick cytodiagnosis, the accuracy of quick cytodiagnosis was 96.9% (220/227), and its sensitivity, specificity and positive and negative predictive values were 97.9%, 95.1%, 97.3% and 96.3%, respectively. CONCLUSION: Liu-stain quick cytodiagnosis is a fast, convenient, safe and effective method for hepatologists in clinic practice to diagnose liver tumor. In few cases of well-differentiated HCC, Liu-stain quick cytodiagnosis has its limitation.
BACKGROUND: To assess the usefulness of combining cytodiagnosis and DNA cytometry on nasopharyngeal brush samples for the detection of nasopharyngeal carcinoma (NPC). METHODS: DNA ploidy analysis was undertaken on 66 nasopharyngeal brush samples that had been previously evaluated cytologically. RESULTS: Cytodiagnosis and ploidy analysis demonstrated a sensitivity of 66% and 55%, respectively. Both techniques had a specificity of 100% for NPC cases that were histologically confirmed. The negative predictive values for cytodiagnosis and ploidy analysis were 29% and 24%, respectively. CONCLUSIONS: The sensitivity and specificity for cytodiagnosis were not improved by the addition of DNA ploidy analysis. Furthermore, combining the two techniques did not confer any significant advantage compared with the use of cytology and DNA ploidy alone. The relatively low negative predictive values are a significant limitation, and combining cytodiagnosis and ploidy analysis on nasopharyngeal brush samples cannot be recommended for the detection of NPC.
Human papilloma virus (HPV) infection is diagnosed by morphological methods (including cytodiagnosis, histodiagnosis and electron microscopy) and DNA diagnostic methods. One of the DNA diagnostic methods, Dot blot hybridization (DBH), is generally regarded to be superior to the morphological methods in terms of specificity and sensitivity. There have recently been reports showing that such morphological methods as cytodiagnosis [for koilocytotic atypia (KC) or koilocytosis] and histodiagnosis are best for HPV detection in laboratories because they have better sensitivity, and are cheaper, and procedurally simpler than the DBH method. We compared detection rates by morphological methods (cytodiagnosis and histodiagnosis) and the DBH method. (Materials and Methods) The subjects were 377 patients who came to the Department of Obstetrics and Gynecology of Juntendo University Urayasu Hospital and had abnormal findings in the uterine cervix by cytodiagnosis of colposcopy. Uterine cervix swabs were scraped during colposcopic examination, and specimens for Papanicolaou and Giemsa staining were prepared on 2 slides. Scraping was again performed for the DBH (Vira pap. and type, Toray Industries, Inc.) method using swabs specified for the kit, and cells were obtained in a collection kit. At the same time, at least 3 sites including, possible atypical conversion zones, were biopsied, followed by paraffin embedding and hematoxylin-eosin staining of the specimens. (Results) 1) Comparison of detection rates by cytodiagnosis and the DBH method The positive rates by the DBH method were determined according to cytodiagnostic category in 377 patients. HPV-DNA was detected in every category and in 86 (22.8%) of all of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
AIMS: To assess the efficacy of cytodiagnosis in necropsy practice. METHODS: Fifty three focal lesions from 46 necropsies were assessed by direct smears taken from the lesions. The smears were air-dried and stained by a modified Giemsa technique, with two cases having supplementary histochemistry. All of the slides were assessed independently before review of the necropsy histology. RESULTS: Of the 35 malignant neoplasms, 34 were correctly identified as malignant and 14 of these were characterised precisely. Three of the four benign neoplasms were recognised as neoplastic. One was characterised precisely. Three of the four infected cases revealed the relevant microorganisms. Seven of the other 10 focal non-neoplastic lesions were correctly diagnosed as non-neoplastic. Only two cases proved unsatisfactory for cytodiagnosis. CONCLUSIONS: Direct smear cytodiagnosis is quick, cheap and technically simple. Tissue autolysis may account for some difficulty in assessing particular tissues, but this should diminish with experience. Necropsy cytodiagnosis is applicable to all necropsies in all centres.
To demonstrate the importance of preoperative diagnosis of pulmonary cancers presenting as peripheral small-sized solitary shadows we evaluated the results of morphologic definitive diagnosis together with various clinical factors in 91 tumors with less than 15-mm diameter resected surgically between 1983 and 1999. Histologically, these tumors consisted of 73 adenocarcinomas, nine squamous cell carcinomas, and nine other types. Regarding the pathologic stage, 57 tumors were classified in stage IA, three in IB, six in IIA, seven in IIIA, 14 in IIIB, and four in IV. Comparing various biopsy techniques, the sensitivity of preoperative cytodiagnosis was 43.7% for transbronchial brushing (n = 48), 52.9% for transbronchial forceps biopsy-stamp cytology (n = 51), 66.6% for transbronchial fine needle aspiration (n = 78), and 85.0% for percutaneous fine needle aspiration (n = 20). The overall sensitivity of preoperative cytodiagnosis was 79.0% for transbronchial biopsy (n = 81), and 87.3% for transbronchial and percutaneous biopsy (n = 87). Of 73 clinical N0 cases in which lobectomy was performed, 10 cases (13.6%) were diagnosed as between pathological degrees N1, N2 and N3. However, lung cancer cases with less than 10-mm diameter did not have lymph node metastasis. Our study of histologic differentiation showed that all cases of well-differentiated adenocarcinomas (n = 20) were pathological degree N0. The overall sensitivity of preoperative diagnosis increased to 89.1% in cases (n = 74) of tumors with 11-15-mm diameter. The sensitivity of cytodiagnosis for peripheral small-sized primary lung cancers is high, and we can estimate histological differentiation based on the cytological findings. Therefore, cytodiagnosis is an effective and indispensable diagnostic method for determination of the optimal treatment approach, including approaches such as intentionally limited resection.
CT guided percutaneous fine needle aspiration cytodiagnosis was performed on 30 patients with pancreatic and periampullary tumors in China-Japan Friendship Hospital from November 1984 to January 1986. In our series, 9 pancreatic head cancers, 4 pancreatic body and tail cancers, 5 ampullary cancers had positive cytodiagnosis (100%-18/18). 2 of 3 (67%) duodenal cancers and 6 of 7 (86%) the distal common bile duct cancers were positive by cytodiagnosis. 2 pancreatitis were negative (100%). The positive rate by CT guided diagnosis was 93.3% (28/30). In the same period, ultrasonically guided percutaneous fine needle aspiration cytodiagnosis was performed on 30 patients with pancreatic and periampullary tumors, a correction rate of diagnosis was 67%. CT guided procedure is more accurate than that ultrasonically guided.
Fine-needle aspiration cytology (FNAC) was performed on 195 cases of salivary gland lesions. The smears were technically adequate in 178 cases. Tissue examination was available for subsequent histocytologic correlation in 57 cases. The cytodiagnosis included inflammatory lesions (59) and benign (68) and malignant (51) tumors (total, 119). The accuracy of cytodiagnosis was 87.7% with a sensitivity of 80.9% and a specificity of 94.3%. Exact histologic typing was possible in 61.9% of the malignant tumors. Mucoepidermoid tumors and cellular-atypical pleomorphic adenoma posed difficulties in cytodiagnosis.