Degree of dysplasia following diagnosis of atypical squamous cells of undetermined significance is influenced by patient history and type of follow-up.

Previous studies have shown that atypical squamous cells of undetermined significance (ASCUS) are a predictor of higher grade lesions when patients are followed up by biopsy. The purpose of this study was to examine follow-up on all patients with ASCUS to determine if the prediction of higher grade lesions seen in association with ASCUS is a function of bias in selection of patients for biopsy. The diagnosis of ASCUS, based on Bethesda System criteria, was made on 235 cases between June 1993 and December 1994 (2% of the total cases at Yale-New Haven clinics). Of these cases, 36 were biopsied and 94 were followed by cervical/vaginal smears (CVS). As has been seen in other retrospective studies, we found that 55% (20 of 36) biopsied after ASCUS on CVS showed condyloma or dysplasia. In cases with CVS follow-up instead of biopsy, only 26% (25 of 94) had significant lesions. We find that if ASCUS is evaluated by biopsy, the prediction for higher grade lesions is roughly twice that predicted by follow-up CVS. We purpose that nonstandardized management by gynecologists results, in many instances, in selection of patients with significant past history for biopsy. Consequently, the current literature finding of ASCUS as predictor of higher grade lesions should be reanalyzed, taking into account other parameters (past history, age, etc.) in the process of defining the clinical and biological implications of the ASCUS diagnosis.

A triple stain for the detection of Helicobacter pylori in gastric brushing cytology.

OBJECTIVE: Helicobacter pylori is a surface bacterium associated with gastritis. The triple stain (TS), combining silver, hematoxylin and eosin, and alcian blue at pH 2.5, is valuable in the detection of H pylori in tissue. We evaluated the usefulness of TS as compared with Papanicolaou stain in detecting H pylori in gastric brushings and biopsy specimens. STUDY DESIGN: Gastric brushings and biopsy specimens were obtained from 21 patients. The Papanicolaou-stained slides were restained with TS, and the brushings and biopsy specimens were independently evaluated by the authors. RESULTS: H pylori was found in 9 of 21 randomly selected cases using TS. Of these, two cases were positive on brushings alone and three on biopsy alone. Only three of the nine cases were positive by Papanicolaou stain. None of the 21 samples were positive with Papanicolaou stain yet negative with TS. Detection of H pylori was restricted to patients with gastric ulcerations but was not limited by paucity of glands. CONCLUSION: TS is useful for detecting H pylori in gastric brushings and provides excellent cytologic detail. Furthermore, TS is superior to Papanicolaou stain for H pylori detection and is a valuable adjunct to biopsy.

Localization and quantitation of expression of the cell motility-related protein thymosin beta15 in human breast tissue.

Thymosin beta15 is a newly discovered 5300-Da protein that binds actin monomers and inhibits actin polymerization and might thus increase cellular motility. Thymosin beta15 is upregulated at both the mRNA and protein levels in prostate cell lines in a manner directly related to their capacity to metastasize. We hypothesize that because this protein is upregulated in cells with a propensity to metastasize, it might be a useful prognostic marker in breast cancer. Because this is a newly described protein, neither the subcellular localization of thymosin beta15 or its expression in breast cancer has been examined. We describe the use of an affinity-purified polyclonal antibody to show that within breast epithelium, thymosin beta15 is localized diffusely throughout the cytoplasm and that thymosin beta15 is upregulated in malignant (compared with benign) breast tissue. In contrast to the prostate model, thymosin beta15 is upregulated in nonmetastatic breast cancer and even ductal carcinoma in situ (compared with benign breast tissue), and, consequently, it might represent a potential early marker for breast malignancy. Additional studies are needed to evaluate the precise role and prognostic value of thymosin beta15 in breast cancer.

Myometrial tissue in uterine septa.

STUDY OBJECTIVE: To assess the frequency of myometrial tissue in the septa of septate uteri. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University-affiliated tertiary referral center. PATIENTS: Twenty-nine consecutive women with uterine septa diagnosed by magnetic resonance imaging (MRI). INTERVENTIONS: The MRI examination was performed with a 1.5 Tesla scanner using high-resolution phased array coils with multiplanar fast-spin echo and T1-weighted sequences. Of resected septa, tissue was available in four for histologic evaluation for the presence of myometrial tissue. MEASUREMENTS AND MAIN RESULTS: In 17 women MRI showed a partial septum, all containing myometrium. The 12 patients with complete septum had evidence of myometrium in the upper part of the septum, with fibrous tissue constituting the lower part. Histology reviewed from four resected septa (2 partial, 2 complete) reported myometrial tissue. CONCLUSION: Uterine septa are frequently composed of myometrial tissue.

Expression of c-met is a strong independent prognostic factor in breast carcinoma.

BACKGROUND: The c-met protooncogene encodes the met protein, the receptor for scatter factor/hepatocyte growth factor, a growth factor that modulates the motility and stable interaction of the epithelial cells. This study assesses the expression of met receptor in breast carcinoma and its prognostic value with respect to survival. METHODS: Immunofluorescence was used to evaluate 91 archival breast carcinoma specimens using a polyclonal antibody to the cytoplasmic domain of the receptor. Cases were scored by two pathologists on a percentage basis and then converted to binary scores (positive or negative) on the basis of a bimodal distribution. RESULTS: Strong expression of met was found in 20 invasive ductal breast tumor specimens (22%). The 5-year survival of patients whose tumors showed decreased met expression was 89%, in contrast to a 52% 5-year survival rate in patients whose tumors expressed met (P = 0.008). This trend also was observed in patients without lymph node metastases at presentation, in whom met negative patients had a 95% 5-year survival compared with only 62% for met positive patients (P = 0.006) Multivariate analysis using the Cox proportional hazards model showed met expression to be an independent predictor of survival, with a predictive value nearly equivalent to that associated with lymph node status. CONCLUSIONS: The authors conclude that expression of met in patients with invasive ductal carcinoma of the breast is a strong, independent predictor of decreased survival and may be a useful prognostic marker with which to identify a subset of patients with more aggressive disease.