Lung cancer treated on the basis of cytologic findings: an analysis of 112 patients.

The authors studied 112 patients who received definitive radiotherapy/chemotherapy solely on the basis of positive cytologic findings in the appropriate clinical context. Eighty patients (71.4%) were treated on the basis of one or more positive sputum studies, while the remainder had at least one positive bronchial cytologic preparation. Eighty-six patients (76.3%) received radiotherapy alone; 19 received both radiotherapy and chemotherapy; only 7 were exclusively given chemotherapy. The utilization of stringent verification criteria revealed that none of our patients was falsely positive for malignancy. For those patients categorized as having malignant disease by verification criteria I-IV, there were no significant disparities between histologic and cytologic diagnoses. This study demonstrated, in a systematic fashion, that patients can be reliably and definitively treated for lung cancer on the basis of positive respiratory cytology findings without tissue corroboration.

The diagnosis of pulmonary small-cell anaplastic carcinoma by cytologic means: a 13-year experience.

This article reports on a series of 432 patients with positive respiratory (sputum and bronchial) cytology and proven malignant respiratory tract disease as corroborated by detailed verification criteria; 54 of these patients were diagnosed as having small-cell anaplastic carcinoma (SCAC). None of the 31 patients with autopsy-and/or biopsy-proven disease had false-positive results for SCAC. Typing accuracy for SCAC versus non-SCAC was 97.7% in the 263 patients with histologic confirmation of their respiratory tract disease. Twenty-three of the 54 patients (42.6%) were treated for SCAC solely on the basis of positive cytology in the context of compatible clinical data. This finding underscores the great importance of proper specimen preparation, quality control procedures, and diligent clinical follow-up in an era of heightened cost-containment awareness when many patients with pulmonary SCAC will be treated on the basis of positive cytology not immediately confirmed by histologic methods.

Clostridial septicemia complicating the course of leukemia.

The authors report an analysis of 47 leukemia patients (including 9 from our own medical center) whose courses were complicated by 48 episodes of clostridial septicemia. There were 36 adults and 11 children; acute myelogenous leukemia and acute lymphoblastic leukemia accounted for 61.7% and 14.9% of cases, respectively. All patients for whom remission status was known were in leukemic relapse. Fever was a presenting complaint in at least 36 patients whereas neutropenia, thrombocytopenia, and gastrointestinal lesions were noted in 100%, 90.9%, and 87.9%, respectively, of the patients for whom information on these parameters was available. Overall mortality from clostridial septicemia was 78%; none of the children and none of the patients with intravascular hemolysis survived. Overall, antibiotic therapy resulted in a 40% survival rate. However, among patients receiving beta lactam and/or chloramphenicol therapy, 57% survived their episode of clostridial septicemia. Prompt initiation of appropriate antimicrobial therapy offers the best chance of survival in leukemia patients with clostridial septicemia.

The clinicopathologic significance of vitreous fluid cytology examinations in a series of 38 patients.

The authors systematically analyze a series of 38 patients having a total of 40 vitreous fluid cytology determinations. Nine of the 38 patients (23.7%) have cytologic results diagnostic for, or at least highly suggestive of, a specific disease process. These include two cases of bacterial endophthalmitis; two cases of fungal endophthalmitis; one case of vitreal amyloidosis; and four cases called positive for intraocular lymphoma. There are no vitreous fluid cytology determinations falsely positive or falsely negative for malignancy in this series. Intraocular lymphoma and the increasingly important role of vitreous fluid cytology examination in its diagnosis are discussed. The authors conclude that a strong commitment to quality control concepts, including detailed clinical follow-up, is essential in order to develop clinician trust and help achieve optimal patient care benefit from this valuable diagnostic modality.

Respiratory cytology: significance of "suspect" results in a series of 435 patients.

We reviewed all "suspect" results of respiratory cytology obtained over a ten-year period at our medical center. There were 435 patients with one or more "suspect" respiratory cytology determinations who were classified as having benign or malignant respiratory tract disease by using a system of detailed, reproducible verification criteria; 61.8% of them had malignant disease. Patients with "suspect" bronchoscopic determinations and those thought to have a specific type of neoplasm were found to have significantly more malignant respiratory tract disease than patients lacking these parameters, though diagnostic efficiency values for these characteristics were low (54.0% and 61.8%, respectively). The most common causes of benign respiratory disease (167 patients) were pneumonia (38.9%) and mycobacterial infection (21.6%). Our data indicate that "suspect" respiratory cytology diagnoses (even bronchoscopic and those suggesting a specific type of malignancy) represent an indeterminate group requiring further evaluation before therapeutic action is taken.

Fine needle aspiration cytology of the breast. A review of 321 cases with statistical evaluation.

To assess the accuracy of fine needle aspirations of the breast performed at our institution, all patients undergoing this procedure between the years 1973 and 1982 were evaluated. Correlation was made between the cytologic and histologic diagnoses whenever possible. Correlations were made with mammography results or clinical impressions when biopsies were not obtained. Our results for sensitivity, specificity, predictive value of a positive diagnosis and predictive value of a negative diagnosis were 65.0%, 100%, 100% and 89.6%, respectively. The data indicate that when adequate, well-prepared samples are submitted to the laboratory, accurate cytologic diagnoses can be made. The high specificity and predictive value of a positive result allow for the early diagnosis, treatment and management of breast cancer.

The significance of "positive" respiratory cytology determinations in a series of 327 patients.

The authors reviewed all "positive" respiratory cytology diagnoses rendered over the past ten years at a medical center. Three hundred twenty-seven patients (with a total of 689 "positive" respiratory cytology determinations) were classified as having nonmalignant respiratory tract disease by using a unique system of explicit, reproducible verification criteria. Five patients with false-positive results (1.5%) and seven false-positive patient determinations (1.0%) were encountered. None of these were typed cytologically as small cell anaplastic carcinoma, and none were bronchial determinations. Overall patient typing accuracy was 72.2%; 75.2% of all sputum and 61.2% of all bronchial determinations were typed accurately. Our lowest typing accuracy (53.3%) was encountered in patients with poorly differentiated carcinoma. The findings from this study confirm the continued need for systematic analysis of respiratory cytology data from large groups of patients. Only then can cytopathologists hope to improve upon the clinical value of this diagnostic modality.

Transthoracic fine-needle aspiration cytology. Analysis of 82 patients with detailed verification criteria and evaluation of false-negative cases.

The authors herein report a series of transthoracic fine-needle aspiration cytology studies performed over a ten-year period at a medical center. The verification criteria they utilized for "positive" and " nonpositive " results are unique to the TFNA literature, as is the authors' detailed analysis of false-negative cases. The authors' statistical findings included specificity, 100%; sensitivity, 79.0%; and overall accuracy, 83.0%. Eleven of 13 false-negative studies (84.6%) were consequent to sampling error; the remaining two cases (both "suspects") were the result of cytopathologist judgment error. In those patients with tissue corroboration of their lung disease, the authors obtained a 93.8% concordance rate between cytology and histology results. They conclude that uniform verification criteria, as well as careful analysis of "suspects" and false negatives, can lead to better patient care through improved quality control.

Psammoma bodies in malignant carcinoid tumor metastases.

A clinically and histopathologically well-documented case of malignant carcinoid tumor (with carcinoid syndrome) is described. The presence of numerous psammoma bodies in metastatic carcinoid tumor deposits, confirmed by histochemical and ultrastructural analyses, represents a heretofore unreported finding.

Hodgkin's disease followed by mycosis fungoides in the same patient. Case report and literature review.

Hodgkin's disease and mycosis fungoides are only rarely reported to occur in the same individual. The authors report a patient who initially presented with Hodgkin's disease but later died with massive visceral mycosis fungoides. This sequence of events is unique in the world's reported lymphoma experience.

Budd-Chiari syndrome complicating metastatic ocular melanoma in a patient not receiving chemotherapy.

The authors report a case of malignant melanoma associated with Budd-Chiari syndrome, that is unique for two reasons; the malignant melanoma metastases arose from an ocular primary site and the patient had not been treated with antimetabolite therapy. A review of neoplasms associated with Budd-Chiari syndrome accompanies the case report.