The role and histological classification of needle core biopsy in comparison with fine needle aspiration cytology in the preoperative assessment of impalpable breast lesions.

AIMS: To investigate the role of needle core biopsy (NCB) in the preoperative assessment of impalpable breast lesions, mainly derived from the NHS Breast Screening Programme (NHSBSP) and to assess our own modifications to a suggested system for the classification of breast NCBs. METHODS: The NCB, fine needle aspiration cytology (FNAC), and radiology scores from 298 women with non-palpable breast lesions presenting between January 1997 and December 1998, together with the open biopsy results (where available) were collated and analysed. RESULTS: The mean follow up period was 15.8 months (range, 5-28). The 298 NCB specimens were categorised as follows: unsatisfactory/non-representative (B1; n = 61; 20.5%), benign but uncertain whether representative (B2r; n = 52; 17.4%), benign (B2; n = 103; 34.6%), lesions possibly associated with malignancy but essentially benign (B3a; n = 9; 3.0%), atypical epithelial proliferations (B3b; n = 10; 3.4%), suspicious of malignancy (B4; n = 7; 2.3%), and malignant (B5; n = 56; 18.7%). Excision biopsy was performed in 43 cases within the B1 (n = 19), B2r (n = 8), B2 (n = 8), and the B3a (n = 8; data unavailable in one case) categories, revealing malignancy in 18 (42.8%) cases and in 65 cases within the B3b, B4, and B5 categories, revealing malignancy in 64 cases (98.5%). The sensitivity of NCB for malignancy was 87.7%, with a specificity and positive predictive value of 99.3% and 98.5%, respectively. FNAC had an inadequacy rate of 58.7%, a complete sensitivity of 34.5% and a specificity of 47.6%. CONCLUSIONS: This study confirms the value of NCB in the preoperative assessment of impalpable breast lesions. Two new categories are suggested for the NCB classification; category B2r for benign breast tissue where representativeness is uncertain, and the subdivision of category B3 into B3a for benign lesions potentially associated with malignancy (for example, radial scars and intraduct papillomas) and B3b for more worrisome atypical epithelial proliferations. These will aid the accurate audit of NCB and identify more clearly the intellectual pathway leading to a particular assessment.

Persistent episiotomy granulation polyps; a polysymptomatic clinical entity.

We describe a number of patients with persistent symptoms of vaginal discharge and discomfort, dyspareunia and postcoital bleeding. They presented 2-4 months following delivery with episiotomy. In these patients, the symptoms were associated with localised granulation tissue polyps, on the episiotomy site. Simple ablation resulted in rapid and effective relief of the symptoms. These lesions may be more common in clinical practice than is suggested by the lack of published reports. They should be looked for in women who may suffer from symptoms for several months after delivery.

CIN 3: the role of lesion size in invasion.

OBJECTIVE: To define the relation between the size of a CIN 3 lesion (measured histologically) and invasive squamous carcinoma. DESIGN: Measurement of CIN 3 by computerized planimetry of histological sections from 39 cone biopsies containing microinvasive cancer. Comparison with previous measurements of CIN lesions, associated with different grades of dyskaryosis. RESULTS: Microinvasive carcinoma of the cervix is associated with extensive CIN 3 on the surface and in endocervical crypts. The mean size of CIN 3 lesions showing microinvasion is seven times greater than that for severe dyskaryosis without invasion, (P less than 0.0001) and a 100-fold greater than with mild dyskaryosis (P less than 0.00001). CONCLUSION: Invasive squamous carcinoma of the cervix arises in large CIN 3 lesions and these are associated usually with severe dyskaryosis. We propose a model for the development of high-grade precancer as a small focus within low grade precancer which then undergoes expansion in size, accompanied by apparent progression in cytological grade.

Cytology of colorectal adenomas.

A study of the cytological appearances of benign and malignant colorectal adenomatous polyps is reported. The aim of the study was to characterize the cytological features of adenomatous polyps and predict the likelihood of malignancy using cytology. A five grade classification of colorectal cytology has been developed and the characteristic appearances of cells from adenomatous polyps are described. The reproducibility of cytological diagnosis based on this classification has been tested in 120 smears from normal mucosa and adenomatous polyps (including polyp cancers). Correlation with histology was achieved in 88% and correlation of the cytological diagnosis between two observers was achieved in 84%. We conclude that cytology can be used reliably as an adjunct to histology in the assessment of malignancy of adenomatous polyps.

The pharmacokinetics and tolerance of oral erythromycin stearate compared with erythromycin ethylsuccinate: implications for preventing endocarditis.

Serum concentrations of erythromycin were monitored in 11 healthy adult volunteers following single dose oral administration of erythromycin stearate, 1.5 g, and erythromycin ethylsuccinate 3.0 g. Peak serum concentrations occurred at 30 min to 2 h after the dose, usually at 1 h. Mean serum peak erythromycin concentrations (standard deviation) were 4.8 mg/l (+/- 2.0) following 1.5 g erythromycin stearate and 2.8 mg/l (+/- 1.4) after 3.0 g erythromycin ethylsuccinate. Both types of erythromycin frequently caused mild gastrointestinal side-effects but there were fewer side-effects associated with erythromycin ethylsuccinate. However, because of the increased serum erythromycin concentrations between 1 and 6 h after the dose of the stearate preparation compared to ethylsuccinate we recommend erythromycin stearate, 1.5 g, as the preferred loading dose, given 1 h before the dental procedure, for preventing endocarditis in susceptible patients allergic to penicillin.