Establishing national noncommunicable disease surveillance in a developing country: a model for small island nations.

Objective To describe the surveillance model used to develop the first national, population-based, multiple noncommunicable disease (NCD) registry in the Caribbean (one of the first of its kind worldwide); registry implementation; lessons learned; and incidence and mortality rates from the first years of operation. Methods Driven by limited national resources, this initiative of the Barbados Ministry of Health (MoH), in collaboration with The University of the West Indies, was designed to collect prospective data on incident stroke and acute myocardial infarction (MI) (heart attack) cases from all health care facilities in this small island developing state (SIDS) in the Eastern Caribbean. Emphasis is on tertiary and emergency health care data sources. Incident cancer cases are obtained retrospectively, primarily from laboratories. Deaths are collected from the national death register. Results Phased introduction of the Barbados National Registry for Chronic NCDs ("the BNR") began with the stroke component ("BNR-Stroke," 2008), followed by the acute MI component ("BNR-Heart," 2009) and the cancer component ("BNR-Cancer," 2010). Expected case numbers projected from prior studies estimated an average of 378 first-ever stroke, 900 stroke, and 372 acute MI patients annually, and registry data showed an annual average of about 238, 593, and 349 patients respectively. There were 1 204 tumors registered in 2008, versus the expected 1 395. Registry data were used to identify public health training themes. Success required building support from local health care professionals and creating island-wide registry awareness. With spending of approximately US$ 148 per event for 2 200 events per year, the program costs the MoH about US$ 1 per capita annually. Conclusions Given the limited absolute health resources available to SIDS, combined surveillance should be considered for building a national NCD evidence base. With prevalence expected to increase further worldwide, Barbados' experiences are offered as a "road map" for other limited-resource countries considering national NCD surveillance.

Advancing Cancer Control Through Research and Cancer Registry Collaborations in the Caribbean.

BACKGROUND: Few national registries exist in the Caribbean, resulting in limited cancer statistics being available for the region. Therefore, estimates are frequently based on the extrapolation of mortality data submitted to the World Health Organization. Thus, regional cancer surveillance and research need promoting, and their synergy must be strengthened. However, differences between countries outweigh similarities, hampering registration and availability of data. METHODS: The African-Caribbean Cancer Consortium (AC3) is a broad-based resource for education, training, and research on all aspects of cancer in populations of African descent. The AC3 focuses on capacity building in cancer registration in the Caribbean through special topics, training sessions, and biannual meetings. We review the results from selected AC3 workshops, including an inventory of established cancer registries in the Caribbean region, current cancer surveillance statistics, and a review of data quality. We then describe the potential for cancer research surveillance activities and the role of policymakers. RESULTS: Twelve of 30 Caribbean nations have cancer registries. Four of these nations provide high-quality incidence data, thus covering 14.4% of the population; therefore, regional estimates are challenging. Existing research and registry collaborations must pave the way and are facilitated by organizations like the AC3. CONCLUSIONS: Improved coverage for cancer registrations could help advance health policy through targeted research. Capacity building, resource optimization, collaboration, and communication between cancer surveillance and research teams are key to obtaining robust and complete data in the Caribbean.

Fine-needle aspiration cytology of thyroid nodules: experience at the Queen Elizabeth Hospital, Barbados (1998-2002).

Fine-needle aspiration cytology (FNAC) of the thyroid nodule has become part of accepted practice defining the role of surgery. This study assessed a 5-year period comparing cytologic with histopathologic diagnosis in 256 samples from 234 patients (203 women and 31 men). Inadequate cytologic samples were obtained in 21.1% of cases. The sensitivity and positive predictive values for the detection by FNAC of thyroid neoplasms was 21.1% and 30.8%, respectively, with a specificity and negative predictive value of 79.5% and 70.0%, respectively. The overall FNAC accuracy was 61.9%. It is anticipated that improvement in diagnosis will develop from specific cytopathological training in thyroid FNAC, consideration of the cytopathologist performing the aspiration biopsy, and the development of immunohistochemical and molecular techniques applied to the cytologic smears. The principal inherent difficulty with thyroid FNAC is the inability to confidently distinguish hyperplastic follicular adenomas from microinvasive follicular carcinomas.

Synchronous mucinous adenocarcinoma of the rectosigmoid seeding onto a pre-existing anal fistula.

Carcinoma within a long-standing fistula-in-ano is rare and may be defined by specific neoplastic involvement of the fistulous track in the absence of rectal mucosal carcinoma. The presence of a carcinoma of mucinous histology occurring synchronously in the perianal region and the colon is exceptionally rare. We present a case with a review of the literature concerning its aetiopathogenesis and treatment. A 72-year-old man with a 2 months history of dark red rectal bleeding and mucus per rectum with alternating constipation and diarrhoea, was observed. Clinical examination and a barium enema showed a perianal fistula and an annular stenosing lesion of the rectosigmoid. Preoperative CT scan confirmed the colonic lesion. Colonic resection and wide fistula excision were performed. Histology showed an adenocarcinoma with a clear resection margins. The fistula also showed a similar histology. Chemoradiation (5-Fluorouracil (425 mg/m2) and Leucovorin (20 mg/m2) with 4500 cGy external beam radiotherapy was utilized. Subsequent clinical follow-up and CT examination of the patient has not revealed recurrent disease at 14 months.

Direct detection of leptospiral material in human postmortem samples.

Leptospiral culture, direct immunofluorescence, and the polymerase chain reaction (PCR) were used to detect leptospiral material in postmortem specimens collected from eight patients who died of leptospirosis. Diagnosis of leptospiral infection was based on clinical summary (premortem) and confirmed by serological analysis and/or culture of leptospires. Leptospiral culture was the least sensitive technique, yielding two isolates (3%) from 65 samples. Both isolates were from the aqueous humour and cerebrospinal fluid of the same patient. Direct immunofluorescence was of intermediate sensitivity for detection of leptospires, confirming the presence of leptospires in 11% (2 of 18) of tissue samples from three patients. PCR analysis was the most sensitive technique for detection of leptospiral material in tissue samples, being positive in 20% (11 of 56) of samples from eight patients. Both samples (cerebellum and liver) positive by immunofluorescence were also positive by PCR. The sensitivity of the PCR assay was 1-10 leptospires ml(-1) sample, and the assay was specific for Leptospira pathogenic species. Multi-system involvement was indicated based on successful amplification of leptospiral DNA from more than one tissue sample, which corroborated with the clinical and pathologic findings. The results suggest that in acute and/or fatal leptospirosis, the pathogenesis of the pathologic features are related to the presence of the organisms in the tissues. In conclusion, PCR combined with serology appears to be a useful tool for diagnosis of leptospirosis and may be invaluable in epidemiological studies.

Establishing national noncommunicable disease surveillance in a developing country: a model for small island nations / Introducción de la vigilancia nacional de las enfermedades no transmisibles en un país en desarrollo: un modelo para las pequeñas naciones insulares

Objective. To describe the surveillance model used to develop the first national, populationbased, multiple noncommunicable disease (NCD) registry in the Caribbean (one of the first of its kind worldwide); registry implementation; lessons learned; and incidence and mortality rates from the first years of operation. Methods. Driven by limited national resources, this initiative of the Barbados Ministry of Health (MoH), in collaboration with The University of the West Indies, was designed to collect prospective data on incident stroke and acute myocardial infarction (MI) (heart attack) cases from all health care facilities in this small island developing state (SIDS) in the Eastern Caribbean. Emphasis is on tertiary and emergency health care data sources. Incident cancer cases are obtained retrospectively, primarily from laboratories. Deaths are collected from the national death register. Results. Phased introduction of the Barbados National Registry for Chronic NCDs (“the BNR”) began with the stroke component (“BNR–Stroke,” 2008), followed by the acute MI component (“BNR–Heart,” 2009) and the cancer component (“BNR–Cancer,” 2010). Expected case numbers projected from prior studies estimated an average of 378 first-ever stroke, 900 stroke, and 372 acute MI patients annually, and registry data showed an annual average of about 238, 593, and 349 patients respectively. There were 1 204 tumors registered in 2008, versus the expected 1 395. Registry data were used to identify public health training themes. Success required building support from local health care professionals and creating island-wide registry awareness. With spending of approximately US$ 148 per event for 2 200 events per year, the program costs the MoH about US$ 1 per capita annually. Conclusions. Given the limited absolute health resources available to SIDS, combined surveillance should be considered for building a national NCD evidence base. With prevalence expected to increase further worldwide, Barbados’ experiences are offered as a “road map” for other limitedresource countries considering national NCD surveillance.

Objetivo. Describir el modelo de vigilancia que se utilizó para crear el primer registro poblacional nacional de múltiples enfermedades no transmisibles en el Caribe (uno de los primeros registros de esta clase en el mundo), la ejecución del registro, las lecciones aprendidas y las tasas de incidencia y mortalidad desde sus primeros años de funcionamiento. Métodos. Esta iniciativa del Ministerio de Salud de Barbados, realizada en colaboración con la Universidad de las Indias Occidentales e impulsada por la limitación de los recursos nacionales, tuvo por finalidad recoger datos prospectivos sobre los casos nuevos de accidente cerebrovascular e infarto agudo de miocardio en todos los establecimientos de atención de salud de este pequeño estado insular en desarrollo del Caribe oriental. El análisis se centró en las fuentes de datos sobre la atención de salud terciaria y de urgencia. La información sobre los casos nuevos de cáncer se obtuvo de manera retrospectiva, principalmente de los laboratorios. Los datos sobre las defunciones se tomaron del registro nacional de mortalidad. Resultados. La introducción progresiva del Registro Nacional de Enfermedades Crónicas no Transmisibles de Barbados se inició con el componente de los accidentes cerebrovasculares en 2008, seguido del componente de infarto agudo de miocardio en 2009 y el componente de cáncer en 2010. Las estimaciones previstas con base en los estudios anteriores fueron en promedio de 378 casos de un primer accidente cerebrovascular, 900 casos de accidente cerebrovascular y 372 pacientes con infarto agudo de miocardio cada año; los datos del registro mostraron un promedio anual cercano a 238, 593 y 349 casos respectivamente. En el 2008, se registraron 1204 casos de cáncer, frente a los 1395 previstos. En función de los datos del registro se definieron los temas de capacitación en salud pública. El éxito de la iniciativa exigió fomentar el apoyo de los profesionales de salud a nivel local y dar a conocer la existencia del registro en toda la isla. Con un gasto cercano a 148 dólares por episodio y 2200 episodios por año, el programa cuesta al Ministerio de Salud alrededor de un dólar por habitante cada año. Conclusiones. Dada la limitación de los recursos absolutos destinados a la salud en los pequeños estados insulares en desarrollo, es preciso analizar la posibilidad de realizar una vigilancia combinada, con el objeto de crear una base nacional de datos fidedignos sobre las enfermedades no transmisibles. Ante la perspectiva de un aumento continuo de la prevalencia mundial, la experiencia en Barbados se ofrece como una “hoja de ruta” destinada a otros países con recursos limitado

Establishing national noncommunicable disease surveillance in a developing country: a model for small island nations / Introducción de la vigilancia nacional de las enfermedades no transmisibles en un país en desarrollo: un modelo para las pequeñas naciones insulares

ABSTRACT Objective To describe the surveillance model used to develop the first national, population-based, multiple noncommunicable disease (NCD) registry in the Caribbean (one of the first of its kind worldwide); registry implementation; lessons learned; and incidence and mortality rates from the first years of operation. Methods Driven by limited national resources, this initiative of the Barbados Ministry of Health (MoH), in collaboration with The University of the West Indies, was designed to collect prospective data on incident stroke and acute myocardial infarction (MI) (heart attack) cases from all health care facilities in this small island developing state (SIDS) in the Eastern Caribbean. Emphasis is on tertiary and emergency health care data sources. Incident cancer cases are obtained retrospectively, primarily from laboratories. Deaths are collected from the national death register. Results Phased introduction of the Barbados National Registry for Chronic NCDs (“the BNR”) began with the stroke component (“BNR–Stroke,” 2008), followed by the acute MI component (“BNR–Heart,” 2009) and the cancer component (“BNR–Cancer,” 2010). Expected case numbers projected from prior studies estimated an average of 378 first-ever stroke, 900 stroke, and 372 acute MI patients annually, and registry data showed an annual average of about 238, 593, and 349 patients respectively. There were 1 204 tumors registered in 2008, versus the expected 1 395. Registry data were used to identify public health training themes. Success required building support from local health care professionals and creating island-wide registry awareness. With spending of approximately US$ 148 per event for 2 200 events per year, the program costs the MoH about US$ 1 per capita annually. Conclusions Given the limited absolute health resources available to SIDS, combined surveillance should be considered for building a national NCD evidence base. With prevalence expected to increase further worldwide, Barbados’ experiences are offered as a “road map” for other limited-resource countries considering national NCD surveillance.

RESUMEN Objetivo Describir el modelo de vigilancia que se utilizó para crear el primer registro poblacional nacional de múltiples enfermedades no transmisibles en el Caribe (uno de los primeros registros de esta clase en el mundo), la ejecución del registro, las lecciones aprendidas y las tasas de incidencia y mortalidad desde sus primeros años de funcionamiento. Métodos Esta iniciativa del Ministerio de Salud de Barbados, realizada en colaboración con la Universidad de las Indias Occidentales e impulsada por la limitación de los recursos nacionales, tuvo por finalidad recoger datos prospectivos sobre los casos nuevos de accidente cerebrovascular e infarto agudo de miocardio en todos los establecimientos de atención de salud de este pequeño estado insular en desarrollo del Caribe oriental. El análisis se centró en las fuentes de datos sobre la atención de salud terciaria y de urgencia. La información sobre los casos nuevos de cáncer se obtuvo de manera retrospectiva, principalmente de los laboratorios. Los datos sobre las defunciones se tomaron del registro nacional de mortalidad. Resultados La introducción progresiva del Registro Nacional de Enfermedades Crónicas no Transmisibles de Barbados se inició con el componente de los accidentes cerebrovasculares en 2008, seguido del componente de infarto agudo de miocardio en 2009 y el componente de cáncer en 2010. Las estimaciones previstas con base en los estudios anteriores fueron en promedio de 378 casos de un primer accidente cerebrovascular, 900 casos de accidente cerebrovascular y 372 pacientes con infarto agudo de miocardio cada año; los datos del registro mostraron un promedio anual cercano a 238, 593 y 349 casos respectivamente. En el 2008, se registraron 1204 casos de cáncer, frente a los 1395 previstos. En función de los datos del registro se definieron los temas de capacitación en salud pública. El éxito de la iniciativa exigió fomentar el apoyo de los profesionales de salud a nivel local y dar a conocer la existencia del registro en toda la isla. Con un gasto cercano a 148 dólares por episodio y 2200 episodios por año, el programa cuesta al Ministerio de Salud alrededor de un dólar por habitante cada año. Conclusiones Dada la limitación de los recursos absolutos destinados a la salud en los pequeños estados insulares en desarrollo, es preciso analizar la posibilidad de realizar una vigilancia combinada, con el objeto de crear una base nacional de datos fidedignos sobre las enfermedades no transmisibles. Ante la perspectiva de un aumento continuo de la prevalencia mundial, la experiencia en Barbados se ofrece como una “hoja de ruta” destinada a otros países con recursos limitados que planean introducir la vigilancia nacional de las enfermedades no transmisibles.

Extensive extranodal adult T-cell lymphoma presenting with a lytic arthropathy of the ankle.

A case is presented of a 44-year-old human T-cell lymphotropic virus-1 seropositive Afro-Caribbean man whose adult T-cell lymphoma presented with an ankle arthropathy. Over a period of weeks he developed subcutaneous tumor masses, osteolytic lesions, sinonasal involvement, and spinal disease culminating in death 4 months after his diagnosis. The case highlights the extranodal manifestations, generally, and rheumatological complications, specifically, of this very aggressive form of lymphoma with review of the relevant literature. Consideration should be given to the possibility of this condition in individuals originating from known endemic areas, notably, the Caribbean, southwestern Japan, South and Central America, parts of southeastern United States, and equatorial Africa.

The changing distribution of colorectal cancer in Barbados: 1985-2004.

PURPOSE: Recent reports have suggested a shift to the right in older female patients of colon cancer. This is believed to be representative of more accessible national endoscopic screening programs. METHODS: We report the demographic shift in colorectal cancer based on an analysis of resection specimens during four five-year time periods from 1985 to 2004 at the University Hospital, Barbados. Differences in population-based colorectal cancer incidence, age, gender, site, stage, and presentation (emergency vs. elective) are analyzed. RESULTS: A total of 1,014 specimens obtained from 993 patients were analyzed, showing a progressive population-based increase in colorectal cancer in Barbados during this 20-year time period. There was an increase in right-sided tumors (P < 0.0001) without a concomitant decline in left-sided tumors. There was a significant increase in Dukes A cancers (P < 0.0001) without gender predilection. During the time period, there was a significant reduction in right-sided tumors presenting as emergencies (P < 0.005) without an effect of stage or gender. CONCLUSIONS: There has been a steady increase in both right-sided and left-sided colonic cancers without gender predilection. The increase in early-stage tumors and reduction in emergency presentations during the latter part of the study suggests value in instituting a formal national colonoscopic screening program to assess its prospective effect on these parameters.

Endometriosis-evidence of blood-borne spread

Theories that have been put forward concerning the histogenesis of endometriosis include retrograde menstruation, metaplasia of the coelomic epithelium, direct myometrial and utero-tubal extension, lymphatic spread, and blood-borne spread of the endometrium. Jeffcoate (1975), Blaustein (1977) and Novak and Woodruff (1979) state that blood-borne spread is the only plausible explanation of the rare cases occurring in the arm, leg and similar sites. There has been no documented proof of this. The case presented illustrates and supports the evidence of blood-borne spread in the pathogenesis of endometriosis (AU)

Autopsy in Barbados - abstract

Since 1977, the status of the autopsy has been the subject of much debate. The following questions have been posed: (i) Has the autopsy outlived its usefulness? (ii) Is the autopsy worth the expended effort and cost? (iii) How can the contributions of this physician service achieve their maximum usefulness and receive appropriate recognition? The College of American Pathologists' Foundation Conference has made an appeal to revitalize the autopsy. There was concern about the falling rate of autopsies in teaching hospitals. The Queen Elizabeth Hospital has been one of the hospitals involved in the Eastern Caribbean Medical Scheme since 1965. There is undergraduate and postgraduate teaching. Medical students have been doing their Pathology and Microbiology clerkships at this hospital since 1981. The morbid anatomy sub-department of Pathology also services the whole island. Is the autopsy rate at this institution, a teaching hospital, acceptable? Is maximum benefit being gained from the autopsies performed? In order to answer the above questions, the autopsy reports from the Pathology Department were reviewed for the four-year period (1979-1982). The autopsy rates were 17 percent, 14 percent, 13 percent and 16 percent respectively. The concordance score of 303 of the 400 autopsies performed during this period was calculated. Ninety-seven cases had to be excluded because of insufficient data. In 149 cases, the primary disease as diagnosed at autopsy had been recognized clinically, but in 154 cases it had not. The predominant diseases missed included sepsis, pulmonary thrombo-embolism, pulmonary oedema and gastrointestinal haemorrhage. Though the autopsy rate is low, there is a high discordant rate. The autopsy in Barbados is therefore potentially capable of improving medical care, not only through the teaching of medical students, but through the interest and involvement of the clinicians in autopsies requested (AU)

Human papilloma virus infection of the cervix uteri: observations in clinical private practice in Barbados - abstract

This study of female private patients was to determine the prevalence of Human Papilloma Virus (HPV) infection, diagnosed on the basis of changes in cervical smears. From January 1986 to July 1988, 14,891 cervical smears were classified by numerical and descriptive systems, and 505 (3.4 per cent) smears had cytological changes of condyloma. Six cases were excluded because their ages were not known. Of the remaining 499 cases, 385 (77 per cent) were diagnosed as class II, 105 (21 per cent) as class III, and 216 (43 per cent) had bunch biopsies and/or endocervical curettage, 34 per cent of class II and 79 per cent of class III. Of those biopsied, 106 (49 per cent) had histological evidence of condyloma (condyloma only, 31 per cent; condyloma and CIN, 18 per cent). Of the 110 (51 per cent) biopsied cases with no histological evidence of condyloma, 16 per cent had evidence of dysplasia and 0.5 per cent frankly invasive carcinoma. Eighty-five per cent of condylomata occurred in the 20-39-year age group. Condyloma with coexisting dysplasia and dysplasia only had a peak frequency in the 20-29-year age group. The frequency of dysplasia in patients with previous class II smears was 19 per cent and 42 per cent of class III smears had no dysplasia but condyloma. Because of the foregoing, patients with a smear diagnosis of class I and cytological changes associated with HPV infection require more intensive follow up (AU)

Yaws in Barbados

The first case of yaws diagnosed in Barbados is documented. The clinicopathological appearance is described, and the Caribbean experience is briefly reviewed. Although the disease is almost completely eradicated, there still has to be continuing vigilance on the part of medical personnel so that the condition is not overlooked. The surgical pathologist can aid in the diagnosis (AU)

Smooth muscle tumours of the gastrointestinal tract

Fifty smooth muscle tumours arising in the gastrointestimal tract and recorded in the surgical pathology files at the University Hospital of the West Indies were reviewed in an attempt to document their histopathological features. The mean age at occurrence was 59.8 years with a range of 34-80 years. Most tumours (64 percent) were symptomatic, while the remainder were incidental findings at laparotomy. The main symptoms were an abdominal mass, gastrointestinal bleeding, weight loss, vomiting, dysphagia and obstructive jaundice. The size of the tumours varied from less than 1 cm in diameter. Thirty-nine were from stomach, two from the duodenum, seven from the jejunum and ileum, one from the colon and one from the rectum. Tumours were classified as either benign, of indeterminate malignancy or frankly malignant. A rough correlation between malignance and the size of the tumours was found. The larger tumours were invariably malignant and the smaller tumours benign. There were three bizarre smooth muscle tumours one of which was frankly malignant.(AU)

Pulmonary teratoma

Intrapulmonary teratoma is reported in an 11-year-old-girl. The tumour is remarkable for its large size, since it occupied the entire right hemithorax. The presence of immature elements suggests that it is potentially malignant. However, complete surgical excision appears to have effected a cure at 5 years follow-up. This is the 14th such case to be recorded in the English literature (AU)

Autopsy experience in Barbados

Although there is world-wide concern about the decrease in autopsy rates, to the authors' knowledge, the rates in Barbados have never been documented. The calculation of the non-coroner's autopsy rates and accordance score, and the possible value of these autopies performed at the Queen Elizabeth Hospital constitute this paper (AU)

Clinical and laboratory studies of bacterial vaginosis in Barbados - abstract

Bacterial vaginosis (BV) is a non-inflammatory infection of the vagina, characterized by the presence of a thin, homogenous, grayish-white discharge. The purpose of this study was to investigate (1) the prevalence of BV in Barbados and evaluate methods for its diagnosis, and (2) the relationship between clinically and microbiologically-confirmed BV and abnormal PAP smear results. Initially, 29 consecutive patients presented with vaginal discharge which was tested for pH and amines, and high vaginal swabs were cultured for Gardnerella vaginalis and obligate anaerobes. Of 21 patients without another demonstrable cause of their discharge, 16 had a vaginal pH o 5; 14 had a positive amine test, clue cells were observed in 8 and a heavy growth of either obligate anaerobes or G. vaginalis was recovered from 10 patients. BV was found in 16 of 29 patients (56 per cent). In a further 43 patients with a clinical diagnosis of BV, a vaginal pH o 5, and a positive amine test, vaginal swabs were obtained for culture and cervical smears stained with Papanicolaou stain. Thirty of these 43 patients (70 per cent) had class II Pap smears, 24 (56 per cent) had evidence of concurrent infection, including yeasts (12 per cent), Trichomonas vaginalis (24 per cent), and cytological evidence of infection with chlamydia (23 per cent) or human papilloma virus (32 per cent). It is concluded that BV is common in Barbados, is easily diagnosed in the physician's office, responds to treatment with metronidazole and is often associated with other genital tract infections which require additional investigations (AU)

Leiomyosarcoma of the rectum

The only case of leimyosarcoma of the rectum seen at the University Hospital of the West Indies is reported. The natural history and pathology of this tumour are similar to those of smooth muscle tumours occurring elsewhere in the gut. When rectal leimyosarcoma invades adjacent organs such as the vagina and bladder, it may give rise to considerable morbidity. In addition, widespread metastases may occur. Aggressive surgical therapy is therefore warranted for early lesions if therapy is expected to be curative (AU)

Detection of oncogenic HPV DNA by a consensus polymerase chain reaction method in genital carcinomas in twenty women in Barbados

Paraffinized tissue from Barbadian women with histologically proven gential carcinoma was subjected to a censensus polymerase chain reaction method. Nineteen patients had cervical and one, vaginal carcinoma. The histological types were 17 squamous cell carcinoma, 2 adenocarcinoma and 1 adenosquamous carcinoma. HPVDNA was detected in 18/20 (90 per cent ). HPVDNA type 16 in 13 (65 per cent ), type 33 and type 45 in 1 (5 per cent ) each and 3 (15 per cent ) could not be typed. HPVDNA, type 16, was detected in one (50 per cent ) of the two cases of adenocarcinoma and 12/17 (71 per cent ) cases of squamous cell carcinoma. DNAHPV, type 33, and type 45 were each detected in 1/17 (6 per cent ) cases of squamous cell carcinoma. No HPVDNA, type 18, was detected.

The significance of atypical squamous cells of undetermined significance in Barbados - Poster abstract

OBJECTIVE: To evaluate the significance of a Papanicolaou (Pap) cervico-vaginal smear diagnosis of atypical squamous cells of undertermined significance (ASCUS) using cytohistologic correlation and to determine the ASCUS squamous intraepithelial lesions (SIL) ratios of five cytopathology laboratories. DESIGN AND METHODS: A combined retrospective and prospective study was undertaken to evalute the histologic diagnoses of the biopsies from patients who attended the colposcopy clinic at the Queen Elizabeth Hospital with the Pap smear cytologic diagnosis of ASCUS during the period, January 1 - April 15, 1998. The laboratory from which the Pap reports were issued was recorded. RESULTS: During this three and a half month period three hundred and sixty-four (364) patients with abnormal smears diagnosed at five different cytology laboratories were investigated. One hundred and fifty (42.1 percent) patients has a Pap smear diagnosis of ASCUS, followed by 161 (46.5 percent) SIL, 130 (35.8 percent) wit low grade intraepithelial lesions (LSIL) and 31 (10.7 percent) high grade intraepithelial lesions (HSIL). Three cases with ASCUS were subsequently excluded from the study because of insufficient data. The histologic diagnosis of the remaining 147 biopsies from patients with the Pap smear diagnosis of ASCUS were LSIL 49 (33.6 percent), HSIL 9 (6.2 percent), atypia/metaplasia 66 (45.2 percent) and inflammation/normal 23 (15.1 percent). The overall ASCUS/SIL ratio was 0.90 and the individual laboratory ratios ranged from 0.25 to 1.70 with a mean of 0.84 ñ 0.63. CONCLUSION: The histologic diagnosis of a cervical cytologic smear assessed as ASCUS may vary from normal to HSIL. Just under 40 percent are likely to be SIL with LSIL predominant. The ASCUS/SIL ratios of Barbadian cytopathology laboratories are less than the ASCUS/SIL ratio (2.0-3.0) suggested by the 1992 NCI Workshop at Bethesda. Hence a diagnosis of ASCUS in Barbados requires careful follow-up.(AU)