The revised BSCC terminology for abnormal cervical cytology.

The BSCC terminology was originally published in 1986 and although highly successful, requires revision. Through a process of professional consensus and literature review this has been undertaken by the BSCC. The revision takes account of recent developments and improvements in understanding of morphology and disease process and is compatible with other terminologies in use elsewhere, whilst still maintaining a focus on practice in the UK cervical screening programmes.

A retrospective clinical audit of cervical smears reported as 'glandular neoplasia'.

The aims of this study were to review the diagnostic pathway of women with smears reported as 'glandular neoplasia' and to outline the management, colposcopy findings, treatment and final histological diagnosis in these women. The design was a retrospective review. A total of 114 women were identified over a 5-year period from the cytology database at the Royal Liverpool University Hospital Cytology Department, whose hospital case notes were available for review. Methods included a review of the case notes for the demographic details, indication for smear, colposcopic findings, investigation and/or treatment procedures, histology, final diagnosis and current disease status. Of 114 smears reported as 'glandular neoplasia', 67 were reported as consistent with cervical glandular intra-epithelial neoplasia (CGIN), six with endocervical adenocarcinoma, 36 with endometrial adenocarcinoma and five with other glandular neoplastic abnormalities. The average age was 46.5 years. 79 (69.3%) smears were routine call/recall and 36 (30.7%) women were symptomatic. The positive predictive value (PPV) for a significant histological abnormality in the CGIN smear group was 80.6% (23.9% invasive carcinomas, 43.3% CGIN and 13.4% CIN) and the PPV of an 'endometrial adenocarcinoma' smear was 86.1%. Smears indicating glandular neoplasia are associated with a high probability of clinically significant lesions, the PPV of a CGIN smear being over 80%. Immediate referral for colposcopy and assessment by an experienced colposcopist is recommended.

Cervical cancer screening, screening errors and reporting.

Screening for cervical carcinoma by cervicovaginal cytology has led to a marked reduction in the incidence of and mortality from this tumor over the last 50 years in essentially all countries with a functioning screening program. It is the most successful cancer prevention program of all times. Consequently, approximately 80% of the current incidence of and mortality from this disease occurs in geographic areas of underserved and underscreened women. Essential components of a successful program are a high coverage rate of the female population, screening at regular intervals, well-trained clinical and laboratory staff, and an efficient follow-up and treatment system. Deficiencies in any of these areas may lead to a failing screening system. Thus, the most important reason for the remaining mortality from cervical carcinoma in developed countries is lack of complete coverage. It is questionable if new and more expensive technologies will be able to renmedy the remaining failures of the system if no improvement in the coverage rate is achieved. Screening errors do occur but represent only a small fraction of screening failures. Currently, there are a number of terminology systems around the world; thus, a unified terminology is currently not a realistic goal.

Differentiation of prostatic carcinoma and benign prostatic hyperplasia: correlation between dynamic Gd-DTPA-enhanced MR imaging and histopathology.

One of the major factors limiting the staging accuracy of conventional magnetic resonance imaging (MRI) for prostatic carcinoma, is the similarity in signal intensity between tumor and coexisting benign prostatic hyperplasia (BPH). As neovascularity is an independent indicator of pathological state, dynamic contrast-enhanced MRI may yield additional information. This study correlates the histopathological findings from 12 radical prostatectomy patients on a region-by-region basis, with pharmacokinetic modeling of dynamic contrast-enhanced (0.2 mmol dimeglumine gadopentetate/kg), fast multiplanar spoilt gradient-recalled echo images, using a two-compartment simplex minimization technique. Quantitative analysis demonstrated differences in the amplitude of the initial contrast upslope and contrast exchange rate between tumor and fibromuscular BPH (P<0.03 and P<0.03, respectively) and for the contrast exchange rate between tumor and fibroglandular BPH (P<0.04), providing improved delineation of intraprostatic tumor extent compared with conventional imaging techniques.

In vivo quantification of citrate concentration and water T2 relaxation time of the pathologic prostate gland using 1H MRS and MRI.

We have previously reported a striking correlation between water T2 relaxation time and citrate concentration in the normal prostate (Liney G.P.; Lowry M.; Turnbull L.W.; Manton D.J.; Knowles A.J.; Blackband S.J.; Horsman A. Proton MR T2 maps correlate with the citrate concentration in the prostate. NMR Biomed. 9:59-64; 1996). In this study we present data from similar studies of the pathologic gland. The findings support the hypothesis that measurement of both citrate concentration and water T2 relaxation time in vivo may aid the differentiation of prostatic carcinoma from benign disease and normal tissue.

Impact of fine-needle aspiration cytology, ultrasonography and mammography on open biopsy rate in patients with benign breast disease.

The management of breast disease has been influenced by breast imaging and fine-needle aspiration cytology (FNAC) for preoperative diagnosis. To investigate the impact of introducing an in-clinic FNAC service on patient management, the pathology records of patients presenting before and after introduction of the service were studied. Four management changes emerged. The number of patients investigated by histology and/or cytology increased (from 266 to 503), as did specimen numbers (392 to 728). The use of pathological services changed, with more cytology specimens (39 to 554), fewer needle-core biopsies (62 to three) and fewer excision biopsies (245 to 118). The number of patients admitted for surgery fell, especially those with a benign histological diagnosis (174 to 49). These figures demonstrate a change in the management of benign breast disease, from surgery with histopathological diagnosis to cytological diagnosis with surgery only if indicated clinically or from imaging.

Fine needle aspiration cytology of salivary gland lesions reported immediately in a head and neck clinic.

This paper describes the application of fine needle aspiration cytology (FNAC) performed on 92 patients with salivary gland lesions in a Head and Neck Surgery Clinic. The aspirates were immediately reported by a cytopathologist and the reports conveyed to the surgeon during the same clinic visit. FNAC results were then compared with histology in those patients who underwent surgery and with the clinical course of the disease at subsequent clinic visits in patients where surgery was not performed. The cytological diagnosis was incorrect in five cases, one of which was a false negative result. There were no false positive results. The sensitivity was 90.9 per cent and the specificity 100 per cent. This rapid report system of fine needle aspiration cytology has been found to be safe, free of complications, and helpful in the planning of treatment.

Implications on laboratory workload of breast cancer screening.

AIMS: To determine whether the recommended methods for the handling of breast excision biopsy specimens from screening patients cause more laboratory work than those used for non-screening patients. METHODS: All breast excision biopsy specimens from 1990 were identified. Ninety one came from patients identified during the prevalent round of breast screening. These were compared with 127 from non-screening patients operated on by the same surgeon. The workload in terms of initial blocks taken, cases which needed extra blocks or other additional work, and the time taken for delivery of slides to the pathologist were assessed. RESULTS: The screening cases required significantly more initial blocks than the non-screening cases (8.03 v 4.95; p = 0.000001). When looking at the malignant diagnoses this difference was maintained (7.74 v 6.02; p = 0.00014). CONCLUSIONS: Excision biopsy specimens from screening patients require more laboratory work per case than those from non-screening patients. The reasons for these differences lie in the nature of the specimens and their subsequent diagnoses, and in the initial indications for biopsy.

Variations in chemical mediators of hypersensitivity in the sputum of chronic bronchitics: correlation with peak expiratory flow.

Histamine, slow reacting substance of anaphylaxis (S.R.S.-A), IgE, eosinophils, and an eosinophil-associated enzyme, arylsulphatase IIB, were measured in sputum from 11 chronic bronchitics at weekly intervals for 6 weeks. The agents were detected in all patients at some time and in the majority at all times throughout the study period although their concentrations varied. The variations in histamine, S.R.S.-A and IgE gave a highly significant negative correlation with the peak expiratory flow-rate, suggesting that chemical mediators of hypersensitivity may play some role in the pathogenesis of airways obstruction in this disease. Sputum eosinophilia correlated with the arylsulphatase IIB concentration but not with the peak expiratory flow-rate, IgE, histamine, or S.R.S.-A, a finding consistent with the view that eosinophils accumulate at the site of type I reactions after the peak of mediator release.

Mediators of immediate-type hypersensitivity in sputum from patients with chronic bronchitis and asthma.

Mediators of immediate-type hypersensitivity were studied in the sputum of patients with chronic bronchitis. The same mediators were also measured in early-onset, skin-test-positive asthmatics, in late-onset, skin-test-negative asthmatics, and in patients with bronchial carcinoma, bronchiectasis, and pneumonia. Sputum eosinophilia was a feature of bronchitics and asthmatics, whereas raised blood eosinophil levels were found only in the early-onset, skin-test-positive asthmatics. Histamine and IgE were present in considerable amounts in the sputum of bronchitics and early-onset, skin-test-positive asthmatics. Smaller amounts were found in the other groups. The sputum in all the groups contained material giving an "S.R.S (slow-reacting substance) like" induced contraction of the guinea pig ileum. "Classical" S.R.S.-A., determined by arylsulphatase IIB susceptibility, was present only in bronchitics and both types of asthmatics. Since the bronchitics were, in general, skin-test negative and had normal concentrations of circulating IgE and eosinophils, it is suggested that the findings in the sputum indicate an element of local immediate-type (type I) hypersensitivity in bronchitis although its significance for pathogenesis is not known.

Slow reacting substance as a preformed mediator from human lung.

Homogenates from human lung contained a preformed slow reacting substance (pSRS). The pattern of contraction on the guinea-pig ileum by pSRS was indistinguishable from that of SRS-A. The activity of pSRS could not be attributed to the presence of K+, Na+, Ca2+ and Mg2+ ions, or any prostaglandin including PGF2 or its 15-oxo derivative. As with SRS-A, pSRS could be absorbed onto Amberlite XAD-2 and silicic acid. Both were eluted from the former with 80 per cent ethanol and from the latter with a mixture of ethanol, ammonia and water. Both pSRS and SRS-A were resistant to the action of NaOH whereas their activities were destroyed by boiling in HCl. Arylsulphatase II B destroyed the activities of both pSRS and SRS-A. An antagonist of SRS-A, FPL55712, inhibited the action of pSRS at comparable concentrations to that of SRS-A. These experiments suggest that pSRS and SRS-A are identical. Thus SRS joins histamine and ECF-A as a preformed mediator. Although SRS was present in a preformed state the amount of material extractable was more than doubled by the anaphylactic reaction. The extraction of slow reacting substance from human lung without apparent requirement for antigen or antibody points to a possible role of this mediator in inflammatory reactions evoked by mechanisms independent of IgE and other tissue-sensitizing antibodies.