Brush cytology of herpes simplex virus infection in oral mucosa: use of the ThinPrep processor

Evaluation was made of oral scraping specimen using Cytobrush from 11 patients with clinical suspicious lesions for herpes simplex virus (HSV) infection. In this study, oral brush cytology prepared using an automated smear apparatus (ThinPrep method) has been applied. The smears prepared by ThinPrep are equally well suited for screening purposes, producing highly cellular specimens with well-preserved cytoplasm and nuclei. The results obtained on the 11 patients, four cytologic specimens, showed pathognomonic viral cellular changes of HSV infection. Viral isolation studies were performed on 10 of the 11 patients and ten specimens tested positive for HSV by culture. Of the ten HSV positive isolates, six were positive by either cytology or immunocytochemical staining. Of the two smears showing HSV positive cells, both smears were also confirmed by in situ hybridization (ISH) with a biotinylated clone DNA probe. Using the ICC technique, detection of HSV antigen in oral scraping smears was of great value in the diagnosis of oral HSV infection, especially in cases of equivocal lesions. Oral cytology by means of ThinPrep method obviously deserves additional trials as an adjunct in the cytology of HSV-suspected lesions.

Endometrial collection and interpretation using the Tao brush and the CytoRich fixative system: a feasibility study

BACKGROUND

The cytological assessment of endometrium entails: (1) a collection device that is easy to use, collects material only from the endometrium, and obtains adequate samples; (2) a fixation process that ensures the preservation of individual cells, maintains cell polarity, and allows the recognition of three-dimensional tissue structures (microbiopsies); and, (3) interpretative algorithms that translate histopathologic to cytopathologic diagnoses. The purpose of this study is to show that it is feasible to achieve these ends when endometrial brush sampling is coupled with suspension fixation.

METHODS

Obtain endometrium from 100 consecutive hysterectomy uteri using an Indiana University Medical Center sampler (Tao Brush), suspension-fix it in CytoRich fixative, prepare it with a cytocentrifuge using large diameter sample chambers, and compare the cytologic diagnosis to the histologic diagnosis of the hysterectomy specimen.

RESULTS

There were no inadequate collections. Cytology regularly separated (1) benign endometrium, (2) low-grade (non-atypical) hyperplasia, (3) high-grade (atypical) hyperplasia/FIGO Grade I adenocarcinoma, and (4) higher-grade carcinomas from one another. Endometrial atrophy was diagnosed in three patients whose histology showed clinically asymptomatic, benign fibrous endometrial polyps. A low volume of abnormal cell aggregates interpreted as endometrial intraepithelial carcinoma was detected in one patient whose initial histology was reported as simple hyperplasia, but whose histology on review after p53 staining revealed intraepithelial surface cancer. In the remaining 96 cases, the cytologic diagnosis consistently represented the histologic diagnosis of the hysterectomy specimen. On a case-by-case basis, any one cytology slide accurately represented the diagnosis of the other cytology slides.

CONCLUSION

Endometrial brushing with suspension-fixation is advocated for the detection of endometrial lesions because (1) fixation is uniform, (2) there is substantial preservation of three-dimensional structures among cell aggregates, which allows pattern-based histologic diagnostic criteria to be applied to cytologic samples, and (3) only a limited number of slides need to be examined.

Direct intrauterine sampling: the IUMC Endometrial Sampler

Endometrial cytology has been studied for more than 25 years, and a variety of cytologic devices have been developed for direct sampling of the endometrium. The quality of endometrial samples procured by various devices is markedly different and greatly affects the diagnostic accuracy. A new endometrial sampling device, the IUMC Endometrial Sampler, was developed at the Indiana University Medical Center and approved by the Food and Drug Administration for general medical use. This device is intended for the early detection of endometrial carcinoma and its precursors. It can be used to monitor the endometrial condition of patients receiving estrogen replacement therapy or tamoxifen. It is also useful for the procurement of uncontaminated endometrial samples for microbiologic studies from patients with suspected endometritis. It has the potential to be used for endometrial dating for patients with infertility disorders. In our clinical trials and sampling tests using hysterectomy specimens, adequate and representative endometrial samples without contamination from endocervix and vagina were consistently obtained by this device. The procedure of endometrial sampling using this device and the preparation techniques for endometrial brushing specimens are discussed and illustrated.

Cervical specimens collected in liquid buffer are suitable for both cytologic screening and ancillary human papillomavirus testing

BACKGROUND

Several new techniques have been developed to improve the sensitivity of cervical carcinoma screening and reduce equivocal cytologic diagnoses referred to as atypical squamous cells of undetermined significance (ASCUS). This study evaluates the effectiveness of combining two newly introduced diagnostic techniques: preparation of thin-layer cytologic slides from ThinPrep liquid buffer and selected Hybrid Capture testing for human papillomavirus (HPV) DNA. Because HPV DNA detection has been strongly associated with the presence of a cervical carcinoma precursor ("squamous intraepithelial lesion," or SIL), HPV testing might be useful for identifying women with ASCUS who have an underlying SIL.

METHODS

Two hundred specimens demonstrating diverse cervical abnormalities were selected from a prospective population-based study of 9174 women conducted in Costa Rica. The entire cohort had been screened with conventional cervical smears; ThinPrep slides made from liquid buffer, PAPNET, a computerized slide reading system; and Cervicography. Patients with any abnormal screening test were referred for colposcopy, punch biopsy, and loop excision of cases with high grade cytologic abnormalities not explained by punch biopsy. For this investigation, the results of ThinPrep cytology and HPV testing alone and in combination were compared with the final diagnoses, with an emphasis on the detection of carcinoma and high grade SIL.

RESULTS

The 200 subjects studied included 7 women with a final diagnosis of carcinoma, 44 with high grade SIL, 34 with low grade SIL, 51 with a variety of equivocal diagnoses, and 64 with normal diagnoses. A ThinPrep cytologic diagnosis of SIL or carcinoma was made in 39 (76%) of the 51 women with final diagnoses of high grade SIL or carcinoma. Hybrid Capture testing detected carcinoma-associated types of HPV DNA in 100% of women with carcinoma, 75% with high grade SIL, 62% with low grade SIL, 20% with equivocal final diagnoses, and 12% of normal women. If colposcopy referral had been limited to women with a ThinPrep diagnosis of SIL or a diagnosis of ASCUS associated with the detection of carcinoma-associated HPV DNA from the same vial, 100% of women with carcinoma and 80% with high grade SIL would have been examined. To achieve this high sensitivity in the entire population of 9174 women would have required the referral of about 7% of the population. The combined screening strategy would have performed marginally better than optimized conventional screening with referral of any abnormal cytology (ASCUS and above).

CONCLUSIONS

A cervical carcinoma screening technique which uses a single sample for cytopathology and HPV testing to triage equivocal diagnoses may be promising if it proves to be cost-effective.

Cellular fixation. A study of CytoRich Red and Cytospin Collection Fluid

OBJECTIVE

To test a new fixative system (Roche Image Analysis System, Inc. [RIAS]) that may create a background free of blood and blood products, and to determine if the CytoRich Red system has a potential for automation of nongynecologic cytology. We compared the amount of red blood cells, background material and diagnostic ability in 40 bloody specimens prepared using the CytoRich Red system and our routine fixative, Cytospin Collection Fluid (Shandon, Inc.).

STUDY DESIGN

Thirty bloody, nongynecologic specimens and 10 fresh FNA surgical specimens were prepared by adding specimen to equal volumes (10 mL) of CytoRich Red Fixative and Cytospin Collection Fluid. After initial centrifugation, the specimens were resuspended and cytocentrifuged using the Cytospin III (Shandon, Inc.) and the Hettich Universal cytocentrifuge. To test system dependency, specimens from each fixative were prepared using the alternate method of cytocentrifugation. Slides from both fixatives were stained, coverslipped and reviewed for the presence of red blood cells, background and diagnostic ability.

RESULTS

Of the 40 CytoRich Red specimens, 92.5% (37) had little or no red blood cells as compared to 22.5% (9) of the 40 Cytospin Collection Fluid specimens. Seventy five percent (30) of the 40 CytoRich Red specimens showed reduction of background material in contrast to 15% (6) of the 40 Cytospin Collection Fluid specimens. Diagnostic ability using CytoRich Red was enhanced by the reduction of red blood cells and background material. CytoRich Red performed equally as well with each cytocentrifugation device.

CONCLUSION

CytoRich Red reduces red blood cells and background. Nuclear and cytoplasmic stain appear improved. This allows better evaluation of the cytologic features and interpretation of bloody specimens. It is non-system dependent and can be used with any method of preparation. Also, the reduction of background and blood lends itself to adaptation in the automation of nongynecologic cytology.

Nasal cytology in rhinitis children: comparison between brushing and blowing the nose

Allergic rhinitis is a common disease in childhood, but nasal cytology is rarely used by pediatricians. We compared two techniques of cell sampling, brushing and blowing the nose, among 77 children suffering from chronic rhinitis, of whom 59 were allergic. Staining by the May-Grunwald-Giemsa method enabled the evaluation of the density of cells and especially differential counting of the inflammatory cells. Staining by the Luna method was used as a control for the eosinophils. For the eosinophil count, we found a strong correlation between the two methods of collecting the nasal secretions (r = 0.96). Because blowing the nose is painless and easy to perform, it is more appropriate than brushing in routine use for the diagnosis of allergic rhinitis in children and in nasal challenge with allergens.

Intraductal biliary biopsy: comparison of three techniques

PURPOSE

To compare the results obtained with three different techniques for percutaneous transhepatic intraductal biopsy.

MATERIALS AND METHODS

Eighty-eight patients with obstructive jaundice underwent placement of percutaneous biliary drainage catheters for biliary decompression. As part of the initial procedure or at a subsequent date, intraductal biliary biopsy (n = 109) was performed with use of one or more of three techniques including cytologic brush (n = 53), clamshell forceps under choledochoscopic guidance (n = 31), and clamshell forceps under fluoroscopic guidance (n = 25).

RESULTS

Forty-eight patients (55%) had a final diagnosis of malignant disease, and 40 (45%) had a diagnosis of benign disease. One hundred six (97%) biopsy procedures yielded technically adequate specimens. No complications directly related to the biopsy procedures occurred. Overall sensitivity and specificity for each biopsy technique were 26% and 96% for the cytologic brush technique, 30% and 88% for the clamshell forceps under fluoroscopic guidance technique, and 44% and 100% for the clamshell forceps under choledochoscopic guidance technique, respectively. The sensitivities of the biopsy techniques for pancreatic carcinoma and cholangiocarcinoma, respectively, were 47% and 0% for brush; 75% and 0% for fluoroscopic clamshell; and 100% and 27% for choledochoscopic clamshell.

CONCLUSION

The choledochoscope-directed biopsy technique had the greatest sensitivity and specificity of the three techniques evaluated, but this difference was not statistically significant versus the brush or fluoroscopic clamshell technique (P > .10). The sensitivity of all three techniques for pancreatic carcinoma was significantly greater than that for cholangiocarcinoma. Multiple biopsies did not increase the overall sensitivity of intraductal biliary biopsy as a diagnostic technique. All three techniques proved to be safe and easy to perform.

Nongynecologic cytology utilizing the ThinPrep Processor

OBJECTIVE

To assess the utility of the ThinPrep Processor (TP) for nongynecologic cytology.

STUDY DESIGN

We reviewed the number of unsatisfactory specimens from the esophagus, common bile duct, hepatic duct, pancreas, gastric, bronchial wang, vertebra, submandibular area and neck over a one-year period, before and after TP implementation. For a one-year period after TP implementation, the cytologic diagnoses of selected TP specimens with corresponding surgical tissue diagnoses were compared, and the TP slides were reviewed in discrepant cases.

RESULTS

The number of unsatisfactory specimens was reduced from 17% to 1% after TP implementations. The cytologic diagnoses of 145 TP specimens were in agreement with surgical tissue diagnoses. However, in 43 cases the cytology and tissue diagnoses were discordant. On review of 26 of the discrepant cases, the majority of TP slides were cellular, with good nuclear and cytoplasmic detail. Discrepancies resulted from sampling errors in 19 cases and TP interpretation errors in 7 cases.

CONCLUSION

In our laboratory, TP is a reliable processor for nongynecologic specimens.

[Evaluation of the role of cytology in the diagnosis of cancer of the lung. Comparison between cytology and pathological anatomy in 330 cases of proximal cancers]

This retrospective study was performed to evaluate the interest of cytology in the diagnosis of pulmonary carcinomas. Bronchial samples were collected from 330 patients known to display a macroscopic lesion which was detected by bronchoscopy. Cytological analysis of the bronchial brushings and washings, removed at the first fibroscopy, allowed the diagnosis of malignancy in 92% of the cases analyzed whereas the biopsy confirmed the malignancy in 77% of the cases. In conclusion cytological studies gave information on malignity and classification in 90% of the cases. However histological classification only could guarantee the choice of the best treatment regimen.

A new procedure for removal of a "lost" intrauterine device

OBJECTIVE

To evaluate the efficacy of removal of a "lost" intrauterine device (IUD) with the use of a cylindrical brush.

METHODS

Women aged 25-43 years with so-called "lost" IUD, in whom the string was indiscernible, were enrolled in the study. During gynecologic examination, a cylindrical brush was rotated in the cervical canal until the device was extracted by a rotating motion. No antibiotics were used after removal of the IUD with the cylindrical brush.

RESULTS

Twenty-seven women whose IUD could not be removed from the uterine cavity because of an indiscernible string were referred for a trial of IUD removal. All patients had used a plastic, copper-releasing IUD. Before admission, they had undergone an attempt at IUD removal by their physician using either a hook or clamp. In 24 patients who were referred to our center, the IUD was removed by using a cylindrical brush to view the string. The IUD was removed by hysteroscopy in three cases, in two of which no string was found.

CONCLUSION

A cylindrical brush can be used safely as an adjunct to remove an IUD and is a simple method that may be performed before another invasive procedure is attempted.

Cytopathology in the Socialist Republic of Vietnam

OBJECTIVE

To determine the differences and similarities between cytopathology practice in Vietnam and North America.

STUDY DESIGN

Through the sponsorship of Friendship Bridge, we traveled to Hanoi and Ho Chi Minh City, Vietnam, in January 1994. By visiting hospitals and medical centers in each city, we observed how economic, demographic and social factors affected cytopathology practice.

RESULTS

In Vietnam, the resources of the medical system, cytopathology in particular, are devoted to diagnosis rather than prevention. Consequently, screening tests, such as the Papanicolaou smear for the detection of cervical-vaginal lesions, are not performed on a routine basis. There are regional differences in Vietnam in the employment of common techniques, such as fine needle aspiration biopsy.

CONCLUSION

Although limited in funds, cytopathology is widely practiced and serves an important role in the medical system of Vietnam.

Optimising the conditions for isolation of Mycoplasma gallisepticum collected on applicator swabs

An experiment to compare the recovery of Mycoplasma gallisepticum (Mg) on dry swabs and swabs wet with mycoplasma broth (MB) was carried out by swabbing choanal clefts of Mg infected turkey poults at days 3, 6, 9, 12 post-infection. Wet swabs yielded significantly greater numbers of mycoplasmas than dry swabs on three out of four sampling days. When low numbers of mycoplasmas were collected on wet or dry swabs (in vitro) and then stored at room temperature (RT) or 4 degrees C for various intervals, those on dry swabs at RT had lost viability by 8 to 24 h. They survived at least 24 h on wet swabs kept at 4 degrees C. When Mg was collected and stored on dry and wet swabs from experimentally infected poults survival was again best on wet swabs stored at 4 degrees C. Swabs pre-wet with MB and stored before sampling could be used without any ill effects on mycoplasma recovery as long as they were stored at 4 degrees C and for no more than 48 h. After storage at RT for 48 h such swabs appeared to be detrimental to the organism. Mg collected on wet charcoal swabs was viable for 48 to 72 h when kept at 4 degrees C whereas it was viable for only 24 h when stored at RT. Mg was recovered from wet charcoal swabs sent through the mail but not from dry or wet plain swabs.

The effectiveness of the Masterson curette in sampling the endometrial cavity

The Masterson curette was used to sample the endometrial cavity of 25 women prior to scheduled hysterectomy for benign or malignant pathology. Adequate amount of tissue was obtained in 20 (87%) of 23 patients who did not have endometrial atrophy. The Masterson curettage detected all seven cases of endometrial hyperplasia or adenocarcinoma for a sensitivity of 100%. However, the Masterson curette does not sample the entire endometrial cavity. If abnormal uterine bleeding persists despite normal histology on curettings obtained with the Masterson or other endometrial sampling device, hysteroscopy is recommended.

[The fine-needle aspiration cytology of lymph nodes suspected of malignancy. Its diagnostic value and capacity to predict the histogenesis]

To examine the usefulness of fine needle aspiration cytology in the investigation of patients with enlarged lymph nodes, the authors made a retrospective evaluation of the results of 1158 aspirations in 838 patients (630 male, 208 female, mean age 44 [4-90] years). In these 1158 cases the diagnosis was verified histologically, serologically or by follow up extending over at least six months. In 94.6% (n = 1096) the aspirate gave an unequivocal diagnosis, in 4.2% (n = 48) the diagnosis was equivocal and in 1.2% (n = 14) no diagnosis was reached. There were 773 correct malignant results, 368 correct benign results and 16 false benign; in one case the assessment was false malignant. Sensitivity was 98% and specificity 99.7%. In benign lymphadenopathies the investigation achieved a specificity of 99.7%, and in metastases and malignant lymphomas the sensitivity was 97.8% and 98.2% respectively. In 211 out of 286 aspirations the cytological diagnosis correctly predicted the subsequent histological diagnosis; in 58 cases correct though imprecise expressions such as "highly malignant non-Hodgkin's lymphoma" were employed. No serious complications were encountered. Fine needle aspiration cytology enables the clinician to devise an exact diagnostic and therapeutic plan in nearly every patient with unexplained lymph node enlargement.

Assessment of an ultrathin bronchoscope that allows cytodiagnosis of small airways

We developed a new type of bronchoscope (BF-2.7T) and cytology brush (BC-0.7T) that permit collection of pulmonary cells during direct observation of the small airways. This kind of cell collection has been previously impossible. With our cytology brush, 3.58 +/- 2.76 x 10(4) cells were collected from small airways. The rate of living cells was 33.13 +/- 3.61 percent from the small airways. Analysis of endoscopic findings and investigation of pulmonary cells are very important for elucidating the pathophysiologic state of the small airways. The use of the BF-2.7T allowed collection of cancer cells under direct endoscopic vision in all five patients with peripheral lung cancer. They also contribute to our understanding of the relationship between exogenous factors and cells that compose the lung, and will provide means for treatment and prevention of diseases.