[The role of stereotactic radiography in nonpalpable breast lesions. The authors' own experience]

Stereotaxis is a well-known technique allowing fine-needle aspiration cytology and preoperative localization of the nonpalpable breast lesions seen on mammograms, permitting early diagnosis and easy surgical ablation. The authors report on their experience (126 cases) with stereotactic aspiration (85 cases) and preoperative localization (41 cases) of nonpalpable lesions. The technique allowed to hit the lesion in 115/126 cases (91.3%). Cytology showed 24 cases of cancer and 38 benign lesions (3 of them were false negatives); in 8 cases cytology was suspect (7 cancers and 1 sclerosing adenosis) and in 15 inadequate (17.7%). Sensitivity and specificity were confirmed by histology or follow-up (6 months + 6 months); sensitivity was 91.2% and specificity 97.2% (excluding inadequate cases). The 41 needle localizers were useful to detect 37 malignancies. Fifty-one lesions were biopsied: 37 of them were malignant and 14 benign (benign/malignant ratio = 0.38/1).

Prospective evaluation of optimal number of biopsy specimens and brush cytology in the diagnosis of cancer of the colorectum

We prospectively studied the diagnostic accuracy of endoscopic biopsy and cytology in the diagnosis of colorectal cancer and sought to ascertain the optimal number of biopsy specimens that should be taken. Seventy consecutive patients with colorectal masses or polypoid lesions that could not be removed by endoscopic polypectomy and which were referred for surgery were studied. Lesions were first brushed for cytology. A series of 10 biopsies were then obtained from each lesion; the first four were placed into the first container, and two were placed into each of three other containers. Cytology and biopsies were read blindly by one pathologist. Findings were compared with the resection specimen results. Ten lesions were benign; all had negative biopsies and cytology. Sixty lesions were malignant: cytology was positive in 77.2% and biopsies in 78.3%. The yield was increased to 91.7% when both were done (cytology plus six biopsies). Cytology detected seven cancers that were missed by biopsy. Biopsy detected eight cancers not diagnosed by cytology. Five cancers were missed by both. Of the 47 cancers detected by biopsy, the first four biopsies made the diagnosis in 41 cases. Taking two more biopsies (six total) identified six more cancers. No additional cancers were identified by taking more biopsies (eight or 10 total). When six different biopsy-cytology strategies were examined: 1) cytology alone, 2) four biopsies (Bx), 3) six Bx, 4) 10 Bx, 5) cytology + four Bx, and 6) cytology + six Bx, the yield was 77.2%, 68.3%, 78.3%, 78.3%, 90.0%, and 91.7%, respectively. We conclude that biopsy and cytology are complementary in the diagnosis of colorectal cancer. The combination of cytology and four to six biopsies is recommended. There appears to be little additional yield to taking more than six biopsies. Even combined biopsy and cytology will miss 8-10% of cancers.

[The cytological possibilities for the early diagnosis of neuroleukemia]

The authors present the results of analyses of 425 samples of the cerebrospinal fluid from 67 patients with acute leukemia and from 30 ones with chronic myeloleukemia, carried out by the sedimentation method. This method permits concentration of the cells on a small site of the slide, involving the minimal injury to the cells, and thus helps obtain the cellular picture of the liquor, available for morphologic analysis. Detection in the sedimentation preparations with normal parameters of liquor cytosis of the blast cells in patients with acute leukemia and of the entire spectrum of maturing granulocytes with blasts in chronic myeloleukemia patients permits the diagnosis of the preclinical stage of neuroleukemia and thus helps detect the patients, for whom all the measures, included in the neuroleukemia prevention program, are absolutely obligatory and whose cerebrospinal fluid cellular composition should be regularly checked up.

[Cytometry and the degree of differentiation of squamous-cell lung cancer]

Cytometric studies of samples from 65 patients (20 with well-differentiated carcinoma, 32 with moderately differentiated and 13 with poorly differentiated tumors), carried out with the Integral-2MT cytoanalyzer, have shown an inverse relationship between the size of the nuclei, nuclear-cytoplasmatic ratio, and the degree of pulmonary carcinoma differentiation. The results of the study will promote a more objective assessment of carcinoma cells and will improve the efficacy of cytologic diagnosis of squamous cell carcinoma of various differentiation degrees.

Use of cotton-tipped applicators during skin examination and dermatologic surgery

The cotton-tipped applicator is a widely available and versatile tool for the dermatologist. In addition to the common uses of this inexpensive tool there are many other ways for the dermatologist to use cotton-tipped applicators. From its usefulness in dermatologic examination and potassium hydroxide preparations to its multiple surgical applications, the cotton-tipped applicator is a valuable and underrated tool.

Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique

BACKGROUND

Although cytologic examination of pure pancreatic juice obtained with a duodenofiberscope has been useful for the diagnosis of pancreatic carcinoma, the rate of false-negative results is reported to be high. To eliminate these false-negative results, the authors developed a new technique, endoscopic retrograde intraductal catheter aspiration cytology, especially for an accurate cytologic diagnosis of carcinoma of the body or tail of the pancreas.

METHODS

The accuracy of conventional cytologic examination of pure pancreatic juice was assessed in 25 patients with pancreatic carcinoma, 29 patients with pancreatitis, and 52 control subjects. Pure pancreatic juice was collected from the pancreatic duct by endoscopic cannulation using a videoimaging duodenoscope after intravenous administration of secretin. The new endoscopic retrograde intraductal catheter aspiration technique was used in four patients with carcinoma of the body or tail of the pancreas and five patients with localized pancreatitis in whom a correct diagnosis was not made by previous cytologic examination of pure pancreatic juice.

RESULTS

Positive cytologic findings were obtained in 76% of the patients with pancreatic carcinoma. Positive cytologic results were more frequent in patients with carcinoma of the head of the pancreas than in those with carcinoma of the body or tail. By the new technique, positive cytologic results were obtained in all of the patients with pancreatic carcinoma. This technique caused no severe complications.

CONCLUSIONS

This procedure of endoscopic retrograde intraductal catheter aspiration cytology seems useful for diagnosis of pancreatic carcinoma.

Inexpensive population screening for abnormal cells from the uterine cervix and valid results using the vaginal cytopipette

Women who have not accepted an invitation by their own general practitioner to have a smear test, or for whom voluntary population screening projects are unavailable because of lack of public funds, may be at increased risk of malignant cervical changes. Such women may be offered self-testing by a cytopipette on the basis of the present analysis of abnormal cell counts and cell density on the cytological slides. As one link in a prophylactic study using the cytopipette, 107 women with abnormal cell findings were reinvited for simultaneous sampling by irrigation smear and by ordinary technique. The cytological findings indicate that the two methods are equal in recovery of abnormal epithelium, provided that the scanned quantity of cells is increased fourfold in the irrigation smear method, this quantity being distributed over two specimens each with double cell density and giving at least 1800 squamous epithelial cells per visual field (125:1) or a total of approximately 10(6) epithelial cells in each cytological specimen. Under these conditions the two sampling methods have the same predictive value.

Elastic plastic tube for detecting exfoliative cancer cells in the esophagus

A simple device for sampling esophageal lesions is described. The instrument, which is easy and inexpensive to make, consists of a single-lumen plastic tube covered with cotton thread. Once swallowed, the end of the tube can be drawn into a loop. The device has been used at locations with a high incidence of esophageal cancer and at our tumor hospital. A series of 746 cases examined had no complications. The tube has a positive diagnostic rate comparable to that of roentgenography, 96%, and seemed acceptable to both physicians and patients. When an obstruction is present, the instrument can easily pass through it and obtain exfoliated cancer cells, while the conventional method, the balloon cytologic smear, is unable to do so.

Value of direct fine needle aspirative cytology in diagnosing palpable abdominal masses

PURPOSE

Fine needle aspirative cytology is a well-established diagnostic tool for evaluating tumor masses. The goal of the current study was to determine the diagnostic accuracy of direct (nonimaging-guided) fine needle aspiration of palpable abdominal masses excluding the liver.

PATIENTS AND METHODS

Direct aspiration of a palpable abdominal mass was performed in 190 patients in order to confirm or to rule out malignancy. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 165 patients, of whom 130 had a malignant abdominal mass and 35 a benign abdominal mass. The cytologic findings were verified by correlation with histologic, cytologic, and clinical findings.

RESULTS

Among the 130 patients with a malignant abdominal mass, the cytologic findings failed to reveal malignancy in 12 patients (9.2%), but did reveal suspected malignancy in five (3.8%) and malignancy in 113 patients (86.9%). Among all 35 patients with a benign abdominal mass, the cytologic findings were reported as nonmalignant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of cytologic findings were 90.8%, 100%, 100%, 74.5%, and 92.7%, respectively. A nonfatal case of bile peritonitis and a case of localized peritonitis that, in retrospective, could have been avoided were the only major complications that followed the fine needle aspirative procedure.

CONCLUSION

With careful patient selection and meticulous attention to the proper procedure, direct fine needle cytology is a simple, safe, and highly accurate method for diagnosing palpable abdominal masses.

The cytological diagnosis of nasopharyngeal carcinoma using a silk swab stick

A prospective study was carried out to investigate the efficacy of exfoliative cytology for the diagnosis of nasopharyngeal carcinoma. Exfoliated nasopharyngeal cells were collected from patients with a clinical suspicion of carcinoma by scraping the nasopharyngeal mucosa with a piece of silk wrapped around one end of a wooden stick. Ninety-eight patients were investigated in this manner, and the results of cytological investigation compared with the histological findings. The sensitivity of cytological investigation was 71% and the overall accuracy was 86%. The combined use of cytology and serology as a method of screening for nasopharyngeal carcinomas is discussed.

Long distance image transfer: first results of its use in histopathological diagnosis

Histopathological images were transferred by use of normal telephone lines between three pathology institutes located in three different cities in the FRG. Images were digitized using a colour TV camera and stored in a special computerized image transmission system. The stored image was transferred and visualized on a (receiver) colour TV screen after dialing the telephone number connected to the receiver image transmission system. An additional telephone dialogue was activated by use of a normal acoustic telephone, and the diagnostic difficulties of the underlying image were discussed. Diagnostic assistance was possible in all transferred cases as well as histopathological diagnosis. Resolution of the images was set at 512 x 512 pixel x 8 bit. Image transfer time was 3.2 min on average. The differences between the original and transferred image were measured by "retransfer" of the original image and by subtracting the two images from each other. No major transfer errors could be measured.

Analysis of rare high-DNA cell populations in serous effusions using continuous-motion imaging

The rare high-DNA cell sub-populations in a series of serous effusion specimens were analysed to determine whether such measurements could provide a basis for the improved diagnosis of malignancy. Monolayer specimens stained with gallocyanin chrome-alum were scanned with the CERVIFIP continuous-motion image analyser to locate and measure the highest-DNA cells in the sample. Two types of features were obtained for the detected sub-populations; firstly, 'percentile ploidy' values which characterise the ploidy levels above which specified proportions of the total cells are found; and secondly 'percentage abnormal' values which characterise the proportion of the cells diagnosed as malignant during examination by a cytopathologist. The classification accuracy for one or both of these features was then obtained by comparison with the clinical outcome of each patient. The results gave a classification error of 9/44 (20%) using the 0.01% percentile ploidy alone, 6/44 (14%) using the 75% percentage abnormal feature alone, but only 2/44 (5%) from a box discriminant using both features. It was therefore concluded that the analysis of the high-DNA cell population could be of value in the diagnosis of malignancy in serous effusion specimens.

Advances in the use of fine-needle aspiration cytology in the diagnosis of palpable lesions of the head and neck

Our experience in performing fine-needle aspiration for the investigation of palpable lesions of the head and neck region is reviewed. Three hundred cases were performed over a period of approximately two years. In most circumstances, a diagnosis could be rendered simply on the basis of routine cytomorphologic interpretation. In some situations, it was necessary to employ ancillary techniques such as immunoperoxidase staining, electron microscopy, and flow cytometry to confirm the morphologic diagnosis. Several cases illustrating the clinical utility of the technique are presented in detail. Fine-needle aspiration is a relatively atraumatic, well-tolerated procedure which can be readily performed in the usual outpatient setting. This technique is an excellent first-line method for investigating the nature of palpable lesions in the head and neck region.

FDA regulation of computerized cytology devices

When talking about computerized cytology devices, a "different" aspect of quality assurance must be addressed. Any medical device intended for in vitro diagnostic use in the United States must be cleared or approved by the Food and Drug Administration (FDA): the May 28, 1976, Medical Device Amendments to the Federal Food, Drug and Cosmetic Act granted authority to the FDA to regulate medical devices. The FDA regulatory process as it relates to computerized cytology devices is discussed. This includes an explanation of the differences between the two types of documents used to clear a medical device: (1) premarket notification [510(k)] and (2) premarket approval (PMA) application. Devices intended for "research use only" are also discussed. A computerized cytology device of current interest, the "automated Pap smear reader," is used as an example to further discuss performance and software considerations.

Endoscopic retrograde brush cytology. A new technique

Endoscopic retrograde cholangiopancreatography has been shown to be a very valuable adjunct in the diagnosis of malignancy involving the biliary and/or pancreatic ductal system. However, characteristic endoscopic retrograde cholangiopancreatography radiographic findings associated with malignant strictures are frequently not specific and cytological confirmation becomes essential for the diagnosis. Unfortunately, the current overall diagnostic yield of positive cytology in such circumstances ranges from 18%-56% depending on the technique. A new brush device has been designed which is uniquely adapted to pancreaticobiliary strictures of varying anatomical configurations. This study shows results using this new cytology brush in a series of 53 patients with pancreaticobiliary malignancy. A significant improvement in the cytological yield of tumor confirmation was obtained with a diagnostic sensitivity of 70% and specificity of 100% using the new brush technique.

Use of cervical Cytobrush samples for dot-blot detection and Southern blot typing of human papillomaviruses using subgenomic probes

The use of Cytobrush samples for the detection and typing of cervical human papillomavirus (HPV) infections was analyzed. The average yield of squamous cells from Cytobrush samples was on the order of 10(6) cells when the sample was collected in a lytic collection buffer, which was approximately double the content of (1) samples collected in ethanol and (2) an average biopsy specimen. The material obtained could be used for sensitive detection and typing of HPV infections using, respectively, a nonradioactive dot-blot method and the Southern blot procedure performed with subgenomic probes, which permitted a simple interpretation even in cases of mixed infections. A sample containing at least 500,000 viral copies was required for the detection and typing. At this level of sensitivity, the frequencies of HPV obtained in different risk groups varied from 6% (in "healthy" young women) to 53% (in women with abnormal cytologic findings in simultaneous smears). The noninvasive nature of the sampling procedure and the relative simplicity of the test should allow this method to be applied in large-scale studies.