Suction sampling technique for obtaining standardized cytologic specimens from the oral mucosa

To enhance the value of exfoliative cytology for the study of the oral mucosa, a simple apparatus was developed to permit adequate sampling of a specific site so that samples collected on different occasions could be compared. The device essentially consists of a collecting cup connected to a blood collection evacuation system. The collecting cup is a modified female half of a stainless-steel filter holder supporting a 13-mm-diameter cellulose filter of 0.05-microns pore size. Suction pressure is applied by means of a 10-mL glass tube of premeasured vacuum. After positioning the collecting cup on the selected site on the buccal mucosa, the vacuum (440 mm Hg) is applied for five seconds. The mucosa is drawn in against the filter, producing a monolayered imprint of cells. This sample may be disengaged from the filter by agitation into a solution; this allows quantitative cytologic studies, such as the measurement of cell numbers by an electronic counter or the estimation of the areas of cells and nuclei by computer-aided image analysis of Cytospin preparations. Five separate samplings from each of three test subjects produced a harvest of 3,000 to 7,000 epithelial cells per sample; the cellular areas ranged from 784 to 1,052 sq microns while the nuclear areas ranged from 18.4 to 21.8 sq microns.

Components of image intensive diagnosis. Codifying visual features for effusion cytology

Components of visual assessment in the diagnosis of effusions were analyzed using relative operating characteristic. Diagnostic performance in the assessment of malignancy and the specification of metastatic origin was measured for two expert cytologists. The component of performance attributable to feature interpretation was measured in protocols which minimized the effects of clinical information and visual search in the decision process. Feature interpretation, as a process, contributed significantly to the evaluation of malignancy and marginally to the specification of metastatic origin. For each of these diagnostic tasks, the process of feature interpretation was codified in the construction of explicit models. The expert cytologists were asked to define a set of localized visual features that incorporate essential visual elements for diagnosis. These features were evaluated for a set of test cases, and regression models were constructed defining malignancy and metastatic origin. Relative operating characteristic analysis indicated that the predictive value of the models for diagnosis was very similar to the component of human performance attributable to feature interpretation.

Endoscopic retrograde wire-guided brush cytology for diagnosis of patients with malignant obstruction of the bile duct

A brush was adapted for use over a guide wire to facilitate reliable acquisition of cytological specimens from tight and potentially malignant strictures encountered during ERCP. Cells collected in this manner were assessed for abnormalities indicative of cancer. We have called this technique endoscopic retrograde wire-guided brush cytology (ERWBC). Thirty-nine strictures (24 malignant, 15 benign) in 34 patients were brushed. There were no complications, and all specimens were adequate for evaluation. Sixty percent of patients with cancer were diagnosed by ERWBC. Sensitivity was highest for cholangiocarcinoma (100%), intermediate for pancreatic cancer (60%), and lowest for patients with biliary obstruction due to metastatic disease (22%). There were no false-positive results (specificity, 100%). The positive and negative predictive values were 100% and 58%, respectively, and accuracy for the test was 72%. Collection of cytological specimens using a brush with a wire guide is effective especially for diagnosis of cholangiocarcinoma. A positive result is sufficient evidence for malignancy, and other invasive diagnostic tests are unnecessary. We recommend ERWBC for brushing all strictures of unknown cause during ERCP in an effort to make a diagnosis of cancer.

[Ultrasonically guided fine-needle puncture. The limits of the method in the abdomen and retroperitoneal space]

The sensitivity and specificity of ultrasound-directed fine-needle biopsy in the differentiation of malignancy or otherwise of structures in the abdomen or retroperitoneal space which look suspicious on ultrasound was evaluated from results in 558 patients (306 men, 252 women). Data from two different centres were used to characterize further the influence of different techniques of puncture, cytopathologists and groups of patients on the validity of the examination. Sensitivity (in the two centres) was 88 and 80%, respectively, specificity 100 and 99%. The validity of the examination was the same at both centres. In both centres the sensitivity was worst for pancreatic tissue, at only 72 and 61% respectively, compared with other organs (e.g. liver, lymph nodes, kidney) (P less than 0.05). Fine-needle biopsy of abdominal and retroperitoneal organs will thus be subject to a not insignificant number of false-negative results of cytological examination.

Brush cytology evaluation of lesions encountered during ERCP

Malignant obstruction of the pancreaticobiliary system is a frequent indication for ERCP. Twenty-five patients with abnormalities suggestive of malignancy were encountered during ERCP at our institution and brush cytology was obtained. Positive cytology specimens were collected in 12 of 20 (60%) cases of malignancy causing biliary obstruction. Using a recently developed cytology brush for the biliary tree, detection of malignancy in strictures of the bile duct had a sensitivity of 50% and a specificity of 100%. Both cases of cholangiocarcinoma were diagnosed with cytology, as were 5 of 10 cases of pancreatic cancer. It is concluded that brush cytology is a diagnostically reliable, highly specific technique for malignant lesions encountered at ERCP. In experienced hands, a positive cytologic result may obviate the need for additional invasive diagnostic studies.

Percutaneous intralesional brushing of cystic lesions of bone: a technical improvement of diagnostic cytology

A modified bronchial brush is presented as a new cytologic method to improve the value of fine-needle aspiration biopsy in the diagnosis of cystic lesions of bone. Four female and six male patients ranging in age from 10 to 44 years were studied. In all cases intralesional brushing was percutaneously performed under fluoroscopic control with local anesthesia. Fine-needle aspiration biopsy preceded intralesional brushing and was performed as described elsewhere. The brush was driven into the walls and septa of an osteolytic lesion through a 14-G needle; material obtained was fixed and processed for cytological and/or histological examinations.

[Brush cytology for the evaluation of dry-eye]

A special brush was developed for collection of conjunctival cells with better integrity of the harvested specimens. Using this brush, cells were collected from temporal bulbar conjunctiva of 20 normal eyes and 40 eyes with dry-eye, and were stained by the modified Papanicolau method, Keratinized cells (K) and goblet cells (G) were classified into 5 categories, from (-) to ( ) according to the numbers of the cells observed. Normal eyes were categorized as K (-):16, K(+/-):4, G (+):2, G(++):18, Eyes with dry-eye were K (-):3, K (+/-):8, K (+) 13, K (++):11, K ( ):5, and G (-):7, G (+/-):7, G (+):22, G (++):4. Clinical severity and the rose Bengal score corresponded to these categories. This technique can detect cytological changes in conjunctival cells in terms of shape and quality of staining. Eyes with dry-eye could be evaluated in relation to the numbers of keratinized cells and goblet cells.

Cytobrush in evaluation of cervical dysplasia. Is cervical curettage necessary?

203 patients suspected of having dysplasia were evaluated by colposcopy, cytologic smear including cytobrush, endocervical curettage, biopsy and conization. The results obtained on the basis of the final cone suggested that directed biopsies and cytological smear by spatula and cytobrush more accurately define the dysplastic lesion than do biopsies and endocervical curettage. Conization seemed necessary for the evaluation of the cervical lesion in patients revealing non-classified dysplasia at successive examinations.

Combined use of brushing cytology and endoscopic retrograde pancreatography for the early detection of pancreatic cancer

Seventy-two cases of pancreatic cancer were examined by brushing cytology combined with endoscopic retrograde pancreatography. The results of this combined method were better than those reported for the exfoliative cytologic study of pancreatic fluid. The method detected a minute cancer of the main pancreatic duct that was not detected with any other method. The cells obtained by this technique had very well-preserved cytoplasm and nuclear chromatin, which facilitated making a correct diagnosis. Though this method can be applied only to the main pancreatic duct, it is effective for the diagnosis of ductal cell carcinoma, especially those located at the head of the pancreas, which is the most common site for pancreatic cancer. It is a safe procedure, with no complications seen in this series. The differentiation of carcinoma cells from the benign atypical cells of chronic pancreatitis is illustrated and emphasized.

Reliability and accuracy of Urotel test, a device for urinary cytology

Many steps are to be taken before a urinary specimen is cytologically examined. The physician can improve the cytologic results by providing the cytologist with the best possible cellular material collected and fixed in a standardized manner as by using the Urotel test. This is a plastic device prefilled with two fixatives. It means a two-step fixation and spontaneous sedimentation of cells to reduce the amount of liquid for easier and safer transportation from the doctors' offices and hospitals with no cytologic facilities to the diagnosing laboratory. The aim of this study was to obtain an estimate of the accuracy of the Urotel test. Based on 903 patients' first urinary specimen and the original diagnoses, this study indicates that the standardized handling with the device described may increase the possibility for the general practitioner to refer his or her patient, who has an early urothelial malignancy, to the urologist for a quick handling without any delay.

CYBEST Model 4. Automated cytologic screening system for uterine cancer utilizing image analysis processing

CYBEST (Cyto-Biologic Electronic Screening System) utilizes image analysis technology for the automated prescreening of cervical cytology specimens. CYBEST Model 3, which includes a television scan system and automatic shading control, achieved our initial goal of rapid specimen processing (no more than three minutes to achieve a final specimen assessment). This paper describes CYBEST Model 4, developed in 1981; with the minicomputer of Model 3 replaced by a microcomputer, Model 4 is considerably smaller, about the size of a business desk. A new parameter, the intranuclear configuration (chromatin pattern), was added to the four parameters used in Model 3. The five parameters now used for the assessment and ranking of cytologic abnormalities are nuclear size, nuclear-cytoplasmic ratio, nuclear optical absorption, nuclear shape and intranuclear configuration. The other features of Model 4 are almost the same as those of Model 3. As an optional function, individual parameter measurement data, assessment of atypicality grade and cell images can be displayed on the CRT monitor by pointing to a cell with a light pen system. After completion of screening of a specimen, the ten cells judged to be most abnormal can be called automatically into the microscope optical field or the CRT monitor (in order ranging from the cell with the highest atypicality rank down) along with their associated data and the system's assessment of the specimen. By connection to a small business computer, all data can be transferred to a floppy disk for later retrieval.

Diagnosis of endometrial carcinoma by histopathological examination of the endometrial aspirate by the Curity-Isaacs sampler

The Curity-Isaacs Endometrial Cell (CIEC) sampler was used for endometrial tissue and cell sampling in 230 patients before dilatation and curettage to determine the efficacy of its use as an outpatient endometrial sampler. Its use was found to be safe and without complication. It could be easily inserted into the uterine cavity in 92.0% of patients and did not cause undue discomfort in 88.9% of them. Using histopathological diagnostic techniques, there was 100% accuracy in the diagnosis of endometrial carcinoma. However, it was found that diagnostic accuracy of endometrial hyperplasia was only 33.3%. It is suggested that the CIEC sampler could be used as a first-line diagnostic procedure to exclude endometrial carcinoma in patients with abnormal vaginal bleeding.

Endometrial carcinoma diagnosed by the Gynoscann method

A simple method for screening of the endometrium is a desirable complement to the gynecological examination. Between February and June, 1984, 94 patients underwent cytological sampling by the Gynoscann method immediately before dilatation and curettage at the Department of Gynecological Oncology, Radiumhemmet, and at the Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm. Ninety-six per cent of the cytological samples were adequate for cytological diagnosis and the same proportion of the curettage specimens for histology. The correlation between cytology and histology was correct in 84% of the cases. Among the 26 cases of endometrial carcinoma, 21 (80%) were correctly diagnosed by cytology. There were no false-positive diagnoses for carcinoma. Atypical hyperplastic endometrium was found in 2 cases by curettage and was correctly correlated with cytology in one case. The sensitivity for endometrial carcinoma was 81% and the specificity 100%. Our conclusion is that the Gynoscann method is safe, easy to use and has proved reliable for the diagnosis of endometrial carcinoma. Further evaluation with larger series giving the cytopathologists increased experience is needed before optimal sensitivity can be achieved.

[Possibilities and departure points for quantitative cytologic evaluation of urothelial cells for cancer diagnosis using microscopic procedures and digital image processing]

Examination of exfoliated urothelial cells present in the urine has been shown to be useful by cytologists, but urinary cytology is not yet widely accepted for routine diagnostic purposes. The accuracy of urinary cytology is almost limited to high-grade transitional carcinoma (grade II-III), but is of limited value in the diagnosis of benign papilloma and low-grade tumors (grade I). The sensitivity of cytology would be increased from 50% to 80% by using a computer-based cytophotometric microscope, especially in differentiating grade I tumors.

Improved technique for the diagnosis of atypical nasopharyngeal cancer

This article presents an improved technique for the diagnosis of atypical nasopharyngeal carcinoma tumor at deep sites beneath mucosa. It includes: 1. using spherical gauze to rub the nasopharyngeal cavity for exfoliative cytology; 2. using 1% H2O2 stain in the nasopharyngeal cavity to direct biopsy for suspected early carcinoma; 3. using multiple-hole needle puncture in the nasopharynx. These methods are simple, safe, quick, and have a high positive rate.

Interpretation of endometrium obtained by the Endo-pap sampler and a clinical study of its use

Endometrical cytology sampling using the Endo-pap sampler is an inexpensive, painless, and simple procedure. Tissue microfragments obtained include surface epithelial sheets, gland segments, and stromal cell aggregates. Gland segments are critical for evaluation of the sample. Glands are dilated in hyperplasia and there is nuclear crowding with increase of chromatin and nucleoli. In adenocarcinoma there is loss of glands with marked nuclear enlargement and pleomorphism. An understanding of endometrial histomorphology and its correlation with cytology is essential for accurate interpretation. In 1027 ambulatory patients screened, no complications were observed and 92% of the samples were adequate for cytologic diagnosis. Tissue diagnosis was obtained in 173 cases. There were 36 adenocarcinomas, of which 34 (94%) were diagnosed cytologically. There were 16 hyperplasias, of which 5 (31%) were diagnosed cytologically. The Endo-pap sampler was found effective in detecting endometrial adenocarcinoma. Further studies are needed to determine its diagnostic effectiveness in hyperplasia.

A culture vessel for amniotic fluid cells allowing faster preparation of chromosome slides

A new culture vessel for amniotic fluid culture is presented (flaskette). It consists of a microscope slide, on top of which a culture chamber is mounted. Amniotic fluid cell cultures using in situ technique in the flaskette were compared to subcultured samples in ordinary (Falcon) tissue culture bottles. Working time was reduced by using this new culture vessel because of a very simple harvest procedure, allowing simultaneous harvest of 15 samples. The interval between amniocentesis and harvest was shorter for the in situ technique than for the subcultivation technique. The frequency of aneuploidy in individual metaphases was higher with the subcultivation technique, while there was no difference in the frequency of structural anomalies.

Efficacy of the Isaacs Endometrial Cell Sampler in the cytologic detection of endometrial abnormalities

The efficacy of the Isaacs Endometrial Cell Sampler to obtain specimens for cytologic examination to detect both hormonal disturbances and precursors of malignancy of the endometrium was assessed in 120 symptomatic women. Correlation of the cytologic results with the histologic diagnosis on curettage specimens showed a diagnostic accuracy of 96.3%. The cytologic criteria for diagnosing samples obtained with the Isaacs device are presented.