RESUMO
In a prospective study at the University Hospital of the West Indies, 187 fine needle aspiration cytology (FNAC) specimens, comprising 100 breast, 75 head and neck, and 12 miscellaneous specimens, were subjected to rapid Papanicolaou staining and immediate assessment. Inadequate aspirates were repeated, and all cases were also evaluated after routine Papanicolaou staining. Histologic and clinical follow-up data were obtained. The overall concordance between rapid and routine cytologic diagnoses ranged from 79% to 87% for the three specimen cohorts. Sensitivity and specificity values were similar for rapid and routine-stained slides and ranged from 80% to 100%. There were no false positive or false negative diagnoses in the cases for which the outcome was known. Rapid staining of cytologic smears is a useful adjunct to the evaluation of aspirated material, improving adequacy rates and overall performance of the FNAC service, and should also result in significant savings in time and cost to patients.
Assuntos
Neoplasias da Mama/patologia , Neoplasias de Cabeça e Pescoço/patologia , Hospitais Universitários , Neoplasias Pulmonares/patologia , Coloração e Rotulagem , Biópsia por Agulha , Neoplasias da Mama/diagnóstico , Citodiagnóstico , Reações Falso-Positivas , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , Índias OcidentaisRESUMO
In a prospective study at the University Hospital of the West Indies, 187 fine needle aspiration cytology (FNAC) specimens, comprising 100 breast, 75 head and neck, and 12 miscellaneous specimens, were subjected to rapid Papanicolaou staining and immediate assessment. Inadequate aspirates were repeated, and all cases were also evaluated after routine Papanicolaou staining. Histologic and clinical follow-up data were obtained. The overall concordance between rapid and routine cytologic diagnoses ranged from 79 to 87 for the three specimen cohorts. Sensitivity and specificity values were similar for rapid and routine-stained slides and ranged from 80 to 100. There were no false positive or false negative diagnoses in the cases for which the outcome was known. Rapid staining of cytologic smears is a useful adjunct to the evaluation of aspirated material, improving adequacy rates and overall performance of the FNAC service, and should also result in significant savings in time and cost to patients
Assuntos
Humanos , Masculino , Feminino , Coloração e Rotulagem , Hospitais Universitários , Neoplasias da Mama/patologia , Neoplasias Pulmonares/patologia , Neoplasias de Cabeça e Pescoço/patologia , Biópsia por Agulha , Citodiagnóstico , Estudos Prospectivos , Neoplasias da Mama/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Seguimentos , Sensibilidade e Especificidade , Índias OcidentaisRESUMO
OBJECTIVE: Our aim was to document the distribution of epithelial abnormalities diagnosed on Pap smears in the Department of Pathology, the University of the West Indies (UWI), Mona, Jamaica, and to determine the likelihood of the prescence of clinically significant disease on biopsy for a given cytological diagnosis. METHODS: We reviewed the results of all Pap smears accessioned in the Cytology Unit of the Department of Pathology, over the 3-year period 1997-1999 and collated the epithelial abnormalities using a hybrid cervical intraepithelial neoplasia (CIN)/Bethesda system. We calculated the atypical squamous cells of undetermined significance (ASCUS) rate, the CIN rate and the ASCUS/CIN ratio. Follow-up histology results were obtained from the departmental files. The likelihood ratios (LRs for clinically significant disease on histology for each cytological category were calculated. RESULTS: During the study period a total of 21,144 Pap smears were accessioned, 1,324 (6.3 percent) of which showed epithelial abnormalities. These abnormal Pap smears were most prevalent in the 21-30 year age group (37.5 percent of patients). The distribution of epithelial abnormalities was: ASCUS 34.7 percent, atypical glandular cells of undetermined significance (ASCUS) 1.1 percent, ASCUS/AGUS 0.2 percent, CIN 141.4 percent, CIN II 12.5 percent, CIN III 8.3 percent, sqaumous cell carcinoma (SCC) 1.3 percent, adenocarcinoma (AC) 0.3 percent and vaginal intraepithelial neoplasia (VAIN) II/III 0.2 percent. The CIN rate, ASCUS rate and ASUCS/CIN ratio were 3.9 percent, 2.2 percent and 0.6 respectively. Histological follow-up was available for 477 (36 percent) cases. The LRs for clinically significant disease for the following cytological diagnoses were: AGUS: 0.08, ASCUS: 0.31, CIN I: 1.12, CIN II: 2.01 and CIN III: 3.38. All cases of SCC, AC and VAIN with histological follow-up were shown to be clinically significant. CONCLUSIONS: There was a relatively low incidence of epithelial abnormalities in Pap smears seen at the UWI during the study period with ASCUS and CIN 1 compromising the majority of cases. Biopsy follow-up showed an increasing likelihood for the presence of clinically significnat disease with increasing degrees of epithelial atypia on Pap smear. (AU)
Assuntos
Adulto , Feminino , Humanos , Esfregaço Vaginal , Células Epiteliais/patologia , Displasia do Colo do Útero/epidemiologia , Jamaica , SeguimentosRESUMO
OBJECTIVE: The aim was to determine the efficacy of the rapid Papanicolaou staining method (RPSM) in fine needle aspiration (FNA) cytology of breast lesions. METHODS: In a prospective study performed between May 1999 and June 2000, FNA specimens were obtained from patients attending the surgical out-patient and breast imaging services of the UHWI for the assessment of breast leisons. One-half of the slides from each specimen were stained by the RPSM, which reduces routine staining time by 80 percent (rapPaps), and the other half stained by the routine Papanicolaou method (routPaps). Specimens that were inadequate based on rapid assessment were immediately repeated. For each group of slides the smear quality, cytologic diagnoses and results of any related biopsy specimens were documented. The concordance between the cytology diagnoses and between the cytologic and histologic diagnoses was determined. RESULTS: One hundred specimens were obtained from 90 patients (M:F = 1:8; average age 42.3 years). RapPaps averaged 2.9 slides per case and routPaps 3.4; 71 percent and 77 percent of rapPaps and routPaps, respectively, had adequate cellular material, and 84 percent and 85 percent of these groups, respectively, displayed satisfactory cellular preservation. There was 83 percent, 52 percent and 56 percent concordance between rapid and routine cytologic diagnoses, rapid and histologic diagnoses, and routine and histology diagnoses, respectively. Non-concordance was due to lack of cellular material in 14/17 (82 percent), 12/23 (52 percent) and 10/21 (48 percent) cases, respectively. Of the remainder, 6 cases represented major diagnostic discrepancies in which atypical cytologic smears were confirmed to be benign lesions on histology. CONCLUSION: These findings show that staining FNA specimens by the rapid Papanicolaou method allows for accurate cytology evaluation of breast leisons at UHWI. The handling of cytologic specimens by this method can be an important cost- and time- saving strategy in the management of patients presenting to the out-patient services. (Au)