bluuebunny/crossref_metadata_2025_split huggingface dataset:
O‐3 A STUDY TO DETERMINE WHETHER THERE IS SIGNIFICANT CELL LOSS ON THE DISCARDED THINPREP BROOM WHEN USED FOR CERVICAL CYTOLOGY
Authors: Umana A. , Kubba A. A. , Dunsmore H. , Kokhan A. R. , Herbert A. 
Published: August 2006

Introduction:  The aims of this study were to find out whether cells could be lost on the discarded ThinPrep (TP) broom. A similar study with SurePath (SP), whose methodology recommends leaving the broom in the vial, showed that cells were lost if the broom was discarded and that the amount was operator dependent.1Methods:  Three experienced colposcopists (C1, C2 and C3) collected TP samples from 306 women. The broom was rinsed thoroughly in a vial (V1) and then rinsed and retained in a second vial (V2). Slides from each case were randomised as A or B to conceal whether they were from V1 or V2, double‐screened and a cytological diagnosis and cell count recorded for each one. Cells were counted in 10 high‐power fields (HPF) and the cellularity classified as follows: high (HC) > 20 per HPF, intermediate (IC) 10–20 per HPF and low (LC) <10 in order to quantitate the cells potentially discarded in V2.Results:  The percentages with high‐grade and low‐grade abnormal cytology decreased with the degree of cellularity of the slide. Abnormal cytology was found in 96/133 (72.2%) of HC, 85/131 (64.9%) of IC and 15/42 (35.7%) of LC in V1 and in 5/8 (62.5%) of HC, 35/54 (64.8%) of IC and 86/244 (35.2%) of LC in V2. The cellularity of V2 was HC or IC in 62/306 (20.3%) and varied between the colposcopists: C1 39/109 (35.8%); C2 20/103 (19.4%); C3 3/94 (3.2%). C1 would have discarded the most cells but had the lowest percentage with LC in V1: 9/109 (8.3%) while the average was 42/306 (13/7%). Abnormal cytology in V2 was also found in V1 in 113/126 (89.1%).Discussion:  Abnormal cells would have been discarded with the TP broom and the amount varied between the colposcopists. This finding could have an affect on adequacy of the sample used for routine diagnosis.Reference:  1. Bigras G, Rieder MA, Lambercy J‐M et al. Keeping collecting device in liquid medium is mandatory to ensure optimized liquid‐based cervical cytology sampling. J Lower Genital Tract Dis 2003;7:168–74.
O‐5 UNIDIRECTIONAL VERSUS BIDIRECTIONAL SCREENING OF SUREPATH® LIQUID BASED CYTOLOGY SLIDES –PITFALLS & PERILS OF STUDY DESIGN
Authors: Holbrook M. , Roebuck J. , Rana D. N. , Marshall J. , Roberts S. , Desai M. 
Published: August 2006

Background:  Liquid based cytology (LBC) is the method of choice for the processing of samples in the cervical screening programme in England and Wales. Two LBC systems are in use; ThinPrep® and SurePath®. The manufacturers of SurePath® recommend that slides are screened in two separate directions perpendicular to each other (bidirectional screening) during the initial learning period. There is currently no evidence to evaluate whether this method is superior to screening in one direction only (unidirectional).Objectives:  To compare the detection rate of high‐grade dyskaryosis in SurePath® preparations between screeners who used a unidirectional method and screeners who used a bidirectional method, to see if the screening method influenced detection rate.Methods:  A questionnaire was sent to 23 screening staff at our Cytology Centre in October 2005, enquiring as to the method they used to screen SurePath® slides, as well as the grade of staff and the number of years experience they had screening cervical cytology slides. The staff were divided into two groups based on whether they screened unidirectionally or bidirectionally. A retrospective computerised search of all the slides screened by the staff for the period September 2004 to August 2005 was carried out, and the high‐grade detection rate at primary screening for the groups were calculated. Further analysis was carried out to determine the statistical significance of any difference between the two groups, as well as to account for potential confounding factors.Results:  Initial results suggesting a statistically significant difference between the screening methods were later shown to be confounded by experience. Critical analysis of the data and study design reveal that no firm conclusions can be made on the basis of this work.Conclusion:  No firm conclusions on screening method can be drawn due to fundamental limitations and confounding factors in this retrospective work‐based study. Recommendations for further studies are made, controlling for confounding factors.
O‐8 FALSE NEGATIVE BRONCHIAL CYTOLOGY
Authors: Feeley L. , Royston D. 
Published: August 2006

Introduction and Aims:  The sensitivity of bronchial cytology (brushings, washings) is in the region of 70–80%. Therefore a significant number of false negatives occur. The main aims of this study were to: (i) To identify negative bronchial washings and brushings performed in 2004 with malignant follow‐up and (ii) To ascertain the cause of the false negative result where possible. 56 patients with negative bronchial cytology and subsequent malignant follow‐up on a pulmonary specimen were identified. These cases formed the basis of the study.Results:  In our series peripheral tumour location and specimen inadequacy accounted for the majority of false negative results. Malignant cells were missed in a minority of cases (5 of 56). An explanation for failure of diagnosis in 4 of the 5 cases was paucity of malignant cells. In one case of small cell carcinoma, malignant cells were abundant, but were not recognized.Recommendations:  What can be done to reduce the false negative rate?(1) In cases where radiology has indicated that the tumour is peripherally located patients could proceed directly to fine needle aspiration.(2) Improved communication between clinicians and pathologists is required in relation to: (a) specimen adequacy and (b) degree of clinical suspicion.
O‐9 AUDIT ON BK VIRUS DETECTION IN RENAL TRANSPLANT RECIPIENTS
Authors: Bhatt N. , McDermott N. , Young M. 
Published: August 2006

Introduction:  BK virus nephropathy is an emerging cause of renal transplant failure accounting for allograft loss in 45–50% of recipients between 2–60 months post‐transplantation. The Renal Transplant Unit in Royal Free Hospital has devised a local surveillance programme for screening renal transplant patients at weekly intervals by urinary cytology (UC) and electron microscopy (EM), and confirmation of positive results by plasma PCR and allograft biopsy.Objective:  (i) To monitor the implementation of local guidelines; (ii) To compare UC with EM and (iii) To identify areas for improvement.Methods:  Decoy cell and EM positive cases were retrieved from the WinPath database for new renal transplant recipients (n = 55) during 1st November 2004 to 31st October 2005 in Royal Free Hospital. Plasma PCR was retrieved for positive cases.Results:  Up to eight samples were sent for UC at random intervals from 47 patients, and up to 7 were sent for EM from 42 patients. Eleven were UC‐positive and one was EM‐positive. PCR was not requested in UC‐positive cases and 3 out of 10 were positive retrospectively. The EM‐positive case was PCR‐positive but UC‐negative.Discussion:  Urine Cytology is more appropriate and cost effective for screening than Electron Microscopy. During the period covered by this audit, samples were sent in an inconsistent fashion after allograft dysfunction rather than for screening. A screening protocol has been agreed and a re‐audit is planned.
P‐10 TO LYSE OR NOT TO LYSE?
Authors: McQueen F. , Fiddler J. 
Published: August 2006

Introduction:  A glacial acetic acid wash performed retrospectively or prospectively on visibly bloodstained cervical ThinPrep® specimens can reduce the unsatisfactory rate and increase the number of diagnostic epithelial cells. This study was undertaken to determine which specimens are most likely to benefit from a prospective glacial acetic acid wash.Methods:  Bloodstained ThinPrep® specimens selected for routine lysing prior to processing were macroscopically assessed and scored based on the level of blood present (+ to +++). Both unlysed and lysed slides were prepared from each specimen and microscopically examined.Results:  Fifty‐eight specimens (32 scored +, 12 ++ and 14+++) were assessed. Three unlysed slides prepared from the ++ specimens and 12 from +++ specimens were evaluated as unsatisfactory due to excessive blood and inadequate numbers of squamous cells. In contrast, only one of the unlysed slides from the 32 + specimens was considered to be unsatisfactory. Almost all the lysed slides were satisfactory and generally more cellular than the unlysed slides. Abnormal cells were found in four cases (both unlysed and lysed paired slides).Discussion:  Although the acetic acid wash increases cellularity of bloodstained ThinPrep® specimens, prospectively lysing all bloodstained specimens is an unnecessary procedure. Lysing only very heavily bloodstained specimens prior to processing will reduce laboratory workload, costs and the possibility of specimen mix up. Occasionally a retrospective wash may be required but screening staff should be aware that although blood may be present on an unlysed ThinPrep® slide, a lysed slide should not be requested unless there are insufficient numbers of squamous cells present.
P‐19 THE LABORATORY AND CLINICAL ADVANTAGES OF PROMPT CERVICAL SMEAR HISTOLOGY MISMATCH AUDIT
Authors: Payne F. B. , McKean M. E. , Lorimer M. Y. , Adam K. A. , Smart L. M. 
Published: August 2006

ABC guidelines require correlation of cervical biopsy and smear results for calculation of positive predictive values. This need only involve retrospective review of cytology with histology considered the ‘gold standard’. Because NHSCSP recommend longer follow up for high than low grade CIN, it is important that high grade CIN is not underdiagnosed. We undertook prompt mismatch review, including both smear and biopsy review to fulfil an improved audit function and facilitate appropriate patient management.Method:  All colposcopy referral smears were entered into an Access database and correlated with the subsequent colposcopic biopsy. All non‐correlating smears were reviewed independently and a consensus result reached. When the consensus remained high grade the histology was reviewed similarly and, if upgraded, a supplementary report was issued.Results:  Over 6 months, 578 women referred to colposcopy with abnormal cytology had biopsies. In 491 (83%) cases, the referral smear and biopsy correlated within one grade. Of 51 smear (9%) ‘undercalls’ relative to the biopsy, 29 (5%) were upgraded to correlate on review. Of 36 smears (6%) classed as ‘overcalls’, 7 were true cytological overcalls and downgraded. 10 biopsies were upgraded, 5 from low to high grade CIN. 19 (3%) high grade smears remained non‐correlating. Correlation increased to 91% after smear and histology review.Conclusion:  This system of mismatch correlation enables clinicians to receive amended results early enough for modification of treatment and follow up based on an accurate CIN grade. Tabulated results highlight non‐correlating cases where the biopsy may be non‐representative and identify cases for clinico‐pathological conferences. Multi‐observer review of true cytology undercalls and overcalls has an educational role and improved accuracy of CIN grading increases PPVs. Although labour intensive, this approach offers significant advantages and audit criteria may be refined to focus on relevant issues.
P‐8 THE LOCAL IMMUNE RESPONSE TO LOW‐GRADE CIN – ALTERATIONS IN T‐CELL AND MACROPHAGE SUBSETS
Authors: Ahmed S. M. , Reid W. M. N. , Poulter L. W. 
Published: August 2006

Introduction:  Despite the cervix having the largest concentration of lymphocytes and macrophages in the lower genital tract, there is limited knowledge of these cell types in CIN. This study was undertaken to compare T‐cell and macrophage populations in women with and without low‐grade CIN.Methods:  Control group: 10 women with a normal recent cervical smear result, mean age 30 years. Study group: 10 women with low‐grade CIN, mean age 33.2 years. Colposcopically directed cervical biopsies were taken from control women and from areas of CIN in the study group, and studied using immunoperoxidase and immunofluorescence staining.Results:  T‐cell numbers remained constant. In CIN, there were increased proportions of recruited (CD8+CD5+), activated (CD8+HLA‐DR+) and cytolytic (CD8+TIA‐1+) CD8 T‐cells. There were more activated CD4+HLA‐DR+ T‐cells in CIN. Memory T‐cell (CD8+CD45RO+ and CD4+CD45RO+) proportions were reduced. Total macrophage numbers (CD68+) remained constant, but activated macrophages (CD68+HLA‐DR+) rose. Phagocytic (RFD7+) macrophage proportions decreased with a concomitant increase in suppresser macrophages (RFD1+RFD7+).Discussion:  Despite cellular numbers remaining unchanged, there were significant changes in T‐cell and macrophage populations in women with low‐grade CIN. There is recruitment of activated and cytolytic CD8 T‐cells. The swing to a predominantly suppressive macrophage phenotype may predispose to CIN. Carcinoma of the cervix occurs more frequently in women who are immunosuppressed. Our data suggests that local and systemic immune mechanisms may be relevant in the response to HPV‐induced neoplasia.
DEFINING DYSKARYOSIS – THE BSCC CLASSIFICATION IN 2006
Authors: Denton K. 
Published: August 2006

The terminology used for reporting cervical samples in the UK is the BSCC classification, which has evolved over many years. In 2002 the BSCC held a consensus conference to review the BSCC classification, with the intention of providing clearer results for women, improving concordance with other terminologies and facilitating consistency with new scientific developments and technologies. The consensus conference was well attended and robust. In the intervening years there have also been other further advances on morphometry, data on outcomes, data from EQA and other sources. Liquid Based cytology (LBC) has been implemented by the NHS CSP. All of these developments have impacted on the proposed classification, which will be presented in full. The term ‘dyskaryosis’ will be retained and several of the current reporting categories will be relatively unchanged, though additional information on LBC will be provided.The major proposed changes are:(1) A move to a single category of ‘High Grade Dyskaryosis’ to replace the existing categories of moderate and severe dyskaryosis.(2) Sub‐division of Borderline change into three categories.Borderline change in glandular cellsBorderline change ?high gradeBorderline change, NOS(3) The current grades of Mild Dyskaryosis and Borderline change with Koilocytosis to be merged.Details of these proposals, together with illustrations and the evidence base for change will be presented.
ETHICAL ISSUES IN CERVICAL SCREENING
Authors: Weller D. 
Published: August 2006

This paper will provide an overview on current ethical dilemmas in cervical screening. Screening has led to very significant reductions in mortality from this disease. Yet it requires a major commitment from a wide range of health professionals and health sectors including pathology, primary care, public health and NHS cancer screening services. Despite its very significant achievements, cervical screening can be associated with adverse events and in contemporary cancer screening programmes, there is a need to provide patients with a balanced view on the benefits of participating. The following areas will be covered:(1) Social inequalities: does cervical screening reinforce health and social inequalities, is it sufficiently available to lower socio‐economic groups and does it target the appropriate sub‐groups within the population?(2) Informed choice: there is a change in focus in cancer screening programmes – until recently most effort has focused on promoting uptake. Informed choice is now seen as a worthy objective of screening programmes. GP practices have, in the past, been accused of overly coercive tactics in achieving their target rates for cervical screening. This has the potential to cause significant harm through such efforts. Ideally we want participants in cancer screening to have a very clear idea of both the risks and benefits of participation, yet this can involve a potentially lengthy process of information sharing between health care providers and invitees. How do we achieve an appropriate balance between informed choice and adequate levels of uptake?(3) Opportunity costs of cervical screening: Screening is an expensive process, the health service is stretched and there is a significant opportunity cost. Should we be diverting resource to other diseases of higher prevalence and greater public health burden?(4) When cervical screening goes wrong: what can we learn from instances in the past where QA systems and other aspects of cervical screening have failed and patients have been caused harm?(5) New challenges posed by HPV testing and vaccination.(6) Future directions. Where should cervical screening be heading, what will the future ethical challenges be?The intention of the paper is to summarise current evidence and issues, and to prompt discussion on ways that health professionals, in conjunction with consumer groups, can move forward on these and other important ethical issues.
THE IMPACT OF CHILDHOOD SEXUAL ABUSE ON WOMEN'S Healthcare
Authors: Myskow L. 
Published: August 2006

Prevalence studies show that between 15 and 30% of women have been sexually abused by a man by the age of 16. Child abuse survivors rarely spontaneously reveal this history to a doctor yet they are more likely than non‐abused patients to suffer multi‐system medical complaints and to indulge in high‐risk behaviours. This of course may make them more likely to appear in gynaecology or colposcopy clinics. It seems sensible that gynaecologists should be well informed about CSA and in particular the impact it may have on their patients so that they can offer the required sensitive treatment in an appropriate environment for these women in particular. Just as with rape the sexual component of child sexual abuse is of secondary importance to power over and manipulation of children, therefore psychological damage to children is much greater if the abuser is a parent or parent figure. Incest is most commonly between father or stepfather and daughter, with stepfathers being the worst offenders. The peculiar difficulties that follow sexual abuse of a child by a family member and which place the child in a seemingly impossible position in the family have been well‐described by Summit (1983). He uses the term CSA accommodation syndrome to describe a reaction, which allows for the immediate survival of the child within the family.There are 5 components to this syndrome:‐(1) Secrecy(2) Helplessness(3) Entrapment and Accommodation(4) Delayed, Conflicted and Unconvincing disclosure(5) RetractionUnfortunately these children develop multiple psychological and emotional disorders in the process e.g. depression, high anxiety and panic attacks, obsessional concerns, eating disorders and abuse of self. They may also develop physical manifestations of emotional pain such as pseudo‐seizures or chronic pelvic pain. Not surprisingly, sexual problems are also common e.g. low sex drive or vaginismus. Despite the fact that abuse of children is very variable in severity, the treatment of abused women follows a recognised process which is similar in each case. Disclosure – therapy starts from this moment so it is important that it is handled well. She is encouraged to talk about the abuse as she remembers it and it is important that her therapist lets her know that her story is believed. Responsibility for the abuse is addressed. Almost without exception, victims of abuse feel responsible in some way for what happened so again her therapist must point out where the blame really lies i.e. with the abuser. Current family relationships have to be reviewed as she may still in fact be living with the abuser and part of the healing process may involve his confrontation. Finally moving from victim to survivor the woman addresses the damage that has been done. Many women attending colposcopy or gynaecology clinics will have suffered sexual abuse. They may find the experience traumatising and will be greatly helped to cope if the environment in which they are treated is sensitive and caring.
A MASTER CLASS IN UNDERSTANDING VARIATIONS IN HEALTHCARE
Authors: Mohammed M. 
Published: August 2006

That there is wide‐spread variation in healthcare outcomes cannot be denied. The question is what does the variation mean and what can we do about it? Using a series of well‐known case‐studies, which include data from the Bristol and Shipman Inquiries, fundamental limitations of traditional methods of understanding variation will be highlighted. These methods, which include comparison with standards, league tables and statistical testing, have flaws and they offer little or no guidance on how to re‐act to the variation. Fortunately, there is a theory of variation that overcomes these limitations and provides useful guidance on re‐acting to variation, which was developed by Walter Shewhart in the 1920s in an industrial setting. Shewhart's theory of variation found widespread application and won him the accolade ‘Father of modern quality control’. His work is central to philosophies of continual improvement. Application of Shewhart's theory of variation, also known as Statistical Process Control (SPC), to case‐studies from healthcare will be demonstrated, whilst highlighting the implications and challenges for performance management/monitoring and continual improvement in the healthcare.References:  1. M A Mohammed, KK Cheng, A Rouse, T Marshall. “Bristol, Shipman and clinical governance: Shewhart's forgotten lessons” The Lancet 2001; 357: 463–7.2. P Adab, A Rouse, M A Mohammed, T Marshall. “Performance league tables: the NHS deserves better” British Medical Journal 2002; 324: 95–98
Increasing EMMPRIN and matriptase expression in hepatocellular carcinoma: tissue microarray analysis of immunohistochemical scores with clinicopathological parameters
Authors: Tsai W‐C , Chao Y‐C , Lee W‐H , Chen A , Sheu L‐F , Jin J‐S 
Published: August 2006

Aims To examine the expression of extracellular matrix metalloprotease inducer (EMMPRIN) and matriptase in hepatocellular carcinoma (HCC) and to correlate this with tumour progression.Methods and results Immunohistochemical analysis of EMMPRIN and matriptase was performed on tissue microarrays of 122 cases of HCC with various histological grades and/or clinical parameters. The expression of EMMPRIN and matriptase was undetectable in normal liver parenchyma of all eight control cases. However, among the 122 HCC cases, EMMPRIN and matriptase immunoreactivity was seen on the cell membrane and in the cytoplasm. The average immunostaining scores of EMMPRIN were 88 for grade I HCC, 195 for grade II HCC and 293 for grade III HCC. Of 85 HCC cases in 122 with detailed clinical TNM stages, the average immunostaining scores of EMMPRIN were 75 for stage T1, 177 for stage T2, 260 for stage T3 and 313 for stage T4 cases of HCC. In addition, the average immunostaining scores of matriptase were 84 for grade I HCC, 187 for grade II HCC, 302 for grade III HCC, and 72 for stage T1, 181 for stage T2, 224 for stage T3 and 284 for stage T4 cases of HCC. More advanced M and N stages of HCC were associated with higher intensity, greater percentages of tumour staining and immunostaining scores of EMMPRIN and matriptase. Higher EMMPRIN and matriptase immunostaining scores in HCCs also correlated significantly with tumour grading and TNM stages.Conclusions Our findings demonstrate for the first time that EMMPRIN and matriptase are overexpressed in HCC. These may be novel biomarkers for the diagnosis and treatment of HCC.