bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posters. P2 Randomized controlled trial of the adequacy of cytological sampling with the cervex brush and aylesbury spatula: results of long‐term follow‐up
Authors: Dey P. , Stocks S. J. , Collins S. , Desai M. , Wright Y. , Woodman C. 
Published: September 2003

Introduction  A randomized controlled trial comparing the adequacy of cytological sampling using the Cervex brush and the Aylesbury spatula, published in 1996, revealed that the Cervex brush did not reduce the inadequate smear rate but smears were more likely to contain cytological abnormalities (odds ratio 1.19; P = 0.05). We report the long‐term follow‐up of women who had a normal smear during the trial.Methods  The trial has been described elsewhere.1 Matching of trial and laboratory databases identified follow‐up smears taken before 31/12/2000 from women with a normal smear during the trial. The analysis was restricted to 66 centres using the laboratory during the follow‐up period when all were supplied with the Aylesbury spatula. The Kaplan–Meier method was used to estimate the cumulative risk of cytological abnormality following a normal smear. The difference between study arms was estimated using the hazards ratio (HR) derived from a Cox proportional hazards model adjusted for the cluster‐randomized design and controlling for centre type.Results  A total of 7129 women had at least one follow‐up smear: 3716 were first sampled with the Cervex brush and 3413 with the Aylesbury spatula. There was no difference between study groups in the incidence of any cytological abnormality (HR 1.11; 95% CI 0.92–1.34) or of moderate dyskaryosis or worse (HR 1.02; 95% CI 0.70–1.49).Conclusion  The excess of abnormal smears observed during the trial in women sampled with the Cervex brush is unlikely to be due to earlier detection, because the incidence of cytological abnormality following a normal smear was similar in the two study arms.
Posters. P6 Infiltrating micropapillary carcinoma of the breast‐cytological and histological correlation in two cases with review of the literature
Authors: Ghataura S. S. , Chan S. Y. 
Published: September 2003

Introduction  Invasive micropapillary carcinoma of the breast has been described as a specific entity over a decade ago. Histologically, it is characterized by a morular growth pattern with surrounding artefactual spaces and reverse polarity in the cellular architecture. It is a distinct entity in histology, but not in the cytology literature and only a handful of case reports describe the cytological features. However, it is an important diagnosis to make as these tumours behave aggressively with a high rate of lymphotropism and axillary lymph node metastases, as well as local chest wall recurrence.Method  We describe two cases of invasive micropapillary carcinoma of the breast, one diagnosed initially on FNA with follow‐up histological confirmation, the other from a local chest wall recurrence, which was confirmed retrospectively after review of the initial histology.Conclusion  The cytological features of invasive micropapillary carcinoma of the breast are unique and differ from other invasive and in situ carcinomas and should be recognized because of its aggressive behaviour.
Posters. P11 Positive predictive values for high and low‐grade cytological abnormalities as surrogates for specificity and sensitivity
Authors: Neda S. , Herbert A. , Blanks R. G. , Moss S. M. 
Published: September 2003

Introduction  Positive predictive value (PPV), measuring the percentage of moderate dyskaryosis or worse confirmed as CIN2 or worse, is used as a measure of accuracy in cervical screening. However, it relates more to specificity than sensitivity because the denominator includes false positives rather than false negatives. Low values reflect over‐reporting of high‐grade dyskaryosis but high values may reflect under‐reporting. Sensitivity is impossible to measure from correlation of cytology with outcome because women with negative cytology are rarely referred for colposcopy. Rates of CIN3 resulting from referrals for low‐grade cytology may be used as a surrogate for sensitivity, as high values may reflect under‐reporting (ref).Study design  Outcome of colposcopy referrals was monitored during a period of 4 years, using a fail‐safe database.Results  PPV at Guy's & St Thomas rose from 54% in 1998/1999 to 69% in 2001/2002. The former was below the NHSCSP recommended range. During the same period of time CIN1 rates for moderate dyskaryosis fell from 37% to 24%, reflecting the main source of discrepancy. While specificity increased (as reflected by increasing PPV) sensitivity remained constant in that CIN3 rates for mild dyskaryosis and borderline remained below 6%: average rates in England have fallen over the last 3 years and were 7.4% in 2000/2001 (ref). CIN2 rates for mild dyskaryosis also remained constant at 11% to 12%.Conclusion  Correlation of biopsy results with high‐ and low‐grade cytological abnormalities is a useful method of monitoring accuracy of cytology reporting, and can be used to measure over‐ and under‐reporting as surrogates for specificity and sensitivity.
Posters. P12 Is there any role for routine cytology after chemoradiation for cervical cancer?
Authors: Singh N. , Taylor A. , Titmuss E. , Powell M. E. B 
Published: September 2003

Aim  Cervical cytology is performed routinely as part of the follow‐up protocol following chemoradiation treatment for cervical cancer. This retrospective review assesses the impact cytology has on the management of patients.Methods  Women treated with concurrent chemoradiotherapy for cervical cancer at St Bartholomew's hospital between April 1998 and December 2002 were identified. All cervical cytology results for these patients have been reviewed, and correlated with the site and timing of relapse.Results  A total of 69 patients were treated: 58 (84%) had squamous cell carcinoma and 11 (16%) had adenocarcinoma. After median follow‐up of 16 months (4–53), 28 (40%) patients have relapsed. A total of 152 cytology results were available for 51 patients. 18 tests were reported as atypical and five suspicious of malignancy, but subsequent tests show no evidence of recurrence in these 13 (25%) patients. Seventeen patients have developed pelvic relapse. Of these, nine patients had cytology during follow‐up. One patient clinically had a vaginal mass confirmed as malignancy on cytology. The other eight patients had normal cytology within 6 months of clinical disease.Conclusions  The pattern of relapse following radical chemoradiation is such that routine cervical and vaginal vault cytology has no indication in the absence of clinical suspicion of disease. The test has questionable sensitivity in this setting because there is a high incidence of false‐positive results that lead to unnecessary investigations. Cytology is valuable for detecting pre‐invasive and pre‐clinical disease, but neither role applies to this patient group.
Posters. P13 Cytohistological correlation in 212 FNAs of thyroid: analysis of discordant cases
Authors: Dina R. 
Published: September 2003

Aim  To detect major pitafalls in thyroid FNA and to confirm its in a clinical sensitivity and specificity.Methods  A total of 9251 fine needle aspirations biopsy carried out at Bellaria Hospital in Bologna from 1991 to 2000 by a pathologist in the FNA Clinic or by a clinician under ultrasonic guidance using a small needle (25–27 G); at least two passes have been made for each nodule. The specimen was considered satisfactory if at least five groups of follicular cells with at least 10 cells each, were seen. The cytological results were tiered in a four categories classification: inadequate, negative, suspicious and positive. Cyto‐histological correlations were available in 212 cases: 127 benign lesions and 85 malignant lesions.An analysis of false positive cases and false negative cases was performed and discordant case reviewed according to the flowing criteria: architecture, cellularity, colloid, pseudoinclusions, nuclear groovings, chromatin pattern, nuclear membrane, cytoplasm, naked nuclei and lymphocytes.Results  Diagnostic distribution in 9251 FNAs from the thyroid: 88.6% negatives, 2.8 suspicious, 2.4% positives and 6.2% inadequates. Specificity was 85.8% and sensitivity was 78.8%. Among the 18 false negative cases eight were papillary microcarcinomas, four papillary carcinomas, five follicular carcinoma and one a Hurtle cell carcinoma.Four false positive cases were found: three reported as papillary carcinomas and one as carcinoma NOS. Review of false positives showed that in three cases the colloid was fluid, in three cases nuclear grooving was rare or absent, in two cases degenerative vacuoles at MGG were interpreted as nuclear inclusions and in three cases benign naked nuclei were present in the background. Review of false negatives confirmed lack of malignant features in 13 (eight papillary microcarcinomas and five follicular carcinomas), five were interpretation errors (three papillary carcinomas, one follicular, one Hurtle cell).Conclusion  FNAC of the thyroid is a sensitive and specific method of assessment for thyroid nodules but false negative and false positive cases do occur. Use of all and only few criteria enhances diagnostic accuracy.
Posters. P14 Adenocarcinoma of cervix a cyto‐histopathological correlation
Authors: Gupta Limci , Dina Roberto 
Published: September 2003

Aim  The current study was undertaken to determine the sensitivity of cytology smears in the detection of cervical adenocarcinoma, to study the incidence of CIN lesions with adenocarcinoma and to estimate sampling, screening and diagnostic errors in this cohort of cytological smears.Methods  Retrospective analysis of all cases of adenocarcinoma of cervix diagnosed in the histopathology department at Hammersmith hospital over the past 10 years (January 1993 till December 2002) either by biopsy or resection specimen. Initially 69 cases of adenocarcinoma of cervix were identified of which nine had several biopsies from the same patients and seven represented either local spread or metastasis. Thus 16 cases were excluded and thereby 53 cases met the criteria for inclusion.Results  Fifty‐three adenocarcinomas were identified, either pure or combined with squamous lesions. The results showed the association of adenocarcinoma with CIN lesions to be 27.3% (one CIN1, three CIN2, 11 CIN3). Cervical smears were available for review in 25 cases.

Analysis of cervical smears

Total
Negative
Positive
Not done
Records not found

53
07
18
18
10

The sensitivity of cytology smears was 68% for all HGEA (High Grade Epithelial Abnormalities); 56% for all glandular lesions and 40% for pure adenocarcinomas. Upon review sampling error was calculated to be 4%; interpretation error was 4% and diagnostic error upon review 0%.Conclusion  The current study provides an encouraging data regarding the sensitivity of Pap smears in detecting adenocarcinoma of cervix and shows a good cytopathological correlation.
Posters. P16 Evaluation of user satisfaction questionnaire (cervical cytology service)
Authors: Marshall Janet 
Published: September 2003

Introduction  A three‐part questionnaire was sent out to 429 clinics submitting smears to the cytology department to evaluate levels of satisfaction with the service provided. Part one dealt with areas including turnaround time, dealing with urgent requests, ease of telephone access for queries, attitude of staff and availability of smear taking equipment. Part two listed services that are currently available and users were asked to prioritize them in order of importance. Part three asked for developments or enhancements in the service that our users would like to see.Results and discussion  A total of 429 questionnaires were issued and 62 were returned (response rate of 14.5%). At that time most clinics waited more than 6 weeks for reports to be returned (top priority for 95%). Over two‐thirds were happy/very happy with the response to urgent work and nearly 90% found it easy to access the department with 96% indicating that staff were very helpful or helpful. Twenty‐five per cent said smear‐taking equipment was not readily available and over 40% said they had problems obtaining extra supplies. The laboratory uses pre‐packaged kits that are sent directly from the manufacturer. Approximately, 95% requested a faster turnaround time for reports, followed by computer links between the laboratory and clinic (71.7%). Many users would like to have regular two‐way feedback between themselves and the laboratory (64.1%), more teaching/training courses (51.2%) and more information about the NHSCSP (48.7%). Other improvements and developments scored by the users include more readily available smear taking equipment, improved courier service, more visits to the laboratory and meetings between the laboratory and clinic. Other than those developments already listed, users would like: changes to the request form to record ‘cervix visualized’ and 360 ‘sweep taken’, a return to the provision of cytobrushes, return to the old‐style envelopes, changes to the report format, provision of standard letters to send to patients, change to LBC. The poor response rate suggests that overall, users are satisfied with the service.
Posters. P17 Accuracy of fine needle aspiration cytology in diagnosis of thyroid swellings
Authors: Mundasad B. , McAllister I. , Pyper P. C. , Carson J. 
Published: September 2003

Introduction  Fine needle aspiration cytology is regarded as the gold standard investigation in diagnosis of thyroid swellings. Published data suggest an overall accuracy rate of 75%1 in the detection of thyroid malignancy. The aim of this study was to determine the accuracy of FNA cytology in detection of thyroid malignancy in our surgical unit.Methods  Between 1989–2002, 144 patients who underwent thyroid resection by single consultant surgeon and who had pre‐operative FNA were enrolled in this retrospective study. The pre‐operative FNA results were compared with definitive histological diagnosis following thyroid resection. Fine needle aspiration cytology was performed using aspirate and non‐aspirate techniques on each thyroid swelling. The cytological sample was assessed by a single cytopathologist and was classified as inadequate, non‐neoplastic, neoplastic, suspicious or indeterminate. The histology was classified as non‐neoplastic (benign) and neoplastic (malignant).Results  Fine needle aspiration cytology analysis revealed 94 (13.88%) non‐neoplastic, six (65.27%) neoplastic and 20 (4.16%) suspicious aspirates. Twenty (13.88%) samples were inadequate and four (2.77%) samples were indeterminate. Histological analysis showed 118 (81.94%) benign, 26 (18.05%) malignant specimens. Fine needle aspiration cytology had a sensitivity, specificity and accuracy rate of 52.6%, 86.6% and 79.1%, respectively for diagnosing thyroid malignancy.Conclusion  The results are comparable with the current published data and demonstrate that FNA cytology in our hands is accurate investigation for pre‐operative diagnosis for the detection of thyroid malignancy.
Posters. P18 Ergonomic microscopes: can they reduce the risks of work‐related musculo‐skeletal disorders?
Authors: Gray Heather , MacMillan Fiona 
Published: September 2003

Introduction  Microscopy work places a high level of musculo‐skeletal stress on the body of the user. Indeed, there are certain types of neck–shoulder disorders associated with microscope operation, especially during cytology work. This field study was carried out to investigate the differences in upper trapezius muscle activity, posture, pain and perceived exertion in cytologists while scanning cervical screening slides using both standard and ergonomic microscopes.Method  The study employed a two‐period crossover experimental design. Thirteen cytologists (mean age 36.1 ± 8.8 years) from one acute NHS Trust consented to participate. Subjects screened eight slides with each microscope while four different measurements were taken: bilateral upper trapezius electromyography; posture, using a Rapid Upper Limb Assessment (RULA); pain, using a body part discomfort diagram and Visual Analogue Scale; and rating of perceived exertion (Borg CR‐10 RPE Scale).Results  The results demonstrated that when operating the ergonomic microscope, there was significantly less upper trapezius activity for both the right (P = 0.015) and left (P = 0.000) shoulders, signifying reductions of 64% and 62%, respectively. However, there was not a statistically significant difference in postures adopted between the microscopes, using RULA (P = 0.173). Neither were there any statistically significant differences in neck (P = 0.084), upper back (P = 0.098) or lower back (P = 0.625) pain when using the ergonomic microscope, although, a statistically significant reduction in shoulder pain was reported (P = 0.043). Finally, the results revealed that the ergonomic microscope required significantly less perceived exertion to operate than the standard microscope (P = 0.009). An additional important finding was that screening took approximately 40 s less per slide using the ergonomic microscope.Discussion  This study indicated that the ergonomic microscope was preferable to the standard microscope in terms of upper trapezius muscle activity, shoulder pain and perceived exertion. These findings have important implications for cytologists, of whom the majority are currently using standard microscopes, in terms of reducing potential risk factors for the development of work‐related musculo‐skeletal disorders. Furthermore, this evidence supports the ergonomic recommendations delineated in the National Health Services Cervical Screening Programme Standards (NHSCSP 1997).Relevance to industry  Cytology laboratories should give close consideration to the types of microscopes purchased. Consideration should be given to adapting existing microscope workstations by providing microscopists with angle‐adjustable arm supports.
Posters. P20 Fine needle aspiration of salivary glands in Beaumont Hospital: a 14‐year audit
Authors: Mulligan A. M. , O'Shea A. M. , Royston D. 
Published: September 2003

Introduction  Fine needle aspiration (FNA) is a well‐established diagnostic technique which is frequently used to diagnose head and neck neoplasms. Clinical decisions concerning treatment of malignant salivary gland tumours, the extent of surgery and advisability of pre‐operative irradiation can be helped by prior knowledge of tumour type.Aim The aim of this study was to do an audit of all salivary gland FNAs carried out in Beaumont Hospital over a 14‐year period.Methods  All salivary gland FNAs between 1989 and 2002 were reviewed. Where available, the corresponding follow‐up histological specimens were studied.Results  During this 14‐year period, 305 patients with salivary gland lesions had FNA of the lesion performed. The total number of aspirates performed was 343. Of these, 184 had histologies available for follow‐up. Eighty‐nine aspirates were reported as inadequate; 89 as inflammatory, normal or consistent with cyst contents. One hundred and thirteen aspirates were diagnosed as a benign entity. Thirty‐three aspirates were reported as malignant (21 of which were felt to be primary to the salivary gland and 12 metastatic). Sixteen cases were called suspicious. Good correlation between FNA findings and histology was seen in the majority of cases (145 of 183). Some diagnostic problem areas were identified. These included the following: lymphomas (seven called benign on FNA), Warthin's tumour (seven not diagnosed or misdiagnosed on FNA) and mucoepidermoid carcinoma (one reported as pleomorhic adenoma and one as benign/cystic on FNA). Seven pleomorphic adenomas were not diagnosed on FNA pre‐operatively, predominantly due to inadequacy of the specimen. Three other malignancies (acinic cell carcinoma, lymphoepithelial carcinoma and carcinoma ex‐pleomorphic adenoma), while not diagnosed on FNA, were called suspicious, with re‐biopsy advised.Conclusion  FNA cytology of salivary glands is an accurate method for evaluation of both benign and malignant lesions, enabling optimum surgical and adjuvant therapy decision‐making pre‐operatively. Well‐defined problem areas are identified and, therefore, clinicopathological correlation is required in these cases.
Proffered papers  9.30–10.00 Monday 15 September 2003 1 British moderates or inconclusive Australians?
Authors: Knowles Simon , Linham Melanie , Harris Michael , Giles John 
Published: September 2003

Both the original Bethesda system and the current UK classifications of cervical cytology have proved robust but each has a major weakness in the area of abnormalities of uncertain significance. Cytologists recognize that sometimes it is simply impossible to differentiate between reactive and dyskaryotic material. For this reason, the Australian version of the Bethesda system introduced a new category of ‘high grade inconclusive’ with a recommendation for referral to colposcopy. Approximately 60% of such cases are found to have high grade lesions at colposcopy (Schoolland M, Sterrett G, Knowles S et al.). The present UK system even with the proposed changes requires of the pathologist, a decision as to whether such cases are probably high grade (=a report of moderate dyskaryosis) or not (= a report of borderline). This continues to ignore the fact that sometimes you just cannot tell, even on review. We have taken a consecutive series of 50 referral smears, reported as moderate dyskaryosis, where the histological outcome (by loop cone) is known. These cases were rescreened and then reviewed blind by a pathologist with extensive experience of the Australian NH & MRC modified Bethesda system. On review, the material was reclassified along NH & MRC lines. The results were compared with the biopsy findings in order to determine whether the category of ‘inconclusive’ might be of value in the context of the NHSCSP.
Proffered papers  9.30–10.00 Monday 15 September 2003 2 Clinicopathologic significance of the ‘borderline nuclear change – high grade dyskaryosis not excluded’ report
Authors: Caroline Brodie , Ritu Kapur , Mary Murray , Derek Magee , Lesley Turner , David Gibbons 
Published: September 2003

Introduction  Recent changes in terminology have recognized that cervical smears may contain cells with a high nuclear‐cytoplasmic ratio, suspicious for high grade dyskaryosis, which are not definitively diagnostic.Aims  The correlation of cyopathological features present in a prospective series of cervical smears diagnosed as ‘borderline nuclear change – high grade dyskaryosis not excluded’ (BNCH) with clinical and histological follow‐up.Methods  We have been using the BNCH diagnosis in our practice since June 1999. Cases of BNCH between June 1999 and June 2002 were retrieved from computerized laboratory records. Questionnaires were sent to referring clinicians regarding clinical follow‐up, including results of colposcopy, histology and follow‐up smears. Smears were reviewed for the presence of microbiopsies or single atypical cells. Numbers of atypical cells were quantified as less than/equal to or greater than 3.Results  A total of 106 reports on conventional cervical smears diagnosed as BNCH from 1999 to 2002 were retrieved; they comprised of 0.098% of a total of 107 634 smears screened over that period. Clinical follow‐up, with histology (n = 54), colposcopy (n = 26) or repeat cytology (n = 10), was available in 88 of 106 cases. Thirty‐one (35%) showed a high grade abnormality (CIN2, CIN3 or invasive squamous or adenocarcinomas), 15 (17%) showed a borderline/low grade abnormality (repeat BNCH or CIN1) and 42 (48%) were negative. Eighty‐seven of these were reviewed cytologically (Table 1).

Microbiopsies
Single cells
Both
Total

High grade
6
18
7
31

BNC/low grade
3
8
4
15

Negative
6
31
4
41

Total
15
57
15
87

Conclusions  The BNCH category has a substantial yield of high grade abnormalities on follow‐up, which may be greater in cases where atypical cells are pre‐dominantly within microbiopsies. These findings support the introduction of the BNCH terminology.