Influence of Cytology Development on Frequency of Pre-Cancerous Lesions and Cervical Cancer in East Croatia, 1978–2001

A B S T R A C T We analyzed the influence of cytology development to frequency of precancerosa (Cervical intraepithelial neoplasia grade 3 – CIN 3) and cervical cancer. The number of examined Pap smears increased significantly in the analyzed period. The calculated linear trend shows an average four-year increase of 17,283.35 smears. The number of detected CIN 3 increased accordingly. The calculated linear trend shows an average four-year increase by 45.03 and decrease of the rate of 0.07. A slight increase in cervical cancer was also noticed. The calculated linear trend shows an average four-year increase in cancer by 1.6 and decrease in the rate of 0.51. Analyses of cervical cancer by stages showed an increase in number of stage I and decrease of other stages. The calculated linear trend shows an average four-year increase of stage I by 4.94 or decrease in other stages of cervical cancer of 3.29 respectively. The rate of cervical cancer stage I decreased by 0.11 and of other stages by 0.39. Further analyses of the stage I showed that the linear trend of IA stage had an average four-year increase by 5.40 and decrease in stage IB of 0.48. The rate of the cervical cancer stage IA increased by 0.02, whereas the rate of IB decreased by 0.13. Cytology development in our country has resulted in detection of higher number of CIN 3 and the earliest stage (IA) of cervical cancer whereas the number of other stages (IB, II, III, IV) has decreased. However, a total number of cervical cancers haven’t changed over the whole period. Thus, it is obvious that opportunistic program of detection, which has been using in Croatia, could not decrease frequency of cervical cancer. In order to achieve it, well-organized national program of detection is needed

Importance of Papanicolaou Smears in Detection of Urogenital Infections

U cerviko-vaginalnom razmazu obojenom po Papanicolaouu rutinski se nastoje prepoznati određeni mikroorganizmi koji infi ciraju sluznicu donjeg dijela genitalnog trakta (Candida albicans, Trichomonas vaginalis, Actinomyces spp., Gardnerella vaginalis, Chlamydia trachomatis, Herpes simplex virus – HSV i humani papilomavirus – HPV). Međutim, citološki nalaz ne može biti zamjena za specifi čnu mikrobiološku dijagnostiku, budući da citološke promjene često nemaju dostatnu dijagnostičku vrijednost. Kliničar stoga citološku dijagnozu treba shvatiti tek kao moguću sugestiju infekcije genitalnog trakta i odnositi se prema njoj u skladu s ukupnim kliničkim nalazom.Papanicolaou-stained cervical smear is used to routinely detect certain microorganisms infecting lower genital mucosa (Candida albicans, Trichomonas vaginalis, Actinomyces spp., Gardnerella vaginalis, Chlamydia trachomatis, Herpes simplex virus – HSV, and Human papilloma virus – HPV). However, cytologic fi nding cannot replace specifi c microbiological diagnosis because cytologic changes are often not diagnostic. Therefore, clinicians should take cytologic diagnosis only as being suggestive of genital tract infection, considering it in the context of overall clinical findings

Possibilities of detection of non-viral pathogens causing sexully transmitted diseases by means of cytological analysis of VCE-smears stained by Papanicolaou

U Papanicolaou- razmazu se od nevirusnih uzročnika spolno prenosivih bolesti opisuju Chlamydia trachomatis, Gardnerella vaginalis, Trichomonas vaginalis i fungi. Citološka dijagnozaa Chlamydiae trachomatis na osnovi intracitoplazmatskih inkluzija i pratećeg upalnog eksudata s osjetljivsti od 0 do 54% i specifičnosti 5 95% nije dovoljno specifična da omogući razlikovanje od drugih infekcija. Dijagnoza infekcije Gardnerellom vaginalis na osnovi nalaza tzv. "clue cells" ima osjetljivost od 49 do 90%, specifičnost od 97 do 100% i pozitivnu prediktivnu vrijednost od 90 do 97%, pa može koristiti za detekciju i dijagnozu koju nije potrebno mikrobiološki verificirati. Identifikacija protozoa u razmazu prilikom infekcije trihomonassom daje citologiji osjetljivost od 56 do 92% i specifičnost između 83-99%, te ima važnu ulogu u detekciji asimptomatske infekcije, s tim da je prije terapije potrebna potvrda nalaza. Identifikacija spora i pseudomicelija u dijagnozi gljivične infekcije daje razmazu osjetljivost od 3 do 49%, specifičnost od 98 do 100%, pozitivnu predikativnu vrijednost od 20 do 100% i negativnu prediktivnu vrijednost od 71 do 85%.Non-viral pathogens causing sexually transmitted diseases, found in Papanicolaou smears, include Chlamydia trachomatis, Gardenella vaginalis, Trichomonas vaginalis and fungi. Cytological diagnosis of Chlamydia trachomatis by means of intracytoplasmic inclusion and inflammatory exudate with the sensitivity of 0-54% and specificity of 5-59% is not specific enough to enable the differentiation from other infections. The diagnosis of Gardenella vaginalis infections by means of "clue-cells" finding has the sensitivity of 49-90%, specificity of 97 - 100% and the predictive value of 90-97%, making it usable for detection and diagnosis not required to be verified microbiologically. Identification of protozoa in the smear in Trichomonas vaginalis infection indicates the cytological sensitivity to be 56-92% and the specificity 83-99%, thus playing a significant role in the detection of asymptomatic infection; however, verification of the finding is necessary before therapy. Identification of spores and pseudomycelium in the diagnosis of fungal infection indicates the sensitivity of smear of 3:49%, specificity of 98-100%, positive predictive value of 20-100% and negative predictive value of 71-85%

Croatian Medical Association - Branch office Osijek (1991-2009)

U raduje predstavljen Hrvatski liječnički zbor - Podružnica Osijek u razdoblju od 1991. do 2009. godine s obzirom na sastav Upravnoga odbora i redovite aktivnosti vezane za unaprjeđenja zaštite zdravlja naroda, stručni i znanstveni rad, njegovanje liječničke etike i zaštite staleških interesa te angažman u Domovinskom ratu.The paper presents Croatian Medical Association - Branch office Osijek in the period from 1991 until 2009 presenting members of the Management Board and regular activities regarding improvement of health protection of the population, professional and scientific work, doctor\u27s ethics and protection of class-interests, as well as participation in the War for Croatian Independence

Possibilities of detection of non-viral pathogens causing sexully transmitted diseases by means of cytological analysis of VCE-smears stained by Papanicolaou

U Papanicolaou- razmazu se od nevirusnih uzročnika spolno prenosivih bolesti opisuju Chlamydia trachomatis, Gardnerella vaginalis, Trichomonas vaginalis i fungi. Citološka dijagnozaa Chlamydiae trachomatis na osnovi intracitoplazmatskih inkluzija i pratećeg upalnog eksudata s osjetljivsti od 0 do 54% i specifičnosti 5 95% nije dovoljno specifična da omogući razlikovanje od drugih infekcija. Dijagnoza infekcije Gardnerellom vaginalis na osnovi nalaza tzv. "clue cells" ima osjetljivost od 49 do 90%, specifičnost od 97 do 100% i pozitivnu prediktivnu vrijednost od 90 do 97%, pa može koristiti za detekciju i dijagnozu koju nije potrebno mikrobiološki verificirati. Identifikacija protozoa u razmazu prilikom infekcije trihomonassom daje citologiji osjetljivost od 56 do 92% i specifičnost između 83-99%, te ima važnu ulogu u detekciji asimptomatske infekcije, s tim da je prije terapije potrebna potvrda nalaza. Identifikacija spora i pseudomicelija u dijagnozi gljivične infekcije daje razmazu osjetljivost od 3 do 49%, specifičnost od 98 do 100%, pozitivnu predikativnu vrijednost od 20 do 100% i negativnu prediktivnu vrijednost od 71 do 85%.Non-viral pathogens causing sexually transmitted diseases, found in Papanicolaou smears, include Chlamydia trachomatis, Gardenella vaginalis, Trichomonas vaginalis and fungi. Cytological diagnosis of Chlamydia trachomatis by means of intracytoplasmic inclusion and inflammatory exudate with the sensitivity of 0-54% and specificity of 5-59% is not specific enough to enable the differentiation from other infections. The diagnosis of Gardenella vaginalis infections by means of "clue-cells" finding has the sensitivity of 49-90%, specificity of 97 - 100% and the predictive value of 90-97%, making it usable for detection and diagnosis not required to be verified microbiologically. Identification of protozoa in the smear in Trichomonas vaginalis infection indicates the cytological sensitivity to be 56-92% and the specificity 83-99%, thus playing a significant role in the detection of asymptomatic infection; however, verification of the finding is necessary before therapy. Identification of spores and pseudomycelium in the diagnosis of fungal infection indicates the sensitivity of smear of 3:49%, specificity of 98-100%, positive predictive value of 20-100% and negative predictive value of 71-85%

Potential Value and Disadvantages of Fine Needle Aspiration Cytology in Diagnosis of Ameloblastoma

Ameloblastoma is a benign, slow growing but locally aggressive tumor that is clinically manifested as swelling in a jaws1. Prone to relapse (30%)2 even 30 years after inadequate primary operation3. The most important cytological features of this tumor are small bazaloid cells in clusters, and single spindle and stellate shaped cells. We report on a case of 79-year-old patient, who was hospitalized due to tumor formation in the buccal region. FNA was performed and liquid material that contained only fagocites was collected. The conclusion was – cyst, while biopsy finding – adenoma baseocellulare, pointed to the salivary gland tumor. Patient refused the proposed surgical treatment. Four years later, the patient was urgently hospitalized due heavy bleeding from the tumor in the same region. It affected the crest portion of the upper jaw and a section of hard palate, and was bleeding on palpation.In second FNA we found phagocytes and a few small clusters of basaloid cells with palisade arrangement at the edges. Because of uniform and benign cytomorphological features it was concluded that it was a cystic tumor. On biopsy pattern the diagnose of ameloblastoma was determinated. The patient underwent surgery, however due to postoperative complications he died. Preoperative diagnosis is usually set on the basis of clinical and often nonspecific radiological findings. As it is very important to get the correct diagnose before planning an adequate surgical procedure, we would like to point out the potential value and disadvantages of FNA cytology in the diagnosis of ameloblastoma

Pap Test – With or Without Vaginal Smear?

The aim of this study was to evaluate medical and economic justification of vaginal smears as a part of primary screening for cervical carcinoma and its precursors. Study included 245.048 participants whose VCE (vaginal, cervical, endocervical) smears were examined at Department of clinical cytology of University Hospital Center Osijek from 2003 till 2008. There were 12.639 (5.2%) abnormal findings, and they were divided into three groups: abnormal cells found only in vaginal smear (V), abnormal cells found in vaginal and in at least one other smear (V+) and abnormal cells not found in vaginal smear (C/E). These three groups were analysed in respect to cytological differential diagnosis and age of participants. It was estimated how many women could be additionally included in the screening, if vaginal smear would be included in the Pap test only after 50 years of age. In 6.9% of cytologically diagnosed lesions abnormal cells were found exclusively in vaginal smears (0.35% of all findings). As for squamous cell lesions, 91.2% were mild lesions (ASC and LSIL). Invasive squamous cell carcinoma was not diagnosed exclusively by vaginal smear in either woman under 50 years of age, while in women over 50 years of age it was diagnosed in 2.3% of cases. Exclusively by vaginal smear was diagnosed 3.9% of all AGC and 6.3% of adenocarcinoma, while in 85.0% of glandular epithelium lesions abnormal cells were not found in vaginal smears. Two thirds of adenocarcinoma diagnosed exclusively by vaginal smears were endometrial adenocarcinoma, but that is only 10.3% of all endometrial carcinoma diagnosed by Pap test. Obtained results show that taking of vaginal smears along with cervical and endocervical smears as a part of primary screening for cervical carcinoma and its precursors in women under 50 years of age is not justifiable, since vaginal smear only has a role in detection of endometrial carcinoma that are extremely rare in younger age groups. If vaginal smear would be taken only in women over 50 years of age, additional 37.7% of women under 50, or 25.1% women over 50 years of age could be included in the screening

Cytologyand colposcopy as a screening test for preinvasive and early invasive lesions of cervix uteri

U 1000 negravidnih žena učinjeni su usporedo konvencionalni Papa test i kolposkopija. U 207 s citološki i/ili kolposkopski pozitivnim nalazom učinjena je histološka verifikacija. Usporedbom s histološkim nalazima određena je dijagnostička vrijednost citologije i kolposkopije kao testa probira, te efikasnost njihove simultane primjene. Uspoređeni su rezultati dijagnostičke vrijednosti tih dviju metoda, te je ocijenjen učinak njihove istodobne primjene. Citologija ima osjetljivost 90%, specifičnost 74%, pozitivnu prediktivnu vrijednost 92%, negativnu prediktivnu vrijednost 69% i dijagnostičku točnost 92%. Proporcija je lažno negativnih nalaza 10 /o ( 3,1 /o pogreška skrininga, 6,9% pogreška uzimanja). Proporcija je lažno pozitivnih nalaza 1,4% (0,6% pogreška interpretacije). Kolposkopija ima osjetljivost 88%, specifičnost 15%, pozitivnu prediktivnu vrijednost 78%, negativnu prediktivnu vrijednost 27% i dijagnostičku točnost 78%. Proporcija je lažno negativnih nalaza 12%. Citologija i kolposkopija primijenjene zajedno imaju osjetljivost 99%, specifičnost 98%, pozitivnu prediktivnu vrijednost 99%, negativnu prediktivnu vrijednost 75% i dijagnostičku točnost 99%. Citologija je točnija u otkrivanju lezija, a glavni su razlozi njezine neuspješnosti loše uzeti uzorci, a rjeđe propusti u skriningu. Kolposkopija je u odnosu na citologiju manje točna, a razlozi su njezine neuspješnosti endocervikalna lokalizacija lezije što rezultira lažno negativnim nalazom, dok istovremeno neke benigne promjene (nezrela pločasta metaplazija) mogu dati kolposkopsku abnormalnost i lažno pozitivan nalaz. Primijenjene zajedno postižu dijagnostičku točnost od gotovo 100%.We have included 1000 nongravid women who had cytological and colposcopical examination done independently. 207 women with abnormal cytological and/or colposcopical finding had a histological examination. Comparing cytological and colposcopical with histological findings, we could determine the value of cytology and colposcopy as methods of screening in the case of intraepithelial and early invasive lesions of cervix uteri. Sensitivity of cytology is 90%, specificity 74%, positive predictive value 92%, negative predictive value 69% and total diagnostic accuracy 92%. The proportion of false-negative findings is 10%, whereof 3.1% can be considered as a screening error and remaining 6.9% as a sampling error. The proportion of false positive findings is 1.4%; whereof 0.6% referred to interpretation errors and 0.8% should be clarified with cytological/histological follow-up. Sensitivity of colposcopy is 88%, specificity 15%, positive predictive value 78%, negative predictive value 27% and total diagnostic accuracy 78%. The share of false-negative findings is 12%. Cytology and colposcopy applied together have sensitivity 99%, specificity 98%, positive predictive value 99%, negative predictive value 75% and total diagnostic accuracy 99%. Cytology is more accurate in detection of lesions and major reasons of its unsuccessfulness are sampling errors, less often - screening errors. In comparison to cytology, colposcopy is less accurate and the reasons for its unsuccessfulness are endocervical localization of the lesion which results in false-negative findings, whereas, at the same time, some benign changes (immature squamous metaplasia) can produce colposcopic abnormality and falsepositive finding. When applied together, cytology and colposcopy can achieve diagnostic accuracy of almost 100%

Influence of Cytology Development on Frequency of Pre-Cancerous Lesions and Cervical Cancer in East Croatia, 1978–2001

A B S T R A C T We analyzed the influence of cytology development to frequency of precancerosa (Cervical intraepithelial neoplasia grade 3 – CIN 3) and cervical cancer. The number of examined Pap smears increased significantly in the analyzed period. The calculated linear trend shows an average four-year increase of 17,283.35 smears. The number of detected CIN 3 increased accordingly. The calculated linear trend shows an average four-year increase by 45.03 and decrease of the rate of 0.07. A slight increase in cervical cancer was also noticed. The calculated linear trend shows an average four-year increase in cancer by 1.6 and decrease in the rate of 0.51. Analyses of cervical cancer by stages showed an increase in number of stage I and decrease of other stages. The calculated linear trend shows an average four-year increase of stage I by 4.94 or decrease in other stages of cervical cancer of 3.29 respectively. The rate of cervical cancer stage I decreased by 0.11 and of other stages by 0.39. Further analyses of the stage I showed that the linear trend of IA stage had an average four-year increase by 5.40 and decrease in stage IB of 0.48. The rate of the cervical cancer stage IA increased by 0.02, whereas the rate of IB decreased by 0.13. Cytology development in our country has resulted in detection of higher number of CIN 3 and the earliest stage (IA) of cervical cancer whereas the number of other stages (IB, II, III, IV) has decreased. However, a total number of cervical cancers haven’t changed over the whole period. Thus, it is obvious that opportunistic program of detection, which has been using in Croatia, could not decrease frequency of cervical cancer. In order to achieve it, well-organized national program of detection is needed

Is the HSIL Subclassification Cytologically Real and Clinically Justified?

The aim of the study was to evaluate the justification of Croatian modification of Bethesda classification after thirteen years of its application, answering the question if the subclassification of high-grade squamous intraepithelial lesion (HSIL) into cervical intraepithelial lesion (CIN) grade 2 (CIN2) and grade 3 (CIN3) is cytologically real and clinically justified. The retrospective study included 3110 women to whom cervical intraepithelial lesion of different grade was diagnosed by cytological examination of vaginal-cervical-endocervical (VCE) smear at Department of Clinical Cytology, Clinical hospital Osijek in period from 1993 to 2005. 57.1% of women were monitored cytologically and colposcopically, while 42.9% of them had also pathohistological examination. The spontaneous regression of cytological finding was noted in 66.3% of the cases. Moderate dysplasia regressed more often (50.98%) than severe dysplasia (31.3%) and more rarely than mild dysplasia (70.1%), which was statistically significant (p0.05) in their biological behaviour and histological finding. In fact, 50.9% of moderate dysplasia spontaneously regressed, 14.4% persisted during follow-up, and 59.7% had a histological finding milder than CIN3. Therefore, in almost 65% of moderate dysplasia lesions it is not justified to apply the same diagnostic therapeutic procedures as for severe lesions, which means that cytological subclassification of HSIL into moderate dysplasia and severe dysplasia lesions is clinically justified. Positive predictive value of differential cytological diagnoses mild, moderate and severe dysplasia calculated in relation to histological CIN3+ statistically significantly increases for every single diagnosis, which also confirms that moderate dysplasia can be individual diagnostic category, thus the subclassification of HSIL is cytologically possible