Exploiting the "toothpick effect" of the Cytobrush by plastic embedding of cervical samples.

The introduction of the combined spatula-Cytobrush sampling method has increased the diagnostic accuracy of cervical cytology. However, the smears from a small number of cases contained epithelial fragments dislodged by the "toothpick effect" of the Cytobrush. Due to their thickness, these epithelial fragments in the smears are very difficult (if not impossible) to scrutinize and are thus undiagnosable. The presence of only such fragments in smears led to false-negative diagnoses in two cases of invasive carcinoma. To solve this problem, these epithelial fragments were embedded in plastic, with thin sections prepared from the blocks. This paper presents the morphologic features and diagnostic accuracy of 77 such problem cases (found among 50,000 cases with spatula-Cytobrush smears) to which this method was applied. In almost all cases, the diagnosis on the plastic-embedded sections matched the diagnosis on the colposcopically directed biopsy. Of these 77 patients, the biopsy diagnosis showed 5 severe dysplasias, 6 carcinomas in situ, 1 squamous-cell carcinoma, 2 adenocarcinomas in situ and 2 adenocarcinomas. In addition, data are presented concerning the nuclear-size and shape-factor differences in smears versus plastic-embedded sections, and the stereologic consequences of smearing and cutting these epithelial fragments are discussed. These plastic-embedded sections are well suited for use in quantitative microscopy, as well as for diagnostic purposes

Diagnostic parameters in liquid-based cervical cytology using a coagulant suspension fixative

Objective To evaluate in detail the morphology of cervical cell samples suspended in the coagulant fixative BoonFix (R) (Finetec, Tokyo, Japan) in liquid-based Papspin (R) slides (Thermo Shandon, Pittsburgh, Pennsylvania, U.S.A) to detect shifts in diagnostic parameters for infections and neoplasia. Study Design Split samples of 1,010 cases were collected. All Papspin (R) slides were scanned with neural network technology. In 849 cases the diagnosis was "within normal limits"; in 22 cases it was preneoplasia. In 151 special cases conventional smears were compared with thin-layer slides. Results In 85% of the 151 special cases, a shift of the diagnostic parameter was observed in the Papspino slide. The parameter adhesion of inflammatory cells to epithelial cells was easier to discern in 94 % of the cases, and adhesion of microorganisms varied 43-100%. Koilocytosis was more visible in 79%. Prominent nucleoli in atypical and malignant cells were e-nhancedin 50-100% ofcases withpi-eneoplasia. The ears were compared with fact that the cells on the Papspin (R) slide were no longer-present in diagnostic streaks posed a problem only in the case of follicular cervicitis. Conclusion The shifts in parameters facilitated the diagnostic process. BoonFix (R) permits the screening of liquid-based Papspin (R) slides, which have proven to he well suited to automated neural network scanning

Diagnostic parameters in liquid-based cervical cytology using a coagulant suspension fixative

Objective To evaluate in detail the morphology of cervical cell samples suspended in the coagulant fixative BoonFix (R) (Finetec, Tokyo, Japan) in liquid-based Papspin (R) slides (Thermo Shandon, Pittsburgh, Pennsylvania, U.S.A) to detect shifts in diagnostic parameters for infections and neoplasia. Study Design Split samples of 1,010 cases were collected. All Papspin (R) slides were scanned with neural network technology. In 849 cases the diagnosis was "within normal limits"; in 22 cases it was preneoplasia. In 151 special cases conventional smears were compared with thin-layer slides. Results In 85% of the 151 special cases, a shift of the diagnostic parameter was observed in the Papspino slide. The parameter adhesion of inflammatory cells to epithelial cells was easier to discern in 94 % of the cases, and adhesion of microorganisms varied 43-100%. Koilocytosis was more visible in 79%. Prominent nucleoli in atypical and malignant cells were e-nhancedin 50-100% ofcases withpi-eneoplasia. The ears were compared with fact that the cells on the Papspin (R) slide were no longer-present in diagnostic streaks posed a problem only in the case of follicular cervicitis. Conclusion The shifts in parameters facilitated the diagnostic process. BoonFix (R) permits the screening of liquid-based Papspin (R) slides, which have proven to he well suited to automated neural network scanning

Diagnostic parameters in liquid-based cervical cytology using a coagulant suspension fixative

Objective To evaluate in detail the morphology of cervical cell samples suspended in the coagulant fixative BoonFix (R) (Finetec, Tokyo, Japan) in liquid-based Papspin (R) slides (Thermo Shandon, Pittsburgh, Pennsylvania, U.S.A) to detect shifts in diagnostic parameters for infections and neoplasia. Study Design Split samples of 1,010 cases were collected. All Papspin (R) slides were scanned with neural network technology. In 849 cases the diagnosis was "within normal limits"; in 22 cases it was preneoplasia. In 151 special cases conventional smears were compared with thin-layer slides. Results In 85% of the 151 special cases, a shift of the diagnostic parameter was observed in the Papspino slide. The parameter adhesion of inflammatory cells to epithelial cells was easier to discern in 94 % of the cases, and adhesion of microorganisms varied 43-100%. Koilocytosis was more visible in 79%. Prominent nucleoli in atypical and malignant cells were e-nhancedin 50-100% ofcases withpi-eneoplasia. The ears were compared with fact that the cells on the Papspin (R) slide were no longer-present in diagnostic streaks posed a problem only in the case of follicular cervicitis. Conclusion The shifts in parameters facilitated the diagnostic process. BoonFix (R) permits the screening of liquid-based Papspin (R) slides, which have proven to he well suited to automated neural network scanning

How to improve cytologic screening for endocervical adenocarcinoma?

Aim: A retrospective study was undertaken to investigate how to improve the diagnosis of endocervical adenocarcinoma in screening programs. Material and Methods: The study group consisted of 29 slides of women diagnosed with cancer but who had negative smears. The slides were subdivided in 12 smears taken less than one year before diagnosis by histology and 17 smears taken between one and 10 years prior to diagnosis. A hundred smears of healthy women were used for comparison. All smears were studied macroscopically after which both groups of smears were scanned by the Neural Network Scanner (NNS). Differences between groups were studied for statistical significance using Pearson's Chi-squared test. Findings: The macroscopic parameter of these smears found to be present most frequently was a heavy admixture, of blood. The presence of blood (lysed or not) in the smears was equally consistently highlighted by the NNS. Statistical significance of the association of this parameter, with the presence of cancer, was demonstrated. Conclusion: The awareness of blood as a background feature of adenocarcinoma of the cervix will help to select cases needing special attention. These difficult bloody smears, studied by light microscopy and by NNS images can also be selected for additional MiB-1 staining. With this approach, blood in smears, otherwise frequently leading to a compromise of classification, can become a blessing in disguise. The diagnosis of endocervical adenocarcinoma in screening smears will therefore be improved

How to improve cytologic screening for endocervical adenocarcinoma?

Aim: A retrospective study was undertaken to investigate how to improve the diagnosis of endocervical adenocarcinoma in screening programs. Material and Methods: The study group consisted of 29 slides of women diagnosed with cancer but who had negative smears. The slides were subdivided in 12 smears taken less than one year before diagnosis by histology and 17 smears taken between one and 10 years prior to diagnosis. A hundred smears of healthy women were used for comparison. All smears were studied macroscopically after which both groups of smears were scanned by the Neural Network Scanner (NNS). Differences between groups were studied for statistical significance using Pearson's Chi-squared test. Findings: The macroscopic parameter of these smears found to be present most frequently was a heavy admixture, of blood. The presence of blood (lysed or not) in the smears was equally consistently highlighted by the NNS. Statistical significance of the association of this parameter, with the presence of cancer, was demonstrated. Conclusion: The awareness of blood as a background feature of adenocarcinoma of the cervix will help to select cases needing special attention. These difficult bloody smears, studied by light microscopy and by NNS images can also be selected for additional MiB-1 staining. With this approach, blood in smears, otherwise frequently leading to a compromise of classification, can become a blessing in disguise. The diagnosis of endocervical adenocarcinoma in screening smears will therefore be improved