Changing spectrum of squamous cell abnormalities observed on papanicolaou smears in Mubarak Al-Kabeer Hospital, Kuwait, over a 13-year period

The aim of this study was to determine the incidence of squamous cell abnormalities in cervical cytology in Mubarak Al-Kabeer Hospital, Kuwait, and to document any change in the pattern of these lesions. Over a 13-year period [1992-2004], 86,434 cervical smears were studied in Mubarak Al-Kabeer Hospital, Kuwait. Conventional Pap smears were first examined by cytotechnicians and finally reported by cytopathologists. The smears were classified according to the modified Bethesda system. The age of presentation of squamous cell abnormalities in Kuwaiti women was analyzed. Smears from 83,052 [96.09%] patients were found satisfactory for reporting while the remaining 3.9% was unsatisfactory. Atypical squamous cells of undetermined significance [ASCUS] were seen in 1,790 [2.2%] cases, atypical glandular cells of undetermined significance [AGUS] in 630 [0.8%] cases, low grade squamous intraepithelial lesion including human papillomavirus changes [LSIL] in 824 [1.0%] cases, high grade squamous intraepithelial lesion [HSIL] in 189 [0.2%] cases, and carcinoma in 79 [0.1%] cases of which 44 [0.05%] were squamous cell carcinoma. A comparison of average cases/annum during the study period revealed a significant increase in ASCUS from 1.13 to 2.83% [p < 0.001] and AGUS from 0.33 to 1.08% [p < 0.001]. However, the percentage of LSIL, HSIL and carcinoma detected in Pap smears remained the same. A significant linear trend [p < 0.001] was observed in satisfactory smears, ASCUS and AGUS over the years. However, no significant change was found in the detection of LSIL, HSIL and carcinoma. A reduction in the age of LSIL/HSIL and an increasing trend in the number of Kuwaiti women over the years was also observed which makes screening of young women essential in Kuwait

Role of fine needle aspiration cytology in the diagnosis of swelings in the salivary gland regions: a study of 712 cases

A mass in the salivary gland region often presents a diagnostic challenge with regard to its site of origin [salivary versus nonsalivary], benign or malignant nature, and tissue-specific diagnosis. The present study describes the utility of fine-needle aspiration [FNA] cytology in the diagnosis of these lesions. Subjects and Over a 6-year period [January 1994 to December 1999], 712 patients aged between 6 months and 91 years [median, 37 years] were subjected to FNA of swellings in their salivary gland regions. Male:female ratio was 1.28:1. The swellings were mostly located in the parotid [323 cases], submandibular [343 cases], and upper cervical region [27 cases]. Swellings of oral [5 cases] and sublingual [2 cases] sites were rare. The lesions diagnosed by FNA cytology were compared among the major salivary glands. Cytologic diagnoses were correlated with histology in 45 cases. Benign nonneoplastic lesions were the most common [73%], followed by neoplasms [20%], and those with atypical cytology [1%]. Cytologic material was inadequate in 6% cases. Parotid gland region was involved more frequently by neoplasms [27.1%] than the submandibular gland region [13.7%, p < 0.0001]. Inflammatory processes affected the submandibular gland region more commonly [42.0%] than the parotid [32.6%, p = 0.0164]. Pleomorphic adenoma was the most common neoplasm [61.5%], followed by Warthin's tumor [12.6%]. Malignancies accounted for 10.5% of neoplasms. Frequency of involvement of parotid by Warthin's tumor [16.7%] was significantly higher than that of submandibular gland [2.3%, p = 0.0191]. However, the submandibular gland was more commonly affected by malignancy than the parotid gland [p = 0.0003]. Sensitivity, specificity, and diagnostic accuracy of FNA cytology for all neoplastic lesions of the salivary gland were 94.6, 75.0, and 91.1%, respectively. The corresponding figures for malignancies were 60.0, 95.0, and 91.1%, respectively. FNA cytology is very useful for the diagnosis of salivary gland lesions. However, sampling and interpretation errors may occur. The low specificity for the diagnosis of neoplasms as a whole and the poor sensitivity for malignancies found in our study can be attributed to the relatively small number of benign nonneoplastic and malignancy cases with available histopathologic diagnoses