RESUMEN
The Bethesda System [TBS] for reporting the results of cervical cytology was developed as a uniform system of terminology that would provide clear guidance for clinical management. According to TBS, the diagnostic report should include a recommendation for further evaluation when appropriate. The aim of this wok was to use TBS terminology in classification of abnormal cervical Pap smears or with persistent significant inflammatory changes, and correlate the results with the final histopathological findings for optimum evaluation and clinical use. This prospective study was conducted in the Cytocolposcopic Unit of Teaching Laboratories and Outpatient Department of Medical City Teaching Hospital over a period of one year [Sep. 2001- Sep. 2002]. Eighty-three married females were included in the study. A cervical smear was taken followed by a punch biopsy, taken under colposcopic guidness, from the suspicious lesions for histopathological study. All cytological interpretations were reported and categorized according to The Bethesda System [TBS]. The rate of different cytological and histopathological findings and a comparison between the results were estimated by a special statistical analysis. Minimal cytological abnormalities were significantly more common than high-grade squamous intraepithelial lesion/HGSIL [95.5% compared to 4.5% respectively]. Atypical squamous cells of undetermined significance/ASCUS, as a single entity, was the most common cytological abnormality [44.8%], followed by low-grade squamous intraepithelial lesion/LGSIL [41.8%], atypical glandular cells of undetermined significance/AGUS [9%], and then HGSIL [4.5%]. [24.1%] of ASCUS in cytology was associated with underlying CIN [SIL] lesions in: histopathology, out of those, [20.7%] had CIN1/LGSIL and [3.4%] had CINII-III/HGSIL [14.3%] of cases with LGSIL.in cytology had CIN II-III [HGSIL] in histopathology, while HGSILs in cytology were associated with 100% high-grade lesions in histopathology. The most common cytologic diagnoses immediately preceding the discovery of histologic HGSIL were LGSIL [57.1%], ASCUS [14.3%], and then HGSIL [28.6%]. Minimal cytological abnormalities in cervical smears were significantly more common than HGSIL. ASCUS, as a single entity, was the most common cytological abnormality. All cases of HGSIL, in cytology, were found to have the same diagnosis by histopathology. So all cases with HGSIL in cytology should be immediately referred for colposcopy for final diagnosis. On the other hand, cases with minor cytological abnormalities were found to have high-grade lesions in histopathology in only 3.3% of women referred with ASCUS smears, and 14.3% of those with LGSIL smears. The latter finding demonstrates that an adjunctive method like colposcopy or close follow-up [particularly with three-smear follow up] is recommended to rule out high-grade lesions
RESUMEN
Fine needle aspiration [FNA] is indicated in the exploration of superficial and deep masses. The accuracy of this procedure differs in various studies, and according to the organ explored. Palpable mammary masses of concern to the patient or clinician should be aspirated, regardless of imaging findings. The present study aimed at evaluation of cytological results of FNA of different palpable breast lesions, using histopathological diagnosis as the gold standard for final diagnosis. This prospective study includes 289 females with palpable breast lesions. FNA aspiration was conducted in a private out patient clinic during the period of 1994-2004. The cytological results of aspirated masses are compared with the histopathological result of biopsies or surgical specimens. Estimation and evaluation of the validity parameters of cytology and histopathology were performed. Out of seventy one [71]cases of malignant neoplasms diagnosed in histopathological: sixty three [63] showed malignant cellular aspirates, four [4] showed atypical cellular changes and four [4] were negative for significant cellular findings on F
A. On the other hand out of [217] benign lesions diagnosed by histopathology; 15 showed atypical epithelial changes on cytological aspirates while the rest showed benign cellular aspirates. Twenty [20] cases out of the whole sample showed epithelial cellular atypia on FNA; four of them proved to be malignant, one case revelead atypical epithelial hyperplasia or epithelioisis, and the other 15 proved to be benign lesions by histopathology. The validity parameters of FNA were as follows; sensitivity= 88.7%, specificity= 100%, False negative results= 11.3% and accuracy= 96.1%. F. N. A. is a quick, inexpensive, relatively painless safe procedure from which results can be obtained in a short time with the other supportive investigations. Adequacy determination must be based not only on the cytological findings but also on their correlation with the clinical, mamrnographic, and ultrasonic findings to avoid false negative results. Atypical epithelial changes on cytological smears indicate the need for immediate excional biopsy
RESUMEN
Soft tissue sarcoma [STS] represents a heterogeneous group of rare malignant tumors. Many diagnostic problems and difficulties are often encountered in the differential diagnosis of these tumors. The variety of appearance gives a wide range of tumor types and subtypes with a high discrepancy rate in tumor typing among pathologists. This study was conducted at the Military Medical Academy [EGYPT] during the period from [1989-1990]. The study aimed to reexamine a routinely processed H and E stained slides of cases previously diagnosed as STS by a group of pathologist and match the old and new diagnoses, with the application of some special stains; histochemical and immunohistochemical, then evaluate the results. Forty cases previously diagnosed as STS were reexamined and classified according to the criteria of Enzinger and Weiss. A descriptive or morphological classification was also used; as spindle, round, myxoid and pleomorphic STS. The results were compared to, and matched with the previous diagnoses. Histochemical stains used are, Picro Sirius red [PSR], Masson trichrome [MT], and Periodic-acid schiff stain [PAS]. Myoglobin was used as immunohistochemical marker for the detection of cross-striated muscle cell differentiation by peroxidase antiperoxidase method [PAP]. Agreement in diagnosis between the previous and the recent diagnosed STS was found to be 47.5%. For spindle cell malignant tumors the agreement was 58.8%, while for round cell malignant tumors was 33.3%. Agreement in diagnosis in mixed malignant soft tissue tumors was 62.5%. PSR and MT demonstrate the amount and distribution of collagen. MT also demonstrates muscle fibers. Using Myoglobin immunohistochemical marker in the previously diagnosed STS: one out of four cases diagnosed as Rhabdomyosarcomas gave a positive result, while two cases from the unsuspected group gave positive results. In the recently diagnosed tumors: all cases diagnosed as Rhabdomyosarcoma gave positive results, while from the unsuspected group one gave positive result. While the ordinary H and E stain will suffice to permit recognition of many of STS, it will not do so for all. Limitation of diagnosis of these tumors, especially the rare ones, to specialized centers or highly qualified pathologists is recommended. Histochemical stains are supportive rather than exclusive for the diagnosis of STS. Myoglobin immunohistochemical marker could be used to aid in the diagnosis of rhabdomyosarcomas. Definite diagnosis of many STS needs further special stains and/or electron microscopy and other sophisticated procedures
RESUMEN
An optimal cancer detection system for preclinical cervical lesions should combine a cytological examination with a colposcopic follow-up examination. Detection at early pre-invasive stage provides an opportunity for treatment to prevent progression to invasive cancer. The present study aimed at evaluation of cytology, colposcopy, and combined cytology and colposcopy in predicting histopathological diagnosis of cervical intraepithelial neoplasia/squamous intraepithelial lesion [CIN/SIL] or other neoplastic changes in patients with abnormal cervical cytological findings. This prospective study was conducted in the Cyto-colposcopy Unit of Teaching Laboratories and Outpatient Department of Medical City Teaching Hospital over a period of one year [Sep. 2001- Sep. 2002]. Eighty-one married females were included in the study. A cervical smear was taken followed by a colposcopic examination of the cervix and then a punch biopsy was taken from the suspected lesions for histopathological study. Estimation and evaluation of the validity parameters of cytology, colposcopy, and combined cytology and colposcopy were performed using different cutoff points by special statistical analysis. Sensitivity, specificity and accuracy of cytology in the diagnosis of CIN/SIL were 73%, 93.2% and 84.0% respectively. The False- negative rate was 27%. Sensitivity, specificity and accuracy of colposcopy in the diagnosis of CIN were 83.3%, 58.5% and 70.1% respectively choosing doubtful findings as a cut-off point. The combination of cytology and colposcopy gave the following results: sensitivity, specificity and accuracy were 94.6%, 61.4% and 76.5% respectively; the negative predictive value [NPV] was 93.1%. When suspicious colposcopic findings were chosen as the cut-off point, the specificity and the positive predictive value [PPV] were higher at the expense of sensitivity and NPV. The conventional Pap smear, a valuable tool in the evaluation of patients with abnormal cervical cytology, was found to be of relatively low sensitivity in predicting CIN/SIL. Colposcopy is a valuable tool too. However, the validity parameters showed variable figures depending on the different cut-off points applied for the diagnosis of CIN/SIL. The ideal cut-off point was when doubtful and higher-grade colposcopic lesions are considered positive. The combination of cytology and colposcopy resulted in an increased sensitivity and NPV. The specificity could be further increased or improved when the threshold was set to distinguish higher-grade lesions [suspicious lesions] from lesser abnormalities