Management of women with abnormal cervical smears: supplement to terminology in gynaecological cytopathology.

Recommendations are made for the management of patients with abnormal cervical smears. Colposcopic examination is indicated for persistent mild and moderate dyskaryosis, as well as for severe dyskaryosis.

Terminology in gynaecological cytopathology: report of the Working Party of the British Society for Clinical Cytology.

The report defines and recommends terms for use in cervical cytology.

Immunocytochemical reaction of Ca1 and HMFG2 monoclonal antibodies with cells from serous effusions.

The Ca1 antibody was used in an alkaline phosphatase immunocytochemical method on cells obtained from 150 specimens of pleural and ascitic fluids. The results were compared with the routine cytology report based on the light microscopical appearances. The Ca1 antibody identified tumour cells in 51 of 57 specimens with malignant cells. The exceptions were four small cell carcinomas, one malignant lymphoma, and one adenocarcinoma. A further seven specimens reported as containing atypical cells but without conclusive evidence of malignancy were Ca1 positive. The Ca1 antibody did not give a positive reaction with benign mesothelial cells. Similar results were obtained with the HMFG2 antibody and malignant cells, but in eight of 18 benign effusions it reacted with mesothelial cells.

Cytological sampling at fibreoptic bronchoscopy: comparison of catheter aspirates and brush biopsies.

A prospective study was undertaken to compare bronchial brushings with dry catheter aspiration for the cytological diagnosis of lung cancer at fibreoptic bronchoscopy. Duplicate samples taken by aspirate and brush were obtained at 103 consecutive routine bronchoscopies. Aspirate and brush samples were reported on separately by two cytologists. At the end of the study a 30% sample, including the 19 cases with different findings by the two methods, were subjected to a blind crossover review, and then an open review. Forceps biopsy specimens for routine histological assessment were taken in 94 cases (92%). Ninety-eight of 103 (95%) aspirates and 99 of 103 (96%) brush specimens were technically satisfactory. Carcinoma was diagnosed at bronchoscopy on cytological or histological evidence or both in 57 cases. Fifty-five of these tumours (96%) were recognised by either the aspirate or the brush method, 52 (91%) by brush, and 50 (88%) by aspirate. Thirty-four cases (60%) could be diagnosed from histological specimens. The order of cytological sampling did not systematically affect yield. It is concluded that fine-catheter aspirates, permitting smears to be prepared in the laboratory, are a satisfactory alternative to brush smears for the cytological diagnosis of lung cancer at bronchoscopy. The routine use of both techniques at bronchoscopy will increase diagnostic yield by about 5%. Duplicate sampling may be especially useful in obtaining diagnostic material from upper-lobe or apical-segment tumours.

Progression and regression of cervical lesions. Review of smears from women followed without initial biopsy or treatment.

Cervical smears were reviewed from patients in whom a cytological abnormality was followed, after an interval without interference, either by regression to ;negative' or else by progression to invasive carcinoma. Twenty-eight cases were from a previously analysed series with positive smears and an interval of at least two years before investigation, resulting from refusal or failure to trace. Slides were also reviewed from 25 cases in which ;positive' smears had regressed to negative without escaping from surveillance, and from 10 patients subsequently developing invasive carcinoma whose previous slides, taken several years earlier, showed abnormalities on review. None of these 63 patients had any biopsy or other surgical procedure to the cervix between the initial smear and the outcome. Slides showing ;superficial cell dyskaryosis' and/or well-differentiated ;parabasal cell dyskaryosis' were found only among the groups with subsequent regression. Those showing dissociated poorly differentiated dyskaryotic parabasal cells regressed to negative in two cases and progressed to invasion in nine. This suggests that many examples of spontaneous regression correspond to mild dysplasias which are not precancerous, and overdiagnosis must often have resulted in unnecessary surgical procedures in the past.;Regressing' and ;progressing' groups both included cases in which the spatula had removed coherent pieces of undifferentiated epithelium. These are difficult to interpret cytologically. In nine of them (including four which regressed) the cytological picture was that of carcinoma in situ. The remainder (14 cases) were probably examples of reserve cell hyperplasia, and it is noteworthy that, of the 21 cases subsequently progressing to invasive carcinoma, five were preceded by appearances of this type. It is concluded that cell aggregates suggesting an unusual degree of reserve cell hyperplasia are a danger signal and require careful surveillance.

Joint fluid cytology in Reiter's disease.

The diagnostic value of the finding of cytophagocytic macrophages (CPM) in the joint fluid of patients with Reiter's disease has been re-examined. CPM were found in 46% of Reiter's disease fluids and in 45% of other inflammatory knee joint fluids. Higher CPM scores, on a 4-point grading, were commoner in Reiter's disease but the difference was not statistically significant. Further, although the graded polymorphonuclear leucocyte phagocytosis shown by CPM was greater in Reiter's disease this also was not significant. It is concluded that the presence of CPM in joint fluid is of little discriminating value.

Adenocarcinoma of the uterine cervix: cytological evidence of a long preclinical evolution.

Adenocarcinoma of the cervix occurred in 13 women who had previously had "negative" cervical smears. These smears were reviewed, and abnormalities were found in six cases, the intervals ranging from two to eight years. It is concluded that adenocarcinoma, like squamous carcinoma of the cervix, can have a prolonged evolution during which it is cytologically detectable.

Oat-cell bronchial carcinoma. Identification of cells in pleural fluid.

An analysis is made of the accuracy of diagnosing oat-cell (small cell) carcinoma of the lung from the cytology of pleural fluid. All the material over a 22-year period has been reviewed. Air-dried smears were used, stained with May-Grünwald-Giemsa. Of 91 cases in which oat-cells were specified in the written report, 90 were either proved histologically to have oat-cell or anaplastic bronchial carcinoma, or else had clinical findings consistent with that diagnosis and were registered as having bronchial carcinoma at death. There was one false positive, and no false suspicious reports. Cytologic diagnosis of this tumor type has, therefore, been no less reliable than would be expected from a histologist examining a surgical biopsy of infiltrated tissue. Of 49 consecutive cases histologically proved to have oat-cell carcinoma, and with pleural effusions examined in this laboratory, 21 showed no malignant cells (43 per cent false negative). Diagnostic features and causes of error are discussed, as well as the advantage of air-dried smears over the standard Papanicolaou method for the detection of this cell type.

Cytodiagnosis of rheumatoid pleural effusions.

The stained smears of the deposits from one pericardial and 19 pleural effusions complicating rheumatoid arthritis were examined. On the basis of clinical and biochemical evidence it was considered that in six cases the effusions were due to the rheumatoid disease while in a further nine cases the association was considered likely. In the remaining five cases the association was considered to be due to chance as other causes for the effusions were diagnosed. On cytological examination, seven cases showed a characteristic picture of degenerating polymorphs with amorphous extracellular material and epithelioid cells many of which were multinucleate. Five others contained similar amorphous material without epithelioid cells; of these two had many plasma cells and a third numerous macrophages probably containing ;droplets' of rheumatoid factor complex. Thus in 12 of 15 cases a definite diagnosis of rheumatoid effusion could be made. In the remaining five cases cytological examination confirmed that the effusions were unrelated to the rheumatoid disease.The extracellular material gave a non-specific fluorescence with labelled anti-gamma globulin antisera, and since this reaction was not seen in control pleural fluid deposits, or with preparations of fibrin, it may have a confirmatory value. It is concluded that in many cases reliable cytological evidence can be found to confirm or refute a diagnosis of rheumatoid pleural or pericardial effusion. This may be helpful in the management of the rheumatoid disease.