Subgrouping and grading of soft-tissue sarcomas by fine-needle aspiration cytology: a histopathologic correlation study.

To evaluate the accuracy and reproducibility of subgrouping and grading soft-tissue sarcomas by fine-needle aspiration biopsy (FNAB), a blind review was conducted of 84 FNAB specimens from 77 malignant and 7 benign soft-tissue lesions. Cytomorphologic subgroups included 31 spindle-cell, 24 pleomorphic, 11 myxoid, 7 epithelioid/polygonal, 3 small round cell, and 8 nondiagnostic cases. Malignancies included one lymphoma and 41 primary, 15 recurrent, and 20 metastatic soft-tissue sarcomas. Adequacy was defined as a majority of slides with at least 5 clusters of 10 unobscured cells. Five originally false-negative cases were considered nondiagnostic on review. Sarcoma was recognized in 59 of 64 adequate cases (92%) with available histology; however, the specific histopathologic subtype was identified in only 9 cases (14%). Benign myxoid and spindle-cell lesions were difficult to separate from low-grade sarcomas in 4 cases, and a B-cell lymphoma with sclerosis mimicked a low-grade myxoid sarcoma. The assigned cytologic grade accurately reflected the histologic grade in 90% of sarcomas when segregated into high and low grades. Pleomorphic, small round cell, and epithelioid/polygonal subgroups corresponded to high-grade sarcomas in all cases with only minor noncorrelations. Major grading noncorrelations occurred in 50% of myxoid and 9% of spindle-cell sarcomas. Therefore, attention should be given to specimen adequacy, and caution should be exercised when attempting to grade myxoid and spindle-cell sarcomas by FNAB.

A cytologic study of oral mucosal cell alterations in smokeless tobacco users and efficacy of a related cessation program.

PURPOSE: The primary objective of the study was to determine if oral tissue changes, as documented by cytologic study and reported to the smokeless tobacco user, provide incentive to discontinue use of smokeless tobacco products. METHOD: Smokeless tobacco users who presented for treatment in the University of Arkansas for Medical Sciences dental hygiene clinic served as the 10 subjects of this one-year study. Calibrated dental hygiene faculty collected cellular specimens from the oral mucosa of subjects at the site of smokeless tobacco placement and a clear site as control. Specimens were collected by a moistened tongue blade scrape, then fixed, stained, and diagnosed by faculty in the department of pathology. Subjects participated in a cessation program: a standardized session in which results of the cytologic findings and risks of smokeless tobacco usage were discussed, using visuals and pamphlets. The subjects, with the exception of the last, were contacted at three- and six-month intervals to determine their compliance with cessation recommendations. RESULTS: Three of the 10 subjects displayed significant tissue changes; these subjects discontinued smokeless tobacco use. The cytologic studies of the other seven subjects revealed only various amount of hyperkeratosis. CONCLUSION: Cytologic assessment and results may be a valuable component of a smokeless tobacco cessation program. This area merits further research.

Sputum cytology within and across laboratories. A reliability study.

A total of 11 cytotechnologists at sites in Texas (TX1, TX2), California (CA) and Arkansas (AR) were assessed for agreement of six-category diagnoses of sputum cytology slides prepared by the method of Saccomanno. For three observers at TX1 there was more agreement within observers (27-60%) than across observers (13-50%). Within-1 category intraobserver agreement underwent a twofold to threefold increase, to 77-93%; within-2 category agreement was 90-100%. Interobserver within-1 category agreement was 47-92%; within-2 category agreement was 83-100%. Agreement was significantly greater than chance (using kappa) in 69% of all intraobserver and interobserver pairings. Intralaboratory agreement was 40% for CA and 40-57% for TX2. Among pairings of the four sites, the range of interlaboratory agreement was 13-60% over several occasions. The overall range of agreement with the TX1 standard was 17-50% over observers/occasions. Within certain categories, outside agreement with the TX1 standard was 53-90% for normal, 39-80% for squamous metaplasia, 68-84% for mild atypia, 80-100% for moderate atypia and 93-100% for severe atypia or carcinoma. We conclude that agreement is acceptable for extreme atypia, but more training or refinement of the guidelines may be needed, if justified, to better differentiate the lowest categories. Good agreement appears to be as likely for observers with many years of overall experience as for those with high exposure to the Saccomanno method. For potential statistical analyses, the scale should probably be condensed into three to four categories to reduce extraneous variability.

A competitive receptor binding radioassay for beta-1 and beta-2 adrenergic agents.

A rapid and sensitive competitive receptor binding assay for beta-1 and beta-2 adrenergic binding for adrenergic agents has been developed. The steps that are critical for the success of the assay are given in detail so that the assay can be set up in any routine laboratory with relative ease. The rationale behind the use of specific reagents is discussed. The assay requires microgram quantities of test compound, a radiolabeled specific beta adrenergic antagonist [3H]dihydroalprenolol (DHA), and turkey erythrocyte beta-1 and rat erythrocyte beta-2 receptor membranes. Serial dilutions of sample are incubated with appropriate receptor membranes and DHA for 1 hr at room temperature. After equilibrium is attained, the bound radioligand is separated by rapid filtration under vacuum through Whatman GF/B filters. The amount of bound DHA trapped on the filter is inversely proportional to the degree of beta-1 or beta-2 adrenergic binding of the sample. Separation of bound from free radioligand by filtration permits rapid determination of a large number of samples. This assay quantitates and differentiates beta-1 and beta-2 adrenergic binding of synthetic adrenergic agents.