Probability of early repeat Pap smear in an integrated cervical screening programme.

The integration of routine Pap smear practice based on self-referral into an organized programme based on personal invitation is the recommended approach to cervical cancer screening. In this study, the cytology archive of the integrated cervical screening programme implemented in the Faenza district (northern Italy) was used to compare the population of women responding to invitation with that of self-referred women for the cumulative probability of early (< 36 months) repeat Pap smear after a negative result. Between 1995 and 1998, women aged 25-64 living in five municipalities of the district were targeted by the first round of the programme. Eligible for the study were 2356 women responding to invitation for screening and 2221 women not invited because of self-referral for Pap smear at any other setting. The probability of early repeat Pap smear was estimated by the life table method. Differences were evaluated by the Gehan test. Multivariate determinants were assessed by the Cox regression analysis. At 36 months' follow-up, the cumulative probability of early repeat Pap smear was 44% among self-referred women and 6% among women responding to invitation (relative hazard = 4.8). For self-referred women, the probability was related to age (with a peak at 35-44 years), previous Pap smear history and municipality of residence. Among women responding to invitation, only an inverse association with age was demonstrated. In conclusion, the observed differences in overall probability and determinants of early repeat Pap smear between the two screening populations provided important information on Pap smear usage in the total target population.

External quality assurance in cervical/vaginal cytology: Interlaboratory agreement in the Emilia-Romagna region of Italy.

OBJECTIVE: To evaluate the diagnostic agreement between seven cervical/vaginal cytology laboratories participating in the first external quality assurance (EQA) scheme developed in Italy. STUDY DESIGN: Between 1991 and 1993, 110 cytologic smears were selected and classified by a committee and circulated and reported on by the laboratories according to the 1988 Bethesda System. Agreement was evaluated with the kappa statistic. Systematic disagreement was assessed by means of the Wilcoxon signed rank test. RESULTS: Interlaboratory kappa values varied between .01 and .29 (group score, .11) for sample adequacy and between .53 and .78 (group score, .67) for epithelial abnormalities. The lowest specific kappa values were observed for the three classes of sample adequacy (unsatisfactory, .07; less than optimal [LTO], .10; satisfactory [SAT], .14) and for the class of atypical cells of undetermined significance (ACUS), (.29). As compared with the study committee, 5/7 laboratories showed a systematic (P<.01) tendency to undercall sample adequacy. Agreement on epithelial abnormalities was also analyzed according to the pattern of adequacy reported by paired laboratories (LTO/LTO, LTO/SAT, SAT/SAT). As compared with smears designated SAT/SAT, those classified as LTO/SAT were associated with lower specific kappa values for agreement on the presence of carcinoma and ACUS and with equal or greater values for agreement on the other classes, suggesting an arbitrary use of notations of LTO inversely related to the severity of epithelial lesions. CONCLUSION: EQA schemes, as applied to cervical/vaginal cytology, can shed light on major deficiencies in specific diagnostic areas.

Bilateral bronchoalveolar lavage in progressive systemic sclerosis: interlobar variability, lymphocyte subpopulations, and functional correlations.

Bilateral bronchoalveolar lavage (BAL) was carried out in right middle and left upper lobes of 22 nonsmoking females suffering from progressive systemic sclerosis in order to assess interlobar differences and functional correlation of the BAL composition. The patients' age ranged from 20 to 66 years, and the mean disease duration was 10.4 years. The most frequent finding was a mild BAL lymphocytosis (right in 11 of 22 patients; left in 8 of 22), but eosinophilic (right in 11 of 22; left in 5 of 22 patients) and neutrophilic (right in 9 of 22 patients; left in 1 of 22) alveolitis was recognized as well. Differential counts suggestive of alveolitis limited to one of the lavaged lobes were demonstrated in about one fourth of the cases. Including increased cellularity among the criteria of pathological BAL fluid composition, 14% of the subjects showed bilateral BAL results within the normal range. OKT8-positive lymphocytes were significantly increased in 3 patients, but the mean values were not. Total lung capacity, vital capacity, and forced expiratory volume in 1 s correlated inversely with BAL neutrophil (p less than 0.05) and granulocytic (p less than 0.01) differential counts; the strongest, positive correlation was demonstrated regarding the lymphocyte/granulocyte ratios (p less than 0.0005). In conclusion, several patterns of alveolitis as well as a bilaterally normal BAL composition were found in our series; moreover, even if inhomogeneous alveolitis did occur, a single lavage performed in the right middle lobe correctly detected or excluded the presence of an alveolitis in 95% of our patients.

Apocrine cells in breast cyst fluid and their relationship to cyst type: a morphometric study.

The morphology of apocrine cells exfoliated in breast cyst fluid (BCF) was studied in 78 BCF samples obtained from 39 premenopausal patients with gross cystic disease who were bearing two simultaneously aspirated cysts. 57/78 samples showed cell clusters suitable for computer-assisted cytometry. This was performed on 5820 cells using a Leitz Texture Analysis System (TAS). We measured the surface areas of cytoplasm, nucleus and nucleolus; we also calculated the nuclear/cytoplasmic (N/C), nuclear/nucleolar (N/n) ratios and the nuclear roundness factor (RF). Cysts were divided according to the cationic pattern of BCF: Type I, K+/Na+ greater than 1.5; Type II, K+/Na+ less than 0.66. The cytometric analysis was made on 47 samples of Type I and 10 samples of Type II. At the light microscope, no difference was apparent between the apocrine cells coming from Type I or Type II cysts. Cytometric measurements showed significant differences for the apocrine cells aspirated from Type I vs. Type II cysts for the mean cytoplasmic area (97.13 +/- 24.28 S.D. mu2 vs. 59.66 +/- 14.90 S.D. mu2, respectively) and the mean nucleolar area (4.35 +/- 0.99 S.D. mu2 vs. 2.75 +/- 0.71 S.D. mu2, respectively). Our data do not allow the inference of apocrine changes in the epithelium lining the cysts simply from the cationic pattern of BCF. The significantly wider cytoplasm and nucleoli of the apocrine cells aspirated from Type I cysts could reflect different functional stages of these particular cells.