ABSTRACT
Liquid-based cytology continues to be utilized as an adjunct to conventional cytology in most Australian laboratories, even though a direct-to-vial ThinPrep protocol has been introduced in many countries with established cervical screening programs. Manual screening of ThinPrep slides has been widely practiced for more than 10 years and the recent introduction of the ThinPrep Imaging System (TPI) has been reported as being more sensitive than the conventional smear (CS) in the identification of high-grade cervical disease.We report our experience with ThinPrep Imaging since its introduction into our routine gynecological cytology service. 87,284 split sample pairs reported using the Imaging System demonstrated a decrease in unsatisfactory reports (3.65% for CS and 0.87% for TPI) and an increase in possible high grade and definite high-grade squamous reports (1.57% for CS and 1.62% for TPI).For 1,083 biopsy confirmed high-grade lesions, the correct diagnosis of high grade or possible high-grade squamous disease was made on the ThinPrep imaged slide in 61.0% (661/1,083) of cases and on the CS in 59.4% (643/1,083). This was not statistically significant. When all abnormalities identified on cytology were considered, including possible low grade and definite low-grade abnormalities, the difference in sensitivity for Thinprep imaged slides of 96.0% (1,040/1,083) and CSs of 91.6% (992/1,083) was statistically significant.
Subject(s)
Cytological Techniques/methods , Imaging, Three-Dimensional/methods , Neoplasms, Squamous Cell/pathology , Uterine Cervical Neoplasms/pathology , Vaginal Smears/methods , Australia , Biopsy , Epithelial Cells/pathology , Female , Humans , Metaphase , Neoplasms, Squamous Cell/diagnosis , Reproducibility of Results , Sensitivity and Specificity , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/pathologyABSTRACT
A review of negative split-sample cervical cytology cases revealed five cases reported as chronic follicular cervicitis. These cases showed characteristic morphological features in conventional smears with lymphoid cells, plasma cells and tingible body macrophages smeared across the slides. This contrasts with the presentation of ThinPrep samples (Cytic Corporation, Boxburgh, MA, USA), where cells were observed aggregated in clumps. The different presentation noted in liquid-based samples may require careful microscopic evaluation at high-power magnification.
Subject(s)
Uterine Cervicitis/pathology , Vaginal Smears , Adult , Chronic Disease , Diagnosis, Differential , Diagnostic Errors , Epithelial Cells/pathology , Female , Humans , Lymphocytes/pathology , Lymphoma/pathology , Middle Aged , Plasma Cells/pathology , Predictive Value of Tests , Reproducibility of ResultsABSTRACT
Conventional cytospin smears prepared from urinary tract specimens were compared with two new thin layer techniques, i.e. ThinPrep and AutoCyte PREP. Cellularity, cell preservation, background features, detection rate, screening time and ease of preparation were evaluated. Thin-layer techniques when applied to urine cytology were found to improve cell yield and cell preservation, and reduce background artefact. The reporting rate for abnormal urothelial cells was comparable to conventional cytospin smears, as was screening time. Laboratory staff found the methodologies to be practicable and easily incorporated into a large routine diagnostic service. We conclude that a one-slide thin-layer urine preparation is comparable to four cytospin slides in the detection of urothelial abnormalities, and that both ThinPrep and AutoCyte PREP have comparable features.
Subject(s)
Clinical Laboratory Techniques , Urinary Tract/pathology , Urine/cytology , Urologic Diseases/pathology , Urologic Diseases/urine , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/urine , Community Health Services , Cytodiagnosis/instrumentation , Cytodiagnosis/methods , Humans , Urologic Neoplasms/pathology , Urologic Neoplasms/urineABSTRACT
In this prospective study, 27,014 Pap smears were selected for PAPNET review on the request of the referring practitioner or patient. Smears that were negative on routine manual screening were submitted for rapid rescreening. Smears considered normal after these two manual screens (n = 25,656) were reviewed using the PAPNET testing system. Routine manual screening identified 1340 (4.96%) of the smears as abnormal, and a further 18 (0.07%) abnormalities were detected by rapid rescreening. PAPNET review identified an additional 102 (0.4%) abnormal smears, including 10 histologically confirmed high grade lesions. The use of PAPNET testing following routine manual screening and rapid rescreening in tandem, enables cytologists to detect additional diagnostically significant abnormalities and reduce the rate of false-negative smears.
Subject(s)
Mass Screening/standards , Papanicolaou Test , Papillomavirus Infections/pathology , Tumor Virus Infections/pathology , Uterine Cervical Neoplasms/pathology , Vaginal Smears/standards , False Negative Reactions , Female , Humans , Papillomavirus Infections/complications , Prospective Studies , Tumor Virus Infections/complications , Uterine Cervical Neoplasms/classificationABSTRACT
Rapid rescreening was established in our laboratory in 1995, following the publication of several studies indicating improved sensitivity for the detection of abnormalities in cervical smears. During the study period, 285,841 negative smears (representing 89.09% of the total workload) were rapidly rescreened. A total of 7,650 (2.68%) were identified as abnormal or suspicious and selected for full rescreening. Of these, 228 cases were considered abnormal following pathologist review and resulted in the issue of an amended report. This represents an increased detection rate for all abnormalities of 0.08%. Of the cases with histological follow-up, a high grade epithelial abnormality (HGEA) was confirmed in 31% of cases and a low grade epithelial abnormality (LGEA) in 42%. We conclude that rapid rescreening is easily incorporated into the daily workflow of a large routine cervical cytology laboratory, Our results support conclusions from previous studies that rapid rescreening is an effective quality control technique resulting in the detection of increased numbers of abnormal smears.
Subject(s)
Mass Screening/methods , Papanicolaou Test , Uterine Cervical Neoplasms/diagnosis , Vaginal Smears , Epithelial Cells/pathology , False Negative Reactions , Female , Humans , Quality ControlABSTRACT
OBJECTIVE: To assess the performance of the PAPNET Testing System and compare the sensitivity of this automated device with that of rapid rescreening. STUDY DESIGN: In this study, 1,000 cervical smears previously diagnosed by our laboratory as negative were seeded with 20 particularly "difficult" cases. We submitted this seeded set of smears for rapid rescreening and to PAPNET to determine cases that could be detected by rapid rescreening, PAPNET or both. RESULTS: Rapid rescreening detected 9 of the 20 cases (45%). The PAPNET system identified 19/20 (95%). This investigation found PAPNET rescreening to be more effective than rapid rescreening in detecting the seeded difficult cases. CONCLUSION: Use of the PAPNET Testing System in tandem with rapid rescreening can reduce the rate of false negatives in diagnostically difficult cervical cytologic smears.
Subject(s)
Image Interpretation, Computer-Assisted/instrumentation , Image Processing, Computer-Assisted/instrumentation , Man-Machine Systems , Mass Screening/instrumentation , Vaginal Smears/instrumentation , Automation , False Negative Reactions , Female , Humans , Neural Networks, Computer , Papillomaviridae , Papillomavirus Infections/diagnosis , Papillomavirus Infections/pathology , Quality Assurance, Health Care , Quality Control , Tumor Virus Infections/diagnosis , Tumor Virus Infections/pathology , Uterine Cervicitis/diagnosis , Uterine Cervicitis/pathology , Uterine Cervicitis/virology , Video RecordingABSTRACT
A direct fluorescent antibody (DFA) method was compared with methenamine silver staining (MSS) for the detection of Pneumocystis carinii in 384 cytological specimens. DFA testing was more sensitive than the MSS, with P. carinii detected in 31 specimens with DFA and 24 with the MSS. Results of the two methods disagreed in 17 specimens, all of which were sputa. Twelve sputum specimens were DFA positive/MSS negative and five were MSS positive/DFA negative. It is concluded that the DFA technique, although relatively expensive, is simple to perform and offers superior sensitivity to the MSS. However, in sputum specimens the combined use of DFA and MSS leads to optimal sensitivity for the detection of P. carinii.
Subject(s)
Fluorescent Antibody Technique , Pneumocystis/isolation & purification , Pneumonia, Pneumocystis/diagnosis , Humans , Methenamine , Sensitivity and Specificity , Silver Staining/methodsABSTRACT
A technique for long-term storage of cytological specimens at -70 degrees C was evaluated with a range of nongynaecological cytology specimens. The effects of frozen storage on the cellularity, morphology, ultrastructure, and reactivity to cytochemical and immunochemical stains were investigated. These parameters were compared in preparations made from specimens processed conventionally and after frozen storage. No significant deterioration in the quality of subsequent preparations was apparent after storage. The method is technically simple and has proven successful for storing a range of specimens, including serous effusions, urine samples, and fine-needle aspirates. This technique allows storage of material until initial microscopic evaluation is complete. If required, the relevant adjuvant procedure, such as cell blocking, may then be carried out using the stored material. Wastage of cytological material on unnecessary preparations is minimised, and material may be stored over years for research or confirmation procedures.
