An audit to establish the proportion of cervical punch biopsies that meet criteria for adequacy.

This audit was carried out to develop the criteria recommended in various guidelines to establish if a punch biopsy of the cervix is adequate, and to determine if these are met in sufficient proportions of patients. A total of 100 patients who had cervical punch biopsies followed by large loop excision of the transformation zone (LLETZ) specimens were audited and the percentage of punch biopsies that met criteria for adequacy, cited in the criteria or developed from them, was established. Most of the biopsies met the criteria for adequacy, the exception being the presence of an intact squamo-columnar junction (SCJ), which was present in 14%. The highest grade of squamous intraepithelial lesion (SIL) on punch biopsy and LLETZ were most likely to differ if the SCJ was traumatised or not represented, or if the original biopsy were negative or showed ungradable SIL. These results suggest that most of these cervical biopsies originated in the optimal anatomical site on the cervix but were being damaged in an excessive number of cases and that this affected the reliability of the punch biopsy to predict the highest grade of SIL on LLETZ.

Immunohistochemical biomarkers of value in distinguishing primary ovarian carcinoma from gastric carcinoma: a systematic review with statistical meta-analysis.

AIMS: To compare the relative risk of antigen expression being detected immunohistochemically in ovarian and gastric carcinoma aggregated from studies performed for diagnostic purposes, with the relative risks of their expression in all patients in the English literature. METHODS AND RESULTS: Both types of series indicated that cytokeratin (CK) 7 expression was greater and that of CK20 and carcinoembryonic antigen less in ovarian than in gastric carcinoma (P < 0.05). Synthesis of all data available for MUC-2 suggested it was more commonly expressed in ovarian carcinoma, whereas the relative risk in papers that directly compared its expression suggested that it was more common in the gastric carcinoma (P = 0.2, NS). Aggregating all possible data suggested villin was more likely to be expressed in ovarian cancers, whereas studies in which its expression was compared directly in both tumours suggested the opposite. Although statistically significant, patient numbers were small. CONCLUSION: Provided sufficient numbers of cases are studied, analysis of studies comparing antigen expression for diagnostic purposes in tumours from two body sites is likely to be supported in the wider literature. The design of such comparative studies is informed by aggregating data from single tumour studies.

Guidelines for gynecological cancer-an audit of current network documents in England and Wales.

The objective of this study was to assess the adequacy of network cancer guidelines paying particular attention to referral criteria, referral routes, tumor diagnosis, staging, and suggested management and care pathways for ovarian and endometrial cancer. Guidelines from 15 regions in England and Wales were analyzed quantitatively and qualitatively as a prospective audit of predefined data items and subsequently agreed management recommendations. Details of unit and center clinicians were included in a minority of documents (2 to 5/15). Multidisciplinary team membership was not usually offered (6/15). Among the least reported data items were histopathology minimum dataset for endometrial cancer and an algorithm for management or summary and clinical symptoms and signs for both cancers. Among the most reported data items were hysteroscopy and ultrasound scanning for endometrial cancer and CA125 and chemotherapy for ovarian cancer. Qualitative analysis revealed differing criteria for the use of endometrial biopsy and radiotherapy in endometrial cancer, for lymphadenectomy and management of recurrent disease in ovarian cancer, and for referral pathways and the use of computed tomography/magnetic resonance (MR) scanning in the assessment of either disease. This study concludes that consideration should be given to the development of national guidelines or templates to ensure consistency of management for gynecological malignancy in England and Wales.

The association between clinical and pathological features in histologically identified chronic endometritis.

Although described originally as the sine qua non for endometriosis, plasma cells have been identified in the endometrium in a variety of other situations. This study of patients who did and did not have plasma cells in their endometrium was carried out to establish the association between the clinical presentations and a variety of pathological characteristics, particularly the presence of inflammatory cells including plasma cells in the endometrium. There was no evidence of an association between any of the presenting clinical conditions and the distribution, intensity or frequency of inflammation, including the component cell types (lymphocytes, eosinophils, plasma cells and neutrophil polymorphs) or stromal pigment, although there was an association between a history of abnormal bleeding and reactive changes in the surface endometrium (P = 0.0259). Thus this study confirms the findings of others that there is no specific clinical syndrome that is associated with the presence of plasma cells in the endometrium.

Prognostic factors associated with vulval carcinoma in women aged above and below 65 years.

The pathological characteristics included in the current FIGO criteria as being of prognostic significance in vulval carcinoma were compared for 62 women aged over and under 65 years. Older women were more likely to have high-grade carcinoma, large tumours and tumours of higher stage than the younger women, although all the cases had infiltrated more than 1 mm into the dermis. Vulval carcinomas in older patients were more likely to have features that are usually associated with a poor clinical outcome than those encountered in the younger patients.

Vimentin expression does not assist in predicting survival in ductal carcinoma of the breast.

AIMS: To establish the value of vimentin expression in predicting survival in patients with breast cancer. METHODS: Five-year follow-up data were obtained for 68 patients with ductal carcinoma (NOS) of the breast in whom vimentin expression had been studied in fresh frozen and formalin-fixed, paraffin-embedded tissue. The predictive value on survival of tumour size, growth fraction (as assessed using the Ki67 monoclonal antibody), oestrogen receptor status and Bloom and Richardson grade of the primary tumour, and the presence or absence of lymph node metastases in axillary samples, were also studied. RESULTS: Twenty-two patients died of their disease within 5 years of diagnosis. Vimentin expression either on frozen or paraffin sections did not provide a statistically significant prediction of survival. On univariate analysis tumour grade, size and the presence of lymph node metastases provided prognostic information. Only lymph node status was of independent prognostic importance on multivariate analysis. CONCLUSIONS: Whilst these results confirm the value of established prognostic factors, they do not support the use of vimentin expression in either fresh or fixed tissue for the prediction of survival in ductal carcinoma (NOS) of the breast.

Distribution of cervical glandular intraepithelial neoplasia: are hysterectomy specimens sampled appropriately?

AIMS: To establish the validity of assuming that by examining midline blocks from the anterior and posterior lips of the cervix, a previously unsuspected cervical intraepithelial glandular neoplasia (CIGN) lesion would be identified. METHODS: The distribution of CIGN in 30 cone biopsy specimens of cervix was examined. RESULTS: Nine low grade and 21 high grade cases were identified involving one or other lip in 29 patients and one or both lateral edges in 20. The distribution of CIGN was unifocal in 20 patients, involved two distinct foci in nine, and three distinct foci in one. Only three patients had a circumferential distribution. Midline disease, either CIGN or squamous cervical intraepithelial neoplasia (CIN), or both, was present in 27 patients. CONCLUSION: These findings suggest that examining the midline blocks from hysterectomy specimens will result in the identification of CIGN lesions in over 90% of patients, either because the CIGN lesion is present in the midline or because an associated squamous CIN lesion will be identified, which will result in the examination of the entire cervix, with the consequent identification of the CIGN lesion.