Automatic analysis of Papanicolaou smears by digital image processing.

Papanicolaou smears from 378 patients were analyzed in a fully automated microscope system using an image analysis technique. The logic of the system subdivided the smears into "normal" (63%), "not possible to analyze in the machine" (17%) and "positive" (20%). The results have been compared with the conventional screening method available today taking into consideration the definition problems of a true diagnosis, cytopathological and histopathological consensus, reproducibility, sample-taking and interpretation mistakes, etc. As 37% (rejected and positive) of the smears in this particular study were analyzed visually after machine prescreening, it could be demonstrated that the false-negative rate among the remaining 63% of the specimens was significantly lower among the machine-screened smears when compared with visual screening if the results were correlated with histopathological consensus. The results clearly indicate that the technology required to build computerized microscope systems, which are able to automatically sort out at least two thirds of Papanicolaou smears is available today. The only limiting factor is the cost-benefit relationship.

Medroxyprogesterone acetate and prednisone in advanced breast cancer. A randomized trial.

In a randomised trial patients with progressive metastatic breast cancer were allocated to one of three different treatments. A: Prednisone 10 mg X 3 daily. B: Medroxyprogesterone acetate (MPA) orally 500 mg daily. C: MPA i.m. 1000 mg daily for 3 weeks followed by 500 mg i.m. weekly. The study included 150 patients and was well-balanced with respect to different prognostic parameters. Most patients (83%) were postmenopausal, and 95% had previously received chemo- or hormonal therapy. In the MPA treated patients, analysis of serum MPA levels was performed once a month. The response rates were 4.6, 7.9 and 12.5% in treatments A, B and C, respectively. This difference was not statistically significant (P greater than 0.05). Furthermore, the follow-up of serum MPA levels revealed no significant difference between responders and non-responders. Analysis of time to progression did not indicate any advantage of MPA over prednisone, irrespective of MPA schedule. In accordance with these data, there was no difference as regards survival in the three groups. In conclusion, the study indicated that MPA is not superior to prednisone in this group of heavily pretreated patients with advanced breast cancer.

Endometrial polyps and hyperplasia as risk factors for endometrial carcinoma. A case-control study of curettage specimens.

As part of a comprehensive case-control study, the impact of previous endometrial pathology on the risk of developing endometrial carcinoma was investigated. The study comprised 254 consecutive women with histopathologically confirmed cancer of the uterine body in a well-defined population, and their age-matched controls. Ninety-eight (39%) of the patients and 81 (32%) of the controls had previously undergone endometrial curettage. More than one previous curettage was positively associated with endometrial carcinoma (odds ratio = 2.5; 95% CL = 1.4-4.5). Endometrial abnormalities in previous curettage specimens occurred significantly more often among carcinoma patients (57%) than among controls (25%) (odds ratio = 4.0; 95% CL = 2.0-8.0). Twelve patients, but no controls, had adenomatous hyperplasia and this hyperplasia antedated the cancer diagnosis by a mean of 4.6 years. Endometrial polyps were present significantly more often in patients (20%) than in controls (10%) (odds ratio = 3.4; 95% CL = 1.3-9.3). The present results suggest that both of these conditions are risk factors for endometrial carcinoma. Among women who had undergone endometrial curettage more than 4 years after the menopause, 19 out of 30 patients, but none out of 7 controls, showed abnormality in the curettage specimens. Postmenopausal women with endometrial abnormality should thus be regarded as being at risk of developing endometrial carcinoma.

Medroxyprogesterone acetate (MPA) plasma levels after oral and intramuscular administration in a long-term study.

In a long-term study (1 year) the plasma concentration of medroxyprogesterone acetate (MPA, Depo-Provera, Provera, Upjohn) was measured in 30 patients with endometrial carcinoma treated with MPA in the following dosages: 1) MPA 1 000 mg i.m. weekly; 2) MPA 1 000 mg i.m. once every second week, and; 3) MPA 100 mg orally twice daily. In the orally treated group the blood samples were taken just before the next tablet. The plasma concentration in the orally treated group rapidly reached steady state, while the i.m. treated group showed gradually increasing levels that had a tendency to level off after 6 months. The mean concentration at the end of the year was about three times higher for MPA 1000 mg i.m. weekly than for MPA 100 mg orally twice daily. This does not take into consideration the peak MPA level that occurs 2-4 hours after each tablet. MPA i.m. has a very good depot effect, with release of MPA from the injection site for up to 9 months. The steady initial increase in MPA plasma concentration seen in the i.m. treated groups is probably due to the additions of new depots rather than accumulation in the body generally.

Comparison between participants and non-participants at a gynaecological mass screening.

Nearly 35% of the women invited to the gynaecological mass screening in Uppsala do not participate. It is therefore of importance to study the reasons for this, especially as previous research in this field is sparse. We used a mail questionnaire which included questions concerning sociological data, gynaecological background, attitude to gynaecological examinations and to mass screening, attitude to cancer and to sexual matters. 87.5% of the sample of 800 women replied. We compared the group of women who had at some time participated in the mass screening with those who had never participated. The sociological variables were found to be closely correlated, and their individual significance could consequently not be distinguished. Those who had not participated did not as a whole constitute a critical group as regards detection of cancer, since it was found that most of these women had attended a gynaecologist elsewhere and, although they had had smears taken, they appeared to be poorly informed as to the type of cancer that the smear is intended to detect. Our questioning failed to show the women's attitude to cancer or to sexual matters was of significance for participation, although there is some evidence that the latter may be of some importance. The most significant difference disclosed between the groups was that non-participants consider gynaecological examinations more unpleasant than do participants. Furthermore it was found that women's expectations of the mass screening differ from what they consider to be included in the examination. Finally, measures intended to increase participation are suggested.