Inter-observer variability in the histologic criteria of diagnosis of hydatidiform moles.

INTRODUCTION: In the event of encountering hydropic villi in products of conception specimens, pathologists will have to distinguish complete and partial hydatidiform mole (CHM & PHM) from hydropic abortion (HA). The histological diagnostic criteria are subjective and demonstrate considerable inter-observer variability. MATERIALS AND METHODS: This study evaluated the inter-observer variability in diagnosis of CHM, PHM and HA according to defined histologic criteria. Ninety abortus conception specimens were reviewed. Representative haematoxylin and eosin-stained slides were assigned independently to two pathologists who were asked to make a diagnosis of CHM, PHM or HA, and provide a report of the identified diagnostic histological criteria. Kappa value was calculated for the inter-observer agreement. RESULTS: There was a total of 36.7% disagreement between two pathologists (K = 0.403, Strength of Agreement = moderate), of which 24.4% and 12.2%, were differentiating PHM from CHM and PHM from HA, respectively. Among defined diagnostic histological criteria, the highest rate of agreement was observed in the identification of cistern formation and hydropic changes (K = 0.746 and 0.686 respectively, Strength of Agreement = substantial). CONCLUSION: There was moderate to substantial agreement rate between two pathologists in identification of two essential histologic criteria for diagnosis of molar pregnancies i.e. "hydropic change" and "trophoblastic proliferation".

Wnt5a influences viability, migration, adhesion, colony formation, E- and N-cadherin expression of human ovarian cancer cell line SKOV-3.

Epithelial ovarian cancer (EOC) cells express Wnt5a, but its role in ovarian cancer progression is poorly defined. The aims of the present study were two-fold: 1) to determine the Wnt5a role in viability, apoptosis, migration, colony formation and adhesion of human serous epithelial ovarian cancer cell line SKOV-3, and 2) to assess the relationship of Wnt5a with E- and N-cadherin in high- and low-grade human serous ovarian cancer specimens. Wnt5a over-expression led to 29% increased serum-independent cell viability (P < 0.05) and 35% decreased caspase-3 activity (P < 0.01) compared to SKOV-3 cells. There was 96% (P < 0.001) increased cell motility in Wnt5a-transfected SKOV-3 (SKOV-3/Wnt5a) cells compared to SKOV-3, which was abrogated in the presence of JNK inhibitor. In addition, there was about 42% increased cell adhesion to Matrigel compared to SKOV-3 cells (P < 0.001). Colony-forming assay showed a 4.4-fold increased colony formation in SKOV-3/Wnt5a cells compared to SKOV-3 cells (P < 0.001). E- and N-cadherin levels were reduced by 49 % and 67 % in SKOV-3/Wnt5a cells compared to mock cells, respectively. Wnt5a and E-cadherin immunoexpression was significantly (P < 0.001) different in low-grade serous ovarian cancer (LGSC) and high-grade serous ovarian cancer (HGSC). In HGSC specimens, strong immunoexpression of Wnt5a was detected compared to LGSC. However, E-cadherin showed moderate immunostaining (84 %) in HGSC, whereas 100 % of LGSC specimens showed strong immunoexpression. In both groups no N-cadherin immunoexpression was detected. Moreover, Wnt5a showed a positive relationship with E-cadherin in the LGSC group (r = 0.661, P = 0.027). These results may support important roles for Wnt5a in EOC progression.

Quality control in cervicovaginal cytology by cytohistological correlation.

OBJECTIVE: Frequent studies attest to the correlation of cytological interpretations with defined histopathological entities. Nevertheless, as part of quality control, cytology laboratories are required to compare Papanicolaou smear reports with those of cervical biopsies to search for discrepancies. We have attempted to determine and categorize the causes of existing discrepancies in our laboratory in order to clarify the source of errors. METHODS: We reviewed 670 cervical smears that were paired with subsequent punch biopsy or endocervical curettage samples, obtained within 2 months of the cytology, and found out that 60 smear-biopsy pairs were discrepant regarding the diagnosis. These cases were categorized into four error groups after careful re-evaluation of the original smear and biopsy slides. RESULTS: In 51 (85%) of 60 cervical smear-biopsy pairs with reports that disagreed, the initial diagnoses of both cervical smear and biopsy were confirmed by the review opinion; in these cases, cytology and biopsy 'sampling errors' were responsible for 40 and 11 instances of discrepancy, respectively. Seven cases (11.1%) were discrepant due to 'smear interpretation errors' and consisted of five cases with initial under-diagnosis and two cases with initial over-diagnosis. One case (1.7%) was due to 'screener error'. In another case, discordance was due to cervical 'biopsy interpretation error', with initial over-diagnosis as squamous intraepithelial lesion. CONCLUSION: In this retrospective study, we determined the causes of cytohistological discrepancies in cervical samples. The main explanation for discrepancy was 'sampling error'.

Can we substitute brush cytology for biopsy in the evaluation of cervical lesions under the guidance of colposcopy?

In cervical cancer screening, colposcopically directed biopsy is the gold standard method for identifying intraepithelial and occult invasive lesions of the uterine cervix. As biopsy needs special expertise and the procedure is not convenient for the patients, we sought to evaluate colposcopically directed brush cytology as a substitute for biopsy of cervical lesions. We studied a series of 150 women who were referred for colposcopic evaluation. Colposcopically directed brush cytology and biopsy were performed for all patients with abnormal colposcopic findings. A total of 40 samples were excluded due to unsatisfactory report of brush cytology. Of the remaining 110 samples, 34 abnormal pathologies were reported in biopsy evaluations, while only 9 abnormal cytologies were reported in brush cytology specimens. Brush cytology sensitivity and specificity were 26% and 97%, respectively. We conclude that colposcopically directed brush cytology is not a safe substitute for biopsy in the evaluation of cervical lesions.