The efficacy of liquid-based cervical cytology using direct-to-vial sample collection.

BACKGROUND: Previous studies of liquid-based cervical cytology (LBCC) have used a split sample collection technique that creates a potential negative bias for its evaluation. Thus, the full diagnostic potential of LBCC has not been established. The purpose of our study was to determine rates of specimen adequacy and cervical cytologic and histologically confirmed diagnoses obtained with a liquid-based Papanicolaou (Pap) test using a direct-to-vial sample collection technique and compare these results with those obtained using the conventional Pap test (CPT). METHODS: A total of 1004 nonpregnant women aged 18 years or older with an intact cervix had Pap tests collected with an Ayre spatula and cytobrush, and the sample was placed in a preservative solution. The specimens were processed as thin layer Pap tests according to the manufacturer's specifications. Another group of 2110 women with a similar patient profile had a CPT collected immediately preceding the initiation of the trial. The subjects in each group consisted of an equal percentage of women presenting for a routine Pap test or a colposcopy examination. We compared the distributions of diagnostic categories between the groups using a chi-square test. RESULTS: A significantly greater percentage of satisfactory Pap tests were obtained using LBCC (84.0%) compared with the CPT (60.5%, P < .001). Fewer satisfactory but limited by (SBLB, 14.8%) and unsatisfactory (1.2%) Pap tests were reported using LBCC compared with the CPT (35.7% and 3.8%, respectively, chi2 = 170.7, P < .001). A significantly greater percentage of low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) Pap test results were reported using LBCC (7.4% and 3.7%, respectively) compared with the CPT (1.7% and 1.7%, respectively, chi2 = 74.4, P < .001). The predictive value of a positive LBCC test (93.9%) was similar to that for a positive CPT (87.8%) when compared with histology results. CONCLUSIONS: Compared with the CPT, LBCC detected a significantly greater percentage of satisfactory Pap tests and significantly reduced the number of unsatisfactory and SBLB tests. Four times the percentage of LSIL and twice the percentage of HSIL Pap test results were obtained using LBCC compared with the CPT. These findings demonstrate that LBCC significantly improves the adequacy of Pap tests and may increase the rate of detection of cervical neoplasia compared with the CPT.

A comparison of colposcopy using optical and video colposcopes.

OBJECTIVE: To compare the colposcopic adequacy, colposcopic impressions, histologic sampling intent, biopsy site location, procedural complications, and difficulty of colposcopic examinations using optical and video colposcopes. MATERIALS AND METHODS: Women and men presenting consecutively for colposcopy were examined independently by two colposcopists using alternately either an optical or video colposcope. Colposcopists individually recorded their exam adequacy, colposcopic impression, biopsy intent and site, procedural complications, and difficulty of examination. Most colposcopists had no prior experience with video colposcopes. RESULTS: Of 300 patients, mean age 35.3 years (±12.2 SD), examined, 29.7% were nulliparous, 4.9% pregnant, 52.5% had a previous biopsy and 34.3% had prior cervical treatment. Agreement between colposcopes was excellent for visualizing the complete squamocolumnar junction (75.6%, x = 6.40, p = 0.09). Colposcopists using the video colposcope had more unsatisfactory exams of the endocervical canal (36.6%, 97/265) than did colposcopists using optical colposcopes (24.9%, 66/265, x = 16.65, p = 0.001). Colposcopic impression agreement with pathology results were not significantly different between the video (58.1%) and optical (57.0%) colposcopes (x = 0.09, p = 0.8). Biopsy intent (79.9% agreement, x = 0.20, p = 0.7) and biopsy site selection by cervical quadrant were not significantly different for the two colposcopes. Both types of colposcopes were rated extremely easy to use, but colposcopy in general (T = 3.97, p < 0.001), visualization (T = 2.98, p = 0.002), assessment (T = 2.76, p = 0.004), and sampling (Wilcoxon = 2.27, p = 0.02) were determined to be easier when using optical colposcopes. CONCLUSIONS: Video colposcopes have similar, clinically relevant outcomes when compared with optical colposcopes. Colposcopists using optical colposcopes reported easier colposcopy exams and fewer unsatisfactory examinations of the endocervical canal. These findings may represent a learning curve effect as colposcopists become familiar with operating the video colposcope.▪.

Expression of AbdB-type homeobox genes in human tumors.

BACKGROUND: Homeobox (HOX) genes of the ANT-C/BX-C type control rostral-caudal patterning during embryogenesis. Previous work has shown that tissues express unique HOX gene expression profiles that persist upon transplantation to distant sites. These properties suggest that analysis of HOX genes may be useful for the diagnosis and evaluation of primary and metastatic tumors. EXPERIMENTAL DESIGN: We analyzed normal and neoplastic tissues for the expression of three AbdB-type HOX genes; HOXD10, HOXA9, and HOXC9 to evaluate three hypotheses: (a) that tumors express HOX genes found in their tissue of origin, (b) that metastatic tumors continue to express HOX genes found in the primary tumor, and (c) that the level of HOX expression is related to tumor grade. RESULTS: Malignant tumors gave consistent patterns of HOX gene expression that paralleled their tissues of origin. Normal kidney and Wilm's tumors expressed all three genes. Other renal tumors expressed distinct permutations of the three genes. One epithelial Wilm's tumor expressed only an aberrant 0.3 kb HOXD10 transcript. Outside of the kidney, HOXD10 was most characteristic of uterine tumors, HOXA9 of colonic adenocarcinomas, and HOXC9 of two groups of tumors: neoplasms derived from neural crest and mesenchymal tumors derived from intermediate mesoderm. Metastatic tumors retained their HOX gene expression profiles and did not express HOX genes transcribed at the site of metastasis. While modulation of HOX gene expression was observed in some poorly differentiated tumors this was not a consistent measure of tumor grade. CONCLUSIONS: HOX gene profile was a reliable indicator of histologic subtype in a variety of tumors and in selected cases provided useful diagnostic information. Persistent expression in metastatic tumors confirmed that HOX expression profiles are potentially useful for diagnosing tumors of unknown origin. Continued analysis of the relationship between level of expression and tumor grade/behavior is indicated.

Merkel cell carcinoma of the vulva.

We present the clinical, histopathologic, and ultrastructural features of a primary vulvar Merkel cell carcinoma. This tumor appears to have a more aggressive behavior than those at other anatomic sites. A review of reported cases is presented. Preoperative evaluation and the role of surgery, radiotherapy, and chemotherapy in the management of these tumors are discussed.

Accidental detection of nonmetastatic ovarian adenocarcinoma in tissue samples recovered during dilatation and curettage.

We report two patients with ovarian cancer who were diagnosed with primary endometrial cancer when detached fragments of adenocarcinoma were identified in their dilatation and curettage specimens. Retrospectively, a fragment of fallopian tube and ovarian stroma were identified in the specimens. These findings served to alert the pathologist to the possibility that extrauterine sampling had occurred as a result of perforation of uterine wall during dilatation and curettage. Previous studies have focused on the cytologic detection of extrauterine cancer or on cases where metastasis to the endometrium has led to a misdiagnosis of primary endometrial cancer.

Bone metastasis from gynecologic carcinomas: a clinicopathologic study.

Between 1948 and 1984, autopsies were performed on 305 patients with primary carcinomas of the cervix, endometrium, ovaries, fallopian tubes, vulva, and vagina. Skeletal metastases were detected premortem and at autopsy in 49 cases (16.1%): cervix, 20 (40.8%); endometrium, 17 (34.7%); ovary, 7 (14.3%); vulva, 4 (8.2%); fallopian tube, 1 (2%). There were no cases of osseous metastasis from vaginal carcinoma. The incidence and sites of metastasis from these gynecologic carcinomas were correlated with their clinical and histopathologic classifications. This clinicopathologic study, based on autopsy data, demonstrates that osseous metastases are not uncommon, are significantly greater than clinically appreciated, and correlate with advanced anatomic stage and histopathologic type and grade.

Immunocytochemical localization of prolactin in carcinoma of the cervix.

Immunocytochemical methods were used to demonstrate prolactin in both normal and malignant human cervices. Four of five cervices with epidermoid carcinoma and three of four cervices with adenocarcinoma demonstrated prolactin. One of four normal cervices stained positive for prolactin in the endocervical glands. Four cervices from pregnant patients were positive for prolactin. The results of this study show prolactin in human cervical carcinomas. The role and source of cervical prolactin is unknown.

The management of elective, repeat cesarean section.

The perinatal outcome of 252 consecutive, elective, repeat cesarean section was studied retrospectively. One hundred fifty patients (60%) were scheduled for delivery within approximately seven days of their expected delivery, cesarean (EDC), designated on the basis of rigorous clinical criteria and corroborative sonographic biparietal diameters. One hundred two patients (40%) did not meet these criteria and required analysis of amniotic fluid for L/S ratio and creatinine prior to their operations. Forty-three patients (17%) labored prior to their scheduled procedure or amniocentesis and underwent cesarean section shortly after admission. No cases of the respiratory distress syndrome were noted in the electively delivered patients. The authors conclude that careful clinical assessment of gestational age will prevent the occurrence of iatrogenic hyaline membrane disease in infants born to mothers by elective, repeat cesarean section. When the EDC is in question, however, amniotic fluid phospholipid analysis is clearly advisable.