Stereotaxic core breast biopsy: value in providing tissue for flow cytometric analysis.

OBJECTIVE: Stereotaxic core biopsy provides intact samples of breast tissue for accurate histologic analysis. We conducted a study to determine if prognostic data could also be successfully derived from such core samples and how the data correlate with surgical biopsy. MATERIALS AND METHODS: Both core and surgical breast biopsies from 135 patients were processed under a uniform flow cytometry protocol. Samples were coded and then randomly processed at an outside flow cytometer and interpreted by an independent pathologist; the code was broken and patients' results correlated only after all samples were completely analyzed. RESULTS: Core breast biopsy provides intact tissue that can be successfully processed by a flow cytometer, even after being embedded in paraffin for initial histologic analysis. Larger cores (14 gauge) had fewer insufficient samples, as recorded on ploidy histograms. Although ploidy may reflect the underlying aggressiveness of a lesion and assist in evaluating breast cancer, surgical-pathologic correlation with stereotaxic biopsy indicated, as has been confirmed in other studies, considerable overlap of different ploidy types between benign and malignant conditions. There was no correlation between mammographic presentation and ploidy or S-phase fractions. CONCLUSION: Stereotaxic large-core biopsy can enable accurate histologic diagnosis of breast disease and furnish sufficient tissue for flow cytometric measurements of ploidy and S-phase fractions, even at an interval following paraffinization. Such prognostic information aids in planning of adjuvant therapy, allows flexibility should surgery fail to provide enough tissue for DNA study, and helps radiologists further market stereotaxic biopsy to clinicians.

Progesterone response to exogenous gonadotropins after suppression with leuprolide acetate in gamete intrafallopian transfer.

Fifty-three cycle of ovarian stimulation with human menopausal gonadotropins after suppression of endogenous gonadotropin release with leuprolide acetate were completed for the purpose of performing gamete intrafallopian transfer. Thirty-seven biochemical pregnancies resulted, with 29 progressing to clinical status, for rates of 69.8% and 54.7%, respectively, per cycle. In comparing characteristics of the follicular recruitment phases of failed cycles to those of cycles resulting in pregnancies, no differences were observed in serum estradiol concentrations or follicular development. However, pregnancy rates were highly associated with peak concentrations of progesterone prior to the administration of human chorionic gonadotropin. Three levels of progesterone range were found on the basis of outcome: 6 high-progesterone cycles produced no pregnancies (0%), 32 mid-range progesterone cycles produced 31 pregnancies (97%), and 15 low-progesterone cycles produced six pregnancies (40%). The pregnancy rate in the last group improved when the luteal support was doubled.

Antisperm antibody detection using concurrent cytofluorometry and indirect immunofluorescence microscopy.

Anti-sperm antibodies from serum and seminal plasma were detected by concurrent flow cytometry and epifluorescence microscopy using fluorescein-conjugated antihuman immunoglobulins. Experimental conditions were designed, taking advantage of several monoclonal antisperm antibodies, to test aspects of the assay before clinical application. Perturbation of membrane integrity altered both the localization of binding and the number of sperm cells positive for bound antibodies. In specimens from selected infertility patients, 21.6% of the females and 40.8% of the males had significant levels of antisperm antibodies. Differences in the incidence of isoimmunity between female partners of antibody-positive or antibody-negative males and differences in the localization of antigens targeted by serum versus seminal plasma antibodies in men support the idea that, in some cases, immunity to sperm cells may be the result of altered sperm antigens.

Prospective study of concurrent ploidy analysis and routine cytopathology in body cavity fluids.

A total of 390 body cavity fluids were analyzed by both cytopathologic examination and flow cytometric DNA analysis. The two methods gave compatible results in analyses of 304 fluids (78%). In 24 patients, cytopathologic studies found the specimens to contain malignant cells, but the DNA content was diploid. This illustrates an area where flow cytometric studies do not extend tumor detection. In 56 fluids from 48 patients, cytologic methods revealed no malignant cells but flow cytometry distinguished aneuploid cell populations; additional clinical information allowed the identification of malignant tumors in 24 (50%) of these patients. Because flow cytometry was able to detect aneuploidy in cases where conventional cytologic examination could not detect malignant cells, the number of patients with tumors detected was increased by 39% beyond those detected by cytologic methods alone in this series.

The application of measurement systems in the management of medical laboratories.

The Workload Recording System, initially developed by the Canadian Association of Pathologists, with subsequent and joint active participation with the College of American Pathologists and numerous other medical laboratory specialist societies, is a powerful tool for the management of medical laboratories. This article describes the system and its implementation.