Lymph node metastases and prognosis in patients with stage IA2 cervical cancer.

Ninety-four patients with squamous cell carcinoma invading the cervical stroma to a depth of >3.0-5.0 mm with 7 mm or less in horizontal spread (FIGO Stage IA2) were evaluated. Depth and lateral extent of stromal invasion were verified using an ocular micrometer. Cell type and lymph vascular space invasion (LVSI) were recorded in each case. Patients were treated primarily by radical hysterectomy with pelvic lymphadenectomy, and those with lymph node metastases were offered postoperative radiation. Following treatment, patients were seen at 3-month intervals for 2 years, and every 6 months thereafter. The mean duration of follow-up was 6.9 years (range 0.4-23.5 years). Seven of 94 patients (7.4%) had lymph node metastases. Five patients had 1 positive node, 1 patient had 2 positive nodes, and 1 patient had 3 positive nodes. Five patients developed recurrent cancer and 4 died of disease. LVSI was present in 31 cases (33%). Tumor recurrence was significantly increased in patients with positive LVSI (9.7% vs 3.2%). The 5-year survival rate of patients with LVSI was 89% vs 98% in patients without this finding (P = 0.058). The 5-year survival rate of all Stage IA2 cervical cancer patients was 95%. Patients with Stage IA2 cervical cancer have a significant risk of lymph node metastases and should be treated by radical hysterectomy with pelvic lymphadenectomy. LVSI is an important prognostic variable in these patients and should be recorded in all cases.

Etiologies for non-correlating cervical cytologies and biopsies.

To investigate the etiologies for discrepancies between cervicovaginal smear and corresponding cervical biopsy results, 615 patients with cytologic diagnoses of dysplasia or malignancy during 1 year were reviewed. Sixty-nine patients (11%) were identified in which the cytologic and histologic diagnoses differed. Utilizing an algorithm developed for the study, these cases were assigned an etiologic category for discrepancy: colposcopic biopsy or cytologic sampling, cytologic screening, histotechnical processing, histologic or cytologic interpretation. The most common cause for a discrepancy was colposcopic biopsy sampling (36 cases, 51%). There were nine errors (13%) in biopsy interpretation, with seven underdiagnoses and two overdiagnoses. Eight errors (11%) in cytologic interpretation occurred with half of these representing underdiagnoses. The other causes for discrepancy were less common--cytologic sampling (6 cases), histotechnical processing (3 cases), cytologic screening (2 cases), and a combination of factors (5 cases). Use of this algorithm allows laboratories to identify problem areas and design specific corrective protocols to improve diagnostic accuracy and patient care.

Fatal disseminated infection with Aspergillus terreus in immunocompromised hosts.

Aspergillus terreus is widespread in the environment but only uncommonly infects humans. It can cause cutaneous and subcutaneous infections, and several cases of local invasive disease have been reported; to our knowledge, however, only five cases of disseminated disease have been documented previously. We describe here four additional patients with disseminated disease caused by A. terreus. All four had an underlying hematologic or lymphoreticular malignancy, were immunocompromised secondary to prolonged neutropenia or immunosuppressive therapy, and had invasive pulmonary disease (a circumstance supporting a respiratory route of infection). Despite treatment with amphotericin B, all four patients died. When recovered from clinical specimens, A. terreus should not routinely be dismissed as a saprobe, particularly in immunocompromised hosts.

Evaluation of MicroScan for identification of Enterococcus species.

Emerging drug resistance of the enterococci necessitates differentiation from group D streptococci and accurate species identification. MicroScan (Baxter Healthcare Corp., West Sacramento, Calif.) has recently developed a microdilution system for identification and antibiotic susceptibility testing of gram-positive cocci. To evaluate the ability of this system to identify Enterococcus species, 100 isolate identified as enterococci by MicroScan were tested by conventional media and 60 isolates of streptococci were tested by MicroScan. Incubation times for conventional and MicroScan methods were 96 and 18 to 24 h, respectively. For 94 strains of enterococci (77 Enterococcus faecalis, 14 Enterococcus faecium, and 3 Enterococcus durans), identification by conventional media and MicroScan agreed. Of the remaining six isolates, four were identified as E. faecalis and two were identified as E. durans by MicroScan, whereas by conventional media the four E. faecalis isolates were identified as Enterococcus solitarius and the two E. durans isolates were identified as Enterococcus hirae. None of the 60 streptococci were identified as enterococci. MicroScan is a reliable method for identification of the commonly encountered enterococcal species E. faecalis and E. faecium; however, modifications of the system are necessary for identification of other Enterococcus species.