Stereotaxic fine needle aspiration cytology of clinically occult malignant and premalignant breast lesions.

Stereotaxic fine needle aspiration (FNA) cytology was used to study clinically occult (nonpalpable) breast lesions in 114 consecutive patients with mammographically suspicious findings prior to excisional biopsy. The aspirate contained insufficient material for cytologic evaluation in 15 cases (13.2%), which were histologically diagnosed as benign (7 cases), atypical hyperplasia (7 cases) or carcinoma in situ (1 case). The cytologic findings indicated a benign lesion in 77 cases (67.5%), which were histologically diagnosed as benign (71 cases) or atypical ductal hyperplasia (6 cases). The cytologic sample showed atypia in eight cases (7.0%), which were histologically diagnosed as severe atypical ductal hyperplasia (three cases), carcinoma in situ (one case) or proliferative fibrocystic disease (four cases). In the eight cases (7.0%) cytologically interpreted as probably malignant, histology confirmed six invasive carcinomas, one carcinoma in situ and one fibrocystic disease. Of six cases (4.4%) cytologically reported as malignant, five were histologically diagnosed as invasive carcinoma and one as carcinoma in situ. Overall, stereotaxic FNA cytology reported as malignant or probably malignant 14 of the 15 cases with a histologic confirmation of malignancy, for a sensitivity of 93.3%. Cytology correctly identified 78 of the 83 histologically negative cases, for a specificity of 94.0%. The 16 cases histologically diagnosed as ductal hyperplasia, which carries a high risk for subsequent malignancy, were studied in detail in an effort to define histologic and cytologic criteria for this entity. Using selected histologic criteria, 11 of these cases were graded as showing mild-to-moderate atypical hyperplasia and 5 as showing severe atypical hyperplasia. Three of the latter cases were similarly identified by an analogous cytologic grading; the other two cases had insufficient cytologic samples. The total results in this series of 114 cases support the use of stereotaxic FNA cytology in the diagnosis of these nonpalpable breast lesions, examples of which are illustrated. In particular, it may help to raise the low specificity yielded by mammography alone, which would represent a significant advance for the patient in terms of the accuracy, expediency and reduced cost of diagnosing these lesions.

A quality-control procedure on cervical lesions for the comparison of cytology and histology.

A new method for the quality control of cytologic and histologic diagnoses of cervical lesions is based on the automated high-resolution scanning, image processing and computer analysis of cytometric data by the TICAS system. It determines and then compares optical-density-based ploidy patterns of cells in cytologic smears and the corresponding histologic sections, with the results available both as computer-graphic displays and printouts. Examples of the former appear for an "agreement case," in which the cytologic and histologic patterns corresponded, and a noncorrespondence (nonrepresentative) case, in which the tissue sample had been nonrepresentative of the lesion sampled by cytology. Computergraphic examples concern one case of condyloma and one of tissue repair, in both of which both the cytologic and histologic diagnoses had been overcalled. A further example shows the method's use in monitoring response to therapy. The DNA ploidy patterns on which this method is based can give diagnostic and prognostic clues when morphology alone may be equivocal or insufficient. The utility of ploidy pattern determinations of material from other body sites is also well established. With the use of microprocessors, the system described could be made inexpensive and operationally simple for the routine quality control of many cytopathologic studies as well as for the clinical follow-up of patients.

Comparison of written-visual and microslide-screening test measures in cytotechnology.

A study was conducted to ascertain the relationships among different competence assessment methods for cytotechnologists. Of primary concern was the extent to which examinations using multiple choice questions, color plate photomicrographs and filmstrip formats measure abilities in common with or predict performance levels on a practical, job-sample-microslide examination format in gynecologic cytopathology. The majority of cytotechnologists who volunteered for these tests were trained in schools of cytotechnology approved by the Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association (AMA). School training, certification by the International Academy of Cytology (IAC) and by the American Society of Clinical Pathologists (ASCP) and participation in current continuing education activities were all associated with relatively higher test scores. The filmstrips format was least consistent in reflecting these distinctions. Overall, participants' scores in each test correlated to varying degrees with their scores on all other tests. Combinations of certain formats appear to have limited potential as performance evaluation methods; some of their drawbacks are presented.