The value of per-operative smear examination during stereotactic biopsy

Summary Sixty-two consecutive CT-directed stereotactic biopsies were studied retrospectively to determine the value of the per-operative smear examination. Overall, in 69% of cases the immediate smear result agreed with the definitive histology. However, a smear diagnosis of malignant glioma was more reliable than that of metastasis (with 100% and 55% aggreement with the final result respectively). In those cases where the final histological diagnosis was that of malignant glioma, immediate smear preparations taken from the hypodense centre were found to be more reliable than those taken from the enhancing edge.     

Current evidence on diagnostic accuracy of commercially based nucleic acid amplification tests for the diagnosis of pulmonary tuberculosis

BACKGROUND: Even though commercial nucleic acid amplification tests (NAATs) have become the most frequently used molecular tests for laboratory diagnosis of pulmonary tuberculosis (TB), published studies report variable estimates of their diagnostic accuracy. We analysed the accuracy of commercial NAATs for the diagnosis of pulmonary TB in smear positive and smear negative respiratory samples using culture as a reference standard. METHODS: English language studies reporting data sufficient for calculating sensitivity and specificity of commercial NAATs on smear positive and/or smear negative respiratory samples were included. Meta-regression was used to analyse associations with reference test quality, the prevalence of TB, sample and test type. Predictive values for different levels of pre-test probability were quantified using Bayes' approach. RESULTS: Sixty three journal articles published between 1995 and 2004 met the inclusion criteria. Pooled sensitivity and specificity were 0.96 and 0.85 among smear positive samples and 0.66 and 0.98 among smear negative samples. The number of culture media used as reference test, the inclusion of bronchial samples, and the TB prevalence were found to influence the reported accuracy. The test type had no effect on the diagnostic odds ratio but seemed to be correlated with sensitivity or specificity, probably via a threshold effect. CONCLUSIONS: Commercial NAATs can be confidently used to exclude TB in patients with smear positive samples in which environmental mycobacteria infection is suspected and to confirm TB in a proportion of smear negative cases. The methodological characteristics of primary studies have a considerable effect on the reported diagnostic accuracy.     

Transmission of tuberculosis from smear negative patients: a molecular epidemiology study

BACKGROUND: While smear positive patients with tuberculosis (TB) are considered more infectious than smear negative patients, the latter can also transmit TB. METHODS: In a molecular epidemiology study of 791 patients in the Greater Vancouver regional district, the number of episodes of TB transmission from two groups of smear negative clustered patients by RFLP (assumed to be involved in recent transmission) was estimated after assessing for potential bias. Group 1 (n = 79) included patients with pulmonary TB or pulmonary + extrapulmonary disease (PTB or PTB+EPTB); group 2 (n = 129) included all patients in group 1 + extrapulmonary cases alone. RESULTS: In the total sample the mean (SD) age was 51 (21) years, 54.3% were male, and 17.0% of patients were clustered. Compared with smear negative patients, smear positive patients were more likely to be in a cluster (OR = 2.0, 95% CI 1.1 to 3.6) and to have had a history of ethanol abuse (OR = 2.7, 95% CI 1.0 to 6.7), diabetes mellitus (OR = 2.8, 95% CI 1.1 to 7.0), injection drug use (OR = 3.1, 95% CI 1.1 to 8.3), and to have had a previous hospital admission (OR = 8.5, 95% CI 5.1 to 14.0). The proportion of episodes of transmission from smear negative clustered patients ranged from 17.3% to 22.2% in group 1 and from 25% to 41% in group 2. CONCLUSION: In Greater Vancouver, smear negative cases appear responsible for at least one sixth of culture positive episodes of TB transmission.     

Significance of a diagnosis of microorganisms on pap smear

The Pap smear has been in use for more than half a century as the primary screening test for preinvasive and invasive lesions of the uterine cervix. Although not the primary use and an imperfect test, it can be extremely useful in the diagnosis of some microorganisms. This review focuses on the use of the Pap smear in the diagnosis of several microorganisms including Actinomyces, Chlamydia trachomatis, Candida, Trichomonas vaginalis, Leptothrix vaginalis, Herpes Simplex Virus, the causative agents of bacterial vaginosis, and other rarer organisms. The accuracy of diagnosis using the smear varies among the different organisms in question.     

Rapid diagnosis of sputum negative miliary tuberculosis using the flexible fibreoptic bronchoscope.

Acid fast bacilli are seldom identified by direct staining of sputum smears in patients with miliary tuberculosis, so that delays in diagnosis are common. We report 41 patients with miliary tuberculosis who had negative sputum smears and who underwent bronchoscopy, bronchial brushing, and transbronchial biopsy. In two patients the procedure was repeated. A definitive diagnosis was obtained from bronchoscopy in 34 patients (83%). Bronchial brushings yielded Mycobacterium tuberculosis in 24 of 42 bronchoscopies (57%), 13 from direct smear and a further 11 from culture only. Transbronchial biopsies were diagnostic in 30 of 41 procedures (73%), 28 from histological appearances, one from direct smear of the biopsy specimen, and another exclusively from culture. A rapid diagnosis was established in most patients (27/34), either by direct smear of brushings or biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and biopsy specimens only (5), by histological examination only (14), or by both direct smear of brushings and histological examination (8). The diagnosis was confirmed later in a further seven patients by culture of brushings or specimens; in five of these non-caseating granulomas were initially found by histological examination. Fibreoptic bronchoscopy is a valuable technique for rapidly establishing the diagnosis of miliary tuberculosis.     

Smear layer production of K3 and ProFile Ni-Ti rotary instruments in curved root canals: a comparative SEM study.

OBJECTIVE: The aim of this scanning electron microscopic study was to compare the quality and amounts of smear layer generated by 2 brands of nickel-titanium rotary instruments during canal preparation in the apical thirds of curved root canals. STUDY DESIGN: Forty mandibular mesial root canals with intact apex and mean curvature between 30 and 35 degrees were selected for this study. The root canals were randomly divided into 2 instrumentation groups of 15 each. Automated preparation was performed with ProFile (Dentsply Maillefer, Ballaigues, Switzerland; n = 15) and K3 (SybronEndo, Orange, Calif; n = 15) instrumentss using a crown-down technique. As a control group, barbed broaches (Mani; Matsutani Seisakusho, Takanezawa-Machi Tochibi-Ken, Japan; n = 10) were used to extirpate the necrotic pulp tissue from the root canals. All root canals were prepared to size #35. Glyde (File Prep, Dentsply Maillefer) was used as lubricant and 1% sodium hypochlorite solution as irrigant. At the conclusion of the experiments, all roots were split longitudinally and the root canal walls were examined at the apical third from 2 different perspectives using a scanning electron microscope. A 4-category scoring system for assessing the smear layer accumulation was used, and the resulting scores were statistically analyzed. RESULTS: Less smear layer was obtained in the K3 group at the selected apical third of curved root canals (P < .05). However, all instruments left a smear layer. The surface texture of the smear layer, in addition to the depth and the frequency of packed materials into the dentinal tubules, varied with instrument type. CONCLUSIONS: This finding may imply that, compared to ProFile, compression of the remaining smear layer is minimized when using the K3 rotary nickel-titanium system.     

The smear method for histological diagnosis of the tumors of the central nervous system (author's transl)]

The smear method for rapid diagnosis of tumors of the central nervous system at operation is not popular in this country, although this has been widely used in North America and Europe since 1930s. During the period from 1958 to 1976 we experienced 1447 histologically verified tumors of the central nervous system. This smear preparation stained by eosin and methylene blue was made for rapid diagnosis in 718 cases of them. We reviewed these cases and described microscopical findings of various kinds of tumors. In over 90% of cases the correct diagnosis will be obtained from the smears. It can be said that the smear method is appropriate for intraoperative rapid diagnosis of neurosurgical cases.     

Analysis of standard methods for diagnosing vaginitis: HIV infection does not complicate the diagnosis of vaginitis

OBJECTIVE: We sought to determine whether the standard diagnostic methods for vaginitis behave similarly among HIV-infected and at-risk seronegative women. MATERIALS AND METHODS: We performed pairwise comparisons over time (1994-2003) for the different diagnostic methods for bacterial vaginosis (BV) (Nugent score and Amsel criteria), vulvovaginal candidiasis (potassium hydroxide smear and Pap smear), and trichomoniasis (culture, wet mount, and Pap smear) among HIV-infected and at-risk HIV seronegative women in the Women's Interagency HIV Study cohort. We stratified subjects by HIV status and among the HIV-infected women by CD4+ cell count strata. RESULTS: For BV and trichomoniasis, kappa statistics comparing clinical diagnostic methods to laboratory-based methods improved after the first year. Significant differences in overall kappa statistics between HIV-infected and at-risk HIV-seronegative women were found only for vulvovaginal candidiasis where potassium hydroxide smear and Pap smear findings were more tightly correlated among HIV-infected women than among at-risk HIV-seronegative women; among these HIV-infected women, concordance was highest at lower CD4 cell counts. No significant differences in kappa statistics were found for the diagnostic methods of BV or trichomoniasis neither by HIV status nor CD4 cell count strata. CONCLUSIONS: The standard diagnostic tests for BV, vulvovaginal candidiasis, and trichomoniasis behave similarly in HIV-infected and at-risk seronegative women. Training and experience are critical for the accurate performance of the diagnostic methods that require clinician interpretation.     

In my own words: misunderstanding of Pap smears and colposcopy among Appalachian women

OBJECTIVE: To evaluate knowledge of Pap smear screening and colposcopy among Appalachian women. MATERIALS AND METHODS: English-speaking women (18 years or older) referred for colposcopy after abnormal Pap testing at a teaching hospital in the southeastern United States were studied. Structured interviews were conducted to assess demographic characteristics, health literacy skills using the Rapid Estimate of Adult Literacy in Medicine, understanding of the Pap smear and colposcopy, state anxiety, and cervical intraepithelial neoplasia distress. RESULTS: The mean age of women was 29.6 +/- 10.94, 93.2% white, 50.2% high school graduates or had an equivalency diploma, and 55.3% current cigarette use. Approximately one fifth (n = 22) of women had limited health literacy skills. Overall, womens' understanding of the Pap test, meaning of abnormal Pap test results, identification of risk factors contributing to abnormal Pap test results, and understanding of colposcopy was limited. Health literacy skills was the lone characteristic to significantly predict overall understanding of the Pap smear and colposcopy (unstandardized beta coefficient [SE] = 0.68 [0.02], p < .05). CONCLUSIONS: These findings demonstrate that Pap smear and colposcopy knowledge is associated with health literacy skills. Health care providers should be aware that many women lack sufficient knowledge of the Pap smear and colposcopy and tailor counseling during the clinical encounter accordingly.     

Papanicolaou smears are of little value in the post-treatment surveillance of patients with ovarian epithelial cancer

275 consecutive patients with ovarian epithelial cancer had routine brush vaginal vault cytology performed as part of routine post-treatment surveillance for recurrent disease screening. No patient with stage I or II disease (75 patients total) developed either recurrent vaginal vault disease or had an abnormal Pap smear indicating recurrent adenocarcinoma or even atypical glandular cells of undetermined significance (AGCUS). Of the 200 patients with stage III or IV disease there were four vaginal vault recurrences (three macroscopic, one microscopic); all of these recurrences had recurrent disease elsewhere and none were detected on the basis of Papanicolaou smear alone. Papanicolaou smear may be safely omitted as part of any post-treatment surveillance protocol for patients with ovarian epithelial cancers.     

Management and Follow-Up of Cervical Intraepithelial Neoplasia Treated by CO2 Laser Vaporization Method

Forty-four patients with cervical intraepithelial neoplasia (CIN) II and 31 patients with CIN III were followed up for up to 6 months after cervical cone vaporization with carbon dioxide laser. In addition to colposcopy and pap smear, all patients underwent cervical biopsies as part of their follow-up. This protocol permitted a diagnosis of persistent disease in the presence of normal colposcopy and pap smear.     

Comparison of smear and imprint techniques for rapid diagnosis in neuro-oncology

The smear and imprint techniques were applied to brain tumor biopsy specimens and the resultant preparations compared for preservation of architecture and cell morphology. The imprint gave excellent detail of cell morphology and good preservation of architecture, especially in soft tumors. The method has enabled a rapid diagnosis to be made in 100 cases of intracranial lesions and is a valuable complement to smear and cryostat sections.     

Clinical value of the measurement of Mycobacterium tuberculosis specific antibody in pulmonary tuberculosis.

BACKGROUND: A serological test that could help to diagnose tuberculosis, especially smear negative disease, would contribute to patient management. METHODS: Levels of antibody to distinct antigens of Mycobacterium tuberculosis were assessed for their value in the diagnosis and management of pulmonary tuberculosis. Serum was taken from 52 patients who were smear positive, from 27 patients who were smear negative but with evidence of active tuberculosis (sputum culture positive in 16, response to antituberculosis chemotherapy in 11), from 11 patients with old healed tuberculosis (pre-antibiotic era), and from 39 healthy subjects vaccinated with BCG. RESULTS: In smear positive tuberculosis an enzyme linked immunosorbent assay using a single 38 kDa antigen gave a diagnostic sensitivity of 80% with a 100% specificity. In smear negative pulmonary tuberculosis, however, combination of the 19 kDa antigen, lipoarabinomannan (ML 34 epitope), and hsp 65 (TB 78 epitope) was needed to achieve a sensitivity of 64% with a specificity of 95%. Recurrent and extensive radiographic disease with a poor prognosis was associated with high anti-38 kDa and low anti-14 kDa antibody levels in patients with active disease. Patients with less pulmonary cavitation had high anti-19 kDa titres. Bacteriological relapse during treatment was indicated by a rise in anti-14 kDa (TB68 epitope) antibodies. Four patients with non-tuberculous mycobacterial infection showed no anti-38 kDa antibody. CONCLUSION: Antigen or epitope specific serology may help in the diagnosis, assessment of prognosis, and monitoring of chemotherapy in patients with pulmonary tuberculosis.     

Randomized Pilot Study Comparing Rates of Endocervical Cell Recovery between Conventional Pap Smears and Liquid-Based Cytology in a Pregnant Population

OBJECTIVE.: To determine whether liquid-based cytology improves Pap smear adequacy, as defined by the presence of endocervical cells, compared with conventional cytology during pregnancy. MATERIALS AND METHODS.: A randomized pilot study was conducted between May 2001 and May 2002. Patients presenting for their first prenatal visit were randomized to receive either a conventional Pap smear or a liquid-based smear (ThinPrep). Rates of endocervical cell recovery and cytologic results were compared between the groups. RESULTS.: Eighty-one patients were enrolled in the study. There were no differences between the groups in age (p = .40), parity (p = .62), gestational age (p = .14), history of abnormal pap (p = .08), previous treatment of neoplasia (p = 1.00), and tobacco use (p = .67). Adequacy of the standard pap versus the liquid-based smear was not different between the two groups (90.5% vs 82.1%, respectively;p = .34). CONCLUSIONS.: The results of this pilot study show that rates of endocervical cell recovery in a pregnant population are not statistically different using conventional or liquid-based cytology. Further research is indicated to assess the utility of the more expensive ThinPrep technology in this population.     

Comparison of ThinPrep versus conventional smear cytopreparatory techniques for fine-needle aspiration specimens of head and neck masses.

OBJECTIVES: Diagnostic accuracy of the ThinPrep process (Cytyc, Boxborough, MA) was compared with that of conventional (smear) cytopreparation for fine-needle aspiration (FNA) of head and neck masses. METHODS: In a prospective, randomized, single-blinded study, 209 patients served as their own controls and underwent 236 FNAs using ThinPrep and conventional (smear) cytopreparatory techniques. RESULTS: ThinPrep produced less air-drying artifact and less mechanical distortion than the conventional method. The conventional technique was diagnostic in 63% of samples; the ThinPrep technique was diagnostic in 55% of samples. When all results were combined, pathologists subjectively preferred the conventional technique but accepted use of ThinPrep as the only cytopreparatory technique for most head and neck masses. CONCLUSIONS: For adequately experienced cytopathologists, ThinPrep is acceptable for FNA of salivary masses, neck cysts, metastatic lymph nodes, and thyroid lesions. Conventional smear technique should be used for FNA of nonmetastatic lymphoid lesions. Use of ThinPrep can complement use of the conventional (smear) cytopreparatory technique when aspirate is nondiagnostic or bloody, when the patient has a blood-borne infectious disease, when the clinician is inexperienced, or when aspirate has entered the syringe.     

Malignant mixed mesodermal tumor: histo- and cytopathologic correlations

To correlate the cytopathological and the histopathological findings in uterine mixed mesodermal malignant tumor (MMMT) we have examined the cervical smear, endometrial curettage and hysterectomy specimen of a patient diagnosed with uterine tumor. The smear was stained by Papanicolaou staining and the tissue processed by routine technique and stained H&E. The original cytological diagnosis was adenosquamous carcinoma. The histopathological diagnosis was MMMT of heterologous type. A review of the smear revealed features which may orientate the diagnosis: multinucleate cells, isolated cells with cyanophilic cytoplasm, hyperchromatic nuclei and prominent nucleoli, elongated cyanophilic cells of sarcomatous origin. We conclude that the cytopathological diagnosis of the MMMT in cervical smears is very difficult. This may be sustained by the evidence of more cell types and cellular features orientating to a sarcomatous origin. The most important differential diagnosis is adenosquamous carcinoma.     

The taking of adequate cervical smears

In order for cytological examination of a cervical smear to be an adequate method of screening for pre-invasive lesions, the smear must contain both squamous and endocervical cells. Figures obtained for 1988 indicated that in South Africa 45% of smears do not contain endocervical cells. The study reported, in which the same patients were compared in successive years but using different techniques, showed that with the use of biomedically designed tools 98.3% of smears can be classified as adequate.     

尿道粘膜印片检测沙眼衣原体

对１０９例前列腺炎病人尿道粘膜上皮印片进行检测，发现上皮细胞内沙眼衣原体包涵体２１例，革兰阴性双球菌１２例，衣原体包涵体和革兰阴性双球菌同时被检出者１５例，其余６１例二者均无。另外对３２例患前列腺炎、尿道炎及附睾炎的病人，分别作前列腺液涂片和尿道粘膜印片检查，结果发现，印片的阳性检出率明显高于前列腺液涂片的阳性率。提示临床医师应注意被检标本的采集。     

The quantitative swab culture and smear: A quick, simple method for determining the number of viable aerobic bacteria on open wounds.

The quantitative swab culture is a reliable method for quantifying the number of viable bacteria colonizing open wounds. For open wounds in burn patients, the swab bacterial count is linearly related to biopsy quantification of viable bacteria in the underlying tissue. This technique is simple and requires no surgical manipulation of the wound. For a wound of uniform appearance, the standard deviation of a single swab culture from the mean log bacterial count for a series of cultures from widely spaced areas on the wound is +/- 0.85 logs; 95% confidence limits are +/- 1.7 logs from the mean. A Gram-stained smear from a wound swab requires less than 10 minutes to prepare. Visualization of bacteria on the smear indicates that 106 or more bacteria per swab are present. The value of the smear and swab techniques for predicting safe wound closure may be inferred from the published reports of others and the direct relationship between the swab and biopsy counts of viable bacteria for open wounds.     

广西HIV感染者呼吸道非结核分枝杆菌定植情况和临床特点分析

目的呼吸道非结核分枝杆菌定植是HIV感染者发生播散性非结核分枝杆菌感染的危险因素,并可能对肺结核的诊断造成干扰。我国HIV感染者中非结核分枝杆菌呼吸道定植情况和临床特点目前尚无较大样本的研究报道。本文分析HIV感染者痰培养中非结核分枝杆菌的阳性率和相关因素,从而总结其临床特点。方法 2006年8月至2008年7月,对广西省4个诊疗机构中CD4〈350的HIV感染者进行临床症状、胸片、痰涂片,痰分枝杆菌培养和血液分枝杆菌培养在内的结核筛查。结果 1073例HIV感染者在结核筛查时进行了痰分枝杆菌培养,检出非结核分枝杆菌87例（8.1%）,129例（12.0%）为结核分枝杆菌。在痰培养阳性的标本中,43%为非结核分枝杆菌。非结核分枝杆菌在呼吸道的定植率随着患者CD4水平降低而逐渐升高,在CD4计数〉200/μl、100～200/μl、50～100/μl和〈50/μl的患者组中分别为2.8%、6.4%、7.1%和9.8%。痰涂片抗酸杆菌阳性的患者中12.0%为非结核分枝杆菌,非结核分枝杆菌呼吸道定植的患者中8.5%痰涂片结果为抗酸杆菌阳性。与痰培养阴性的患者相比,有呼吸道非结核分枝杆菌定植的患者CD4水平较低,除体重下降更多见外,其他临床症状如发热、咳嗽、盗汗、乏力等,以及胸片异常表现均未增加。结论我国HIV感染者中痰培养非结核分枝杆菌的阳性率较高,尤其是在CD4〈200的患者中,需要加强临床观察。在未有进行细菌培养的情况下,非结核分枝杆菌在呼吸道的定植可能造成结核的误诊,应给予重视。