Liquid‐based Papanicolaou test (SurePath) interpretations before histologic diagnosis of endometrial hyperplasias and carcinomas

BACKGROUND.

In addition to the reporting of atypical glandular cells (AGC) and adenocarcinoma (ADCA), the 2001 Bethesda System requires the reporting of benign‐appearing endometrial cells in women aged >40 years (BAEMC). In this study, the authors evaluated the contribution of each of these reporting categories to the sensitivity and specificity of a liquid‐based Papanicolaou test for endometrial carcinoma or hyperplasia.

METHODS.

Over the 3‐year study period, in the setting of a large, multihospital health care system, the authors analyzed the results from liquid‐based Papanicolaou tests that were performed within the 6 months that preceded a histologic diagnosis of endometrial carcinoma or hyperplasia and that were reported according to the 2001 Bethesda System.

RESULTS.

Two hundred seventy‐two women had a histologic diagnosis of endometrial hyperplasia (n = 199) or malignancy (n = 73) within 6 months after a Papanicolaou test. In total, 188,594 Papanicolaou tests (91,385 from women aged >40 years) were interpreted during the study period and resulted in 3810 diagnoses of BAEMC, 326 diagnoses of AGC, and 30 diagnoses of ADCA. Only 28 of 73 women (38.4%) with endometrial carcinoma had cytologically AGC or ADCA reported on a previous Papanicolaou test. The reporting of BAEMC increased this sensitivity by only 5.5% (4 additional tests) but decreased the specificity of the Papanicolaou test for endometrial malignancy from 99.8% to 96%. For endometrial hyperplasias, the sensitivity of the Papanicolaou test was even lower (39 of 198 tests; 19.7%), but BAEMC represented the majority of endometrial‐type cells reported (36 of 39 tests).

CONCLUSIONS.

The reporting of BAEMC led to an only marginal increase in sensitivity that had to be weighed against the significant loss in specificity of the Papanicolaou test for endometrial neoplasia. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.     

缺血性肠病CT检查与诊断

目的着重探讨45例缺血性肠病患者的病因、CT检查技术及其影像表现。资料与方法45例缺血性肠病均经螺旋CT扫描。26例经过手术证实,14例经过治疗痊愈,5例急性死亡。结果其中肠系膜动脉缺血24例,肝固有动脉缺血4例,肠系膜静脉缺血17例。结论严格掌握CT检查技术,根据CT影像表现并密切结合临床,对缺血性肠病患者可以作出确定诊断。     

Are liver and renal lesions in East Greenland polar bears (<Emphasis Type="Italic">Ursus maritimus</Emphasis>) associated with high mercury levels?

Background  

In the Arctic, polar bears (Ursus maritimus) bio-accumulate mercury as they prey on polluted ringed seals (Phoca hispida) and bearded seals (Erignathus barbatus). Studies have shown that polar bears from East Greenland are among the most mercury polluted species in the Arctic. It is unknown whether these levels are toxic to liver and kidney tissue.     

Effectiveness of the Thin Prep® Imaging System in the detection of adenocarcinoma of the gynecologic system

BACKGROUND.

The ThinPrep Imaging System (TIS) has been approved by the U.S. Food and Drug Administration for use to decrease the number of false‐negative results in ThinPrep (TP) gynecologic specimens and increase cytotechnology productivity. Although the increased detection of squamous abnormalities using the TIS has been well documented, to the authors' knowledge, data regarding the impact of the TIS in the detection of glandular abnormalities is limited. The goal of the current study was to evaluate the effectiveness of the TIS in detecting glandular abnormalities in cervicovaginal specimens.

METHODS.

TIS evaluated TP tests with histologic confirmation of adenocarcinoma involving the gynecologic system were included in the current study. Two cytotechnologists independently reviewed the cases for the presence or absence of atypical glandular cells. Review results were correlated with initial cytologic and histologic diagnoses.

RESULTS.

A total of 124 cases met the criteria for inclusion in the current study. Seventy of these cases (56%) were found to contain atypical glandular cells on the TP slide. TIS was able to identify atypical cells in 97% of these cases (68 of 70 cases). Nine cases initially reported as benign were found to contain atypical glandular cells on secondary review. All but 1 of these cases contained atypical glandular cells detected by the TIS. The majority of these false‐negative cases (6 of 9 cases) derived from endometrial adenocarcinoma. No cytologic evidence of a glandular abnormality was found in the 54 remaining cases.

CONCLUSIONS.

The TIS was found to be effective in identifying atypical glandular cells in specimens containing malignant glandular cells, leading to a full review of the slide. Cancer (Cancer Cytopathol) 2008. © 2007 American Cancer Society.     

A Clinicopathological Study of Adenocarcinoma in Situ of the Cervix. The Influence of Cervical HPV Infection and Other Factors, and the Role of Conservative Surgery

Adenocarcinoma in situ (ACIS) of the uterine cervix is an increasingly recognized disease. Thirty-seven cases were reviewed to determine the effect of HPV, marital status, parity, smoking habit and age on the topography and behaviour of this lesion. Using a commercial probe, 25% of 28 lesions tested were positive for HPV 16/18. The presence of HPV and a history of smoking appeared to exert no significant influence upon the topography and behaviour of ACIS. Nulliparity and a history of never being married was associated with a significant reduction in the incidence of coexisting CIN lesions. Age less than 36 years was associated with a significant reduction in the proximal linear extent of ACIS. While hysterectomy is probably the definitive treatment for ACIS of the cervix, there is an important place for conservative management by conization alone. Patients younger than 36 years are most likely to be desirous of retained fertility and appear to have the lesions most amenable to conservative surgery.     

The Significance of Mild Squamous Atypia on Cytology

Summary: Between January, 1991 and February, 1993 inclusive, 396 Papanicolaou smears were reported to show Mild Squamous Atypia with or without Human Papilloma Virus (MSA ± HPV). All women with MSA ± HPV smears were routinely recalled for colposcopy. To determine the significance of MSA ± HPV on routine smear screening, the records of all patients were reviewed.
Three hundred and thirty-seven women (85.1%) attended the colposcopy clinic and are the subjects analyzed for this report. The remaining 59 (14.9%) failed to attend. Intraepithelial neoplasia was found in 61 patients (18.1%), of whom 27 (8.0%) had a high grade lesion (CIN 2 or 3 or GIN 2). No patient had invasive cancer of the cervix. Only 1 of the 45 pregnant women had a significant lesion.
It is concluded that all asymptomatic women with MSA ± HPV on cervical smear may be managed in accordance with the current NH and MRC recommendations (1) and have a repeat smear in 6 months and colposcopy if the abnormality persists at 12 months.     

The neuroendocrine recovery function of sleep

The hypothalamo-pituitary-adrenal (HPA) system is a most important mediator of the organism's response to stress. Secretory activity of this endocrine system displays a specific regulation during normal nocturnal sleep in humans. Pituitary release of adrenocorticotropin (ACTH) as well as adrenocortical release of cortisol decreases to a minimum during early sleep which is simultaneously characterized by maximum release of growth hormone (GH) and a predominance of slow wave sleep (SWS). In contrast, release of ACTH and cortisol reaches a maximum during late sleep which is simultaneously characterized by minimum plasma concentrations of GH and a predominance of rapid eye movement (REM) sleep. The nadir activity of the pituitary-adrenal system during early sleep reflects an active inhibition of this 'stress' system. One of the factors mediating this inhibition presumably is the sleep associated hypothalamic secretion of a release inhibiting factor of ACTH. In addition, limbic-hippocampal neuronal networks contribute to the inhibitory control over HPA activity during early sleep. Those structures appear to coordinate HPA inhibition and cortical activity (with prevalent SWS) during early sleep, thereby facilitating the formation of memories in sleep. As indicated by studies testing the effects of elevated plasma glucocorticoid levels, the inhibition of HPA activity during early sleep is an essential prerequisite for the memory function of sleep. Possibly, immunological memory formation likewise benefits from this inhibition. The suppression of pituitary-adrenal secretory activity during early sleep can be significantly weakened after profound acute stress as well as in states of chronic stress (including normal aging) which thereby disturb regular memory formation in sleep.