Histological Follow-up Results Research Articles

The significance of extensive HPV genotyping for cervical high-grade neoplasia among women with atypical glandular cells.

To examine the associated risk of cervical intraepithelial neoplasm grade 3+ (CIN3+) lesions in patients with AGC and extensive human papillomavirus (HPV) genotyping. Cases with atypical glandular cell (AGC) interpretation on a Papanicolaou (Pap) test were identified along with associated extensive HPV genotyping and histologic follow-up results. Within this cohort of 469,694 Pap tests, 0.4% were diagnosed as AGCs. In total, 1267 cases had concurrent high-risk HPV (hrHPV) genotyping, and 40.3% were hrHPV positive. The percentage of AGC cases with cervical CIN3+ on histologic follow-up was 52.2% when hrHPV was positive, whereas it was 4.9% with a negative hrHPV result. The top 5 hrHPV genotypes associated with cervical CIN3+ in this cohort were HPV16, HPV18, HPV58, HPV52, and HPV33. Indeed, 92.8% of the hrHPV-associated CIN3+ lesions identified in this cohort were positive for at least one of these HPV genotypes. The sensitivity of detecting cervical CIN3+ lesions was 85.6% with the top 5 hrHPV genotypes (HPV16/18/58/52/33) and only increased to 89.0% when the additional 12 genotypes were included. In patients with an AGC Pap, the risk of having a cervical CIN3+ lesion is greatly increased by positivity for hrHPV types 16, 18, 58, 52, and/or 33. Incorporating comprehensive HPV genotyping into AGC cytology allows for refined risk stratification and more tailored management strategies.

Quantitative MR Perfusion for the Differentiation of Recurrence and Radionecrosis in Hypoperfusion and Hyperperfusion Brain Metastases After Gamma Knife Radiosurgery.

ObjectivesDynamic susceptibility contrast perfusion weighted imaging (DSC-PWI) plays an important role in the differential diagnosis between radionecrosis and recurrence of brain metastases (BMs) after gamma knife radiosurgery (GKRS). While the perfusion condition of preliminary hyperperfusion and hypoperfusion BMs when recur has not been studied, as well the separating performance of quantitative DSC-PWI in both kinds of BMs.MethodsFrom February 2017 to October 2019, quantitative DSC-PWI was performed in patients with untreated BMs in this observational study. Patients were assigned to hyperperfusion and hypoperfusion group according the quantitative cerebral blood volume (qCBV). During follow-up after GKRS, patients with a diagnostic pitfall of radionecrosis and recurrence accepted second quantitative DSC-PWI. Final diagnosis was based on the histological results or follow-up results. Receiver operating curve analysis was used to explore the performance of qCBV.ResultsTwenty-nine patients (mean age: 61.3 ± 9.4 years old; male/female: 13/16) were assigned to the group of hypoperfusion group, and 26 patients (mean age: 58 ± 10.4 years old; male/female: 14/12) to hyperperfusion group. The mean qCBV values between hypoperfusion and hyperperfusion groups when recurred were not significantly different (3.17 ± 0.53 ml/100 g vs. 3.27 ± 0.47 ml/100 g, p = 0.63). qCBV was feasible to separate radionecrosis and recurrence in both groups (AUC=0.94 and AUC=0.93, separately).ConclusionBoth premilitary hyperperfusion and hypoperfusion BMs would transform to a high microvascular density when recurs. qCBV is feasible to distinguish radionecrosis and recurrence among both kinds of BMs after GKRS.

The reporting rates of high-grade squamous intraepithelial lesions and their human papillomavirus testing and histologic follow-up results: A comparison between ThinPrep and SurePath preparations.

Liquid-based cytology (LBC) tests SurePath (SP) and ThinPrep (TP) have largely replaced conventional Papanicolaou (Pap) tests for cervical cytology screening due to higher sensitivity. However, comparison between SP and TP test sensitivity and efficacy in detecting squamous abnormalities is lacking. Our study aims to compare high-grade squamous intraepithelial lesion (HSIL) reporting rates, human papillomavirus (HPV) positivity rates, and histologic outcome between these two LBC methods. We performed a retrospective search of the period between January 2014 and June 2017, when both TP and SP were utilized at our institution, to identify HSIL cases and collect the HPV testing and histologic follow-up results for those cases. One hundred twenty-five HSILs were identified from the 15 382 TP specimens (0.81%) and 93 HSILs were identified from the 25 105 SP specimens (0.37%), a statistically significant difference (P < .0001). The corresponding HPV positivity rates were 95.6% and 89.7% in TP-HSILs and SP-HSILs, respectively, a statistically non-significant difference. Histologic follow-up showed HSILs or carcinomas were identified in 78% (49/63) of TP-HSILs and 79% (45/57) of SP-HSILs, with no statistically significant difference. TP demonstrated a higher HSIL detection rate than SP with no significant difference in follow-up HPV or histologic results.

High-Risk Human Papillomavirus Testing, Genotyping, and Histopathologic Follow-up in Women With Abnormal Glandular Cells on Papanicolaou Tests.

This study examined the association of high-risk human papillomavirus (hrHPV) status and HPV genotype with histopathologic follow-ups in women with an atypical glandular cell (AGC) interpretation. Cases with AGC interpretation on a Papanicolaou (Pap) test were retrieved along with hrHPV testing, genotyping, and histologic follow-up results if available. A total of 561 AGC cases were identified, with histologic follow-up available for 471 cases (84%). The follow-up diagnoses included benign or reactive changes (60% of cases), low-grade cervical intraepithelial neoplasia (18%), high-grade cervical intraepithelial neoplasia (CIN2-3; 7%), cervical carcinoma (5%), and other malignancies (10%). Tests for hrHPV were positive in 128 of 426 (30%) cases, including HPV16 (30%), HPV18 (14%) and other HPV subtypes (56%). A positive hrHPV result significantly increased the risk of developing CIN2-3 or cervical carcinoma (odds ratio, 24.6; 95% CI, 9.9-58.9) and HPV16 or HPV18 further increased the risk (odds ratio, 49.5; 95% CI, 17.7-123.7). Our data demonstrate that in women with an AGC Pap interpretation, a positive hrHPV result, especially type 16 or 18, is associated with an increased risk of developing cervical CIN2-3 or higher lesions, suggesting potential implications of hrHPV testing for the management of patients with an AGC result on a Pap test.

Clinical performance of the aptima HPV assay in 4196 women with positive high-risk HPV and ASC-US cytology: A large women hospital experience.

Despite Aptima assay as the latest US Food Drug Administration (FDA)-approved high-risk human papillomavirus (hrHPV) test has been implemented as an adjunct in cervical cancer screening for years, histological follow-up data remain limited with respect to its performance in women with ASC-US Pap tests and positive hrHPV results. Cases with results of ASC-US cytology and positive hrHPV by Aptima assay during the period 06/ 2015-02/2017 were retrieved from archived pathology reports. Immediate histological follow-up results were analyzed within 6 months interval after cotesting. Among 4196 women with ASC-US Pap tests and positive hrHPV, 51.1% of them had the immediate histological follow-up within 6 months. With positive Aptima hrHPV as the adjunct, 46.5% (95%CI 46.2-46.8) of ASC-US women were found to have cervical intraepithelial neoplasia type 1 (CIN1); 8.8% (95%CI 8.1-9.5) women were detected CIN2+ lesion including eight adenocarcinoma in-situ (AIS)s. CIN2+ detection rates were highest in women under 25 (15.4%, n = 65), when comparison with different age cutoffs, younger age women had higher CIN2+ lesion detection rate than that in older group (P <.01). This is by far one of the largest retrospective studies to analyze the histological follow-up results of ASC-US women with positive hrHPV tested by Aptima hrHPV mRNA assay. The results indicated that younger women with ASC-US and positive hrHPV testing have highest risk of developing high grade CIN lesions as compared to the older women. Lastly, with positive HPV as the adjunct, 55.3% (1186/2145) of ASC-US women will result in the positive finding on histological follow-up.

Cytohistological correlation in patients with atypical glandular cells on Papanicolaou test in a Chilean population.

The standard screening test for detecting cervical lesions and cancers is a Papanicolaou (Pap) smear. While squamous cell abnormalities remain the most common positive Pap test result, cytologic findings of glandular cell abnormalities have become more frequent in recent decades. The 2014 Bethesda System for reporting cervical cytology includes the classification "atypical glandular cells" (AGC). AGC have morphological abnormalities that fall outside the range of reactive changes, but are insufficient for a diagnosis of invasive adenocarcinoma. In several histologic follow-up studies, most AGC cases were found to represent a benign condition. In the current study, we evaluate the significance of AGC cytology findings by analyzing the histologic follow-up results of a large number of patients with AGC. Most patients with AGC in this study were found to have a significant lesion on follow-up (63.9%), with negative histologic results in only 36.1% of patients. Among patients with significant lesions, the most common result was low-grade squamous intraepithelial lesion (26.6%), followed by high-grade squamous intraepithelial lesion (23.2%). This provides further evidence to support the Chilean Clinical Guidelines for Cervical Cancer, which recommends diagnostic follow-up studies in all women with AGC to minimize the chance of undetected serious cervical disease.

The reporting rates of atypical glandular cells and their HPV testing and histologic follow-up results: a comparison between ThinPrep and SurePath preparations from a single academic institution

The interpretation of atypical glandular cells (AGCs) remains a major challenge in gynecologic cytopathology using liquid-based cytology (LBC) (ThinPrep and SurePath). The comparison of performance of detecting glandular abnormalities using these 2 methods is lacking. We investigated the reporting rates of AGCs, human papillomavirus (HPV) testing, and histologic follow-up results in ThinPrep (TP) and SurePath (SP) samples. In our institution, both TP and SP were utilized during the period between January 2014 and June 2017. A retrospective search was conducted to identify patients with AGCs from 58,591 LBCs (27,041 TP and 31,550 SP). Roche (Pleasanton, CA) cobas HPV testing and histologic follow-up results were collected. The reporting rates of AGCs for TP (0.7%) or SP (0.2%) were within the College of American Pathologists benchmark ranges, but the reporting for TP was significantly greater than that for SP (P < 0.0001). The HPV-positive rates were 26.0% and 19.4% in TP-AGCs and SP-AGCs, respectively, with no statistical significance. A total of 137 (74.9%) TP-AGCs and 54 (74%) SP-AGCs had histologic follow-up. High-grade squamous intraepithelial lesions (HSIL)/squamous cell carcinoma were identified in 8.8% (12 of 137) of TP-AGCs and 13% (7 of 54) of SP-AGCs. Adenocarcinomas including endocervical and endometrial adenocarcinomas were identified in 9.5% (13 of 137) of TP-AGCs and 13% (7 of 54) of SP-AGCs. Together, 18.2% (25 of 137) of TP-AGCs and 25.9% (14 of 54) of SP-AGCs showed either HSIL or carcinoma in histologic follow-up, but with no statistical significance. TP preparation detected considerably more AGCs than SP preparation. There was no statistical significant difference in HPV-positive rates or histologic follow-up outcomes between TP-detected AGCs and SP-detected AGCs.

The “Atypical Glandular Cells” Papanicolaou Test: Recent Updates

Abstract Atypical glandular cells are gynecologic cytology abnormalities representing glandular cells with morphologic changes that exceed obvious reactive/reparative changes, but fall short of an interpretation of adenocarcinoma either quantitatively or qualitatively. This cytological diagnosis occurs in less than 1% of the results of gynecologic cytology tests (0.2%–0.8%) but potentially reflects a wide range of conditions, from benign changes and cervical squamous/glandular precursor lesions, to invasive cervical or other gynecologic cancers. In this article, we aim at reviewing different subcategories, potential ancillary studies, histological follow-up results, and clinical management of atypical glandular cells.

Clinicopathological significance of atypical glandular cells on cervicovaginal Pap smears

To evaluate the histologic correlation and clinical significance of atypical glandular cells (AGC) detected on Pap tests. Pap tests interpreted as AGC were retrieved from an institutional cytopathology database. The AGC subcategories according to the Bethesda system 2001 include atypical glandular cells, not otherwise specified (AGC-NOS), atypical endometrial cells (AEM), and atypical endocervical cells (AEC). Clinicopathologic variables were collected from medical records retrospectively, and histologic follow-up diagnoses were correlated with AGC subcategories. From January 2009 to December 2014, 741 (0.17%) of 435778 cervical smears were interpreted as AGC. Of 713 cases included in the study analysis, the distribution of AGC subcategories was as follows: AGC 15.3%, AEM 59.6%, and AEC 25.1%. Of 508 cases with histologic follow-up results, 33.9% of cases were diagnosed to have clinically significant lesions, which include cervical squamous or glandular neoplasia (1.4% and 10.0%), endometrial neoplasia (21.5%), and other metastatic carcinoma (1.0%). Endometrial neoplasia was the most common significant pathology in women aged ≥40 years (28.4%), whereas cervical glandular neoplasia was the most commonly diagnosed lesion in women aged <40 years (14.5%, P < 0.001). When considering past histories which could affect the Pap results, IUD use (10.3%) and pregnancy (7.3%) were most frequently documented. Although IUD users showed low prevalence of significant pathology (2.6%), AGC cases related with pregnancy preceded significant pathologic lesions in 14.3%. The relatively high incidence of significant neoplasia linked to AGC emphasizes the importance of adherence to the AGC management guidelines which recommend early and intensive investigation using multiple testing modalities.

The largest CAP-certified Chinese reference laboratory experience with the Bethesda system for reporting thyroid cytopathology: correlation with histologic and BRAF data

Thyroid fine needle aspiration biopsy (FNAB) has not been widely used in most areas of China. We investigated a large cohort of thyroid FNAB using the Bethesda system for reporting thyroid cytopathology (TBSRTC) from the largest College of American Pathology (CAP)-certified reference laboratory in China. Patients with thyroid FNAB between 2014 and 2016 from Guangzhou Kingmed Diagnostics were retrospectively retrieved and the histologic follow-up results and BRAF results were collected and analyzed. A total of 7355 thyroid FNAB cases were identified. The average age of these patients was 48.03 years (range: 5-90 years). A total of 875 cases (11.9%) were reported as nondiagnostic, 4041 (54.9%) cases were benign, 736 cases (10.0%) were atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 53 cases (0.7%) were suspicious for follicular neoplasm, 615 cases (8.4%) were suspicious for malignancy, and 1035 cases (14.1%) were positive for malignancy. Histologic follow-up was available on 552 patients. Among 13 cases of AUS/FLUS, 8 (61.5%) had malignancy on histology; 195 (92.0%) of the suspicious for malignancy cases had malignancies on histology, and 320 (98.5%) of the positive for malignancy cases had malignancies on histology. BRAF analysis was performed on 578 cases. Sixty cases with BRAF data had histologic follow-up, all 4 benign cases had negative BRAF, one follicular adenoma had negative BRAF, and 37 of the 55 PTC cases (67.3%) had positive BRAF. BRAF mutation has a 100% positive predictive value of malignancy for the indeterminate thyroid FNABs. This is the largest cohort of thyroid FNA reported using TBSRTC in China and the data are helpful for better understanding the status of thyroid FNA in China.

Comparison of fine needle aspiration and non-aspiration cytology for diagnosis of thyroid nodules: A prospective, randomized, and controlled trial.

To compare the sampling efficiency and diagnostic performance of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) and fine-needle non-aspiration cytology (FNNAC) for thyroid nodules. 629 thyroid nodules in 629 cases (477 females, 152 males) were randomly subjected to FNAC or FNNAC from Jun 2014 to Feb 2015. Diagnostic performance was calculated in reference to the histological findings or follow-up results. 629 patients (152 men, 477 women) with 629 thyroid nodules were enrolled in the study. Pathological results were obtained in 173 nodules and benign nodules at FNA with more than six months' follow-up were found in 65 nodules. Tumor size for FNAC ranges from 3.0 to 51.0 mm (mean±SD; 10.2±6.9 mm); whereas FNNAC (2.0-43.0 mm; 11.9±7.7 mm). Non-diagnostic results were found in 7.59% (24/316) of FNNAC procedures and 7.59% (25/313) of FNAC (P > 0.05). Determinate and indeterminate results were found in 50.63% (160/316) and 41.77% (132/316) of FNNAC procedures, whereas 58.15% (182/313) and 33.87% (106/313) of FNAC (P < 0.05). In order to obtain determinate cytological results, FNAC might be more suitable than FNNAC for diagnosis of nodules with hypovascularity (51.38% vs. 41.78%, P < 0.05) and macrocalcifications (9.72% vs. 6.50%, P < 0.05). No US and Color-Doppler US characteristics, such as the presence of hypervascularity (P > 0.05), microcalcifications (P > 0.05), internal component (P > 0.05), or size(P > 0.05), were significantly different to obtain determinate cytological results between the FNAC and FNNAC groups. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy of FNAC and FNNAC were as follows: 96.67% vs. 100%, 89.74% vs. 96.5%, 87.88% vs. 96.97%, 97.22% vs. 100%, 92.75% vs.98.36%, respectively (all P > 0.05). Both FNAC and FNNAC are effective for diagnosis of thyroid nodules. However, FNAC is more effective than FNNAC to acquire determinate cytological results for nodules which US present hypovascularity and macrocalcifications.

Intérêt de la TEP/TDM au 18FDG dans les sous-types histologiques agressifs de cancers thyroïdiens (oncocytaire et peu différencié)

IntroductionThe objective of our study was to evaluate the performance of 18FDG PET/CT in aggressive histological subtypes of differentiated cancer of the thyroid and its therapeutic impact. MethodThirty-three patients (22 Hürthle cell carcinoma and 11 poorly differentiated carcinoma) who underwent FDG PET/CT were retrospectively included. Nine scans have been performed for initial staging, 16 for suspicion of recurrence (with 11 having a rising Tg), 3 for the reassessment of metastatic disease under systemic treatment and 30 systematically during follow-up. The results of PET/CT were confronted with histological data and follow-up results. ResultsThirteen out of 18 positive scans were confirmed (8 locoregional recurrences and 5 distant metastases). The majority of them were performed for a suspicion of recurrence (8) or for initial staging (2). The sensitivity, specificity, PPV, and NPV were respectively 81.2%, 88.1%, 72.2% and 92.5%. For Hürthle cell carcinoma and poorly differentiated carcinoma, the sensitivity and specificity were respectively 100% vs. 57% and 86% vs. 93%. Systematic PET scans were most of the time negative (26/30) and in accordance with histological and follow-up results. It was the same in case of scans performed for undetectable initial Tg (16/22). PET/CT modified patient management in 14% of the cases. ConclusionThis study confirms the good performances of 18FDG PET/CT for initial staging and in case of elevated Tg during the follow-up of aggressive histological subtypes of thyroid cancer. It does not seem relevant in the absence of a suspicion of recurrence or in the case of undetectable initial Tg.

Agreement between rapid on‐site evaluation and the final cytological diagnosis of salivary gland specimens

Rapid on-site evaluation (ROSE) has been shown to be beneficial in determining the adequacy and a preliminary diagnosis in multiple organ systems. However, little is known regarding the diagnostic values and agreement of ROSE compared with a final cytological diagnosis in salivary gland fine needle aspiration (FNA). The aim of the present study was to evaluate agreement and compare accuracy between ROSE and a final cytological diagnosis of salivary gland FNA, using a final histological diagnosis as a gold standard. All patients with salivary gland lesions who underwent FNA with ROSE during 2009 to 2013 were evaluated. The patient demographic data, clinical characteristics, ROSE, final cytological diagnosis and final histological diagnosis were obtained. Agreement and accuracy were assessed by Kappa statistic and receiver-operating characteristic (ROC) curve analysis, respectively. Of 386 FNAs with ROSE, 248 (64%) lesions were from parotid glands, and 171 (44%) had histological follow-up results. Agreement between ROSE and the final cytological diagnosis was good to excellent (simple kappa=0.76; linear weighted kappa=0.81). There were discrepancies in 25 lesions (6.8%). Of these, 10 (2.7%) were major discrepancies, resulting in a change in clinical management. Only one of 36 malignant lesions by ROSE was downgraded to suspicious. No significant difference was found in accuracy between two interpretations (area under the curve 0.82 vs 0.84, P=.17). These findings suggest that, in addition to an excellent agreement and comparably good accuracy between ROSE and final cytological evaluation, malignant results of ROSE may be useful to facilitate an early clinical decision.

HPV test results and histological follow-up results of patients with LSIL Cervical Cytology from the Largest CAP-certified laboratory in China.

Background: Age-adjusted evaluations have explored the possible utility of (HPV test results in women with LSIL Pap. We investigated HPV test results and histopathologic follow-up results of LSIL patients from China's largest CAP-certified laboratory.Methods: Patients with LSIL between 2011 and 2015 from the Guangzhou Kingmed Diagnostics were retrospectively retrieved and their hrHPV test results and histological follow-up results were collected and analyzed.Results: LSIL result was identified in 37,895 cases from 2,206,588 Pap tests (1.7%) including 1,513,265 liquid-based cytology and 693,323 conventional Pap tests. The average of these women was 38.4 years (15-88). The LSIL reporting rate in women <30 years was significantly higher than that in women > 30 years (2.1% vs 1.7%). The age specific reporting LSIL rates declined with increased age. 8,014 of 37,895 (21.2%) women with LSIL cytology also had HC2 HPV test results. 75.8% of women with LSIL Pap tests were hrHPV+ and the HPV+ rates declined with increased age except in patients older than 60 years. Overall histopathologic diagnoses within 6 months after LSIL were identified in 5,987 of 37,895 patients at Guangzhou Kingmed Diagnostics. CIN2/3 was identified in 15.2% patients, CIN1 in 66.9%, negative in 14.9% patients. No invasive carcinoma was found in all patients. Of 8014 patients with LSIL Pap test and HPV testing results, 1727 patients had histological follow-up within 6 months after Pap cytology test and HPV testing. The detection rate of CIN2/3 was significantly higher in patients with positive HPV testing result than that in patients with negative HPV testing result (17.8% vs. 8.1%). Among patients with LSIL/HPV negative tests, CIN2/3 was detected in 1 of 30 (3.3%) women aged 50 years and above, appearing lower than those in women less than 50 years (8.0%, 28/351, P=0.357).Conclusion: This is the largest histological follow-up study in women with LSIL Pap from China and the data are helpful in establishing a baseline for better understanding the status of cervical screening in China. The 85.1% positive predict value of LSIL Pap cytology for follow-up CIN lesion was within currently recognized benchmark ranges.

Significance of high-risk HPV detection in women with atypical glandular cells on Pap testing: Analysis of 1857 cases from an academic institution.

The role of high-risk human papillomavirus (hrHPV) testing in women with various types of atypical glandular cells (AGC) on Papanicolaou (Pap) test is undetermined. Herein, the authors retrospectively searched their pathology database for cases of AGC with concurrent hrHPV testing and histological follow-up results within 1 year between January 2008 and December 2013. Among 3709 AGC cases occurring during the study period, 2287 had concurrent Hybrid Capture 2 HPV testing results. The overall rate of hrHPV positivity (hrHPV+) was 27.7%. Of these 2287 cases, 1857 cases (81.2%) had histological follow-up results within 1 year, including 529 hrHPV + cases and 1328 hrHPV-negative (hrHPV-) cases. Among the hrHPV + cases, 16.8% had cervical intraepithelial neoplasia 2/3 (CIN2/3), 5.7% had cervical adenocarcinoma in situ (AIS)/adenocarcinoma (ADC), and 1.1% had an endometrial carcinoma. Among the hrHPV- cases, 0.6% had CIN2/3, 0.2% had AIS/ADC, and 3.8% had an endometrial carcinoma. The rate of high-grade cervical lesions (CIN2/3, AIS, or ADC) was significantly higher in women who were hrHPV + compared with hrHPV- women for all age groups. Endometrial carcinoma was most commonly present in women aged ≥50 years. To the authors' knowledge, the current study is the largest follow-up study published to date regarding women with AGC cytology and HPV testing. The study data indicate that hrHPV testing is useful for predicting the risk of high-grade cervical neoplasia in women with AGC, but has no significant value in evaluating the risk of endometrial carcinoma. The combination of cytology, hrHPV testing, and patient age can significantly aid in the appropriate management of these individuals. Cancer Cytopathol 2017;125:205-211. © 2016 American Cancer Society.

Follow-up of women with inadequate Pap smears: a prospective cohort study.

Inadequate Pap smears do not provide satisfactory cell samples for evaluation, thus making it more difficult to detect cervical cytological abnormalities. The objective of this study was to determine the cytological and histological follow-up results from women with inadequate smear reports in primary healthcare centers in Santiago, Chile 2010-2011. Prospective cohort study at primary healthcare clinics in Santiago, Chile. The population was taken from the "Cito-Expert" database of 2010. The data were then organized according to the cytological and histological follow-up results of 2,547 women with inadequate cervical cytological reports over the 12-month period. The samples were assigned to groups based on the cause of inadequacy (smears with endocervical cells alone; insufficient, hemorrhagic, inflammatory or poorly fixed samples; insufficient and hemorrhagic samples; or insufficient and inflammatory specimens). The data were analyzed using the "conditional probability tree diagram" and descriptive statistics. Half of the women (n = 1,285) met the requirements of the Ministry of Health for repeating these inadequate smears, and 1,104 of these women had normal cytological results (85.9%). The detection rate for cervical lesions according to group ranged from 0% (smears with endocervical cells alone or insufficient and hemorrhagic specimens) to 4.1% (poor fixation). The large proportion of normal results justifies revision of the current clinical guidelines. The results showed that it is not necessary to repeat the Pap test early on, with the exception of inadequate hemorrhagic and inflammatory cytological results.

Aggressive B-cell lymphomas of gastrointestinal tract: a clinicopathologic analysis of 54 cases

To study the histological features, diagnosis, differential diagnoses of aggressive B-cell lymphomas of the gastrointestinal tract and to correlate clinical prognosis with pathologic parameters and immunophenotypes with an emphasis on c-myc, Tcl-1 and CD38 expression and their values in predicting the status of c-myc gene translocation. Fifty-four cases of aggressive B-cell lymphomas of the gastrointestinal tract with complete clinical and pathologic data were retrospectively collected. The clinical data, histologic and immunohistochemical findings and follow-up results were analyzed. Predictive immunohistochemical stains including c-myc, Tcl-1 and CD38 were performed and ROC curve analysis was used to confirm the accuracy of these markers in predicting c-myc translocation. Of 54 cases, there were 33 males and 21 females with median age of 56 years. Histological types of lymphomas included 49 cases of DLBCL (11 cases of germinal central B cell like and 38 cases of activated B cell like by Hans classification), 4 cases of DLBCL/BL and 1 case of BL. Eleven of 54 patients died within 97 months, with median survival of 42 months. Histologically, full-thickness infiltration of the gastrointestinal tract by large atypical cells with evident phagocytosis of karyorrhexis by macrophages ("starry sky") were seen in 18/54 cases. The lymphoma cells were positive for CD20 (54/54), CD79a (54/54), CD43 (4/54), CD5 (7/54), bcl-2 (26/54), Tcl-1 (17/54) and CD38 (15/54), but all negative for CD3 and CD30. The proliferative index by Ki-67 ranged from 40% to 100%. The univariate survival analysis indicated that B symptoms, general performance, high LDH, high IPI, distant metastasis, high clinical stage and tumors with over 90% of cells positive for c-myc were negative predictors for the patient's survival. In addition, cases of DLBCL positive for CD5 had an unfavorable prognosis. Cox regression analysis showed c-myc translocation, distant metastasis and high LDH were independent predictors for unfavorable prognosis. ROC curve revealed the percentage of c-myc positivity predicted the presence of c-myc gene translocation, with 75% as the optimal threshold. Aggressive B-cell lymphomas of the gastrointestinal tract with a prognosis influenced by variable clinicopathologic factors. DLBCL and DLBCL/BL may possess c-myc translocation and tend to be Burkitt-like or atypical Burkitt lymphoma. As independent prognostic indicator, c-myc expression may be used for selection of therapeutic regimens and prognostication. High percentage of tumor cells with c-myc positivity may be used to predict the presence of c-myc gene translocation.

Human papillomavirus genotyping as a predictor of high‐grade cervical dysplasia in women with mildly cytologic abnormalities: A two‐year follow‐up report

High-risk human papillomavirus (HR-HPV) DNA testing has emerged as another testing modality for women with mildly cytologic abnormalities. We conducted a two-year follow-up study of 108 women with mildly abnormal cervical cytology for detection of CIN 2/3. A cervical swab sample was obtained for HPV genotyping by a HPV blot and histologic follow-up results were correlated with HR-HPV types. Of the 108 cases, 93 (86.1%) were positive for HR-HPV DNA. HPV-16 was detected in 45.1% of patients. CIN grade 2 or 3 was confirmed in 25 (23.1%) of the 108 women during the two-year follow-up period. The two-year cumulative incidence rates of CIN 2/3 were 38.6% (17/44) among HPV-16- positive women, but only 5.6% among HR-HPV-positive women without HPV-16 or HPV-18. The sensitivity of a positive HPV-16 test for CIN 2/3 was 68.0%, the specificity was 67.5%. Our results demonstrated that the type-specific HPV-16 test increased sensitivity of detecting high-grade cervical dysplasia for women who have mildly cytologic abnormalities. The implication of the present findings is that HPV genotyping may identify women with the greatest risk of high-grade CIN.

Clinical significance of the diagnosis of low‐grade squamous intraepithelial lesion, cannot exclude high‐grade squamous intraepithelial lesion

The diagnosis of low-grade squamous intraepithelial lesion (LSIL), cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) was not included in the 2001 Bethesda System. It is used in some institutions to diagnose cases that fulfill criteria for both the diagnosis of LSIL and atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H). In this study, the authors reviewed their experience with cases reported as LSIL-H during a 4-year interval. Clinical information and histologic follow-up data were retrieved for Papanicolaou (Pap) tests (PTs) that were diagnosed as LSIL-H, LSIL, ASC-H and high-grade squamous intraepithelial lesion (HSIL) from January 1, 2004 to December 31, 2007. Of 235,645 PTs (97% SurePath) that were processed during the study period, the laboratory diagnosed 0.52% as ASC-H, 2% as LSIL, 0.30% as LSIL-H, and 0.39% as HSIL. Biopsy follow-up was available for 47%, 49%, 56.7% and 74% of these cases, respectively. Cervical intraepithelial neoplasia 2 (CIN-2) and CIN-3 or more severe lesions (CIN-3+) were identified on follow-up cervical biopsy more often in women who had diagnoses of LSIL-H and ASC-H (33.14% and 26.33%, respectively) than in women who had a diagnosis of LSIL (16.11%). The similarity of histologic follow-up results between LSIL-H and ASC-H suggested that the management of women who have a diagnosis of LSIL-H should be similar to the management of women who have a diagnosis of ASC-H.

Initial experience with FDG-PET/CT in the evaluation of breast cancer

We retrospectively reviewed FDG-PET/CT images in patients with breast cancer to determine whether PET/CT improved the level of diagnostic confidence as compared with PET and to compare PET/CT and CT findings at the location of suspected malignancies. The study included 75 patients with known breast cancer. The initial PET/CT study for each patient was retrospectively reviewed to determine whether improved diagnostic confidence (IDC) regarding lesion localization and characterization was observed with PET/CT as compared with PET alone. PET/CT and CT findings were compared regarding lesion characterization and staging in 69 of the 75 patients, and in the case of discordant findings, comparison with histological or informative follow-up results was also performed. Fifty of the 75 patients exhibited increased FDG uptake in a total of 95 regions. In the comparison of PET/CT and PET, PET/CT resulted in IDC in 30 (60%) of these 50 patients and in 52 (55%) of the 95 regions. In the comparison between PET/CT and CT in 69 patients, PET/CT demonstrated a significantly better accuracy than CT (P<0.05). PET/CT showed definitely positive findings in 60 regions with malignancies, among which CT exhibited positive findings in 43 (72%). PET/CT and CT accurately staged 59 (86%) and 53 (77%) of the 69 patients, respectively. PET/CT added incremental diagnostic confidence to PET in more than 50% of patients and regions with increased FDG uptake. PET/CT accurately detected more regions with malignancies than did CT. This initial evaluation suggests that PET/CT is preferable to PET or CT in the diagnosis of breast cancer.