Sample Inadequacy Research Articles

P2.01-073 The Diagnostic Value of Carcinoembryonic Antigen and Squamous Cell Carcinoma Antigen in Lung Adenosquamous Carcinoma

Lung adenosquamous carcinoma (ASC) is a rare malignant tumor with an adenocarcinoma and a squamous cell carcinoma component, and associated with a lower 5-year survival rate than lung squamous cell carcinoma and lung adenocarcinoma. Surgical specimen histology revealed inadequacy of conventional transbronchial needle aspiration sample in the diagnosis of lung ASC. Most of lung ASC patients are not suitable to receive surgery, and it is difficult to diagnosis ASC. This study is to explore the possibility of using serum carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) as a supplementary diagnostic test for ASC. We retrospectively analyzed the preoperative serum CEA and SCC levels in 34 patients with lung ASC, 35 cases of lung adenocarcinoma patients, 35 cases of lung squamous cell carcinoma patients. 36 cases of lung benign disease patients and 35 cases of healthy people as control group were also retrospectively collected and analyzed from January 2012 to December 2014 at the Zhejiang Cancer Hospital, China. The differences of CEA and SCC among the groups were evaluated, and the area under the curve (AUC), sensitivity and specificity were calculated. The levels of SCC and CEA in lung ASC group were significantly higher than those in healthy control group and benign disease group (P<0.05), and SCC level in lung ASC group was significantly higher than that in lung adenocarcinoma group (P<0.05). CEA and SCC had good diagnostic sensitivity and specificity compared with the healthy control group, and the difference was statistically significant (P<0.05). Our retrospective study suggested a role for serum CEA and SCC levels as reference markers in the diagnosis of lung ASC. If the patients which CEA and SCC levels were elevated and diagnosed as lung adenocarcinoma by limited biopsy materials should be offered further work-up to reach an accurate diagnosis and treatment.

The Diagnostic Value of Carcinoembryonic Antigen and Squamous Cell Carcinoma Antigen in Lung Adenosquamous Carcinoma.

Lung adenosquamous carcinoma (ASC) is a rare malignant tumor with an adenocarcinoma and a squamous cell carcinoma component and associated with a lower 5-year survival rate than lung squamous cell carcinoma and lung adenocarcinoma. Surgical specimen histology revealed the inadequacy of conventional transbronchial needle aspiration samples in the diagnosis of lung ASC. Most lung ASC patients are not suitable to receive surgery, and it is difficult to diagnose ASC. This study is to explore the possibility of using serum carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) as a supplementary diagnostic test for ASC. We retrospectively analyzed the preoperative serum CEA and SCC levels in 34 patients with lung ASC, 35 cases of lung adenocarcinoma patients, 35 cases of lung squamous cell carcinoma patients. 36 cases of lung benign disease patients and 35 cases of healthy people as a control group were also retrospectively collected and analyzed from January 2012 to December 2014 at the Zhejiang Cancer Hospital, China. The differences of CEA and SCC among the groups were evaluated, and the area under the curve (AUC), sensitivity, and specificity were calculated. The levels of SCC and CEA in the lung ASC group were significantly higher than those in the healthy control group and benign disease group (p < 0.05). The SCC level in lung ASC group was significantly higher than that in lung adenocarcinoma group (p < 0.05). CEA and SCC had good diagnostic sensitivity and specificity compared with the healthy control group, and the difference was statistically significant (p < 0.05). Our retrospective study suggested a role for serum CEA and SCC levels as reference markers in the diagnosis of lung ASC. Patients with elevated CEA and SCC levels and diagnosed as lung adenocarcinoma by limited biopsy materials should be offered further work-up to reach an accurate diagnosis and treatment.

Comparison of the accuracy of US-guided biopsy of breast masses performed with 14-gauge, 16-gauge and 18-gauge automated cutting needle biopsy devices, and review of the literature.

To compare the diagnostic accuracy of ultrasound (US)-guided core needle biopsy (CNB) of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. We retrospectively reviewed the charts of 1,112 patients who underwent US-guided breast CNB with 14-gauge, 16-gauge and 18-gauge needles. Cases with surgical excision or a minimum of 2years of imaging follow-up were included. Rates of sample inadequacy, discordance with surgical or imaging findings and upgrade of DCIS to invasive cancer or high-risk lesion to in situ or invasive cancer were computed for each needle size. The study included 703 CNBs: 203 performed with 14-gauge, 235 with 16-gauge and 265 with 18-gauge needles. There were no significant differences between 14-gauge, 16-gauge and 18-gauge needles in rates of specimen inadequacy (0%, 0.4% and 1.9%, respectively) (p = 0.084); surgical discordance (2.6%, 2.9% and 3.8%) (p = 0.76); imaging discordance (0%, 0% and 2%) (p = 1.0); DCIS upgrade (43%, 43% and 36%) (p = 1.00) or high-risk lesion upgrade (38%, 25% and 55%) (p = 0.49). There was no statistically significant difference in diagnostic accuracy of US-guided CNB of breast masses performed with 14-gauge, 16-gauge and 18-gauge needles. • Percutaneous image-guided breast core needle biopsy (CNB) is the standard of care. • Breast CNB with 14-gauge, 16-gauge and 18-gauge needles has similar diagnostic accuracy. • Smaller gauge needles can be confidently used for ultrasound-guided breast CNB.

Molecular characterization of Gleason patterns 3 and 4 prostate cancer using reverse Warburg effect-associated genes.

BackgroundGleason scores (GS) 3+3 and 3+4 prostate cancers (PCa) differ greatly in their clinical courses, with Gleason pattern (GP) 4 representing a major independent risk factor for cancer progression. However, Gleason grade is not reliably ascertained by diagnostic biopsy, largely due to sampling inadequacies, subjectivity in the Gleason grading procedure, and a lack of more objective biomarker assays to stratify prostate cancer aggressiveness. In most aggressive cancer types, the tumor microenvironment exhibits a reciprocal pro-tumorigenic metabolic phenotype consistent with the reverse Warburg effect (RWE). The RWE can be viewed as a physiologic response to the epithelial phenotype that is independent of both the epithelial genotype and of direct tumor sampling. We hypothesize that differential expression of RWE-associated genes can be used to classify Gleason pattern, distinguishing GP3 from GP4 PCa foci.MethodsGene expression profiling was conducted on RNA extracted from laser-capture microdissected stromal tissue surrounding 20 GP3 and 21 GP4 cancer foci from PCa patients with GS 3+3 and GS ≥4+3, respectively. Genes were probed using a 102-gene NanoString probe set targeted towards biological processes associated with the RWE. Differentially expressed genes were identified from normalized data by univariate analysis. A top-scoring pair (TSP) analysis was completed on raw gene expression values. Genes were analyzed for enriched Gene Ontology (GO) biological processes and protein-protein interactions using STRING and GeneMANIA.ResultsUnivariate analysis identified nine genes (FOXO1 (AUC: 0.884), GPD2, SPARC, HK2, COL1A2, ALDOA, MCT4, NRF2, and ATG5) that were differentially expressed between GP3 and GP4 stroma (p<0.05). However, following correction for false discovery, only FOXO1 retained statistical significance at q<0.05. The TSP analysis identified a significant gene pair, namely ATG5/GLUT1. Greater expression of ATG5 relative to GLUT1 correctly classified 77.4 % of GP3/GP4 samples. Enrichment for GO-biological processes revealed that catabolic glucose processes and oxidative stress response pathways were strongly associated with GP3 foci but not GP4. FOXO1 was identified as being a primary nodal protein.ConclusionsWe report that RWE-associated genes can be used to distinguish between GP3 and GP4 prostate cancers. Moreover, we find that the RWE response is downregulated in the stroma surrounding GP4, possibly via modulation of FOXO1.Electronic supplementary materialThe online version of this article (doi:10.1186/s40170-016-0149-5) contains supplementary material, which is available to authorized users.

Cytohistological discordance on gastrointestinal brushings: Facts unfolded.

Introduction:Brush cytology is a rapid, cost-effective, and reliable tool to diagnose gastrointestinal tract (GIT) lesions in low-resource settings. Most of the studies on GIT brushings have focused on upper GI lesions. We have studied the diagnostic accuracy of brush cytology in the entire length of GIT and correlated the cytological diagnosis with histopathology. The aim of this study is to study diagnostic utility of brush cytology of GIT lesions in the context of correlation with biopsy and study the factors responsible for cytohistological discordance.Materials and Methods:A retrospective analysis of 101 cases of prebiopsy brush cytology samples of GIT lesions was done over a period of 1 year (June 2014 to May 2015). The cytological diagnosis was compared with histopathological diagnosis and percentage of correlation was calculated. The reasons for discordance were noted and studied.Results:The cytological diagnosis of 79 (78.2%) correlated with histopathological diagnosis. There was discordance in cytological and histological diagnosis in 22 cases (21.8%). Inadequacy of cytological sample and overlap of nuclear atypia caused by regenerative changes and malignancy were significant factors for cytohistological discordance.Conclusion:The diagnostic accuracy of brush cytology can be improved by taking appropriate measures to eliminate factors responsible for fallacies in cytological diagnosis.

P004. Management of partial breast defects following breast conserving surgery in patients with previous augmentation mammoplasty

P004. Management of partial breast defects following breast conserving surgery in patients with previous augmentation mammoplasty

Abstract 248: Developing a Specialty Specific Interventional Physician Dashboard

Background: Personalized benchmarking of practice is assuming increasing importance to assure patient safety and quality, cost-effective care. Comparing performance with national and local benchmarks has value for providing feedback and opportunity for continued practice improvement to the practitioner. From a hospital and practice perspective it can be used to identify outliers and potential concerns (either system or attributable to the individual) as well as its potential uses to reduce variance, validate care, and support “value purchasing” and managed care participation. Objectives: With the input of physicians, hospital administration, and CQI personnel, a tool was developed to allow assessment of individual and aggregate physician performance. The developed tool was developed to meet both personal and institutional objectives. It had to be timely, standardized, and accurate, with available national or institutional benchmarks. Both process and outcome indicators were felt to be appropriate for inclusion. Mandated, validated and relevant data collection was given preference for inclusion (ranked in order of preference: NYS DOH angioplasty data base, NCDR data, in-house non reported data) and objective hard outcomes were given preference over more subjectively collected information. A rolling 4 quarters of data was included for statistically infrequent events to minimize outliers due to sample inadequacy. In addition to tracking process and outcome metrics, utilization was also felt to be appropriate for inclusion. The developed tool incorporated data from multiple data sets with different validation turn around times, which resulted in different reporting time intervals. A total of 38 measures were collected including : mortality, major comorbidity, quality and utilization concerns. Measures deviating from benchmarks or demonstrating substantial variance were targeted for drill down and intervention to improve care. Results: A physician dashboard was developed and applied to 18 interventionalists, permitting benchmarking of individual and overall lab performance in meeting defined process, outcome and volume metrics. The dashboard facilitates individual and system benchmarking of performance, identifies areas of concerns, provides physician feedback, and promotes process improvement. Results are highlighted in green (goal met) or red (goal not met) for rapid assessment. The developed dashboard will be displayed. Conclusions: A dashboard was created to provide timely, rapid, visible assessment of comparative physician performance. The developed tool has proven useful to both hospital administration and physicians in monitoring and improving performance. The dashboard continues to evolve with continued periodic modifications addressing specific goals and concerns.

Abstract P1-09-06: A prospective longitudinal study of the impact of breast cancer treatment with adjuvant chemotherapy or tamoxifen alone on ovarian reserve

Abstract Background: Many women with breast cancer (BC) of reproductive age would prefer to preserve their fertility and ovarian function, if possible. However, available information is insufficient to predict the likelihood and extent of ovarian damage that will be suffered by an individual woman. In prior studies, menses was used as a surrogate for fertility, but it is a poor marker of future fertility. Preliminary work suggests that anti-mullerian hormone (AMH) may be a better surrogate for ovarian reserve. The goal of this study is to delineate the extent of ovarian damage from specific treatment regimens by using serum AMH. Here we report results from the largest longitudinal study with a pretreatment evaluation to measure the impact of both chemotherapy (chemo) and tamoxifen (tam) on ovarian reserve in BC patients. Methods: A multi-institutional longitudinal IRB-approved study was performed in 207 premenopausal women with stage 0-III BC. AMH levels were evaluated at baseline and 1 yr post completion of adjuvant chemo or 1 yr post initiation of tam. After the exclusions (failure to follow-up, sample inadequacy, presumed PCOS and consent withdrawal), 115 women ages 26-46 (median 38) were available for analysis at 1 yr post treatment (primary endpoint). AMH levels were measured in frozen sera with an in-house ultrasensitive ELISA assay and were log transformed due to non-normal distribution. Results were analyzed with Wilcoxon rank sum test and repeated measures ANOVA to adjust for age, tam use and stage. Results: In the 115 evaluable women, 98 pts had HR positive BC &amp; 17 had triple negative BC. 77 pts received anthracycline-based (ddAC-T/EC-T) chemo, 26 non-anthracycline-based chemo (TC/CMF/TH) &amp; 12 tam only. In the 103 women who received chemo, compared to baseline (median 0.21 ng/ml, 0.001-3.9 ng/ml), AMH levels declined significantly (median 0.11 ng/ml, 0.001-4.47 ng/ml; p&amp;lt;0.0001) at 1 yr post chemo. The type of chemo, stage and adjuvant tam use did not significantly impact the results. In the 12 women who received tam only, compared to baseline (median 0.505 ng/ml, 0.010-1.27 ng/ml), AMH levels declined significantly (median 0.155 ng/ml, 0.010-0.91 ng/ml; p=.0049) at 1 yr. Despite a significant decline in ovarian reserve by AMH, 69% (66/95) of pts who received chemo had return of menses by 1 yr post treatment. Conclusion: This longitudinal study shows that BC chemo is detrimental to ovarian reserve. Although a decline in AMH was also seen in pts treated with tam only, this is a small cohort and the results are hypothesis generating. The decline in AMH may be due to ovarian stimulation from tam, which can cause predominance of larger follicles that produce less AMH rather than actual reduction in ovarian reserve. This needs to be studied in a larger cohort. The fact that the majority of pts resumed their menses despite a significant decline in their ovarian reserve by AMH indicates that resumption of menses is not the best measure of ovarian normalcy/fertility. This new info can be used for counseling pts in childbearing ages so they can make better informed decisions on fertility preservation, if desired. Supported by NIH RO1 HD053112, Jodi Spiegel Fisher Cancer Foundation and Susan G. Komen Foundation. Citation Format: Shari B Goldfarb, Giuliano Bedoschi, Eli Grunblatt, Sumanta Goswami, Tessa Cigler, Jessica Quistorff, Fernanda Pacheco, Robert Stobezki, Mark Robson, Fred Moy, Clifford Hudis, Sujata Patil, Maura Dickler, Kutluk Oktay. A prospective longitudinal study of the impact of breast cancer treatment with adjuvant chemotherapy or tamoxifen alone on ovarian reserve [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-06.

Surgical specimen histology revealed inadequacy of conventional transbronchial needle aspiration sample in the diagnosis of adenosquamous lung carcinoma.

We retrospectively reviewed the accuracy of conventional transbronchial needle aspiration (cTBNA) in the subtyping of lesions located in or around central airways by comparing the histological diagnosis based on TBNA and surgical specimens. cTBNA was conducted in consecutive patients with lesions located in or around the central airways (trachea, left and right primary bronchi, hilar and mediastinal masses or lymph nodes) between October 2012 and May 2014 in Wuhan No. 1 Hospital. The aspirated specimens in all patients were performed cytological and/or histopathological examination. Of these patients, some were subjected to surgical resection and histopathological examination was performed by the Department of Pathology. In the patients with gross specimens, the final diagnosis was established based on histopathological results from these specimens. In 63 patients diagnosed with cTBNA for the lesions located in or around the central airways, 23 patients with a diagnosis of lung cancer or atypical hyperplasia underwent surgery. The final diagnosis based on histopathology of surgery specimen was lung cancer in 22 patients [3 small cell lung cancer (SCLC), 9 squamous cell carcinoma (SCC), 5 adenocarcinoma (ADC), 4 adenosquamous carcinoma (ADS) and 1 neuroendocrine carcinoma], and inflammatory pseudotumor in 1 patient. The overall diagnostic yield of cTBNA for lung cancer was 95.7% (22/23), but the accuracy for histological typing of lung cancer is only 63.6% (14/22), for adenosquamous lung carcinoma was only 25% (1/4). cTBNA is a safe and effective procedure that can be used for the diagnosis of central lung cancer. However, the accuracy of TBNA for the histological classification of lung cancer is relatively low, especially for adenosquamous lung carcinoma.

Prevalence of EGFR mutations in newly diagnosed locally advanced or metastatic non-small cell lung cancer Spanish patients and its association with histological subtypes and clinical features: The Spanish REASON study

Background and objectivesThe aim of the REASON study is to determine the frequency of EGFR mutation in advanced non-small cell lung cancer (aNSCLC) patients in Spain (all histologies), and to better understand the clinical factors (gender, smoking habits and histological subtypes) that may be associated with EGFR mutations, in an unselected sample of aNSCLC patients. MethodsAll newly diagnosed aNSCLC patients from 40 selected centers in Spain were prospectively included for a 6-month period. Patient characteristics were obtained from clinical records. Mutation testing was performed on available tumor samples. Exploratory analyses were performed to characterize the clinico-pathological factors associated with presence of EGFR mutations. ResultsFrom March 2010 to March 2011, 1113 patients were included in the study, of which 1009 patients provided sample for EGFR mutation analysis (90.7%). Mutation analysis was not feasible in 146/1113 patients (13.1%) due to either sample unavailability (79/1113; 7.1%) or sample inadequacy (67/1113; 6.0%). Twenty-five out of 1113 patients (2.3%) were excluded due to unavailable information. Most patients (99.5%) were Caucasian, 74.5% were male, and predominantly were current (38.1%) or former smokers (44.0%). Median age was 66 years (range 25–90) and 70.7% of patients had non-squamous histology (57.8% adenocarcinoma, 1.8% bronchoalveolar, 11.1% large-cell carcinoma). Exon 19 deletions and the exon 21 L858R point mutation were analyzed in 942/1009 (93.4%) samples. Mutation rate was 11.6% (82.6% exon 19 dels and 17.4% L858R). To be never smoker (38.1%), female (25.4%), with bronchioloalveolar carcinoma (22.2%) or adenocarcinoma (15.4%) histology was associated with a higher prevalence of EGFR mutations. Exons 18, 20 and 21 (excluding L858R) were analyzed in 505/942 samples, and EGFR mutations were found in 22/505 samples (4.4%). ConclusionThe estimated prevalence of sensitizing EGFR mutations (exon 19 del, exon 21 L858R) in an unselected samples of newly diagnosed aNSCLC patients in Spain (all histologies) is consistent with previous published data in Caucasian patients. When a sample is available, EGFR mutation testing is feasible in over 90% of cases, and may therefore be suitable for routine clinical practice. ClinicalTrials.gov IdentifierNCT01081496.

Manual liquid based cytology for Pap smear preparation and HPV detection by PCR in Pakistan.

This study was conducted on female patients with different gynecological problems attending the gynecology out-patient departments of two tertiary care hospitals in Peshawar city of Khyber Pakhtunkhwa, Pakistan between August 2012 and October 2013. The 200 patients had an age range of 21-65 years. Smears were taken with cervical brushes and preserved in preservative medium and processed for manual liquid based cytology (MLBC) for Pap staining. Out of 200 collected samples, 30 samples were found inadequate on cytology. Of the remaining 170 samples, 164 (96.47%) were normal, 5 (2.94%) were of atypical squamous cells of unknown significance (ASCUS) and 1 (0.6%) was of high grade squamous intraepithelial lesion (HSIL). On PCR all the samples were positive for beta globin gene fragment including those reported inadequate on cytology. Out of the 5 ASCUS samples, 2 samples were positive for HPV, one each for HPV 16 and HPV 18, and the rest of the 3 samples were negative for HPV DNA. The 1 sample of HSIL was positive for HPV 16 on PCR. Out of 164 normal samples on cytology, only 1 sample was HPV 16 positive. So overall, 4 (2%) out of 200 samples were positive for HPV DNA, where 3 were HPV 16 (1.5%), and 1 was HPV 18 (0.5%) positive, and thus the ratio of infection with of HPV 16 to HPV 18 was 3:1 in the general population. In conclusion, PCR based HPV detection is a more sensitive method for screening of HPV infection than cytology as sample inadequacy does not affect the results. However, it can be combined with cytology methods in a HPV positive female to achieve the maximum results.

Reduction of preanalytical errors in laboratory by establishment and application of training system.

Errors in preanalytical phase occupied for almost half of total errors in clinical laboratory, and the causes are related to medical staff's quality awareness and behaviors. In order to reduce the preanalytical errors in our hospital, we established and applied a training system to improve the situation. The disqualified sample types and major causes of errors in the preanalytical phase were investigated in clinical laboratory department from September 2008 to August 2009. In the following year, we established and applied a training system to affect the quality awareness and behaviors of medical staff. Questionnaire investigation was analyzed to illustrate the changes of respondents' quality awareness and behavior, and the preanalytical errors were reanalyzed according to different departments to evaluate the effects of the intervention measures. The total disqualification rate in the preanalytical phase obtained from September 2008 to August 2009 was 1.36%, and the major types of disqualified samples were coagulation of anticoagulant sample, sample inadequacy, sample container error, sample information error, and sample type error. After application of established training system, respondents' quality awareness on preanalytical samples changed dominantly, and respondents' own behavior and behavior to others also changed notably. The total disqualification rate in preanalytical phase dropped to 0.94%, among 33 clinical departments, the preanalytical errors in 25 departments decreased to various degrees, and 10 departments had overall decreasing amplitude over 50%. The overall effect of the application of established training system is very good, and the disqualification rate of the major departments decrease to various degrees.

A systematic review of ultrasound-guided FNA of lesions in the head and neck--focusing on operator, sample inadequacy and presence of on-spot cytology service.

The objective of this review is to perform a systematic review of ultrasound-guided fine-needle aspiration (FNA) services for head and neck lesions with assessment of inadequacy rates and related variables such as the presence of immediate cytological assessment. A computer-based systematic search of articles in English language was performed using MEDLINE (1950 to date) from National Health Service evidence healthcare database and PubMed. Full texts of all relevant articles were obtained and scrutinized independently by two authors according to the stated inclusion and exclusion criteria. The primary search identified 932 articles, but only 78 met all the study criteria. The overall inadequacy rate was 9.3%, 16 studies had on-site evaluation by a cytopathologist/specialist clinician with a rate of 6.0%. In seven studies, a cytotechnician was available to either assess the sample or prepare the slides with an average inadequacy rate of 11.4%. In 1 study, the assessment was unclear, but the inadequacy rate for the remaining 54 studies, without immediate assessment, was 10.3%. The rate for the cytopathologist/specialist clinicians was significantly different to no on-site assessment but this was not found for assessment by cytotechnicians. The review suggests that the best results are obtained with a cytopathologist-led FNA service, where the pathologist reviews the specimen immediately, in relation to the clinical context, thereby deciding on adequacy and need for further biopsies. A systematic review looking at ultrasound-guided FNA of head and neck lesions has not been published previously.

A systematic review of ultrasound guided FNA of lesions in the head and neck - focusing on operator, sample inadequacy and presence of on-spot cytology service.

A systematic review of ultrasound guided FNA of lesions in the head and neck - focusing on operator, sample inadequacy and presence of on-spot cytology service.

Reduction of preanalytical errors in clinical laboratory through multiple aspects and whole course intervention measures

Errors in preanalytical phase decrease the accuracy of reports from clinical laboratory department. Considering the disqualified rate of preanalytical sample in our hospital, we performed several intervention measures to improve the situation. The disqualified sample types and major causes of errors in the preanalytical phase were investigated in clinical laboratory department from September 2008 to August 2009. In the following year, we utilized multiple measures to properly intervene the key points of whole sample collection process, and the preanalytical errors were reanalyzed trimonthly, then the disqualification rate of total, major disqualified sample types and different test groups were calculated to evaluate the effects of the intervention measures. The total disqualification rate in the preanalytical phase obtained from September 2008 to August 2009 was 1.36%, and the major types of disqualified samples were coagulation of anticoagulant sample, sample inadequacy, sample container error, sample information error and sample type error. After one year intervention through key points of whole preanalytical sample collection process, the total disqualification rate dropped to 0.94%, and the disqualification rate of coagulation of anticoagulant sample, sample inadequacy, sample container error, sample information error, and sample type error decreased by 20.45%, 28.00%, 25.00%, 76.92%, and 66.66%, respectively. As for test groups, the decreasing amplitude of biochemical, routine, immunological, microbiological and emergency test group was 47.36%, 33.33%, 20.00%, 50.00%, and 21.43%, respectively. The overall effect of the interventions is very good, and the disqualification rate of the main causes decreases to various degrees.

Evaluation of an Automated Microplate Technique in the Galileo System for ABO and Rh(D) Blood Grouping

A number of automated devices for pretransfusion testing have recently become available. This study evaluated the Immucor Galileo System, a fully automated device based on the microplate hemagglutination technique for ABO/Rh (D) determinations. Routine ABO/Rh typing tests were performed on 13,045 samples using the Immucor automated instruments. Manual tube method was used to resolve ABO forward and reverse grouping discrepancies. D-negative test results were investigated and confirmed manually by the indirect antiglobulin test (IAT). The system rejected 70 tests for sample inadequacy. 87 samples were read as "No-type-determined" due to forward and reverse grouping discrepancies. 25 tests gave these results because of sample hemolysis. After further tests, we found 34 tests were caused by weakened RBC antibodies, 5 tests were attributable to weak A and/or B antigens, 4 tests were due to mixed-field reactions, and 8 tests had high titer cold agglutinin with blood qualifications which react only at temperatures below 34 degrees C. In the remaining 11 cases, irregular RBC antibodies were identified in 9 samples (seven anti-M and two anti-P) and two subgroups were identified in 2 samples (one A1 and one A2) by a reference laboratory. As for D typing, 2 weak D+ samples missed by automated systems gave negative results, but weak-positive reactions were observed in the IAT. The Immucor Galileo System is reliable and suited for ABO and D blood groups, some reasons may cause a discrepancy in ABO/D typing using a fully automated system. It is suggested that standardization of sample collection may improve the performance of the fully automated system.

Assertion Aware Sampling Refinement: A Mixed-Signal Perspective

Sampling has been one of the key issues in simulation-based verification of analog and mixed signal (AMS) systems. Recent attempts toward extending assertion languages to the AMS domain has brought forward an obvious question. In what way should sampling be done to ensure that assertions are evaluated correctly? Increasing sampling granularity often comes with substantial simulation time overhead. On the other hand, interpolation of the analog signals between consecutive samples introduces inaccuracies in the signal values and, hence, in the truth of the assertions. This paper explores how temporal assertions are handled for inadequately sampled signals. We propose a three-valued semantics (true, false, and unknown) for AMS assertions to address the uncertainty caused by the inadequacy of samples. The evaluation algorithm reports the time intervals where additional samples are required to resolve the uncertainty, thereby paving the way for adaptive sampling refinement in assertion aware AMS simulation.

The Bethesda System for Reporting Thyroid Cytopathology : A Five-Year Retrospective Review of One Center Experience

Fine-needle aspiration (FNA) of the thyroid gland is a widely accepted and accurate method for triaging patients with thyroid nodules. Thyroid FNA suffers from a reporting confusion due to multiplicity of category terminologies. To address this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was recently introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. The aim of this study was to report the diagnostic utility of TBSRTC at our institution and report the malignancy risk for FNA of thyroid lesions among Saudi patients using this system at KAUH (King Abdulaziz University Hospital), Jeddah, Saudi Arabia. A retrospective study identifying 250 thyroid FNAs performed among Saudi patients between Jan 2005-Dec 2010 was undertaken. Cytology specimen data was collected through a computerized search of our cytopathology archives. Among the 250 thyroid FNAs, 84 were followed by surgical resection. The overall surgical yield of malignancy was 23.8%. The malignancy rate for the 6 categories was as follows: non diagnostic: 20%, benign: 3.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 20%, suspicious for malignancy: 80%, malignant: 100%. Retrospective classification of FNAs of thyroid lesions among Saudi patients using TBSRTC at KAAUH, Jeddah, Saudi Arabia, validates the diagnostic reproducibility of this system and yields similar results for risk of malignancy as reported by others. However the associated rates found for non diagnostic (20%) raise the possibility of malignancy risk in this category and validate the past observations that sample inadequacy is a common cause of false negative thyroid FNAs.

The benefits of on-site cytology with ultrasound-guided fine needle aspiration in a one-stop neck lump clinic.

In the National Institute for Health and Clinical Excellence (NICE) guidance on cancer services published in 2004, it was recommended that specialist clinics should be set up for the assessment of patients with neck lumps, structured in a similar way to one-stop breast lump clinics with a cytopathologist present and preferably ultrasound guidance. The aim of this study was to audit the performance of ultrasound-guided fine needle aspiration (FNA) with on-site cytology in a one-stop neck lump clinic at The Royal Liverpool University Hospital. Data were collected between November 2008 and May 2009 (7 months). Details of the adequacy rate for the FNA were recorded and whether multiple passes were required. The likely adequacy rate if ultrasound guidance was not available was also calculated. A total of 274 patients were included in the audit. Of these, 227 (83%) patients required a single pass for adequate diagnostic material. Of the remaining, 45 (16%) required two passes and 2 (1%) required three passes. The overall sample inadequacy rate was 11 of 274 (4%). From these results, it could be predicted that, if immediate cytological evaluation was unavailable, the inadequacy rate would have been 41 of 274 (15%). This audit has illustrated the benefits of a one-stop clinic with on-site cytology in providing a rapid diagnostic head and neck cancer service.

The benefits of on-site cytology with ultrasound-guided fine needle aspiration in a one-stop neck lump clinic.

In the National Institute for Health and Clinical Excellence (NICE) guidance on cancer services published in 2004, it was recommended that specialist clinics should be set up for the assessment of patients with neck lumps, structured in a similar way to one-stop breast lump clinics with a cytopathologist present and preferably ultrasound guidance. The aim of this study was to audit the performance of ultrasound-guided fine needle aspiration (FNA) with on-site cytology in a one-stop neck lump clinic at The Royal Liverpool University Hospital. Data were collected between November 2008 and May 2009 (7 months). Details of the adequacy rate for the FNA were recorded and whether multiple passes were required. The likely adequacy rate if ultrasound guidance was not available was also calculated. A total of 274 patients were included in the audit. Of these, 227 (83%) patients required a single pass for adequate diagnostic material. Of the remaining, 45 (16%) required two passes and 2 (1%) required three passes. The overall sample inadequacy rate was 11 of 274 (4%). From these results, it could be predicted that, if immediate cytological evaluation was unavailable, the inadequacy rate would have been 41 of 274 (15%). This audit has illustrated the benefits of a one-stop clinic with on-site cytology in providing a rapid diagnostic head and neck cancer service.