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OBJECTIVE To analyze the cervical cytologic smear history of women with carcinoma in situ (CIS). STUDY DESIGN We examined cytologic smears obtained within the three-year period prior to a histologic diagnosis of CIS in 585 women for whom at least one prebiopsy smear was available. RESULTS Among 454 patients with only one smear available for review, 9 (2%) had a negative cytologic diagnosis, 58 (13%) had low grade squamous intraepithelial lesion (LSIL), and 387 (85%) had high grade squamous intraepithelial lesion (HSIL). One hundred thirty-one women had two to five smears taken within the previous three years available for review. All the smears taken prior to biopsy showed HSIL. The original diagnosis on the other smears was negative for 78 women (60%), HSIL for 46 (35%) and LSIL for 7 (5%). ALl 132 smears originally classified as negative from 87 of 585 (14.8%) women were reviewed. Twenty-seven (20%) were then classified as showing HSIL, 10 as LSIL, 10 as atypical squamous cells of undetermined significance, 7 as unsatisfactory and 78 (59%) as remaining negative. CONCLUSION Of smears classified as negative and taken in the three years before biopsy-proven CIS, 41% were reclassified, with half reclassified as showing HSIL.

Mục tiêu: Phân tích tiền sử tế bào học cổ tử cung ở bệnh nhân ung thư biểu mô tế bào tại chỗ.

OBJECTIVE The Wisconsin Cytology Proficiency Testing Program (WCPTP) was developed cooperatively by the Wisconsin State Laboratory of Hygiene, the Wisconsin Society of Pathologists and the Wisconsin Society of Cytology to enable pathologists and cytotechnologists in Wisconsin to meet Clinical Laboratory Improvement Act of 1988 (CLIA '88) requirements for proficiency testing (PT). STUDY DESIGN A joint steering committee designed the WCPTP to comply with all CLIA '88 regulations. The WCPTP application to the Health Care Financing Administration received tentative approval in May 1994. In 1994, mock PT was conducted at meetings of both state societies, and voluntary, on-site PT was conducted at 19 laboratories. RESULTS Each of the 119 participants (49 pathologists, 70 cytotechnologists) was tested with sets of 10 glass slides, each representing one of four specified categories: A, unsatisfactory; B, normal/benign; C, low grade squamous intraepithelial lesion; and D, high grade squamous intraepithelial lesion and cancer. The failure rate for pathologists was 22.5% (11/49) and for cytotechnologists, 1.4% (1/70). The CLIA '88 scoring system for pathologists is more stringent. If cytotechnologists were scored as pathologists, 10% (7/70) would have failed. Using the cytotechnologist grid, 14.5% (7/49) of the pathologists would have failed. CONCLUSION This voluntary program provided some preliminary insights into the issues related to PT evaluation of personnel competence and diagnostic criteria.

MỤC TIÊU: Chương trình thử nghiệm thành thạo về tế bào học Wisconsin (WCPTP) được phát triển bởi Phòng thí nghiệm vệ sinh bang Wisconsin, Hiệp hội bệnh học bang Wisconsin và Hiệp hội tế bào học Wisconsin nhằm giúp các nhà bệnh lý học và công nghệ tế bào ở Wisconsin đáp ứng được Đạo luật cải thiện phòng thí nghiệm lâm sàng năm 1988 (CLIA 88).

OBJECTIVE To determine what percentage of cervical cytologic diagnoses initially classified as false positives (based on a negative cervical biopsy within three months of the cervical cytologic smear) are recategorized as histologic false negatives when subsequent studies reveal abnormalities. STUDY DESIGN A three-year review of 1,242 cervicovaginal biopsies with corresponding cytology in the preceding three months revealed 68 cases (5.5%) where the cytology was positive for a squamous intraepithelial lesion but the biopsy was within normal limits or showed benign cellular changes. Follow-up cytologic and/or histologic diagnoses were obtained for 53 of the 68 cases from the patients' hospital and physician office records. RESULTS Of the 53 cases with follow-up, 24 (45%) were found to have a subsequent squamous intraepithelial lesion (indicating a sampling error at the time of the initial biopsy), and 9 showed atypical squamous cells of undetermined significance. In addition, 9 of the 20 patients (45%) who had negative follow-up studies had benign abnormalities on the initial, noncorrelating biopsy that may have contributed to the discrepancy. CONCLUSION This study emphasized the importance of diligent follow-up of patients with noncorrelating studies since they represent a population at high risk for the subsequent detection of premalignant conditions.

Xác định tỷ lệ các chẩn đoán tế bào cổ tử cung ban đầu được xếp vào nhóm dương tính giả (dựa trên kết quả sinh thiết âm tính trong vòng 3 tháng sau sinh thiết) được xếp lại vào nhóm âm tính giả về mặt mô học khi các nghiên cứu tiếp theo cho thấy có bất thường. Nghiên cứu mô tả cắt ngang trên 1.242 trường hợp sinh thiết cổ tử cung với các kết quả tế bào học tương ứng trong vòng 3 tháng trước đó cho thấy 68 trường hợp (5,5% ) có kết quả tế bào học dương tính với tổn thương niêm mạc nhưng sinh thiết

OBJECTIVE To determine the false negative fraction (FNF) at a small community hospital and its relation to the discovery of a significant error. STUDY DESIGN All cervical cytologic smears (6,889) initially interpreted over a one-year period (1992) as "normal" or "near normal" were retrospectively rescreened and interpreted by outside institutions, without knowledge of the initial interpretation, to calculate yearly and quarterly FNFs. RESULTS The overall FNF for 1992 was 12.3% and was 19.1%, 22.2%, 3.8% and 6.1% per successive quarters in 1992. A significant error was discovered at the start of the third quarter that subsequently received both local and national media attention. CONCLUSION This study gives further proof that the FNF can be reduced to < 5% by motivated cytotechnologist/ pathologist teams, although it may not be possible to maintain this low an FNF.

Xác định tỷ lệ âm tính giả (FNF) tại một bệnh viện cộng đồng nhỏ và mối liên quan của nó với việc phát hiện một sai số đáng kể. Nghiên cứu thiết kế: Tất cả các mẫu tế bào học cổ tử cung (6.889) ban đầu được coi là "bình thường" hoặc "gần bình thường" trong khoảng thời gian một năm (1992) được tái khám và giải thích bởi các cơ sở bên ngoài mà không có kiến thức về cách giải thích ban đầu, để tính FNF hàng năm và hàng quý. KẾT QU

OBJECTIVE To assess the significance of nonatypical glandular cells in vaginal smears from patients who had undergone total hysterectomy. STUDY DESIGN Vaginal smears with nonatypical glandular epithelium obtained from post-total hysterectomy patients were identified in our files over a 4.5-year period. The cytologic findings were correlated with the clinical data. RESULTS Smears with nonatypical glandular epithelium from 15 post-total hysterectomy patients were identified, making this the largest series in the literature. The patients' mean age was 59 years. Most patients (73%) had a history of gynecologic malignancy, and 60% had received radiotherapy. All patients had a normal gynecologic examination when the vaginal smear was obtained. None of the patients developed recurrent or de novo vaginal adenocarcinoma. CONCLUSION The presence of nonatypical glandular epithelial cells in smears from total hysterectomy patients is not indicative of adenocarcinoma.

MỤC TIÊU TÁC DỤNG TẾ BÀO BỆNH NHÂN UNG THƯ TRÊN MÔ TẢ LÂM SÀNG TRONG PHẪU THUẬT THUỐC TRÊN BỆNH NHÂN PHẪU THUẬT TRÊN BỆNH NHÂN PHẪU THUẬT TRÊN BỆNH NHÂN PHẪU

OBJECTIVE To study the diagnostic role of fine needle aspiration biopsy (FNAB) of the testis in male infertility. STUDY DESIGN A retrospective study of 586 cases of infertile males with oligospermia and azoospermia. The material obtained was stained with Diff-Quik. The proportion of Sertoli cells versus spermatogenic cells was studied. RESULTS Cytologic examination revealed normal spermatogenesis in 10.2%, hypospermatogenesis in 31.4%, Sertoli cells only in 30.2% and an atrophic pattern in 28.6%. CONCLUSION The patterns recognized by FNAB were comparable to those obtained by open biopsy. However, FNAB is less invasive, with very few complications. The procedure was well tolerated by all patients. There were very few complications. The findings of this study support the contention that FNAB of the testis is a reliable, relatively noninvasive procedure that has an important role in male infertility.

MỤC TIÊU: Nghiên cứu vai trò chẩn đoán của sinh thiết hút tinh hoàn bằng kim nhỏ trong vô sinh nam.