The role of immunoperoxidase staining in diagnostic cytology

A survey was made of the immune staining characteristics of 60 malignant neoplasms. Cytologically positive smears from each case were tested against a panel of six antibodies (alpha-antichymotrypsin, carcinoembryonic antigen, cytokeratin, desmin, vimentin and S-100 protein). The smears were decolorized and stained with polyclonal sera using the standard avidin-biotin immunoperoxidase procedure. In selected cases, the application of Diatex compound for partition of smears was necessary to obtain optimal results. Most staining reactions reflected the histogenesis of the neoplasms. However, more than one of five reactions was nonconclusive due to background staining, scanty cellularity or poor cytoplasmic preservation; furthermore, the 238 reactions scored as positive or negative included 33 unexpected positives and 15 unexpected negatives. In a series of 20 additional cases, selective immunoperoxidase staining was used in an attempt to solve specific diagnostic problems; the results in 13 of 15 cases with conclusive staining agreed with the cytologic impression. It is concluded that standard immunoperoxidase techniques can contribute to the solution of certain diagnostic problems in cytology; however, the results should be interpreted with caution and with full knowledge of the limitations of the technique.     

The diagnostic significance of nuclear deoxyribonucleic acid measurement in automated cytology.

Flow cytometric analysis of cytologic samples from four different organs shows that nuclear DNA content of malignant cell populations depends to a large extent on organ of origin of the tumor. This fact must be considered in planning screening systems.     

Multiple myeloma.

Multiple myeloma occurs in over 2000 new patients in England and Wales each year. It presents most frequently as bone pain and patients tend to become dehydrated and may develop renal failure. No available treatment is curative, but about two thirds of patients achieve a stable response with low dose combination chemotherapy. Combination chemotherapy including doxorubicin and carmustine with the alkylating agents cyclophosphamide and melphalan achieve a higher stable response rate than conventional treatment with melphalan and prednisone without additional haematological toxicity. These responses are associated with loss of bone pain and patients remain symptom free for months without further treatment. Relapse occurs on average in a little under two years and, though second responses are frequently obtained, the disease eventually becomes refractory. This paper looks at who should be treated and the benefits that may be expected from the treatments available.     

Esophageal exfoliative cytology samplers. A comparison of three types

OBJECTIVE: To compare three types of esophageal exfoliative cytology samplers in terms of patient acceptability, ease of use, final destination of the sampler tip in the gastrointestinal tract and cellular yield. STUDY DESIGN: A controlled, single-blind, cross-over study was undertaken to compare the balloon, sponge and sponge-mesh samplers in healthy volunteers. After completing the three procedures in random order, participants were asked about their preferred method. Ease of use was defined as the technician's ability to perform the intubation successfully. Final destination of the samplers was assessed fluoroscopically. Cytopathologists determined the cellular yield of each sampler using the Bethesda System. RESULTS: Sixty-two volunteers participated. The two encapsulated samplers were significantly preferred over the balloon (P < .0001). There was no significant difference in ease of use, final destination or cellular yield of the three techniques. All three samplers were successfully intubated on the first attempt and retrieved adequate numbers of squamous and glandular cells in > 78% of cases. CONCLUSION: All three samplers obtained satisfactory yields of squamous and glandular cells, but the encapsulated samplers were more patient acceptable. The sponge-mesh sampler may be the least complicated sampler for field screening use. Larger-scale studies will be required to test the accuracy of these three samplers for detecting esophageal dysplasia and carcinoma.     

Cytobrush and wooden spatula for oral exfoliative cytology. A comparison.

The Cytobrush has been used frequently in cervical cytology, but as yet its value in oral exfoliative cytology has not been assessed. A study was undertaken to compare the efficiency of the Cytobrush with that of the wooden tongue spatula. For 26 patients, two smears were collected from clinically normal mucosa from four sites in the oral cavity (buccal mucosa, dorsal tongue, ventral tongue and hard palate). The smears were graded for cell yield and dispersion on a three-point scale. The results were analyzed using the chi 2 test. The Cytobrush was found to be significantly more efficient than the wooden spatula, in terms of both cell yield (P less than .005) and cell dispersion (P less than .005). When each site was examined separately, the Cytobrush produced significantly better dispersion for the dorsal tongue, ventral tongue and buccal mucosa and a better cell yield for the tongue surfaces. No significant difference for cell yield or dispersion was found for the hard palate. The study showed that the Cytobrush is an effective instrument for use in exfoliative cytology of normal oral mucosa.     

Amoebiasis: diagnosis by aspiration and exfoliative cytology

The present study was undertaken to evaluate the use of fine needle aspiration and exfoliative cytology in the identification of amoebic cysts/trophozoites, and to characterize amoebiasis. The subjects consisted of 15 patients, 11 diagnosed by fine needle aspiration cytology (FNAC) as amoebic abscesses (14 liver and one pulmonary) and four women whose cervical smears contained Entamoeba histolytica cysts or trophozoites. Of 128 ultrasonographically guided FNAC of hepatic lesions over a four year period, 17 were abscesses of which 10 were diagnosed as amoebic. A single case of pulmonary amoebiasis was detected in an 18-year-old male. The case was initially diagnosed as tubercular due to deceptive symptomatology. Three cases of amoebic cysts and one trophozoite were reported on routine cervical smear screening. All four cases were unsuspected for amoebic infection. The disease may easily go undetected unless meticulous screening is exercised, and the search for cysts or trophozoites is made with clear concepts of the morphological characteristics of E. histolytica in mind.     

Oral exfoliative cytology in the diagnosis of paracoccidioidomycosis

OBJECTIVE: To assess the efficacy of conventional oral exfoliative cytology as a diagnostic tool in paracoccidioidomycosis. STUDY DESIGN: Cytologic smears and incisional biopsies were obtained from 10 patients with a clinical suspicion and oral manifestations of paracoccidioidomycosis. Cytologic smears and sections of the incisional biopsy underwent methenamine silver staining for fungi according to the Gomori-Grocott method. The dry glass slides were examined at 400 or 1,000 x magnification, and the presence and shape of yeasts of Paracoccidioides brasiliensis were investigated. RESULTS: Yeasts of the fungus P brasiliensis were clearly identified in cytologic smears and sections from incisional biopsies in all cases analyzed (100.0%). CONCLUSION: Cytology of oral samples proved an effective diagnostic method for the detection of paracoccidioidomycosis in humans.     

Quantitative exfoliative oral cytology in iron-deficiency and megaloblastic anemia

A study was undertaken to ascertain if there were any morphometric or morphologic changes in exfoliated oral squames in either iron-deficiency or vitamin B12-deficiency states. The results revealed a significant (P less than .05) increase in nuclear area and a significant alteration in nuclear/cytoplasmic ratio in vitamin B12 deficiency; both returned to normal following replacement therapy. No changes were seen with iron deficiency anemia or non-vitamin B12 megaloblastic anemia. Ultrastructurally, the surface morphology showed similar features in all groups, with the plasma membrane forming complex folds (microplications) in three patterns: branching, parallel and network. The microplication widths and interplication distances were remarkably constant in both control and study groups, regardless of pattern.     

Quantitative oral exfoliative cytology. Effect of alcohol on normal buccal mucosa

OBJECTIVE: To assess the effect of chronic alcohol intake on the DNA distribution and cell area of normal oral mucosal cells. STUDY DESIGN: Smears were taken from clinically normal buccal mucosa of 50 patients attending an alcohol-problem service (i.e., chronic alcohol use) and average alcohol units per week recorded. DNA distribution histograms and total cell area values were then compared to those obtained from smears taken from a control group (which included social drinkers) of patients attending for routine dental treatment. Nuclear DNA content was assessed on 100 randomly selected, Feulgen-stained nuclei using a Seescan TV image analysis system, and total cell area was assessed on 50 Papanicolaou-stained cells using the Vids V image analysis system. RESULTS: The DNA distribution histograms were essentially diploid in appearance for the alcohol group, although there was an increase in nuclear DNA content in the occasional nucleus. A highly significant reduction in total cell area was found for the alcohol group when compared to the controls. CONCLUSION: The chronic ingestion of alcohol is associated with a reduction in total cell area but appears to have little effect on nuclear DNA content. Our previous research using the same technique showed that oral cancers are frequently nondiploid. Thus, a nondiploid DNA distribution histogram for smears taken from a clinically suspicious lesion in someone who consumes excessive amounts of alcohol is unlikely to be due to alcohol use alone and should indicate biopsy.     

Role of exfoliative cytology in diagnosis of laryngeal tumors

OBJECTIVE: To evaluate the value of cytologic examination in the diagnosis of laryngeal tumors. STUDY DESIGN: A series of 100 patients with suspected tumorous lesions of the larynx were included in the study. The material for cytologic analysis was obtained by use of a modified instrument, that is, a slightly concave discoid knife, during direct microlaryngoscopy, followed by biopsy for paraffin and frozen section histopathology. The findings obtained by cytology and frozen section histopathology were compared with the findings of paraffin section histopathology. RESULTS: Cytology showed an 83.9% sensitivity, 100% specificity and 90% accuracy compared with histopathologic findings (p < 0.05; chi2 = 7.7). Frozen section pathohistology vs. paraffin section histopathology showed an 80.6% sensitivity, 97.4% specificity and 87% accuracy (p < 0.05; chi2 = 8.1). CONCLUSION: Cytologic examination showed higher accuracy compared to frozen section histopathology, also giving an insight into the type of laryngeal pathology in the case of precancerous lesions. The use of cytology and frozen section histopathology during direct microlaryngoscopy improves clinical diagnostic accuracy.     

The diagnostic accuracy of sputum and urine cytology

The diagnostic accuracies of sputum and urinary cytology were examined in series spanning more than 20 years. The sensitivity and respiratory tract cytology in 1,289 patients with subsequently proven lung cancer was 69% while that or urine cytology in 860 patients with urinary tract cancer was 77%. The specificities were 96% for lung cancer and 97% for urinary tract cancer. Neither procedure was widely used for routine screening, but diagnostic cytology played an important part in providing a definite morphologic diagnosis in many of these cases. Urinary cytology was also very effective in the follow-up of patients with treated bladder cancer because of its high sensitivity for detecting carcinoma in situ.