Ki67与MRI在宫颈癌根治性手术后宫颈癌淋巴结转移中评价对比

摘要 目的：探究Ki67与MR在宫颈癌根治术后宫颈癌淋巴结转移中评估价值的对比。方法：选择2016年1月至2018年1月于我院接受宫颈癌根治术的151例宫颈癌患者,分别对其实施Ki67检测及MRI检测,以病理学检测结果为金标准,计算两种检测方式对宫颈癌淋巴结转移评估的准确度、敏感度、特异度、阳性预测值及阴性预测值,并进行对比分析。结果：检测评估发现,MRI对宫颈癌淋巴结转移评估准确度为31.79 %,灵敏度为46.75 %,特异度为16.22 %,阳性预测值为36.73 %,阴性预测值为22.64 %。Ki67检测对宫颈癌淋巴结转移评估准确度为42.38 %,灵敏度为52.56 %,特异度为31.51 %,阳性预测值为45.05 %,阴性预测值为38.33 %。两种检测方式对比显示Ki67对宫颈癌淋巴结转移具有更高的诊断准确度。结论：3 相比于MRI检测,Ki67对宫颈癌淋巴结转移具有更高的诊断准确度、特异度和阴性预测值,分析其原因与MRI检测受个体因素影响更大有关。     

Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography.

OBJECTIVE--To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer. DESIGN--The serum CA 125 concentration of each subject was determined and those with a concentration > or = 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire. SETTING--General practice, occupational health departments, ovarian cancer screening clinic. SUBJECTS--22,000 women volunteers who were postmenopausal and aged over 45 years. MAIN OUTCOME MEASURES--Apparent sensitivity, specificity, positive predictive value, years of cancer detected. RESULTS--41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21,959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21,951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 1.4 years. CONCLUSIONS--This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.     

Utility of imprint cytology for early presumptive diagnosis in clinically suspicious cervical cancer

OBJECTIVE: To determine the utility of imprint cytology (IC) in providing an early presumptive diagnosis of clinically suspected cervical carcinoma. STUDY DESIGN: A total of 219 clinically suspicious cervical cancer cases underwent Pap test, punch biopsy and IC at the same sitting. Correlations were performed between these diagnostic modalities to determine the sensitivity and specificity of IC in diagnosis of cervical cancer. RESULTS: The overall accuracy of IC in detecting cervical cancers was 96.2%. About 78% of squamous cell carcinomas (SCC), 60% of adenocarcinomas and 100% of small cell carcinoma could be accurately typed on imprints. Twelve malignant lesions were diagnosed on IC among 26 unsatisfactory biopsies. Although there was no false positive result, 3.5% false negative diagnoses were given on IC. The sensitivity and specificity of imprint smear cytology to detect malignancy was 96.2% and 100%. Agreement between imprint cytology and Pap smear diagnosis of malignancy was 95.3%. kappa Statistics revealed excellent agreement between imprints and biopsies and between imprints and Pap smears in diagnosis of malignant lesions. CONCLUSION: IC can be used as an adjunctive technique for an early and reliable preliminary presumptive diagnosis of cancer of the uterine cervix.     

Acetic acid test: a promising screening test for early detection of cervical cancer

OBJECTIVE: To determine whether the acetic acid test (AAT) could be used as a screening testfor early detection of cervical cancer. STUDY DESIGN: A hospital-based study was carried out. A sample of 376 women who attended the early cancer detection program of the Instituto Mexicano del Seguro Social in the state of Durango during 1998 was included. The AAT was applied during the gynecologic examination. Each women underwent colposcopy and directed cervical biopsy. RESULTS: The biopsies revealed that five women had cervical intraepithelial neoplasia grade 1 (CIN 1) and 51, 2/3. Four values (true positive,false positive, false negative and true negative) were obtained according to the pathologic test for CIN 1(5, 129, 0 and 191) andfor CIN 2/3 (47, 129, 4 and 191). Sensitivity, specificity, negative predictive value and positive predictive value in women with CIN 1 were 1.00, .60, 1.00 and .04 and with CIN 2/3 were .92, .60, .98 and .27, respectively. CONCLUSION: This test is promisingfor early detection of cervical cancer given its high sensitivity. Understanding the biologic mechanisms underlying acetowhite changes necessitates further studies.     

Fine needle aspiration cytology of salivary gland lesions: advantages and pitfalls

Fine needle aspiration cytology (FNAC) was performed on 52 patients with salivary gland lesions. A definitive cytodiagnosis was possible in 45 cases: a sensitivity of 89% and a specificity of 94% was achieved. The pitfalls of FNAC of salivary gland lesions are reflected by the false positive and false negative rates which were 4%. Errors of cytodiagnosis are due to the morphological variability of these tumours which make sampling and interpretation difficult.     

Diagnostic value of the thin-layer, liquid-based Pap test in endometrial cancer: a retrospective study with emphasis on cytomorphologic features

OBJECTIVE: To examine the diagnostic value (sensitivity and specificity of the ThinPrep Pap test in the detection of endometrial cancer and assess the morphologic features of endometrial cancer in ThinPrep tests. STUDY DESIGN: In a retrospective, case-controlled study, we identified 60 Pap slides performed within 12 months of the tissue diagnosis of endometrial carcinoma and 56 comparison slides from patients without known carcinoma. The slides were blindly reviewed by the authors without knowledge of the surgical diagnosis. An independent diagnosis was given for the tests based on 14 diagnostic criteria from the 2001 Bethesda System and 6 additional criteria proposed by the authors. RESULTS: The sensitivity of detecting endometrial carcinoma was 88.3% (95% CI 77.8-94.2%) and specificity was 87.5% (95% CI 76.4-93.8%). The positive likelihood ratio was 7.067 (95% CI 3.513-14.217) and negative likelihood ratio was 0.133 (95% CI 0.066-0.269). Enlarged nuclei and the presence of nucleoli in endometrial cells were the most reliable indicators of endometrial cancer or atypical endometrial cells. CONCLUSION: The ThinPrep Pap test has high sensitivity and specificity in detecting or suggesting the presence of endometrial cancer. Certain cytomorphologic features are helpful in distinguishing benign and malignant endometrial lesions.     

Diagnostic accuracy of liquid‐based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women

C. Remondi, F. Sesti, E. Bonanno, A. Pietropolli and E. Piccione
Diagnostic accuracy of liquid‐based endometrial cytology cytology in the evaluation of endometrial pathology in postmenopausal women Objective: The aim of this study was to compare liquid‐based endometrial cytology with hysteroscopy and endometrial biopsy regarding its diagnostic accuracy in a series of postmenopausal women with abnormal uterine bleeding (AUB) or asymptomatic women with thickened endometrium assessed by transvaginal ultrasound as a screening procedure. Methods: Inclusion criteria were: menopausal status; the presence of AUB and/or thickened endometrium assessed by ultrasound (cut‐off 4 mm); a normal Papanicolaou (Pap) smear; and no adnexal pathology at ultrasound. Exclusion criteria were: previous endometrial pathology; and previous operative hysteroscopy. Of 768 postmenopausal women referred to our general gynaecology clinics, 121 fulfilled the inclusion criteria and were recruited to the trial. Twenty‐one refused to participate. Cytological sampling was carried out by brushing the uterine cavity using the Endoflower device with no cervical dilation and the vial was processed using a ThinPrep® 2000 automated slide processor. The slides were stained using a Pap method. Results: In 98 cases with histological biopsies, endometrial cytology detected five cases of endometrial carcinoma, 10 of atypical hyperplasia and 47 of non‐atypical hyperplasia; 36 cases were negative. In two cases cytology was inadequate because of uterine cervical stenosis. Taking atypical hyperplasia or worse as a positive test and outcome, the diagnostic accuracy of the endometrial cytology was 93.5%, with a sensitivity of 92% and specificity of 95%, a positive predictive value of 73% and a negative predictive value of 99%. All the carcinomas were detected by cytology. Only 42% of women with a positive diagnosis were symptomatic. The cytological sampling was well tolerated by all patients. No complication was registered. Conclusions: Liquid‐based endometrial cytology can be considered an useful diagnostic method in the detection of endometrial pathology as a first‐line approach, particularly if associated with transvaginal ultrasound.     

Large performance variation does not affect outcome in the Finnish cervical cancer screening programme

S. Lönnberg, P. Nieminen, L. Kotaniemi‐Talonen, H. Kujari, J. Melkko, G. Granroth, M. Vornanen, T. Pietiläinen, J. Arola, J. Tarkkanen, T. Luostarinen and A. Anttila Large performance variation does not affect outcome in the Finnish cervical cancer screening programme Objective: Cytology screening for prevention of cervical cancer can reduce incidence and mortality by more than 80% in settings with good organization and rigorous quality control. Audit studies are essential for reaching and maintaining a high quality of screening. The aim of this study was to evaluate variation in performance indicators by screening laboratory and assess the impact on the effectiveness of screening as indicated by cervical intraepithelial neoplasia grade 3 and above (CIN3+) rates after a negative screen. Methods: Seven cytology screening laboratories operating during 1990–1999 with a total of 953 610 screening tests performed were included in the study. By linking screening and cancer register files, all cases of CIN3+ diagnosed in the screened population were identified. For 395 CIN3+ cases with a preceding negative screen and 787 controls, a re‐evaluation of smears was undertaken to uncover false negative screening tests. Performance parameters and rates of CIN3+ after a negative screen were analysed for interlaboratory heterogeneity. Results: The rates of follow‐up recommendations and referrals varied by up to 3.6‐ (2.8–10.2%) and 4.0‐fold (0.03–0.12%), respectively. CIN1, CIN2 and CIN3+ screen detection rates differed by up to 8.5‐ (0.02–0.17%), 5.4‐ (0.05–0.25%) and 3.3‐fold (0.05–0.18%). False negative rates determined by re‐evaluation showed up to 2.1‐fold differences (29–62%). Rates of CIN3+ after a negative screen (0.023–0.048%) and as a proportion of total CIN3+ (15–31%) in the screened population were low and did not vary significantly. Conclusions: There were large variations in the sensitivity–specificity trade‐off between laboratories, reflected in all performance indicators as well as in the test validity estimates of the re‐evaluation phase, but not in screening effectiveness. Even though performance variations do not always have an impact on the effectiveness of screening, they lead to variations in cost, treatment and psychological burden, and should be addressed.     

Value of fine needle aspiration in the diagnosis of breast lesions.

OBJECTIVE: To evaluate the accuracy values of 276 fine needle aspriations (FNA) of breast lesions with a subsequent excisional biopsy diagnosis and to make a comparison between 25 studies of the literature using the same criteria to calculate those values. STUDY DESIGN: Cytologic findings were compared with the histologic diagnosis of each mass. The correlation of results was analyzed by a decision-analysis approach, and the following values concerning diagnostic accuracy were calculated in the present study and in 25 other reports: sensitivity, specificity, positive predictive value, negative predictive value, false positive fraction and false negative fraction. To calculate those values, we eliminated unsatisfactory results and assumed that suspicious and positive cytologic findings represented carcinoma of the breast. RESULTS: Comparing our results with the means in the literature (numbers in parenthesis), FNA detected cancer with a sensitivity of 92.1% (87.7%), specificity of 98.6% (94.7%), positive predictive value of 99.4% (92.8%), negative predictive value of 82.1% (90.7%), false positive fraction of 0.6% (7.1%) and false negative fraction of 17.9% (13.4%); in 6.2% of cases the material was unsatisfactory (13.4%). CONCLUSION: All the rates varied enormously between the studies and during the past 13 years. It seems that false positive and false negative fractions tended to diminish and stabilize in more recent years, and specificity and sensitivity underwent a slight increase. The differences between the rates of those studies suggest that FNA of the breast has some unavoidable limitations.     

Primary Screening for Cervical Cancer Based on High-Risk Human Papillomavirus (HPV) Detection and HPV 16 and HPV 18 Genotyping,in Comparison to Cytology

Objectives

The objective of the present study is to assess the performance of a high-risk human papillomavirus (HR-HPV) DNA test with individual HPV-16/HPV-18 genotyping as a method for primary cervical cancer screening compared with liquid-based cytology (LBC) in a population of Greek women taking part in routine cervical cancer screening.

Methods

The study, conducted by the “HEllenic Real life Multicentric cErvical Screening” (HERMES) study group, involved the recruitment of 4,009 women, aged 25–55, who took part in routine cervical screening at nine Gynecology Departments in Greece. At first visit cervical specimens were collected for LBC and HPV testing using the Roche Cobas 4800 system. Women found positive for either cytology or HPV were referred for colposcopy, whereas women negative for both tests will be retested after three years. The study is ongoing and the results of the first screening round are reported herein.

Results

Valid results for cytology and HPV testing were obtained for 3,993 women. The overall prevalence of HR-HPV was 12.7%, of HPV-16 2.7% and of HPV-18 1.4%. Of those referred for colposcopy, cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was detected in 41 women (1.07%). At the threshold of CIN2+, cytology [atypical squamous cells of undetermined significance (ASC-US) or worse] and HPV testing showed a sensitivity of 53.7% and 100% respectively, without change between age groups. Cytology and HPV testing showed specificity of 96.8% and 90.3% respectively, which was increased in older women (≥30) in comparison to younger ones (25–29). Genotyping for HPV16/18 had similar accuracy to cytology for the detection of CIN2+ (sensitivity: 58.5%; specificity 97.5%) as well as for triage to colposcopy (sensitivity: 58.5% vs 53.7% for cytology).

Conclusion

HPV testing has much better sensitivity than cytology to identify high-grade cervical lesions with slightly lower specificity. HPV testing with individual HPV-16/HPV-18 genotyping could represent a more accurate methodology for primary cervical cancer screening in comparison to liquid-based cytology, especially in older women.     

18F-FDG PET/CT 在宫颈癌诊断及分期中的临床价值

目的:探讨氟代脱氧葡萄糖(~(18)F-FDG)正电子发射断层显像/X线计算机体层成像仪(PET/CT)检查在局灶早期宫颈癌中的临床应用价值。方法:53例病理确诊为早期宫颈癌的患者行全身~(18)F-FDG PET/CT检查,并在检查结束10日内行广泛性全子宫切除术+双附件切除术+盆腔淋巴结清扫术,计算~(18)F-FDG PET/CT诊断宫颈原发部位肿瘤及盆腔淋巴结转移的敏感度,特异度与准确度。结果:~(18)F-FDG PET/CT检查诊断的宫颈原发部位肿瘤的敏感度为79.25%,特异度为86.79%,准确度为84.9%;以病人为单位诊断盆腔淋巴结转移的准确度为85.71%,特异度为97.87%;以淋巴结为单位诊断盆腔淋巴结转移的准确度为84.61%,特异度为99.00%。结论:PET/CT显像对宫颈癌诊断,分期诊断及盆腔淋巴结转移的检出具有重要临床意义。     

Analysis of the performance of 100% rapid review using an average time of 1 and 2 minutes according to the quality of cervical cytology specimens

E. J. C. Manrique, N. L. A. Souza, S. B. N. Tavares, Z. B. P. Albuquerque, L. C. Zeferino and R. G. Amaral Analysis of the performance of 100% rapid review using an average time of 1 and 2 minutes according to the quality of cervical cytology specimens Objectives: To compare the performance of the 100% rapid review method carried out in a mean time of either 1 or 2 minutes according to cytological final result, and to assess whether the presence of obscuring factors in cervical smear samples affects the frequency of false‐negative results. Methods: A total of 5 235 smears classified as negative (93.0%) or unsatisfactory (2.1%) at routine screening were submitted to 100% rapid review using mean times of 1 and 2 minutes. Results: Of the 5 235 smears submitted to 1‐minute rapid review, 88 were considered suspect and of these, 45 were confirmed as abnormal in the cytological final result. When the time used was 2 minutes, 67 smears were considered suspect, 44 of which were confirmed as abnormal. Sensitivity and specificity were similar in the 1‐ and 2‐minute reviews. In smears in which samples were satisfactory and had no obscuring factors, sensitivity and specificity were 64.2% and 98.9% and 61.5% and 99.5% for the 1‐ and 2‐minute reviews, respectively. In comparison, in smears in which the sample was satisfactory for analysis but partially obscured (50–75%), sensitivity and specificity were 64.7% and 99.9% and 70.6% and 99.8% for the 1‐ and 2‐minute reviews, respectively. Conclusions: The method of rapid review of 100% showed no difference in the detection of false‐negative results using the time of 1 or 2 minutes. The quality of the sample did not influence the detection of false‐negatives.     

MRI 在宫颈癌分期中的应用价值

目的:探讨宫颈癌的MRI表现与分期,评价其诊断价值及临床意义。方法:由2名经验丰富的妇科肿瘤医师前瞻性地对80例宫颈活组织病理检查证实为宫颈癌或可疑早期浸润癌的患者进行妇科盆腔检查,共同决定分期和手术可行性。对可直接手术或经先期治疗后有手术可能的患者,于开始治疗前2周内(平均6.5d)行盆腔和腹膜后MRI扫描。在MRI图像上观察原发肿瘤的位置、信号特征及侵犯范围。将MRI分期与临床分期进行对比,手术病理分期为金标准,采用诊断检验方法,以敏感度、特异度、准确度3项指标分析MRI判断宫颈癌分期、宫旁侵犯和盆腔淋巴结转移的价值。结果:MRI对宫颈癌术前分期的总准确度为88.7%,对浸润性癌(Ⅱa及Ⅱa以上)诊断准确度为86.7%。MRI对宫旁侵犯的判断敏感度为85.2%,特异度为85%,准确性为85.1%,MRI预测淋巴结转移的敏感度为58%,特异度为96%,准确性为90%。结论:MRI能多方位清晰显示宫颈癌瘤灶及侵犯范围与途径,明显优于其他影像学检查方法,MRI对术前宫颈癌分期明显优于临床,可做为宫颈癌术前常规的影像检查方法。     

Could nuclear matrix protein 22 (NMP22) play a role with urine cytology in screening for bladder cancer? – experience at Kuwait University

Objectives:  This prospective study was undertaken to evaluate nuclear matrix protein (NMP22) compared to urine cytology in the detection of bladder cancer and also to determine whether indexing suspicious cytology to NMP22 could enhance the clinical utility of cytology.
Methods:  Cytological findings of voided urine collected prior to a cystoscopic biopsy were correlated with urine NMP22 assay in 46 patients attending the urology clinic in Mubarak Al-Kabeer Hospital. The patients were clinically categorized into newly diagnosed cases of transitional cell carcinoma (TCC), recurrent TCC, TCC in remission and controls.
Results:  Using histological diagnosis as the gold standard the sensitivity and specificity of NMP22 were 78% and 43% respectively and of cases with malignant urine cytology were 30% and 87% respectively. If suspicious and malignant cytology were combined as positive results the sensitivity increased significantly to 87% while the specificity decreased but not significantly to 74%. Suspicious or malignant cytology enhanced by positive NMP22 gave a sensitivity of 70% and specificity of 87% neither of which was significantly different from cytology alone. There were three false positive cases on cytology and 13 false positive cases on NMP22 assay. There were three false negative cytology and five false negative NMP22 cases but only one was false negative for both, resulting in a high sensitivity (96%) but low specificity (30%) if either positive NMP22 or malignant or suspicious cytology was taken as a positive result.
Conclusion:  Combining NMP22 with malignant or suspicious cytological result improved sensitivity for the detection of bladder cancer but with a major decrease in specificity, suggesting a potential role in screening rather than diagnosis.     

Reporting the presence of significant epithelial atypia in pancreaticobiliary brush cytology specimens lacking evidence of obvious carcinoma: impact on performance measures

OBJECTIVE: To assess the clinical impact of recognizing and reporting the presence of significant atypia in brush cytology specimens from the biliary and pancreatic ducts lacking obvious features of carcinoma. STUDY DESIGN: Analysis of 120 pancreaticobiliary brushings from 99 patients over a 4-year period. There were 114 bile duct and 6 pancreatic duct specimens obtained via endoscopic retrograde cholangiopancreatography at a tertiary care center. RESULTS: Overall sensitivity, specificity, accuracy, and positive and negative predictive values for carcinoma were 47%, 99%, 79%, 95% and 76%, respectively. When the presence of "significant epithelial abnormalities," cancer or cellular atypia less than carcinoma, was reported, the overall sensitivity, specificity, accuracy, and positive and negative predictive values were 62%, 93%, 82%, 85% and 80%, respectively. CONCLUSION: Recognizing and reporting the presence of significant epithelial abnormalities in pancreaticobiliary specimens lacking obvious features of malignancy in brush cytology specimens led to a modest improvement in sensitivity for "significant epithelial abnormalities" and cancer, along with a slight decrease in specificity and positive predictive value and slightly increased accuracy and negative predictive value. Maintaining high specificity is essential to avoiding false positive diagnoses on pancreaticobiliary brush cytology.     

Comparison of conventional Papanicolaou smear and SurePath® liquid-based cytology in the Copenhagen population screening programme for cervical cancer

OBJECTIVE: To compare diagnostic performance of conventional Papanicolaou smear with SurePath liquid-based cytology in a population screening programme. METHODS: A retrospective comparison was performed on data from two 18-month periods of the screening programme for cervical cancer in the municipality of Copenhagen with conventional Papanicolaou technique (n = 82,116) and liquid-based cytology (n = 84,414). RESULTS: After the conversion to liquid-based cytology the percentage of unsatisfactory samples decreased from 2.3% to 0.3% (P < 0.001), whereas the number of normal cervical samples lacking an endocervical component increased from 8.5% to 8.9% (P < 0.005). The percentage of samples with atypical cells and cells suspicious for malignancy increased from 3% to 4.2% (P < 0.001) and from 1.9% to 2.4% (P < 0.001), respectively. The subsequent histological follow-up showed normal findings decreased from 70.5% to 68.9% and from 28.0% to 26.1%, respectively. However, in relation to the entire screening populations, there was an increase of normal findings from 2.12% to 2.89% after primary atypical diagnosis and from 0.53% to 0.62% after diagnosis of suspicious cells after conversion to the liquid-based technique. CONCLUSIONS: This study showed the number of unsatisfactory samples to be significantly reduced with the liquid-based technique. The data suggest that there is an increased detection rate of cervical precancerous lesions with liquid-based cytology, but the number of false positive tests is still high. The specificity of the two tests seems similar, but this cannot be ascertained exactly, because of the fact that follow-up of negative cases is unavailable.     

Molecular biomarker-based screening for early detection of cervical cancer

OBJECTIVE: To evaluate the effectiveness of a molecular biomarker-based screening method for early detection of cervical cancer. STUDY DESIGN: Fluorescent immunochemical labeling was used to classify cervical cytology specimens as probably normal or probably abnormal. These specimens were then Papanicolaou stained and evaluated twice by a cytotechnologist and by a pathologist when appropriate. The first evaluation was performed as conventional Pap screening to assign a reference per-specimen diagnosis. The second evaluation assigned a cytologic diagnosis to each cell in the specimen. The fluorescence results were correlated with those from each of the two morphologic evaluations to determine the sensitivity and specificity of the method on a per-specimen and a per-cell basis. Where available, in cases of positive morphologic analysis, biopsy was compared to fluorescence results. RESULTS: The per-specimen sensitivity and specificity were 87.5% and 81.8%, respectively, when using atypical squamous cells of undetermined significance and "above" as the decision threshold. For the same specimens evaluated on a cell-by-cell basis, the corresponding sensitivity and specificity were 71.4% and 66.3% when the same threshold was used. The per-specimen sensitivity for high grade squamous intraepithelial lesions was 100% under these conditions. CONCLUSION: This method appears to be a robust and reliable means of detecting cervical dysplasia and is now being evaluated in additional clinical studies.     

Test characteristics of various screening modalities for cervical cancer: a feasibility study to develop an alternative strategy for resource-limited settings

OBJECTIVE: To determine test characteristics - sensitivity, specificity, positive and negative predictive values - of different screening modalities to detect cervical precancerous and cancerous lesions in order to devise an effective alternative strategy for cervical cancer screening in resource-poor settings. METHODS: A total of 472 women presenting with nonspecific gynecologic symptoms were screened by cytology, visual inspection with acetic acid application (VIA), VIA with magnification (VIAM) and human papillomavirus (HPV)-DNA testing. Colposcopic examination was performed in all and on-site biopsy was taken if any grade I and above lesion was detected on colposcopy (230). On histopathological examination, 105 showed cervical intraepithelial neoplasia II and above lesions. Sensitivity, specificity and predictive values for each test were calculated taking colposcopy and or directed biopsy as the gold standard. Comparisons were made with cytology in order to assess the feasibility of alternative strategies in resource-poor settings. RESULTS: VIA was less sensitive (86.7% versus 91.4%) but more specific (90.7% versus 86.6%) than cytology at low grade squamous intraepithelial lesion (LSIL) threshold but the difference was not statistically significant (P > 0.01). HPV testing improved the sensitivity over cytology (97.1% versus 91.4%) but there was a nonsignificant loss of specificity (84.2% versus 86.6%). Results of VIAM were more or less similar to VIA. CONCLUSION: VIA can be used as a mass screening tool for cervical cancer in resource-poor settings.     

Transrectal sonography in prostate cancer detection--our 25 years experience of implementation

Prostate cancer is a leading public health problem of male population in developed countries. Gold standard for prostate cancer diagnosis is true cut biopsy guided by transrectal ultrasound. Aim of this study was to determine sensitivity, specificity, accuracy, positive and negative predictive value of transrectal sonography (TRUS) in prostate cancer detection. The analysis was made for two time periods, before and after routine implementation of prostate specific antigen (PSA) in prostate cancer diagnostics. From 1984 to 1993 TRUS guided prostate biopsy was performed in 564, and from 1994 to 2008 in 5678 patients. In the second period PSA was routinely used in prostate cancer diagnostics. In the first period by TRUS we have made an exact diagnosis of prostate cancer in 18.97% of patients what was confirmed by biopsy. 4.61% ware false positive and 11.34% ware false negative. In the second period prostate cancer was recognized in 30.34% of patients, confirmed by biopsy. False positive cases ware 6.11% and false negative 29.31%. Sensitivity of transrectal sonography in the first period was 62.57%, specificity 94.2%, accuracy 86.2%, positive predictive value 80.45% and negative predictive value 87.72%. In the second period sensitivity was 50.87%, specificity 91.93%, accuracy 73.84%, positive predictive value 83.24% and negative predictive value 70.39%. Based on our experience we can conclude that prostate cancer is mostly found in the peripheral zone. Smaller tumors are hypoechoic and bigger tumors are hyperechoic. Prostate cancer lesions are impossible to differentiate from chronic prostatitis only by TRUS. Implementation of PSA has significantly decrease sensitivity, accuracy and negative predictive value of TRUS in prostate cancer detection. TRUS guided true cut biopsy is a gold standard in prostate cancer diagnostics.     

Brush cytology of colorectal malignancies

OBJECTIVE: To evaluate the specificity and sensitivity of brush cytology and biopsy in colorectal malignancies. STUDY DESIGN: The study was performed over 3 years, 1998-2000. Seventy-six patients with any colorectal lesion on colonoscopy were selected, and in all of them brush cytology and biopsy were done at the same time. The cytologic smears and biopsies were reviewed separately. The cytologic smears were categorized as negative, suspicious, suggestive or positive for malignancy. The results of cytology and biopsy were compared based on sensitivity and specificity. The gold standard for positive cases was the tissue specimen after surgery; negative cases were followed for at least 1 year. Cases with 1 year of disease-free survival were considered negative. RESULTS: Among 76 cases, 4 were excluded because of unsatisfactory cytologic smears. Of the remaining 72 cases, 31 were male and 41 female. The age range was 19-80 years. Cytology showed 23 positive and 49 negative cases (1 false positive and 3 false negative). Biopsy showed 24 positive and 48 negative cases (no false positives and 1 false negative). There were 47 negative cases, followed for at least 1 year, and after that we considered them definitively negative for malignancy. Sensitivity of cytology and biopsy was 88% and 96%; specificity was 98% and 100%, respectively. Combined use of brush cytology and biopsy had the highest sensitivity, 100%. CONCLUSION: Brush cytology of the colon is a safe, fast and reliable method for the diagnosis of colorectal cancer. We recommend performing it in conjunction with biopsy. It is also reasonable to perform a repeat biopsy in patients with negative biopsy and positive cytology for a definitive diagnosis.