Posters. P1 A 2‐year audit of thyroid fine needle aspiration cytology

Introduction Fine needle aspiration (FNA) cytology of the thyroid is a well‐established test in the clinical work‐up of patients with solitary nodules of the thyroid. Thyroid FNA does however have limitations and audit of diagnostic performance is important. Methods The histopathology archives of the Royal Victoria Hospital were searched for all thyroid resections and the histopathological diagnosis was correlated with the pre‐operative cytological diagnosis, where available. Special emphasis was placed on the accuracy of tumour diagnosis. Results A total of 173 cases were identified during the 2‐year period, of these 93 had available pre‐operative FNA. A total of 57 tumours were identified. A small number (six of 57) of significant discrepancies were identified. These included a malignant lymphoma diagnosed as Hashimoto's thyroiditis, a metastasis which the FNA had suggested was a medullary carcinoma and an insular carcinoma diagnosed as medullary carcinoma on FNA. False positives included a colloid cyst diagnosed as suspicious of malignancy and a cytological diagnosis of papillary carcinoma not confirmed on histology. Discussion At present, the majority of thyroid FNAs in our clinics are performed by surgeons and material is not routinely available for immunocytochemistry. In spite of these limitations, there were few major discrepancies. These might be reduced if pathologist aspirators were able to perform FNAs and collect material for further studies, where necessary. This would allow identification of medullary carcinomas and malignant lymphomas. Conclusion FNA of thyroid lesions is a useful investigation in our clinical setting, however, some areas of potential for improvement have been identified.     

Posters. P17 Accuracy of fine needle aspiration cytology in diagnosis of thyroid swellings

Introduction Fine needle aspiration cytology is regarded as the gold standard investigation in diagnosis of thyroid swellings. Published data suggest an overall accuracy rate of 75% 1 in the detection of thyroid malignancy. The aim of this study was to determine the accuracy of FNA cytology in detection of thyroid malignancy in our surgical unit. Methods Between 1989–2002, 144 patients who underwent thyroid resection by single consultant surgeon and who had pre‐operative FNA were enrolled in this retrospective study. The pre‐operative FNA results were compared with definitive histological diagnosis following thyroid resection. Fine needle aspiration cytology was performed using aspirate and non‐aspirate techniques on each thyroid swelling. The cytological sample was assessed by a single cytopathologist and was classified as inadequate, non‐neoplastic, neoplastic, suspicious or indeterminate. The histology was classified as non‐neoplastic (benign) and neoplastic (malignant). Results Fine needle aspiration cytology analysis revealed 94 (13.88%) non‐neoplastic, six (65.27%) neoplastic and 20 (4.16%) suspicious aspirates. Twenty (13.88%) samples were inadequate and four (2.77%) samples were indeterminate. Histological analysis showed 118 (81.94%) benign, 26 (18.05%) malignant specimens. Fine needle aspiration cytology had a sensitivity, specificity and accuracy rate of 52.6%, 86.6% and 79.1%, respectively for diagnosing thyroid malignancy. Conclusion The results are comparable with the current published data and demonstrate that FNA cytology in our hands is accurate investigation for pre‐operative diagnosis for the detection of thyroid malignancy.     

Posters. P9 A case of carcinosarcoma presenting in a cervical ThinPrep® sample

Introduction Direct endometrial sampling with cytology and or histology is used at our hospital as part of the investigation of abnormal uterine bleeding. It is used in cases where there is a low clinical suspicion of malignancy. The advantage of the technique is that it can be done as an outpatient procedure with minimal patient discomfort. Reports in the literature give mixed results. We present a 3‐year retrospective of our experience with follow‐up.

Posters. P3 North west non‐gynaecological cytology EQA pilot CD ROM scheme 2002–2003

The 8th circulation of this scheme was preceded by a CD ROM circulation of selected digital images and presented as individual JPEG file images in a single folder on the CD ROM. The number of images per case ranged from three to eight. The delegates will have an opportunity to assess these themselves prior to uncovering the consensus diagnosis provided by the participants. Of the 76, 29 participants of the scheme provided a completed answer sheet for the image‐based circulation. To date, 19 have now also supplied answers on the actual slide circulation. The same diagnosis on image and slide circulation varied from 5/19 to 19/19 with a mode of 14/19. The case that provided the poorest correlation was because of a generalized undercall of suspicious in a case which achieved almost complete consensus on the slide circulation. It had been the most difficult to photograph. The case that provided the next poorest correlation 11/19 was the case that had the poorest consensus diagnosis on the slide circulation. The two cases that provided the best correlation 18/19 and 19/19 were two cases that provided 100% consensus diagnosis on the slide‐based circulation. Comments were received from 20 participants about the image circulation ranging from ‘great’ to ‘awful’ with the majority of 12 participants not happy for their diagnostic capability to be assessed on such images alone. Two stated that the CD was easier to use on their home computer than their NHS one. In conclusion an image circulation overcomes many of the inherent problems with a slide circulation for EQA purposes and can provide an overall 70% correlation with a slide circulation but a significant number of pathologists do not find this an acceptable method for EQA.     

Posters. P19 Cervical carcinoma with metastases to the tympanic membrane: an unusual presentation

Introduction Fine needle aspiration (FNA) is a well‐established diagnostic technique which is frequently used to diagnose head and neck neoplasms. Clinical decisions concerning treatment of malignant salivary gland tumours, the extent of surgery and advisability of pre‐operative irradiation can be helped by prior knowledge of tumour type. Aim The aim of this study was to do an audit of all salivary gland FNAs carried out in Beaumont Hospital over a 14‐year period. Methods All salivary gland FNAs between 1989 and 2002 were reviewed. Where available, the corresponding follow‐up histological specimens were studied. Results During this 14‐year period, 305 patients with salivary gland lesions had FNA of the lesion performed. The total number of aspirates performed was 343. Of these, 184 had histologies available for follow‐up. Eighty‐nine aspirates were reported as inadequate; 89 as inflammatory, normal or consistent with cyst contents. One hundred and thirteen aspirates were diagnosed as a benign entity. Thirty‐three aspirates were reported as malignant (21 of which were felt to be primary to the salivary gland and 12 metastatic). Sixteen cases were called suspicious. Good correlation between FNA findings and histology was seen in the majority of cases (145 of 183). Some diagnostic problem areas were identified. These included the following: lymphomas (seven called benign on FNA), Warthin's tumour (seven not diagnosed or misdiagnosed on FNA) and mucoepidermoid carcinoma (one reported as pleomorhic adenoma and one as benign/cystic on FNA). Seven pleomorphic adenomas were not diagnosed on FNA pre‐operatively, predominantly due to inadequacy of the specimen. Three other malignancies (acinic cell carcinoma, lymphoepithelial carcinoma and carcinoma ex‐pleomorphic adenoma), while not diagnosed on FNA, were called suspicious, with re‐biopsy advised. Conclusion FNA cytology of salivary glands is an accurate method for evaluation of both benign and malignant lesions, enabling optimum surgical and adjuvant therapy decision‐making pre‐operatively. Well‐defined problem areas are identified and, therefore, clinicopathological correlation is required in these cases.     

Posters. P7 Development of a web‐based resource pack for cytology training officers

The NHSCSP Cervical Cytopathology Training Log and accompanying Workbook are central to the education and training of new recruits in cytology laboratories in the UK. These are currently available only in paper format and do not fully address the needs of training officers and trainees in Wales. A web‐based resource pack, which complements the NHSCSP training documents, has been developed by the Welsh Cytology Training School to address these problems. The pack consists of the following sections and has recently been posted on the Welsh intranet:

• ? guide for training officers;
• ? teaching aids, including handouts and ‘powerpoint’ tutorials;
• ? image library;
• ? worksheets; and
• ? competency sheets.

The electronic format allows for instant updating and simultaneous availability to all training officers in Wales. It has been devised in an effort to standardize the training of new cytology recruits in laboratories throughout Wales, thereby ensuring that all new trainees receive the same high‐quality education and training wherever they are employed. CPD modules in gynaecological and non‐gynaecological cytology are being developed. Samples from the resource pack will be presented.     

Posters. P5 Comparison of cervical smears including HPV status in systemic lupus erythematosus patients compared with controls

Systemic lupus erythematosus (SLE) is an autoimmune multi‐system disease with a variable course and prognosis. Significant immunosuppressive therapy is occasionally required to control active disease. It remains uncertain from existing studies whether patients with SLE have an increased incidence of abnormality on cervical smears. Previous studies of abnormalities on cervical smears in SLE are flawed, mostly because of small size of the lupus cohort examined. In Nortern Ireland, we are particularly fortunate to have a stable population and a good regional pathology database, which records the cervical screening history for all women in the province. Due to other reports of genitourinary cancers developing in SLE patients with or without cytotoxic medication, we are currently reviewing our experience to date, to confirm if patients with SLE have an increased incidence of abnormality on cervical smears, and if so, if this is related to disease activity, pre‐disposition to infection or treatment, and to perform a real‐time cervical smear analysis of our SLE patients as well as HPV status. HPV infection is known to be a risk factor for cervical cancer. However any role with regard to SLE and cervical abnormality is yet to be defined. Lupus patients may be either immunosuppressed or suffer immune deficits as a result of disease and may be more prone to develop HPV infection. This research will be able to identify if the SLE population in NI have a different pattern of abnormality on cervical smears and if they have a different or more frequent prevalence of HPV. These changes if present can then be related directly to the disease, it's activity or treatment. Though this research is currently underway, sufficient results are currently not available for statistical analysis to be documented in this abstract, but will be by September for the BSCC.     

Posters. P11 Positive predictive values for high and low‐grade cytological abnormalities as surrogates for specificity and sensitivity

Introduction Positive predictive value (PPV), measuring the percentage of moderate dyskaryosis or worse confirmed as CIN2 or worse, is used as a measure of accuracy in cervical screening. However, it relates more to specificity than sensitivity because the denominator includes false positives rather than false negatives. Low values reflect over‐reporting of high‐grade dyskaryosis but high values may reflect under‐reporting. Sensitivity is impossible to measure from correlation of cytology with outcome because women with negative cytology are rarely referred for colposcopy. Rates of CIN3 resulting from referrals for low‐grade cytology may be used as a surrogate for sensitivity, as high values may reflect under‐reporting (ref). Study design Outcome of colposcopy referrals was monitored during a period of 4 years, using a fail‐safe database. Results PPV at Guy's & St Thomas rose from 54% in 1998/1999 to 69% in 2001/2002. The former was below the NHSCSP recommended range. During the same period of time CIN1 rates for moderate dyskaryosis fell from 37% to 24%, reflecting the main source of discrepancy. While specificity increased (as reflected by increasing PPV) sensitivity remained constant in that CIN3 rates for mild dyskaryosis and borderline remained below 6%: average rates in England have fallen over the last 3 years and were 7.4% in 2000/2001 (ref). CIN2 rates for mild dyskaryosis also remained constant at 11% to 12%. Conclusion Correlation of biopsy results with high‐ and low‐grade cytological abnormalities is a useful method of monitoring accuracy of cytology reporting, and can be used to measure over‐ and under‐reporting as surrogates for specificity and sensitivity.     

Chromosome numbers in wild and semidomesticated Brazilian Capsicum L. (Solanaceae) species: do x = 12 and x = 13 represent two evolutionary lines?

Chromosome numbers were determined in 29 accessions of wild and semidomesticated Capsicum species from the EMBRAPA Hortaliças (Brazil) germplasm collection. 2 n  = 24 was found in C. baccatum var. praetermissum , C. chinense , C. flexuosum and C. parvifolium , while C. buforum , C. campylopodium , C. cornutum , C. schottianum , C. villosum var. villosum and five other native south-eastern Brazilian species not yet taxonomically named all had 2 n  = 26 chromosomes. These are the first chromosome number determinations for C. cornutum , C. schottianum , C. villosum var. villosum and the five other Brazilian taxa. Our data confirm published data for C. baccatum var. praetermissum , C. campylopodium , C. chinense , C. flexuosum and C. parvifolium , but not for C. buforum . The prevalence of 2 n  = 26 chromosomes among Brazilian species, along with the morphological and ecological characteristics presented by the wild and semidomesticated species occurring in Brazil, form a pattern different from that found in Andean wild and semidomesticated species. This supports the hypothesis that there are two different evolutionary lines in the genus and that the native south-eastern Brazilian species belong to the ancestral Capsicum gene pool. © 2006 The Linnean Society of London, Botanical Journal of the Linnean Society , 2006, 151 , 259–269.     

Fly pollination in Cypripedium: a case study of sympatric C. sichuanense and C. micranthum

Most Cypripedium spp. are known to be pollinated by bees. However, myiophilous traits are found in some species, especially in sections Trigonopedia and Sinopedilum. Here we chose C. micranthum and C. sichuanense, two sympatric species endemic to Sichuan, China, to test whether these orchids are fly pollinated. Artificial pollination showed that both flowers are self‐compatible but need pollen vectors for successful reproduction. Field observation showed that C. micranthum was pollinated by fruit flies and C. sichuanense by dung flies, both novel pollinators of Cypripedium orchids. These sympatric Cypripedium spp. are also cross‐compatible, but hybrids were not found in nature. The pollination syndromes of C. sichuanense and C. micranthum fit into the complex sapromyiophily pattern. It appears that pollinator specificity is responsible for their reproductive isolation. The discovery of fly pollination in C. sichuanense and C. micranthum, which belong to the related sections Trigonopedia and Sinopedilum, suggests a shift from bee to fly pollination in the genus Cypripedium. Unlike most Cypripedium spp., the anthers of C. micranthum release discrete pollinia with narrow stalks instead of the usual amorphous pollen smears. This ‘proto‐pollinarium’ is described, probably for the first time. These pollinia are most likely an adaptation for pollination by microdiptera, so the fly can carry the contents of both chambers in the same anther. © 2012 The Linnean Society of London, Botanical Journal of the Linnean Society, 2012, 170 , 50–58.     

Fine needle aspiration cytology of the thyroid: a cytohistologic study with evaluation of discordant cases

OBJECTIVE: To analyze the diagnostic efficacy of fine needle aspiration cytology (FNAC) in the initial evaluation of thyroid nodules, with special emphasis on discrepant cytologic diagnoses. STUDY DESIGN: A total of 192 thyroid fine needle aspirates with subsequent histopathologic follow-up were analyzed. The cytologic diagnoses were divided into 4 categories: positive for malignancy, negative for malignancy, indeterminate for diagnosis and nondiagnostic. The detailed cytologic features were studied along with histopathology sections in all these cases by 2 observers (S.J. and P.D) independently. RESULTS: Cytohistologic correlation was seen in 78.1% of cases and discordance in 21.9%. Indeterminate diagnoses accounted for 15.1% of cases. The majority of these were "follicular neoplasms." The overall sensitivity was 84.44% and specificity 99.11 %. A false positive diagnosis was made in 1 case (0.5%), proven a follicular adenoma on histopathologic examination. A false negative diagnosis was seen in 3.6% of cases. These were cases of papillary microcarcinoma. CONCLUSION: FNAC is a safe, sensitive and specific technique in the initial evaluation of thyroid nodules. A correct cytologic diagnosis can be achieved in a majority of cases, thus obviating the need for a second surgical intervention. A careful and diligent search for various cytologic features and accurate sampling can help in reducing the number of indeterminate, false positive and false negative diagnoses.     

Morphometric and population genetic analyses elucidate the origin,evolutionary significance and conservation implications of Orchis × angusticruris (O. purpurea × O. simia), a hybrid orchid new to Britain

We report the first confirmed occurrence in Britain of Orchis × angusticruris Franch. ex Rouy, a hybrid between two closely related orchid species of anthropomorphic Orchis (O. purpurea Huds. × O. simia Lam.) that hybridize frequently in Continental Europe. Seven individual hybrids, most likely F1 plants representing a single interspecific pollination event, first flowered with both parents in May 2006 at a nature reserve in the Chiltern Hills near Goring, Oxfordshire. Univariate and multivariate morphometric analyses (43 characters plus 12 indices), internal transcribed spacer sequencing, plastid microsatellites and amplified fragment length polymorphism (AFLP) analyses together readily separate the parents and confirm that O. purpurea was the ovule parent and O. simia the pollen parent, presumably reflecting the greater frequency and/or later flowering period of the latter at the site. This study reinforces a more general observation that, in most orchids, the ovule parent contributes substantially more to the hybrid phenotype than does the pollen parent, perhaps reflecting cytoplasmic inheritance. In contrast, the hybrids are placed closer to O. simia than to O. purpurea in the AFLP tree. Apparently recent arrivals, the few O. purpurea plants at Goring contrast genetically with the two other small populations of this species known in the Chilterns, but rather are consistent with relatively uncommon Continental populations. This suggests that the plants may have been deliberately introduced at Goring by man, although transport from the Continent in high‐level air currents cannot be ruled out. The Goring population of O. simia is likely to have become genetically impoverished through (1) preferential removal of many relatively fit plants to herbaria in the 19^th century and/or (2) a catastrophic population crash in the first half of the 20^th century. However, both our re‐examination of herbarium specimens and our population genetic data indicate past hybridization among anthropomorphic Orchis species occurring naturally in the Chilterns. Thus, we tentatively recommend retention of the hybrid plants at Goring, despite their likely anthropogenic origin from Continental material and the partial viability of their pollen and seeds, which offers opportunities for future introgression. Although the Goring hybrids broadly resemble morphologically O. militaris, another anthropomorphic Orchis still found at two Chiltern localities, sufficient morphological and molecular differences were observed to strongly refute our initial hypothesis that O. militaris could have originated through hybridization between ancestors that resembled O. purpurea and O. simia. The comparatively complex genetic properties evident in both O. simia and O. purpurea merit further study. © 2008 The Linnean Society of London, Botanical Journal of the Linnean Society, 2008, 157 , 687–711.     

Carbon : nitrogen stoichiometry in forest ecosystems during stand development

Aim Carbon (C) and nitrogen (N) stoichiometry is a critical indicator of biogeochemical coupling in terrestrial ecosystems. However, our current understanding of C : N stoichiometry is mainly derived from observations across space, and little is known about its dynamics through time. Location Global secondary forests. Methods We examined temporal variations in C : N ratios and scaling relationships between N and C for various ecosystem components (i.e. plant tissue, litter, forest floor and mineral soil) using data extracted from 39 chronosequences in forest ecosystems around the world. Results The C : N ratio in plant tissue, litter, forest floor and mineral soil exhibited large variation across various sequences, with an average of 145.8 ± 9.4 (mean ± SE), 49.9 ± 3.0, 38.2 ± 3.1 and 18.5 ± 0.9, respectively. In most sequences, the plant tissue C : N ratio increased significantly with stand age, while the C : N ratio in litter, forest floor and mineral soil remained relatively constant over the age sequence. N and C scaled isometrically (i.e. the slope of the relationship between log‐transformed N and C is not significantly different from 1.0) in litter, forest floor and mineral soil both within and across sequences, but not in plant tissue either within or across sequences. The C : N ratio was larger in coniferous forests than in broadleaf forests and in temperate forests than in tropical forests. In contrast, the N–C scaling slope did not reveal significant differences either between coniferous and broadleaf forests or between temperate and tropical forests. Main conclusions These results suggest that C and N become decoupled in plants but remain coupled in other ecosystem components during stand development.     

Mesothelioma Symposium 11.30–12.30 Tuesday 16 September 2003. Cytopathology of malignant mesothelioma

The diagnosis of malignant mesothelioma on the cytology of serous effusions is a two‐phase process. First is to determine that the effusion is malignant based on morphological features such as a highly cellular fluid with many large three dimensional cell aggregates, and/or the recognition of minor malignant criteria including prominent cell engulfment, uniformly present very prominent nucleoli, or the finding of very large (giant) cells. In cell block sections, strong positive staining with EMA often with cell membrane accentuation provides compelling support for a cytological diagnosis of malignancy. Second is to recognize that the malignant cells have a mesothelial phenotype and do not represent metastatic malignancy (usually adenocarcinoma). Criteria in support of mesothelioma include the lack of a ‘two cell’ population, that is one native (mesothelial) and one foreign (metastatic), cells with abundant dense staining cytoplasm, the presence of ‘windows’ where mesothelioma cells lie in close apposition and intracytoplasmic glycogen presenting either as small peripheral vacuoles on MGG stained smears or large yellow refractile crescents on Papanicolaou stained smears. In addition, mesothliomas often possess connective tissue stromal cores occurring as either well‐formed collagen within papillary aggregates or lying free as pink (MGG) or light green (Pap) amorphous material in the background of the smear or in loose association with mesothelioma cells. Finally small orange staining squamous‐like cells can occasionally be identified and sometimes this may be a very prominent finding and has resulted in the false impression of a squamous cell carcinoma. Almost certainly these cells represent apoptotic tumour cells. The connective tissue mucin hyaluronic acid may be found as a net‐like pattern in the smear background or as large hard‐edged magenta‐stained vacuoles on MGG‐stained smears. Cell block sections provide architectural information and it is usually possible to separate mesothelioma aggregates with their cuboidal cells, central nuclei and abundant dense cytoplasm arranged in solid, papillary or hollow clusters from those of adenocarcinoma with less dense, often foamy cytoplasm, often composed of columnar cells with elongated nuclei. Aggregate form in adenocarcinoma can be variable but true acini are a rare finding. These cell block sections provide an ideal medium for histochemistry (PAS with and without diastase digestion) and immunocytochemistry. By using a panel of antibodies (Calretinin and CK 5/6, BerEp4, CEA, B72.3) it is almost always possible to distinguish mesothelioma from metastatic adenocarcinoma. Calretinin and CK 5/6 positive staining and absent staining with BerEp4, CEA and B72.3 is considered diagnostic of mesothelioma.     

Clinicopathologic analysis of fine needle aspiration cytology of the thyroid. A review of 1,613 cases and correlation with histopathologic diagnoses

OBJECTIVE: To evaluate the accuracy of fine needle aspiration (FNA) of thyroid lesions at our institution and to ascertain its usefulness in determining the therapeutic approach. STUDY DESIGN: The authors reviewed the results of 1,613 cases of FNA cytology of thyroid nodules performed from 1999 to 2001 at the Department of Pathology, Chonnam National University Hospital. Cytologic diagnoses were compared with histologic diagnoses in 207 cases that included both FNA and thyroid surgery. RESULTS: The sensitivity for the detection of neoplasms (carcinoma and follicular adenoma) was 78.4% and the specificity 98.2%. A false positive diagnosis was made in 1 case (1.8%) and false negative ones in 28 cases (21.5%). The diagnostic accuracy was 84.4%, with a positive predictive value of 99.0% and negative predictive value of 66.3%. The predictive value of a cytologic diagnosis was 100% in papillary carcinoma. CONCLUSION: FNA is a useful test in determining the therapeutic approach of thyroid lesions.     

“Infant Mortality in Armenia 1992–2003”: A comment

The purpose of this comment is to counsel caution in some of the conclusions drawn in an otherwise fine article recently published in Economics and Human Biology on infant mortality in Armenia by Hakobyan, Mkrtchyan and Yepiskoposyan. These relate first, to the reliability of estimates and trends in infant mortality estimated from DHS data; second, to the interpretation of what the authors consider to be a ‘low’ infant mortality rate in former communist countries given their level of economic development; and third, to the role of the health care infrastructure in countries of the former Soviet Union in producing these ‘low’ infant mortality levels. This comment argues that trends in infant mortality in Armenia and other CIS countries, although probably declining, are perhaps less certain than the authors allow, that existing evidence does not suggest that they are uniformly low by global standards, or that the health care systems in CIS countries are uniformly effective in reducing infant deaths.     

New Systematic Insights in the Ceramium Sinicolacomplex: Resurrection of C. Interruptum S. & G. (Ceramiaceae,Rhodophyta)

Setchell & Gardner (1924) provided a taxonomic treatment for the genus Ceramium from lower California and the Gulf of California, Mexico, in which they described several new species, including C. sinicola S. & G. described from Ensenada, BCN and C. interruptum S. & G. described from the vicinity of La Paz, BCS. The latter was later reduced to variety rank in C. sinicolaby Dawson (1950), a taxonomic decision that has subsequently been widely adopted. Phylogenetic analyses inferred from three molecular markers (chloroplast‐encoded rbcL, the RUBISCO spacer, and nuclear encoded SSU rDNA) from recent collections from the Pacific North‐west (California, Oregon) and the Gulf of California reveal a well supported assemblage of three corticated taxa: C. codicolaJ. Ag. 1894, C. sinicola and C. sinicola var. interruptum. Sequence divergence values among the three taxa are sufficient to warrant separate species ranking; hence, we reinstate C. interruptum as a widely distributed epiphyte for the region. C. sinicolais more closely related to C. codicolathan to C. interruptum, with the former two restricted to the host Codium. The molecule‐based relationships are congruent with evolutionary trends in cortication pattern and attachment mode.