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. 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.     

Development of a technical external quality assurance scheme in non‐gynaecological cytology in UK

Technical external quality assurance (EQA) schemes are well established for histopathology and cervical cytology but, to date, sadly lacking for diagnostic cytology (DC). This timely review redresses the balance by describing the development and evaluation of a technical EQA scheme for DC available to the UK, Europe and beyond.     

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. 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.     

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. P13 Cytohistological correlation in 212 FNAs of thyroid: analysis of discordant cases

Aim To detect major pitafalls in thyroid FNA and to confirm its in a clinical sensitivity and specificity. Methods A total of 9251 fine needle aspirations biopsy carried out at Bellaria Hospital in Bologna from 1991 to 2000 by a pathologist in the FNA Clinic or by a clinician under ultrasonic guidance using a small needle (25–27 G); at least two passes have been made for each nodule. The specimen was considered satisfactory if at least five groups of follicular cells with at least 10 cells each, were seen. The cytological results were tiered in a four categories classification: inadequate, negative, suspicious and positive. Cyto‐histological correlations were available in 212 cases: 127 benign lesions and 85 malignant lesions. An analysis of false positive cases and false negative cases was performed and discordant case reviewed according to the flowing criteria: architecture, cellularity, colloid, pseudoinclusions, nuclear groovings, chromatin pattern, nuclear membrane, cytoplasm, naked nuclei and lymphocytes. Results Diagnostic distribution in 9251 FNAs from the thyroid: 88.6% negatives, 2.8 suspicious, 2.4% positives and 6.2% inadequates. Specificity was 85.8% and sensitivity was 78.8%. Among the 18 false negative cases eight were papillary microcarcinomas, four papillary carcinomas, five follicular carcinoma and one a Hurtle cell carcinoma. Four false positive cases were found: three reported as papillary carcinomas and one as carcinoma NOS. Review of false positives showed that in three cases the colloid was fluid, in three cases nuclear grooving was rare or absent, in two cases degenerative vacuoles at MGG were interpreted as nuclear inclusions and in three cases benign naked nuclei were present in the background. Review of false negatives confirmed lack of malignant features in 13 (eight papillary microcarcinomas and five follicular carcinomas), five were interpretation errors (three papillary carcinomas, one follicular, one Hurtle cell). Conclusion FNAC of the thyroid is a sensitive and specific method of assessment for thyroid nodules but false negative and false positive cases do occur. Use of all and only few criteria enhances diagnostic accuracy.     

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.     

CD measurements of β‐amyloid (1–40) and (1–42) in the condensed phase

Circular dichroism (CD) spectroscopy of proteins/peptides in thin films can provide valuable information on the structures in the aggregated states; however, it is difficult to estimate the secondary structure content quantitatively due to artifact signals arising from macroscopic anisotropies which is unique to the solid phase. Using a Universal Chiroptical Spectrophotometer (UCS‐1) together with the measurement and analytical procedures we have developed, we could obtain artifact‐free CD spectra of cast and Langmuir‐Blodgett (L‐B) films of synthetic peptides, Aβ (1–40) and (1–42) which are related to Alzheimer's disease. The work gave insights into the mechanisms for structural transformation and amyloid‐like aggregation. © 2010 Wiley Periodicals, Inc. Biopolymers 95: 127–134, 2011.