Well Differentiated Follicular Neoplasms of the Thyroid: Reproducibility and Validity of A''Decision Tree''Classification Based On Nucleolar and Karyometric Features

This study was conducted on fine-needle aspirates of well differentiated follicular neoplasms of the thyroid. A 'decision tree' classification based on the percentage of nucleolated nuclei, percentage of nuclei with two or more nucleoli and mean major nuclear diameter was adopted. We observed that the reproducibility and the validity of the follicular adenoma vs follicular carcinoma discrimination are greater than in the subjective evaluation. Moreover, similar classification results were obtained when measurements were performed either with a fully automated image analysis system or with semiautomatic or manual instrumentation. As for reproducibility of the inter-instrument comparisons, the k statistic values ranged from 0.85 to 1.00 (mean value 0.90, that is, an 'almost perfect' degree of agreement); in the subjective evaluations, the inter-observer comparisons showed values ranging from 0.20 to 0.56 (mean value 0.37, that is, 'fair'). In the decision tree classification, feature value thresholds were selected in order to have specificity of 100% and the predictive value of a positive result (carcinoma) of 100%; accuracy was 87% (range 86-89%), sensitivity 74% (71-79%), the predictive value of a negative result (adenoma) 79% (78-82%). In the subjective evaluation the values were as follows: accuracy 67% (64-71%), sensitivity 57% (50-64%), specificity 77% (71-79%), predictive value of a negative result (adenoma) 64% (61-69%), predictive value of a positive result (carcinoma) 71% (67-75%). The conclusion is that, by using a routine microscope equipped with a micrometer, the preoperative diagnosis of follicular carcinoma from smears can be formulated with a high degree of certainty.     

Chromosome cytology and karyotype change inGalaxia (Iridaceae)

Basic chromosome number inGalaxia is believed to be x = 9, and this number, or multiples, occurs in all species of subgenusGalaxia. In subgenusEurystigma, G. barnardii has n = 8,G. versicolor n = 8 and 7,G. citrina n = 8, 7 and 17 whileG. variabilis has n = 7 exclusively. Karyotypes in forms ofG. versicolor with n = 7 and inG. variabilis are quite different and clearly originated independently. Karyotypic features provide evidence for the hypothesis that changes in chromosome number were accomplished through chromosome fusion either by classical Robertsonian translocation, or unequal reciprocal translocation.     

The effect of temperature and ageing on root apical meristems during seedling growth of Triticum aestivum L.: a specific effect on nucleoli

Abstract. Growth and cytology of root apical meristems of Chinese Spring wheat were studied in relation to temperature. The maximum rate of growth increased with temperature, a marked rise occurring between 10°C and 12°C. At all temperatures studied nucleolar volume increased to a maximum and then declined. The maximum nucleolar size achieved showed particular temperature sensitivity, higher volumes being attained at lower temperatures. The peak at 5°C was 70% higher than at 20°C. However, in comparison, cell and nuclear volumes were only 38% and 47% larger, respectively. Ultrastructural analysis of the nucleoli revealed a temperature-dependent relationship between the proportion of granular component and dense fibrillar component. The results are discussed in relation to the regulation of ribosome synthesis and function during growth and development at different temperatures.     

Improving diagnostic yield of biliary brushings cytology for pancreatic cancer and cholangiocarcinoma

Biliary brushings are currently the best accepted method to obtain a cytological diagnosis of pancreatic cancer or cholangiocarcinoma. The technique has good specificity but poor sensitivity. Two dedicated pathologists reviewed 137 consecutive biliary brushings from 127 patients between February 1997 and February 2000. The ultimate diagnosis was determined by review of radiology, operative diagnosis and patient outcome. The sensitivity, specificity, positive predictive value and negative predictive value of the original results and the review results were calculated and compared. Additional diagnostic categories 'suspicious' and 'atypical possibly benign' were included on review. After review, the sensitivity improved from 49.4% to 89.0% and the specificity remained 100%. The use of the additional diagnostic category 'suspicious' increased the sensitivity to 90.4%, at the expense of a fall of the specificity to 66.7%. We conclude that review by two dedicated pathologists and additional diagnostic categories can improve the diagnostic accuracy of biliary brushings.     

Machine learning of diffraction image patterns for accurate classification of cells modeled with different nuclear sizes

Measurement of nuclear‐to‐cytoplasm (N:C) ratios plays an important role in detection of atypical and tumor cells. Yet, current clinical methods rely heavily on immunofluroescent staining and manual reading. To achieve the goal of rapid and label‐free cell classification, realistic optical cell models (OCMs) have been developed for simulation of diffraction imaging by single cells. A total of 1892 OCMs were obtained with varied nuclear volumes and orientations to calculate cross‐polarized diffraction image (p‐DI) pairs divided into three nuclear size groups of OCM_S, OCM_O and OCM_L based on three prostate cell structures. Binary classifications were conducted among the three groups with image parameters extracted by the algorithm of gray‐level co‐occurrence matrix. The averaged accuracy of support vector machine (SVM) classifier on test dataset of p‐DI was found to be 98.8% and 97.5% respectively for binary classifications of OCM_S vs OCM_O and OCM_O vs OCM_L for the prostate cancer cell structure. The values remain about the same at 98.9% and 97.8% for the smaller prostate normal cell structures. The robust performance of SVM over clustering classifiers suggests that the high‐order correlations of diffraction patterns are potentially useful for label‐free detection of single cells with large N:C ratios.     

Diagnostic difficulties in the interpretation of fine needle aspirates of salivary gland lesions: the problem revisited

Diagnostic difficulties in the interpretation of he needle aspirates of salivary gland lesions: the problem revisited
Cases of salivary gland lesions ( n =325), mainly neoplastic but including a small number of non-neoplastic lesions, investigated by fine needle aspiration (FNA) and with histological correlation, are reviewed. The review identified a number of differential diagnostic problems which are discussed in some detail. One false-positive and eight false-negative diagnoses had been made resulting in a 99.5% specificity and a 85.5% sensitivity. If type-specific diagnoses are made only when all defined diagnostic criteria are present and if any uncertainty is clearly conveyed to the clinician, FNA is a safe and accurate tool in the investigation of salivary gland lesions.     

Cytophotometric studies of cell populations

Technologic advances in the recording of digitized imagery have made the study of large cell populations by image analytical methods feasible. Computed image information provides quantitative, and novel, information that allows an exact measurement of minute changes in the chromatin distribution of cell nuclei, and the detection of subpopulations of cells or changes in the functional state of the cells. The sensitivity of the detection exceeds that of human observers; the specificity of the measured changes must be the subject of basic cell biologic research.     

Monitoring and evaluating the performance of the UK NHS Cervical Screening Programme: monitoring performance by using cytology outcomes adjusted for population characteristics

Current quality assurance measures used in the NHS cervical screening programme (NHSCSP) include a review of laboratories with percentages of moderate/severe and borderline/mild smear results outside the 10th-90th percentiles. The method is limited by the fact that many of these outlier smear percentages may reflect laboratories covering populations with low or high risk and/or short or long average screening intervals. This paper outlines a new approach to aid the detection of outlier laboratories, by using data collected at the primary care trust (PCT) or health authority (HA) level and making allowances for population characteristics and screening interval. The setting is the NHSCSP in England using annual data provided by HAs. Data from the screening year 2000-01 is used to illustrate the methodology, although the methods can also be applied to data at the PCT level (now being collected for 2002-03 onwards). Percentages of smear results have been analysed against a series of explanatory variables using logistic regression models. These explanatory variables include Townsend deprivation index, uptake-corrected ethnic minority composition, a measure of screening interval, area type and region. An expected percentage of borderline/mild and moderate/severe smears is estimated from the models and an observed : predicted ratio (OPRmod/sev and OPRbord/mild) calculated. Low values are suggestive of relative undercalling and high values overcalling, after allowance for population characteristics. Analysis of data for 2000-01 showed that the OPRmod/sev for the 99 HAs varied from 0.68 to 1.44. Laboratories with low percentages of moderate/severe smears, but associated with PCTs or HAs with OPRmod/sev values closer to unity may not need to be investigated as their observed rates are consistent with predicted rates based on population characteristics. The method could also be directly applied to laboratories if further information on the population covered by each laboratory were routinely collected.     

Should the laboratory assess the sampling adequacy of cervical smears?

Should the laboratory assess the sampling adequacy of cervical smears? The results of a questionnaire answered by 14 out of the 18 NHS laboratories in Scotland reporting cervical smears showed that, since the publication of Guidelines for Judging the Adequacy of a Cervical Smear, by the British Society for Clinical Cytology (BSCC), rates of unsatisfactory smears had risen from a mean of 3.3% to 6.5%, with some laboratories reporting rates of over 10%. Four laboratories followed the guidelines closely in requiring the presence of two indicators of sampling of the transformation zone, i.e. endocervical cells, metaplastic cells or endocervical mucus. Seven laboratories required one indicator either in all smears or in a subset, whilst three did not require any indicator at all. The laboratories observing the guidelines closely had a higher mean unsatisfactory rate than those partially observing them. The main impediment to the full implementation of the BSCC guidelines appeared to be fear of an unmanageably high unsatisfactory smear rate. The accuracy of the assessment of adequacy is questioned, as is the cost effectiveness of doing so.     

Acinic Cell Tumour: A Metastasis In the Lung Diagnosed By Electron Microscopy of Aspirated Material

A case of acinic cell carcinoma, metastatic to lung is presented. Fine needle aspiration showed a low-grade adenocarcinoma. Electron microscopy of the aspirated material, however, allowed definite preoperative diagnosis of metastatic acinic cell carcinoma. The lesion was successfully resected and diagnosis confirmed on histology. Ten years previously an acinic cell carcinoma of similar histology had been excised from the left parotid region.