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Objective: To assess differences based on gender in nuclear area (NA), cytoplasmic area (CA), and nuclear‐cytoplasmic ratio (N:C ratio) values for clinically normal buccal smears in apparently healthy subjects of a South Indian population, thereby providing definitive baseline cytomorphometric measurements for the South Indian population. Methods: Buccal smears were collected from 60 healthy subjects (30 males and 30 females) of a South Indian population above 18 years in age. Values of the NA and CA were measured, and the N:C ratio calculated, using ImageJ software. Statistical analysis of the data with independent t tests and 95% confidence intervals was done using SPSS version 21 (significance set at P < 0.05). Results: The results showed that there were significant differences in the NA, CA, and N:C values between males and females irrespective of age (P = 0.01). Conclusion: Definitive gender‐specific baseline cytomorphometric data can be established using exfoliative cytology for the South Indian population, and this may be helpful in deciphering the occurrence of oral pre‐malignant diseases and oral squamous cell carcinoma in this population, as the incidence of these conditions varies with gender and different ethnic groups. [ABSTRACT FROM AUTHOR]

The Kymi Odyssey Honorary Ceremony was held in Kymi, Greece to celebrate the life and career of Dr. George N. Papanicolaou, the founder of exfoliative cytology and developer of the Pap test. The ceremony took place in the newly renovated Papanicolaou homestead, which will become the future G.N. Papanicolaou Museum. Various artifacts related to Dr. Papanicolaou were donated for the museum, including handwritten letters, photographs, scientific manuscripts, and dedicated postage stamps. The ceremony was attended by international cytologists and local authorities, and the future museum is set to open in mid-August 2024. [Extracted from the article]

Involvement of the central nervous system (CNS) by anaplastic large cell lymphoma (ALCL) is rare, most being primary CNS ALCL with only occasional reports of CNS involvement in systemic ALCL. Establishing a diagnosis of CNS infiltration by systemic ALCL is difficult but carries immense prognostic significance. This report presents a such a case, diagnosed on CSF cytology complemented by CSF flow cytometry and immunocytochemistry on the cyto‐spots. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to perform an audit of oral and maxillofacial specimens submitted for cytological diagnosis to verify the importance of this complementary examination. Methods: A retrospective analysis of our institutional cytopathology database was performed over an 18‐year period. Clinical information and cytological data were collected. Associations between independent variables and outcomes were assessed using the Pearson χ2 test or Fisher's test, with a 5% significance level. When available, the histological diagnosis was compared with cytological diagnosis to identify the percentage of agreement and the specificity, sensitivity and accuracy of cytology in identifying malignant neoplasms. Results: A total of 1082 cases were identified, which included 65 different cytological diagnoses. Exfoliative cytology (EC) was performed in 312 cases (29.1%) and fine needle aspiration cytology (FNAC) in 770 cases (70.9%). EC was mainly employed to diagnose oral infectious diseases (P < 0.001) and FNAC to diagnose neoplasms, cystic, reactive and miscellaneous lesions (P < 0.001). Cell‐block was performed in 555 FNAC cases (51.3%). Panoptic, Papanicolaou and haematoxylin‐eosin staining were performed in FNAC and periodic acid‐Schiff in EC (P < 0.001). In 211 cases (19.5%), the histological diagnosis was available and the percentage agreement with the cytological diagnosis was 41.2%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy to identify malignant neoplasms were 84.6%, 100%, 100%, 77.8% and 90.0%, respectively. Conclusions: EC was mainly performed for diagnosis of infectious diseases and FNAC for diagnosis of salivary gland tumours, odontogenic lesions, reactive lesions and cervical metastasis. This audit of oral and maxillofacial specimens submitted for cytological diagnosis over an 18‐year period highlights the utility of exfoliative cytology in diagnosis of infectious diseases and of fine‐needle aspiration cytology in assessing swellings. For salivary gland tumours, odontogenic lesions, reactive lesions and cervical metastatic neoplasms, cytology is particularly helpful in differentiating benign from malignant lesions in preoperative management. [ABSTRACT FROM AUTHOR]

Objective This study was conducted to evaluate the reliability of using an interactive automated screening system ( IAS) to determine the presence of endocervical and/or metaplastic cells (transformation zone material; TZM) in liquid-based cytology ( LBC) Papanicolaou (Pap) smear slides. Materials and methods A series of LBC Pap smears was manually screened to determine the presence or absence of TZM. The results were compared to those obtained through IAS. Results ThinPrep® Imaging System (Imager)-assisted screening indicated that 22.4% of the slides did not contain TZM in cases in which previous manual screening revealed that 100% of the slides did contain TZM. Conclusion The reliability of determining TZM through IAS is limited. Manual screening of the slides appears to be necessary to report the presence of TZM accurately. [ABSTRACT FROM AUTHOR]

The purpose of our study was to summarize the knowledge on exfoliative cytology during the 19th century and to track down Papanicolaou's predecessors. A thorough study of texts, medical books and reports, together with a review of the available literature in PubMed, was undertaken. The study of cytological preparations as a diagnostic procedure can be traced back to the work of the famous French microscopist Alfred François Donné. However, the systematic study and the criteria for the diagnosis of malignant cells should be attributed to Johannes Müller. The increasing interest in the cytological examination of various fluids of the human body can be confirmed by a plethora of studies published during this period. By the end of the 19th century, the invention of new techniques in pathology, such as the introduction of cell block techniques, tissue sections and new staining methods which provided the opportunity to study surgical specimens in three dimensions, led to a decrease in the interest in exfoliative cytology, which was re-discovered by George Papanicolaou almost three decades later. [ABSTRACT FROM AUTHOR]

N. Mollaoglu, P. Metzler, J. Zenk, E. Nkenke, F. W. Neukam and J. Ries Prediction of recurrence using exfoliative cytology and melanoma-associated antigen-A mRNA analysis following wide excision of oral squamous cell carcinoma: short report Background: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer. The local recurrence of OSSC might result from the existence of occult cancer cells around tumour margins. Exfoliative cytology has lately gained great importance as a method for obtaining RNA samples from suspicious oral mucosal lesions in order to carry out molecular diagnosis. In addition, melanoma associated-A antigens (MAGE-A) are expressed in various tumours and their detection is a highly accurate sign that cancer cells are present. Objective: The prediction of a recurrence using MAGE-A mRNA expression analysis to follow-up OSCC cases using a newly established molecular diagnostic technique applied to cytological materials. Methods: RNA was extracted from three recurrent OSCC cases and from 20 healthy volunteers as a control group using a cytobrush. The expression of MAGE-A3, A4, A6, A10 and A12 was investigated in these specimens using quantitative real-time (RT-PCR). Results: There was no expression of MAGE-A in the specimens of normal oral mucosa. However, the expression analysis of five different MAGE-A genes indicated a high potential for malignant change in biopsy-proven recurrent OSCC cases. Except for MAGE-A10, the rest of the genes were expressed in different ratios by the three recurrent cases, which had been determined on histopathology to be OSCC or carcinoma in situ. Conclusion: It is suggested that analysis of MAGE-A expression may be used as a risk prediction method in the diagnosis of recurrence after wide excision of OSCC to enhance the accuracy of exfoliative cytology, which has limitations due to false negative and false positive results. [ABSTRACT FROM AUTHOR]

Objectives: Helicobacter pylori (Hp), a major cause of peptic ulcer disease and an important risk factor for gastric malignancy, can be diagnosed by several methods. Touch cytology (TC) of the gastric mucosa has been noted to give good results and has been found to be very simple, inexpensive and rapid. However, evidence regarding the accuracy of different staining methods of TC is lacking. The present study aims at defining the diagnostic accuracy of four different staining methods of TC. Methods: Biopsy specimens were taken from the antral mucosa of one hundred consecutive patients referred for upper gastrointestinal endoscopy (UGIE) for various indications. TC slides were processed by four staining methods: Wright, Giemsa, Papanicolaou and Gram. Rapid urease test (RUT) and histological examination of specimens were also performed. The same experienced pathologist evaluated the coded samples. A patient's Hp status was established by minimum concordance of the three tests, including histology, RUT, and ‘Touch mean’. The latter was defined positive when at least three of the four TC staining methods were positive. Results: Forty-six patients (46%) were positive for Hp according to Hp status. TC stained by Wright had excellent agreement with both histology ( κ = 0.80, P < 0.001) and RUT ( κ = 0.84, P < 0.001). Regarding Hp status, histology was 100% sensitive and RUT was 100% specific. Wright-stained TC (88.89%) was significantly more specific than both Giemsa- (74.07%; P < 0.05) and Papanicolaou-stained (70.37%; P < 0.05) TC. Conclusions: RUT should still be acknowledged as the primary test in diagnosing Hp following UGIE. If RUT is negative and Hp detection is intended only, Wright-stained TC can safely substitute for histology. However, when assessment for severity of mucosal damage or cell atypias is meant, histology cannot be neglected. [ABSTRACT FROM AUTHOR]

Objective: Cervical screening programmes in England are in transition as the liquid-based cytology (LBC) method replaces conventional Papanicolaou screening and staff in NHS laboratories are trained to analyse LBC smears. Cytoscreeners and biomedical scientists undertake routine microscopy of slides, but the scientists usually have a wider professional role. Attitudinal surveys were carried out in laboratories where LBC was partially introduced. Methods: Staff in two cytology laboratories in Greater Manchester were surveyed twice over 6 months. The questionnaire assessed work pressures using scales from the Measures of Work Characteristics instrument, work-related stress using the General Survey version of the Maslach Burnout Inventory, job intentions and job satisfaction. Results: Cytoscreeners, many aged over 50 years, formed over 60% of respondents in both surveys (27/42 in the first survey), and biomedical scientists and doctors, 30%. Both groups were under moderate pressure from work demands in each survey, but cytoscreeners had significantly less autonomy over their working methods ( P < 0.001). Although both groups experienced similar levels of exhaustion, cytoscreeners were much more cynical or indifferent towards work in the second survey ( P = 0.008) and had lower expectations of being effective ( P < 0.001). For the cytoscreeners, there were strong negative correlations in both surveys between cynicism and the work characteristics of influencing decisions and autonomy/control. Conclusions: The strength of the relationship between work performance and wellbeing serves to emphasize the importance of the new LBC technology in ameliorating low morale where it exists. Further attitudinal research involving larger samples of laboratories is warranted to assess the full impact of this innovation. [ABSTRACT FROM AUTHOR]

Objective: Cervical screening programmes in England and Wales were advised by the National Institute for Clinical Excellence in 2003 to adopt liquid-based cytology (LBC) in place of conventional Papanicolaou (Pap) cytology to facilitate laboratory efficiency. Pilot evaluations in England and Scotland monitored daily or weekly workloads of smear readers and concluded that LBC could increase hourly throughput rates. This study, instead, used timing surveys to determine screening rates. Methods: Two National Health Service cytology laboratories in Manchester and Stockport were partially converted to the LBC ThinPrep® process for a cervical screening trial. Three 1-week timing surveys were conducted over 7 months. The surveys covered all LBC-trained staff. The first survey in Manchester also covered staff undertaking conventional Pap screening. The smear readers used timers to record time taken for examining and reporting each slide. Results: In Manchester, in the first survey, nearly 1 minute per slide was saved by the LBC method during primary microscopy. In both laboratories, the mean microscopy time for primary screening of LBC slides was reduced by almost 1 minute between the first and second surveys. There was no difference between the second and third surveys. Microscopy by cytopathologists was also 1 minute per slide quicker with LBC than conventional Pap. The LBC inadequate rates for both laboratories were <2.0%. Organizational factors impacted on the hourly LBC primary screening rates in the laboratories, the rate for Stockport being higher than the rates in the pilot evaluations. Conclusions: The timing surveys confirm that the LBC ThinPrep® technology can improve laboratory efficiency. However, decision-makers should also consider the overall costs and benefits of introducing the technology in screening programmes, including the capital investment and workforce implications. [ABSTRACT FROM AUTHOR]

Objective: To compare the frequency of Pap test results in a prospective series of direct to vial ThinPrep tests to a cohort of conventionally prepared tests. To follow-up all test results for a minimum of 2 years and assess performance based on this outcome. Methods: All women presenting for either routine screening or colposcopic examination in 2001 were enrolled in the ThinPrep cohort. A similar, population of conventionally prepared tests was extracted from the year 2000 laboratory data. Information on all concurrent and follow-up cervical specimens over the ensuing 2 years was retrieved. Results: The ThinPrep cohort comprised 2288 Pap tests and the conventional, 2211. The frequency of normal [within normal limits (WNL) and benign cellular changes (BCC)] results in the ThinPrep cohort was 6% lower and the frequency of abnormal [≥atypical squamous cells of undetermined significance (ASCUS)] results was 6.8% higher. Respective ThinPrep and conventional cohort results were 1156 (51%) and 1291 (58%) WNL, 625 (27%) and 561 (25%) BCC, 101 (4%) and 65 (3%) ASCUS, 21 (1%) and 2 (0.1%) atypical glandular cells of undetermined significance, 301 (13%) and 224 (10%) low-grade squamous intraepithelial lesion (LSIL), and 74 (3%) and 40 (2%) high-grade SIL (HSIL) ( P < 0.0001). Follow-up was available for nearly 80% of each cohort. LSIL or higher was confirmed in 57.5% ( n = 266) of the abnormal ThinPrep and 60.9% ( n = 190) of the abnormal conventional tests. The ThinPrep yield of confirmed tests however was almost 50% higher than the conventional test. Conclusion: In this population, ThinPrep was superior to the conventional Pap test. [ABSTRACT FROM AUTHOR]

Provides information about the extent of cytopathology program in Finland. Prime movers of clinical cytology in the country; Outcome of the cervical cancer mass screening program; Involvement of midwives in smear taking activities.

Following the decision to establish an Advanced Biomedical Scientist Practitioner grade for senior biomedical scientists in the NHS Cervical Screening Programme, a conjoint examination board has been appointed by the Royal College of Pathologists and Institute of Biomedical Science to oversee the Certificate in Advanced Practice in Cervical Cytology examination. The examination consists of a multiple-choice paper, short-answer written questions and practical microscopy sections covering screening of unmarked slides, and more complex discussion cases. In the first year there were 58 entries with 29 successful candidates, a pass rate of 50%. The standard of performance in the examination showed a wide range, and some candidates appear to have underestimated the degree of preparation, knowledge or level of microscopy skill required. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Examines the effect of nonscreening smears on screening smear results using statistical analysis. Data suggesting that there is a possibility that a greater exposure to abnormal smears results in a greater tendency to detect them; No data supporting the use of 15000 as a designated figure when quality monitoring and service provision become a specific issue.

Discusses the use of whole slide rapid review for examining cervical smears in Great Britain. Screening for dyskaryosis; Sensitivity and specificity of rapid screening; Superiority of rapid review over random re-screening.

oommen r., curling m., adams c., barrett e., titmuss e. and widdowson a. (1998) Cytopathology 9, 46–49 Evaluation of 40 ×3 20 mm coverslip area in cervical cancer screening Nine hundred and twenty-three smears covered by 40 × 22 mm size coverslips were examined inside and outside the coverslip area to determine whether this coverslip size could be responsible for missed dyskaryotic cells in conventional cervical cancer screening. There was no instance when abnormal cells seen outside the coverslip were not also present within the coverslipped area. [ABSTRACT FROM AUTHOR]

Comments on proposed guidelines and standards on cervical cancer screening. Series of objectives and measurements for cervical screening programs; Reference to evidence from scientific literature; Policy implications.

Discusses the debate concerning the use of metaplastic and endocervical cells as a measure of cervical smear adequacy. Frequency of abnormal cells; Standards for cervical screening; Subjective assessment.

The article presents a case study of a 17-year-old girl who had a history of pleomorphic xanthoastrocytoma. She was diagnosed with extraneous epithelial cells from thromboplastin in cell blocks. The patient was administered with thromboplastin Simplastin Excel S to well-preserved nucleated epithelial cells. It examines the artefactual contaminants in cell blocks due to fungal over growth in reagents.

We promote FNA as the first line investigation for lymphadenopathy. Patients subjected to FNA have direct smears and needle rinses routinely prepared for morphological interpretation and, if appropriate, immunosuspension (using immunoflourescence and FACS), immunostaining, microbiology investigations, and PCR. Patients with a cytological diagnosis of lymphoma are then subjected to surgical biopsy if clinically appropriate. We are aware that in many haemato-oncology services, especially those where the pathologist has only limited experience of cytology, FNA is regarded as either inferior to histology, or of no use, in identifying and classifying lymphomas. In this audit we address this misconception. All cases coded by SNOMED as lymphoma at St George's between January 2000 and December 2002 were retrieved and their diagnostic pathway was reviewed. We identified those cases that had preceding FNA from those that did not, and we determined which samples had which ancillary tests. Our audit shows that: •FNA is highly sensitive for B-cell lymphoma, which is increased by immunosuspension studies to 100%. •FNA has a lower sensitivity for T-cell lymphoma, which is slightly increased by immunosuspension studies to 73%. •FNA has a lower sensitivity for Hodgkin lymphoma of 73%, which is not increased by immunosuspension studies. •We do not use PCR enough for statistically significant data on its utility. •Core biopsy provides no information than cannot be obtained by FNA. We conclude that: •FNA is an appropriate means of identifying and classifying lymphoma. •The utility of FNA is greatly enhanced by ancillary tests, especially immunosuspension studies. •Core biopsy is no better than FNA for diagnosing and classifying lymphoma. •Excision biopsy is still important in the comprehensive documentation of lymphoma. •Excision biopsy is an essential second line investigation in cases where the lymphadenopathy persists or progresses regardless of the FNA findings. [ABSTRACT FROM AUTHOR]

Aims (1) To identify the outcome status of women with borderline and mild dyskaryosis smears. (2)To determine whether the presence or absence of koilocytosis influences the outcome status. (3)To identify the proportion of women with borderline smears showing koilocytosis. Materials and methods Borderline and mild dyskaryosis cervical smears diagnosed during January to March 1997 were identified from the laboratory database. Each slide was reviewed by two researchers independently, who then agreed a final consensus diagnosis. All slides were classified according to the presence or absence of koilocytosis. Slides were excluded from the study if the review diagnosis was negative, inadequate or high-grade dyskaryosis. The outcome status was classified according to the worst lesion identified histologically and/or cytologically during the 5-year follow-up period. Results 1974 women were identified with borderline or mild dyskaryosis cervical smears of which 1597 were included in the study. Table 1 shows the outcome status of these women. Table 2 shows the outcome of women with borderline and mild dyskaryosis smears with or without koilocytosis. Table 3 shows the proportion of borderline and mild dyskaryosis cervical smears with or without koilocytosis. Conclusions (1)Sixty-eight per cent of women with a borderline cervical smear had a normal outcome. (2)Thirteen per cent of women with a borderline cervical smear developed a high-grade lesion. (3)The presence or absence of koilocytosis in borderline and mild dyskaryosis cervical smears does not appear to affect the outcome status of these women. (4)Twenty-four per cent of smears showing borderline nuclear changes were found to have koilocytosis. [ABSTRACT FROM AUTHOR]