Biomedical subjects
Publications and source records attributed to C di Loreto.
The authors describe a case of cerebellar abscess by Nocardia in a patient with the acquired immunodeficiency syndrome (AIDS) that was submitted to a posterior fossa craniectomy for diagnosis and treatment. Pathological and neuroimage findings are discussed as well as the surgical approach taking into account literature data on the subject.
The authors report their experience with the use of biopsy guns for the histologic sampling of breast lesions. Cytologic sampling by means of FNAB has been preferred so far because it was thought to be simpler, less risky and more reliable. Nevertheless, cytologic sampling exhibits several drawbacks--e.g., the need of repeated punctures to get sufficient cell material, frequent problems in diagnosing benign lesions and the decisive influence of the operator's skills. The use of biopsy guns for histologic sampling solves the above problems, because the value of the sample is not affected by the operator's skills; moreover, fewer punctures are needed and their value does not depend on lesion nature. Our series of cases includes 65 patients who underwent histologic sampling for suspected lesions over 10 months. A hundred and seventy-two samples were collected and 77 lesions were diagnosed, 47 of them malignant and 30 benign (fibroadenomas, fibrocystic changes, epitheliosis). Sensitivity, specificity and diagnostic accuracy of the method were 93.6%, 100% and 96.1%, respectively, with 6.4% false negative due to 3 cases where the lesion was not centred due to misguidance.
Three pathologists evaluated a number of designated architectural features to assign grades to 41 cases of well- to moderately differentiated adenocarcinoma, and their opinions were compared. The consensus opinion was obtained and evaluated against objective measurements of glandular architecture that were obtained by morphometric techniques. The observers agreed on gland size, gland uniformity, and the number of glands per field in only 49%, 31%, and 39% of cases, respectively. There were significant differences in the Gleason grades assigned by observers. Paired matching of individual Gleason grades showed agreement among observers in 44% (18 of 41), 56% (23 of 41), and 75% (31 of 41) of cases, respectively. This level of interobserver disagreement occurred even though cases with predominant patterns were selected carefully and those with variable patterns were excluded. A direct relationship appears to exist between increasing Gleason grade and increasing glandular variability, and there is an inverse relationship between Gleason grade, gland lumen area, and the number of glandular nuclei, as assessed by a group of pathologists.
Novel software was developed to perform quantitative measurements of architectural and nuclear features in tissue sections. A pilot study was then undertaken to determine the diagnostic relevance of these quantitative features in prostatic tissue and the relationship of these objective features to the subjective clues used by practicing pathologists in the grading of prostatic adenocarcinoma. From a group of 82 cases of adenocarcinoma of the prostate with long-term follow-up, a subset of 15 cases that included 5 each in Mostofi grades I, II and III was carefully selected for analysis. Consecutive sections from each case were stained with hematoxylin and eosin or the Feulgen stain for visual and cytometric evaluations, respectively. The most important differences in the objective architectural features observed between the Mostofi grade I and II cases were the number of nuclei per gland and their distance from the glandular center. Significant differences were also noted in gland size and the variation in gland size. The Mostofi grades were also significantly different in terms of quantitative high-resolution features measuring nuclear size and its variation, total nuclear DNA content and the proportion of very aneuploid nuclei. There was a fairly good agreement between many of the subjective diagnostic clues and their corresponding quantitative architectural and nuclear features. This work (1) significantly extended the capabilities of our PC-based microphotometer system to analyze glandular tissue specimens, (2) provided insight into the objective bases for the expert diagnosis of adenocarcinomas of the prostate and (3) gave preliminary evidence of the ability of quantitative architectural features and high-resolution cytometric features to discriminate between the major diagnostic categories of these lesions.
In research for the development of a computer-aided workstation for the objective grading of prostatic carcinoma, tissue architectural (histometric) features were analyzed in ten cases each of well-differentiated, moderately differentiated and poorly differentiated carcinoma (as subjectively graded by the consensus of a panel of experts). Sections were cut at 4 microns, stained by the Feulgen reaction and digitized by two different video-based photometric systems. Some images were interactively segmented, considering the histometric clues to be studied; others were automatically segmented by an expert system-guided technique. The latter procedure produced good results, with over 90% of the nuclei judged to be correctly segmented in 64% of the fields studied and over 80% in another 24% of the fields. While the number of nuclei per field provided some separation of well-differentiated from other lesions, the number of nuclei per gland distinguished between well-differentiated and moderately differentiated lesions. Simplicial decomposition of the images also provided a measure of the degree of differentiation, as did the "texture" of the nuclear placement, based on two run-length statistics. Combination of the run-length features distinguished the three categories of lesions with statistical significance. The results of this study provided insights into the problems (such as the effect of field boundaries) faced in the design of an computer-aided grading system. They also showed the value of expert system-guided scene segmentation and of such histometric features as the field cellularity and the number of nuclei per gland for the discrimination between lesions of different grades of differentiation.
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OBJECTIVE: To value LCNB accuracy in the determination of morphobiological parameters and as an alternative to the open SB diagnostic procedure of breast lesions. SETTING: University Hospital, Italy. SUBJECTS: From May 1992 to February 1995 196 biopsies have been performed. The diameter of the neoplasms examined varied from 0.6 to 7 cm with an average of 1.9 cm. MAIN OUTCOME MEASURES: The accuracy of the two methods in the evaluation of histological degree, receptor state, protein c-erb B2 and p53 were compared. RESULTS: No inadequate sampling were ever recorded. LCNB has shown values of 97% sensitivity and 100% specificity. The positivity and negativity predicted values obtained were 100% and 89% respectively. Retrospectively 70 sample-cases of carcinoma were selected and the morphobiological parameters evaluated. The correlation coefficients for the data obtained with SB and LCNB in the evaluation of Progesteron and Oestrogen receptor expression, protein c-erb B2 and p53 were excellent. Furthermore it was noted that LCNB allows a saving of at least 1/3 of the cost vs intraoperative SB. CONCLUSIONS: Percutaneous LCNB has high diagnostic accuracy for histological classification. LCNB has the same accuracy as SB for morphobiological parameters. The cost of LCNB is markedly lower than SB.
UNLABELLED: The cytohistologic diagnosis concordance of the cervix-uterine lesions was evaluated and the discordances are discussed. PURPOSE: To evaluate the level of cytohistological diagnosis agreement in the Pathology Division of the Adolfo Lutz Institute and enhance parameters of quality assurance system developed in this institution. METHODS: The authors retrospectively evaluated 157 pairs of cytologyhistology consecutive cases from the files the Adolfo Lutz Institute (Division of Pathology). RESULTS: Agreement was found in 119 cases (75.8%); in the remaining cases cytologic diagnosis were higher than histology in 11 lesions (7.0%) and lower in 27 (17.2%). We also observed that in 5 cases previously diagnosed as inflammatory, 2 of them were reclassified as CIN 1; after revision, the others remained as inflammatory even though they had a histological diagnosis of CIN. CONCLUSION: These results showed the role of cytohistological correlation to the quality assurance system of cytological diagnosis and also stressed the importance of taking the cervical scrapes with accurate care to avoid diagnostic discrepancies.