Biomedical subjects

Janie Roberson

Publications and source records attributed to Janie Roberson.

13 recordsLinked to original sources

PubMed2006

Incidence and clinical significance of morphologically benign-appearing endometrial cells in patients age 40 years or older: the impact of the 2001 Bethesda System.

BACKGROUND: The 2001 Bethesda System (TBS 2001) introduced a new diagnostic category-normal endometrial cells in women age 40 years or older (EM >or= 40). The objective of the current study was to determine whether there was any significant increase in the frequency with which this diagnosis was reported after the implementation of TBS 2001 and the clinical significance of this diagnosis. METHODS: All women who had a Papanicolaou (Pap) test and a diagnosis of EM >or= 40 between January 1999 to December 2003 were identified. Follow-up included repeat Pap tests and/or surgical pathology. TBS 2001 was implemented on January 1, 2002. RESULTS: In total, 556 Pap tests with a diagnosis of EM >or= 40 were identified, accounting for 0.52% of the 106,204 Pap tests evaluated during the study period. The incidence of EM >or= 40 before and after implementation of the new TBS was 0.47% and 0.61%, respectively, and showed a statistically significant difference. One hundred four patients (19%) underwent endometrial tissue sampling, including 22 patients who underwent hysterectomy (4%) and 82 patients who underwent endometrial biopsy (15%). Overall, 1 patient (2%) had significant endometrial pathology, namely, complex endometrial hyperplasia without atypia. CONCLUSIONS: A significant increase in the incidence of EM >or= 40 was observed with the implementation of TBS 2001. However, there was no difference in the proportion of patients that underwent endometrial tissue sampling. In addition, the incidence of clinically significant endometrial lesions associated with such a diagnosis was very low. The authors recommend that women with benign endometrial cells on Pap tests in women age 40 years or older should undergo endometrial biopsy only when additional clinical indicators are identified.

Adult↗

PubMed2006

Negative colposcopic biopsy after positive human papilloma virus (HPV) DNA testing: false-positive HPV results or false-negative histologic findings?

We studied histologic examination-related factors contributing to false-negative colposcopic biopsy results. Patients positive for high-risk human papillomavirus (HPV) DNA with negative cervical histologic findings were identified between January 2002 and December 2003. Three additional H&E-stained levels were obtained when the original diagnosis was confirmed on review. Patients with atypical squamous cells of undetermined significance (ASC) Papanicolaou test results, positive HPV DNA results, and negative cervical histologic findings accounted for 4.5% of all ASC smears submitted for HPV DNA testing. Slides and tissue blocks were available for 95 cases; 4% had focal HPV infection or mild dysplasia. When deeper levels were examined, 31% had clinically significant lesions: HPV infection or cervical intraepithelial neoplasia (CIN) 1, 19%; CIN 2/3, 8%; and dysplasia, not otherwise specified, 3%. Of the remaining patients, follow-up revealed squamous abnormalities in 25%. About 5% of patients with positive HPV DNA results had a negative follow-up biopsy result. "False-negative" biopsies accounted for one third of cases. Additional levels should be obtained for discrepant results. Close follow-up is crucial when the initial biopsy result is negative because a small number of patients will have squamous abnormalities in subsequent studies.

Biopsy↗

PubMed2005

Reflex human papilloma virus infection testing detects the same proportion of cervical intraepithelial neoplasia grade 2-3 in young versus elderly women.

BACKGROUND: The American Society for Colposcopy and Cervical Pathology recently recommended triage of women with atypical squamous cells of undetermined significance (ASCUS) through reflex human papilloma virus (HPV) infection testing. Because age is an important determinant of the incidence of both ASCUS and HPV infection, the current study was conducted to determine the impact of age on reflex HPV infection test performance. METHODS: The authors reviewed all liquid-based Papanicolaou tests submitted for reflex HPV infection testing to the University of Alabama Medical Center during the period from January 2002 to January 2004. To assess the impact of age on reflex HPV infection testing, women were divided into 6 age groups (<25, 25-34, 35-44, 45-54, 55-64, >64 years). Trend of different diagnostic categories with age was assessed using the chi-square test for linear trend. As a measure of test performance, the proportions of cervical intraepithelial neoplasia (CIN) lesions confirmed by biopsy through reflex testing (of the total CIN lesions detected in the study population) were then compared among different age groups. RESULTS: During the study period, 25,164 ThinPrep tests were performed during the study period, with 2672 (11%) cases of ASCUS and 1371 (5%) cases of squamous intraepithelial lesions (SILs). A total of 2309 (86%) ASCUS cases were tested for HPV infection, of which 789 (34%) were positive. Biopsy specimens were obtained from 831 patients with SILs and from 316 patients with HPV+ASCUS. Of 246 patients with CIN Grade 2-3 (CIN2-3) detected on biopsy, 36 (15%) were triaged through reflex HPV infection testing and the rest were triaged through cytologic diagnosis of SILs. Despite the trend in the prevalence of HPV+ASCUS and SILs with increasing age (P < 0.05), there was no significant difference in the proportion (range, 9-23%) of CIN2-3 detected through reflex HPV infection testing in different age groups. CONCLUSIONS: Reflex HPV infection testing performed similarly for women in different age groups, including perimenopausal and postmenopausal women.

Adult↗

PubMed2005

Clinical significance of unsatisfactory conventional pap smears owing to inadequate squamous cellularity defined by the Bethesda 2001 criterion.

To determine the incidence of clinically significant lesions in long-term follow-up after a diagnosis of inadequate squamous cellularity using former and new criteria, we reviewed conventional Papanicolaou (Pap) smears (January-December 1998) for adequacy based on the Bethesda System 2001 criterion. Of 23,302 Pap smears evaluated in our laboratory, 114 (0.489%) were classified as unsatisfactory and 245 (1.051%) as "satisfactory but limited by" based on the 10% rule. Follow-up information for 5 years was obtained for 172 patients without a concurrent cervical epithelial abnormality: 25 (14.5%) had squamous abnormalities (atypical squamous cells, 22; low-grade squamous intraepithelial lesion, 2; and high-grade squamous intraepithelial lesion, 1). With the Bethesda System 2001 criterion, 167 (97.1%) of 172 smears had inadequate squamous cellularity and 5 (2.9%) were adequate. No differences in the incidence of squamous abnormalities detected on follow-up were noted between patients with unsatisfactory Pap smears owing to inadequate squamous cellularity and patients with satisfactory and negative smears. Our findings raise the question whether patients with unsatisfactory Pap smears and a negative history of gynecologic diseases require repeated Pap smears within 2 to 4 months as suggested by the American Society for Colposcopy and Cervical Pathology guideline.

False Negative Reactions↗

PubMed2004

Endoscopic ultrasound-guided fine-needle aspiration biopsy of the adrenal glands: analysis of 24 patients.

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy allows the detailed imaging and FNA not only of both intramural and extramural structures and lesions of the gastrointestinal (GI) tract but also of various intraabdominal organs. Thus, EUS-FNA biopsy offers a novel opportunity to evaluate and obtain cytology samples from adrenal gland lesions. The objective of the current study was to determine the utility of EUS-FNA in the diagnosis of adrenal lesions. METHODS: The authors conducted a prospective evaluation of 24 consecutive EUS-FNA biopsy specimens obtained from patients with adrenal lesions. An attending cytopathologist was present on site to assess specimen adequacy and to provide rapid interpretation of air-dried material that had been stained with Diff-Quik (Baxter Scientific Products, McGraw Park, IL). Additional samples were obtained for ThinPrep (Cytyc Corporation, Boxborough, MA) preparation, and cell blocks subsequently were prepared. Appropriate immunohistochemical staining was performed as indicated. The cytologic diagnosis was then analyzed for correlations with the final diagnosis, which was based on relevant correlative cytologic or histologic examination of biopsied/resected pathology materials and/or final clinical follow-up. RESULTS: In total, 24 EUS-FNA biopsy specimens (from 18 males and 6 females) were obtained from adrenal glands. The mean patient age was 62.2 years (range, 48-81 years). Adequate cellularity was noted in all 24 samples. Seven of 24 samples (29%) were reported to be positive for carcinoma. All samples that were diagnosed as metastatic carcinoma were confirmed on subsequent follow-up. EUS-FNA performed simultaneously with adrenal gland aspiration either from the primary site (n = 1) or from metastases to lymph nodes (n = 3) supported diagnoses of metastatic carcinoma. Six of seven samples were metastatic from the lung, and one specimen was a direct extension of a transitional renal cell carcinoma. EUS-FNA biopsy of the right adrenal gland in one patient revealed myelolipoma. In 16 patients, benign adrenal gland cells were noted on EUS-FNA biopsy specimens from enlarged adrenal glands. In 5 samples (31%), signs of adenoma were evident. Morphology alone could not distinguish between adrenal adenoma and adrenal hyperplasia. No significant complications were reported after EUS-FNA biopsy of adrenal glands. CONCLUSIONS: EUS-FNA biopsy is a highly specific and safe technique for confirming the diagnosis of carcinoma metastatic to the adrenal glands. Along with cytologic evaluation, EUS imaging is needed to support the diagnosis of adrenal adenoma.

Adenoma↗

PubMed2004

Women with atypical glandular cells: a long-term follow-up study in a high-risk population.

To determine the incidence of clinically significant lesions in high-risk patients with atypical glandular cells (AGCs) after 4 to 6 years of follow-up, we reviewed repeated Papanicolaou (Pap) test and surgical pathology results for a 3-year period for 337 patients; 62 (18.4%) had only repeated Pap smears; 84 had Pap smear and histologic evaluations. In a range of repeated Pap smears from 1 to 11 (mean, 4.2), 9 patients had persistent AGCs/atypical squamous cells; remaining Pap smears were judged normal. Histologic follow-up revealed a clinically significant lesion in 110 (40.1%) of 274 patients--low-grade squamous intraepithelial lesion (LSIL), 46; high-grade squamous intraepithelial lesion (HSIL), 47; endocervical adenocarcinoma in situ (AIS), 3; endometrial hyperplasia, 4; endocervical or endometrial adenocarcinoma, 10. Among patients with histologic follow-up, 14 lesions (12.7% of patients with clinically significant lesions) were diagnosed after a mean of 37 months (range, 21-59 months): LSIL, 7; HSIL, 4; AIS, 1; endometrial adenocarcinoma, 2. Seven patients had negative cytologic and/or histologic evaluations between the initial cytologic AGC diagnosis and the final histologic diagnosis. Patients with AGCs are at risk of harboring clinically significant uterine lesions and should be followed up for a substantial period despite initial negative findings.

Adult↗

PubMed2003

Glandular cell atypia on Papanicolaou smears: interobserver variability in the diagnosis and prediction of cell of origin.

BACKGROUND: The 2001 Bethesda System recommended qualification of atypical glandular cells (AGC) to indicate the site of origin and separated endocervical adenocarcinoma in situ (AIS) from "AGC favor neoplastic" as a specific diagnostic category. To the authors' knowledge, the literature evaluating the reproducibility of Papanicolaou (Pap) smear diagnosis of glandular cell abnormalities with emphasis on the cell of origin is limited. The aim of the current study was to investigate whether a variety of benign to neoplastic glandular lesions can be reliably classified on Pap smear with regard to diagnosis and cell of origin. METHODS: Twenty-three conventional Pap smears (CPS) with glandular cellular changes varying from benign to adenocarcinoma (ACA) were reviewed by six observers. They were asked to categorize each smear according to cell of origin (endocervical vs. endometrial) and diagnosis (benign, AGC, or ACA). Kappa statistics were used to evaluate interobserver agreement and correlation of interobserver agreement with experience. RESULTS: There was no consensus among observers for both the origin of the cells and the diagnosis. Interobserver agreement for site was poor (kappa < 0.4) especially in the AGC category. Unanimous agreement for site was reached for 7 of 23 smears (30%). Two of five endocervical AIS were classified as endometrial and another two were classified as benign by four observers. Interobserver agreement was poor in all diagnostic categories (kappa < 0.4) and showed slight correlation with level of experience. Unanimous agreement for diagnosis was reached for only 2 smears (9%). Three of 11 (27%) smears demonstrating preneoplastic/neoplastic processes were diagnosed as benign by 3 observers. Three (25%) benign CPS were diagnosed as ACA by 2 observers. Accurate prediction of the final histologic diagnosis by observers varied from 30% to 87% and did not correlate closely with experience. CONCLUSIONS: Cytologic diagnosis of glandular lesions by CPS was problematic and suffered from significant interobserver subjectivity.

Adenocarcinoma↗

PubMed2003

Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. A follow-up study of conventional and liquid-based preparations in a high-risk population.

We compared the histologic follow-up of 368 smears or slides with an interpretation of "atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion" (ASC-H) based on conventional and liquid-based preparations and age groups in a high-risk population. Patients with an ASC-H interpretation were 17 to 87 years old (mean, 36.8 years). The specimens were 52 liquid-based preparations and 316 conventional smears. For 218 cases (59.2%), including 28 liquid-based preparations (65%) and 190 conventional smears (58%), histologic follow-up was available. In 20 liquid-based preparations (71%) and 152 conventional smears (80.0%), cervical intraepithelial neoplasia (CIN) or higher was revealed on subsequent biopsy. Other results were as follows: liquid-based preparations, CIN1, 11 (55%); CIN2/3, 9 (45%); conventional smears, CIN1, 78 (51.3%); CIN2/3, 70 (46.1%); squamous cell carcinoma, 4 (2.6%). There was no statistically significant difference in the incidence of CIN or higher on subsequent biopsy after an interpretation of ASC-H based on preparation types. The incidences of CIN in patients 40 years old or older and patients younger than 40 years were 66% and 84%, respectively, a statistically significant difference. Because of the high incidence of clinically significant lesions noted on subsequent follow-up, patients with an interpretation of ASC-H should be observed closely and referred for colposcopic examination regardless of their age.

Adolescent↗

PubMed2002

Interobserver variability: comparison between liquid-based and conventional preparations in gynecologic cytology.

BACKGROUND: Studies have shown that the ThinPrep Papanicolaou test (TP) increases the detection of epithelial cell abnormalities compared with the conventional preparation. Little is known about the interobserver variability of reporting gynecologic cytology results using the TP preparation and its comparison with results obtained using the conventional method. METHODS: To compare the interobserver variability between the TP method and the conventional method for reporting the diagnoses of gynecologic cytology, 20 pairs of conventional and TP slides (total, 40 slides) that were prepared from split samples were evaluated blindly by 19 cytotechnologists from three different laboratories. Each reviewer was asked to categorize each slide into the following five categories: within normal limits, benign cellular changes, atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). For both conventional and TP preparations, interobserver variability was analyzed using Spearman rank correlation coefficients. The mean correlation coefficients (weak, 0.0-0.4; fair, 0.4-0.7; and strong, 0.7-1.0) between the TP method and the conventional method were then compared. RESULTS: The overall interobserver agreement as well as interobserver agreement within each laboratory was good for both TP and conventional preparations. Based on the set of conventional cervical smears, only one slide that was diagnosed as HSIL had unanimous agreement; whereas, based on the set of TP slides, three slides, including two diagnosed as HSIL and one diagnosed as LSIL, had a unanimous diagnosis. The difference in the interobserver agreement between TP and conventional methods, based on comparing their mean +/- standard deviation correlation coefficients (TP method, 0.84 +/- 0.081; conventional method, 0.82 +/- 0.105; P < 0.001), was statistically significant. CONCLUSIONS: Interobserver agreement in reporting gynecologic cytology using the TP method is good, particularly for squamous intraepithelial lesions, and appears to be superior to the conventional method.

Carcinoma, Squamous Cell↗

PubMed2002

Accuracy of reporting endocervical component adequacy--a continuous quality improvement project.

Inaccurate reporting of the absence of an endocervical (EC) component on Pap smears often results in slide rescreens, amended reports, clinician dissatisfaction, and sometimes unnecessary repeat smears. Therefore, the accuracy of reporting EC component adequacy was selected as a quality indicator for the laboratory continuous quality improvement program (CQI). The process consisted of problem identification, analysis of the situation, collection of data, implementation of solutions, and evaluation of results. The objective of the study was to determine if the accuracy of reporting EC component adequacy on Pap smears improved after application of such a program. During the first phase, 150 Pap smears originally reported with the absence of an adequate EC component and 150 smears reported with the presence of an adequate EC component were rescreened to measure the baseline accuracy of EC component adequacy reporting. The improvement process was then implemented. A cause-and-effect diagram was developed and root cause was determined. A presentation was then made to the cytology staff. Criteria for EC component adequacy were reviewed, examples were shown, and standardized marking of EC component was implemented. Following improvement actions, a second audit of 150 Pap smears reported with the absence of an adequate EC component as well as 150 smears reported with the presence of an adequate EC component was undertaken to measure change in performance in assessing EC component adequacy. For the baseline rescreening, before initiation of the CQI program, 98% accuracy was achieved with smears that were reported as adequate for EC component present. However, the accuracy with smears reported as absence of an adequate EC component was only 71%, i.e., an adequate EC component was identified in almost 1/3 of these cases on rescreen. After the implementation of improvement actions, the accuracy with smears reported with the presence of EC component remained high (98%) and the accuracy of reporting the absence of EC component was 90%. The difference of the latter before and after the implementation was statistically significant (P = 0.015, z-test). The accuracy of reporting EC component adequacy increased following the CQI process. Using reporting EC component adequacy as an example, we demonstrate that by treating clinical problems as quality control issues and applying basic quality improvement tools, a positive outcome can be effected.

Cell Biology↗

PubMed2002

Fine needle aspiration biopsy of the islet cell tumor of pancreas: a comparison between computerized axial tomography and endoscopic ultrasound-guided fine needle aspiration biopsy.

The objective of the present study is to compare the cytologic features of islet cell tumor (ICT) of pancreas obtained by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and computed tomography guided FNA (CT-FNA). We also describe the cytologic features associated with malignant ICT. Eleven cytology samples from 121 CT- FNA and 30 EUS- FNA of the pancreas were obtained from nine patients with ICT. Diff-Quik, Papanicolaou, and immunohistochemical stains to determine neuroendocrine differentiation and the hormonal status were evaluated. Cytologic features and specimen adequacy were compared between the two techniques. Cytologic features noted in both benign and malignant ICT were also compared. Nine patients (5 men, 4 women) ranging in age from 29 to 84 years (mean age, 53.8 years). Diagnoses consisted of benign (4) and malignant (5) ICT. EUS-FNA was superior to CT-FNA in obtaining adequate cells (2/2 v 7/9) for the diagnosis and increased cellularity to perform additional immunohistochemical stains (2/2 v 4/7). Single, plasmacytoid cells with finely granular chromatin distribution characterized ICT on cytology. Mitoses (3/5) and necrosis (1/5) were noted in malignant ICT but not in benign ICT. EUS-FNA is superior to CT- FNA for obtaining cells for the diagnosis of ICT. Detection of mitoses and or necrosis from patients with ICT should initiate a search for metastasis.

Adenoma, Islet Cell↗

PubMedDate not supplied

High-risk HPV DNA detection rate in patients with atypical squamous cells and its relationship to the atypical squamous cell: squamous intraepithelial lesion ratio.

OBJECTIVE: To determine if there is any relationship between the atypical squamous cell (ASC):squamous intraepithelial lesion (SIL) ratio and high-risk HPV DNA detection rate. STUDY DESIGN: Data on the frequency of various cytologic diagnoses for each pathologist were retrieved from 2002 to 2003. ASC:SIL ratio for each pathologist was calculated. In addition, data related to high-risk HPV detection rate was obtained during the study period. HPV DNA testing was performed using HC II (Digene, Gaithersburg, Maryland U.S.A). Cases with insufficient quantity were excluded. RESULTS: Five pathologists, with experience ranging from 2 to 15 years, reviewed Pap tests during the study period. For the entire laboratory, the ASC:SIL ratio was 2.0, and the high-risk HPV DNA detection rate in ASC specimens was 31%. For individual pathologists, ASC:SIL ratio ranged from 1.2 to 4.0 and high-risk HPV DNA detection rate from 31% to 38%. No significant correlation was noted between the ASC:SIL ratio and high-risk HP DNA detection rate. CONCLUSION: Our ASC:SIL ratios (except for 1 pathologist) and high-risk HPV DNA detection rates were within an acceptable range. We did not observe any association between ASC:SIL ratio and high-risk HPV detection rate.

Cervix Uteri↗

PubMedDate not supplied

Bethesda 2001. Impact on the reporting of gynecologic cytology.

OBJECTIVE: To examine the impact of implementing Bethesda 2001 in one laboratory. STUDY DESIGN: A computer search identified all cervicovaginal specimens evaluated between July 2001 and June 2002. Bethesda 2001 was implemented on January 1, 2002. The rates of specimen adequacy and the frequency of each diagnostic category 6 months before and 6 months after the implementation of Bethesda 2001 were compared. RESULTS: A total of 21,332 cervicovaginal specimens were evaluated during the study period. During the first 6 months, 10,695 specimens were examined; 40% were liquid-based preparations. During the next 6 months, 10,367 specimens were examined; 60% were liquid-based preparations. Prior to the implementation of Bethesda 2001, the percentages of each category were as follows: 74.99% within normal limits, 7.10% reactive/reparative cellular changes (R/R), 10.29% atypical squamous cells (ASC), 0.24% atypical glandular cells (AGC), 3.45% low grade squamous intraepithelial lesion (LSIL), 3.44% high grade squamous intraepithelial lesion (HSIL) and 0.73% unsatisfactory. In addition, 19.00% were classified as "satisfactory but limited by" (SBLB). Following the implementation of Bethesda 2001, the percentages of each category were as follows: 80.09% negative for intraepithelial lesion and malignancy including 6.94% with the qualifier R/R, 10.32% ASC, 0.27% AGC, 4.54% LSIL, 3.44% HSIL and 0.81% unsatisfactory. In addition, 17.40% were satisfactory with a quality indicator (SAT with QI). The incidence of reporting benign endometrial cells in patients over age 40 was the same for both periods. There was a significant decrease in the percentage of specimens classified as SAT with QI when compared to that of specimens classified as SBLB. A statistically significant increase in the percentage of specimens was noted in the category LSIL (P < or = .001) and satisfactory (.005) after implementing Bethesda 2001. No significant changes were noted in other categories. CONCLUSION: Our laboratory experienced some changes in the laboratory statistics of reporting gynecologic cytology after the implementation of Bethesda 2001. Continuous monitoring of reporting trends is indicated to clearly understand the impact of Bethesda 2001 on laboratory statistics.

Cervix Uteri↗