C. Jay Marshall

Cell block preparation as an adjunctive diagnostic technique in ThinPrep monolayer preparations: a case report.

The cell block preparation, which increases cellular yield by capturing any small tissue fragments in a fluid specimen, has been used to define the histologic pattern of the cells in question. This report describes a case in which processing a cell block on residual ThinPrep® Pap Test™ material, using a thrombin‐based technique, was useful in augmenting the diagnosis of a glandular lesion. Diagn. Cytopathol. 24:142–144, 2001.

Improved quality-control detection of false-negative Pap smears using the Autopap 300 QC system.

Federally‐mandated quality control (QC) in Papanicolaou (Pap) smear testing requires rescreening of 10% of negative smears, to include cases selected randomly as well as smears from patients that may have a higher risk for developing cervical cancer based on clinical information. FDA approval of NeoPaths AutoPap 300 QC system (NeoPath, Inc., Redmond, WA) allows practical QC rescreening of all negatives. We tested the ability of AutoPap to help increase identification of detection errors compared to random 10%/high‐risk selection. From March 1–August 30, 1997, we utilized AutoPap/high‐risk status to select cases for manual rescreen, and compared the rate of identification of primary screening errors to that for the preceding year using 10% random selection/high‐risk status. Of 35,027 smears accessioned, 31,240 (89.1%) were screened as negative and 7,965 were selected for manual rescreen. Of these, 353 were determined to be abnormal. Most abnormals identified by this protocol were classified as atypical squamous or glandular cells of undetermined significance (ASCUS or AGUS). However, 59 low‐grade squamous intraepithelial lesions (LSIL) and 13 high‐grade squamous intraepithelial lesions (HSIL), many with few abnormal cells, were also identified. These results represented an increase in pickup rate of false negatives due to detection errors of 2.3‐, 2.8‐ and 5.6‐fold for atypical squamous or glandular cells of undetermined significance, LSIL, and HSIL, respectively, when accounting for the volume differences over the time period measured. Our findings strongly support the conclusions drawn from clinical trials of the AutoPap that false negatives due to detection error can be significantly reduced when using AutoPap as part of a routine quality control program. Diagn. Cytopathol. 1999;20:170–174.

Acid-fast-positive Legionella pneumophila: a possible pitfall in the cytologic diagnosis of mycobacterial infection in pulmonary specimens.

The acid‐fast stain is commonly used in the rapid cytologic assessment of bronchoalveolar lavage (BAL) fluid to detect pulmonary mycobacterial infections, particularly in immunocompromised patients. The identification of acid‐fast, rod‐shaped organisms may be taken as presumptive evidence of such an infection, in the appropriate clinical setting. However, this determination is made less specific by the occasional acid‐fast positivity of microorganisms other than mycobacteria. We report on the occurrence of a fatal pneumonia caused by acid‐fast positive Legionella pneumophila detected by BAL. This is a potential pitfall in the rapid diagnosis of pulmonary mycobacterial infections. Diagn. Cytopathol. 2000;22:45–48.

Accuracy of a Slide Profiler for Endocervical Cell Detection in No-Further-Review Conventional Pap Smears

OBJECTIVE To evaluate the reliability of the Focal-Point slide profiler (TriPath Care Technologies, Burlington, North Carolina, U.S.A.) in determing the absence of endocervical cells in conventional Pap smear slides. STUDY DESIGN A consecutive series of conventional Pap smears, designated by FocalPoint as requiring no further review (NFR) and as lacking endocervical cells, was manually screened to determine the true presence or absence of endocervical cells. These results were compared to those obtained by FocalPoint. RESULTS From January 1, 2000, to December 31, 2001, FocalPoint indicated that 797 NFR slides did not contain endocervical cells. In contrast, manual screening revealed that 504/797 (63.2%) did contain endocervical cells. CONCLUSION The reliability of a negative FocalPoint determination for endocervical cells is limited. Manual screening of NFR slides designated by the instrument as lacking endocervical cells appears to be necessary.

A Stiff Bristled, Spiral-Shaped Ectocervical Brush: A Device for Transepithelial Tissue Biopsy

OBJECTIVE To compare a new spiral‐shaped tissue‐sampling brush with a standard cervical punch biopsy. METHODS Before large loop excision of the transformation zone, women with cervical intraepithelial neoplasia underwent a transepithelial brush biopsy of a portion of a colposcopically identified lesion, followed by a punch biopsy of the remaining portion. Brush biopsy samples were processed using liquid‐based cytology and cell block techniques. Diagnoses were made using a consensus of three pathologists. Brush biopsy samples without basal cells were considered inadequate. The histological diagnosis was compared with the brush biopsy and punch biopsy samples. Patient‐reported pain and physician‐reported bleeding for punch and brush biopsies were compared. RESULTS Fifty‐two women were enrolled in the study; 47 successfully completed the study protocol. Eight brush biopsy specimens were inadequate. Thirty‐nine women showed abnormal pathology (human papillomavirus/cervical intraepithelial neoplasia I or worse) on large loop excision of the transformation zone, and 32 women had high‐grade (or worse) lesions. The punch biopsy correlated with high‐grade disease in 53.1% of these women. The brush biopsy result correlated with high‐grade disease in 79.3% of these women using a cell block technique and 76.7% using liquid cytology. There was significantly less pain (P < .001) and significantly less bleeding (P < .001) with the brush biopsy. CONCLUSION When an adequate sample is collected, spiral brush biopsy is as good as a standard punch biopsy for detecting cervical pathology, with substantially less pain and bleeding. User training and guidelines for sampling are needed to assure that an adequate sample is collected.

Response:Proliferative Breast Disease: Diagnosis and Implication

M. H. Skolnick et at. (1) obtained specimens by multiple fine-needle aspiration from the breasts of women with and without a family history of breast cancer. They assessed the prevalence of certain cytologic changes in these groups of women, which they labeled proliferative breast disease (PBD). Skolnick et al.s use of this term is unfortunate because PBD is a well-recognized histologic diagnosis (2, 3) of changes that bear only a slight and untested resemblance to the cytologic findings in (1). In order to avoid confusion, we will hereafter use PBD in its conventional sense. Although PBD is consistently associated with increased breast cancer risk (4), studies have not been performed which show that cytologic abnormalities or similarly defined patterns have such an association. Skolnick